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NUR_1213 Exam 4
SPC: Spinal Cord Injury,Seizures, Menginitis, Encephalitis
| Question | Answer |
|---|---|
| What are the clinical manifestations of a neuro. impaired/damaged pt? | *Pain<center>*Seizures</center>*Dizziness/Vertigo<center>*Visual Disturbances</center>*Weakness<center>*Abnormal Sensations</center> |
| During initial assessment of a neuro. pt who is unresponsive to verbal stimulation, how long do you try to arrouse the pt with painful stimuli? | 15-30 seconds |
| What are the 4 techniques used to stimulate responses that come from the brain not spinal or reflex? | *Sternal Rub<center>*Trapezius Squeeze</center>*Supraorbiyal Pressure<center>*Mandibular Pressure</center> |
| Romberg Test | Screening test for balance. Loss of balance is considere abnormal and scored as a positive Rombergs test. (swaying ok) |
| When doing a sternal rub on a pt & everything moves except his right arm, you consider this an indication of? | a periperal prob.. not neural. |
| What is the 1st thing you assess in a neuro exam? | LOC (earliest & most sensitve indicator that something is changing) |
| When assessing LOC during a neuro exam, what 4 components would you include to determine pts level of awareness? | *Orientation<center>*Memory</center>*Calculation<center>*Fund. of Knowledge</center> |
| You notice that your pt's LOC has changed and he now appears restless. What is this a possible indication of? | Hypoxia |
| When checking motor responses, what 3 things would you assess for? | 1) Following Comandes-highest level<center>2) Purposeful Movements-2nd highest (doesnt follow commands but extubates self or pulls out IV)</center>3)Withdrawing-3rd highest |
| What are the 2 posturing responses? | 1)Decorticate-flexion/less severe <center>2) Decerebrate-Extension/worse & less hope |
| Decerebration- | an abnormal body posture associated with a severe brain injury, characterized by exteme extension of the upper and lower extremities. |
| Decorticatio- | an abnormal posture associated with a severe brain injury, characterized by abnormal flexion of upper extremities and extension of lower extremities. |
| Cushing's Triad- | <center>brains attempt to restore bld flow by increasing artiral pressure to overcome increased ICP.</center>3 Classic Signs: bradycardia 40-50, HTN (bp/pp), & bradypnea (abnormal respirations).<center>Seen w/ pressure on medulla d/t brain stem herniation |
| ICP | pressure exerted by the volume of the intracranial contents within the cranial vault. |
| Status Epilepticus- | episode in which the pt experiences multiple seizure burts with no recovery time in between |
| Seizures- | paroxysmal transient disturbance of the brain resulting from a discharge ob abnormal activity. |
| Guarding against brain herniation | changes in LOC, loss of detail to orientation, forgetfulness, restlessness, sudden quietness, pupillary change (dialation), motor changes, VS |
| Positive Kernig's Sign- | when pt laying w thigh flexed on abdomen, the leg cant be completely extended. |
| Positive Brudzinski's Sign- | when pt neck is flexed, flexion of kneeds and hips are produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity. (more sensitive indicator of mengingeal irritation) |
| Septic Meningitis is caused by? | bacteria. |
| aseptic meingitis is caused by? | viral or 2ndary to lymphoma, leukemia, or HIV |
| Streptococcous pneumoniae & Neisseria meningitidis | most common pathogens causing septic mengingitit in US |
| Meningitis- | an inflammation of the pia matter, the arachnoid, and the CSF filled subarachnoid space. |
| S&S of meningitis | HA, Fever, Muchal rigidity (neck stiffness), anorexia, vomitting, photophobia, seizure, LOC, stupor, poss. cold symptoms |
| antibiotic treatment for meningitis | 3rd generation Cephalosporines (Rifampin), Vancomycin, Cefotaxime |
| Testing for meningitis | lumbar puncture, CSF analysis |
| Two forms of encephalitis | *Primary- virus directly invades brain & spinal cord. (Sporadic-spontanious, Epidemic-long term, Serious-enters brain)<center>*Secondary-(most common) virus 1st infects another part of the body & enters brain 2nd |
| S&S of encephalitis | drowsiness, confusion, seizures, fever, HA, N&V, tremor, stiff neck (see more S&S than in MM) |
| Main causes of encephalitis | Arboviruses, Herpes, childhood infections (mesles) |
| Herpes is most common cause for? | acute encephalitis. HSV-1 children/adults & HSP-2 neonates |
| Dx of encephalitits | Lumbar Puncture, EEG, Brain biopsy, brain imaging, blood test |
| Treatment of encephalitis | Antiviral-zovirax, Anticonvulsant-dilantin (mixed with NS given w/ filter), Anti-inflammatory-Dexamethazole |
| Prognosis of encephalitis | Varies<center>Mild-Full Recovery</center>Severe-PERMANENT DAMAGE<center>Death-48 hrs</center> |
| Care of pt during seizure | dont use tongue blade, protect head, turn pt so doesnt aspirate if vomits, loosen tight clothing |
| 2 types of epileptic seizures | *Partial-initiated frm specific part of brain, focal discharges, simple:no LOC, complex: +LOC,Ora *Generalized-affect entire brain, convulsive:tonic/clonic, nonconvulsive: absence or myoclonic |
| Nonconvulsive Generalized | Absence-appears daydreaming, momentary LOC <center>Myoclonic-brief forceful jerks which affect whole or parts of body</center> |
| Convulsice Generalized | Tonic (stiff)/Clonis (shaking): may/maynot have ora, tongue biting, clenching of jaw, incontinence, dyspnea,apnea,cyanosis. Lasts 1-3 mins. Post-ical confusion,HA, muscle soreness, fatigue, drowsiness, deep sleep |
| Tests for seizures | EEG (most defenitive/showing brain activity), MRI, LP |
Created by:
lprovoost
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