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Med Surg Neuro.
neuro
| Question | Answer |
|---|---|
| conduct impulses toward CNS | Afferent |
| conduct impulses away from CNS | Efferent |
| Neurons consist of what? | cell body, dendrites, axon |
| What forms the gray matter of the CNS? | Cell bodies |
| What forms the white matter of the CNS? | Axons (which are myelinated) |
| Which neurons have the ability to regenerate after injury? | only peripheral neurons |
| What is action potential? | rapid changes in membrane electrical charges that transmit impulses |
| What are the three stages of action potential? | resting, depolarization, repolarization |
| What is a synapse? | location where impulses move from neuron to neuron via neurotransmitters |
| What is nerve impulse affected by? | pH, supply of transmitter, ECF, O2, medications |
| What is dopamine? | a catecholamine |
| What is dopamine required for? | complex movement, emotional response, attention |
| What is serotonin needed for? | Onset of sleep, Mood control, Pain pathway inhibitor in spinal cord |
| What is Acetylcholine (ACh) needed for? | Nerve and muscle transmission, Parasympathetic usually, Preganglionic sympathetic system |
| What disease is Ach very important in the treatment of? | Alzheimer’s |
| What is Gamma-aminobutyric acid (GABA)? | Affects 1/3 of brain neurons, Inhibits nerve and muscle transmission, R/T anxiety and seizures |
| What do the skull and vertebral column protect? | brain and spinal cord |
| What are the meninges for? | cover brain and spinal cord to provide support and protection |
| What is the dense, fibrous outer layer of the brain that forms fissures in the brain that separate hemispheres and lobes? | Dura mater |
| What is the delicate, vascular, middle layer of the brain? | Arachnoid |
| What is very delicate and adheres closely to the surface of the brain and spinal cord? | Pia mater |
| What are the three spaces formed by the meningeal layers and skull called? | Meningeal spaces |
| How much of the blood and oxygen supply does the brain require? | The brain requires 750ml/min of blood and uses 20% of the oxygen supply |
| What do the Internal carotids and basilar artery combine to form? | Circle of Willis |
| Where is the Circle of Willis located? | at the base of the skull |
| What are the three pairs of vessels that branch off the Circle of Willis? | anterior, middle, and posterior cerebral arteries |
| How is venous drainage accomplished in the brain? | Dural venous sinuses found between the dura drain into the internal jugular veins |
| What is the tight junction between capillaries and cells that form spinal fluid and selectively permits substances to pass from the blood to the neurons called? | blood brain barrier |
| What does the blood brain barrier prohibit? | many meds and albumin from passing into the brain such as polar medications, fat-soluble meds |
| How do some meds get past the blood brain barrier? | enter via the choroid plexus and then diffuse into the brain |
| Where is CSF formed? | in the cerebral ventricular system, by the choroid plexus in the lateral ventricles |
| How much CSF is formed per hour? | 25-30ml/hr |
| Areas that hold large amounts of CSF are called what? | cisterns |
| CSF is reabsorbed into venous system constantly by what? | arachnoid villi |
| What receives CSF from the subarachnoid space and empty into the internal jugular vein? | dural venous sinuses |
| What increases the surface area of the brain? | Gyri (peaks) and sulci (valleys) |
| What are the cerebral hemispheres connected by? | the corpus collosum |
| What does ipsilateral refer to? | same side |
| What does contralateral refer to? | the opposite side |
| Which hemisphere is responsible for language in 95% of people and is considered dominant? | left (but it depends on handedness) |
| Which hemisphere processes information such as spatial orientation and perspective? | right |
| Which lobe is 1/3 of each hemisphere; is responsible for abstract thinking, judgment, emotion, motor function and motor aspects of speech (Broca’s area)? | frontal |
| Which lobe is responsible for perception of verbal material (Wernicke’s area), memory, behavior, emotion? | temporal |
| Which lobe is responsible for analyze sensation, spatial-perceptual ability? | parietal |
| Which lobe is responsible for vision, visual interpretation? | occipital |
| What is at base of cerebrum, made of gray matter, and works with cerebellum in coordination and control of fine motor activity? | Basal ganglia |
| What plays role in sleep/wakefulness, pain perception, relay of ascending impulses? | thalamus |
| What works with autonomic nervous system in regulating pituitary hormones, heart rate, body temp, lyte balance, appetite ? | hypothalamus |
| What does the brain stem do? | Connects spinal cord and brain, contains reticular formation |
| What is the brain stem divided into? | midbrain, pons, medulla oblongata, reticular activating system (RAS) |
| What does the midbrain do? | Aqueducts, pain, cranial nerves III and IV |
| What does the pons control? | Rate and pattern of respirations |
| What does the Medulla oblongata control? | Swallowing, vomiting, respirations, vasomotor activities |
| What does the reticular activating system (RAS)control? | Sleep and wakefulness |
| What does the cerebellum do? | Coordination of gross and fine motor activities, equilibrium, proprioception , Skilled and voluntary movement |
| What transmits sensory impulses from the spinal cord to the brain? | spinal cord major sensory pathways (ascending) |
| All spinal cord major sensory pathways (ascending) do what? | cross over (decussate) and end in the thalamus, which interprets and sends to appropriate area of cerebral cortex |
| What are the two tracts of descending messages? | corticospinal (pyramidal) tract, extrapyramidal tract |
| What does corticospinal (pyramidal) tract descending messages control? | Voluntary movement, (they cross over) |
| What does extrapyramidal tract descending messages do? | Functions with the basal ganglia and cerebellum to ensure coordination, accuracy, and smoothness of muscle movement |
| What includes cranial nerves that arise in the brain stem? | peripheral nervous system (PNS) |
| How many cranial nerves are there? | 12 pairs |
| How many spinal nerves are there and where are they? | 31 pairs, adjacent to vertebra |
| Where does the spinal cord ends at? | L1-L2 |
| What does each spinal nerve have? | Dorsal (sensory/afferent), Ventral root (motor/efferent) |
| What are dermatomes? | Correspond to the level of the spinal cord at which the spinal nerves innervating that region enter and exit |
| What equipment would you need for a neuro assessment? | cotton, flashlight, newspaper, Ophthalmoscope, otoscope, reflex hammer, safety pins, Snellen chart,tape measure, tongue depressor, tuning fork, different shaped objects, stoppered vials |
| How would you assess mental status with a physical exam? | Mini-mental status exam, Evaluation of cerebral cortex, Includes orientation, judgment, Serial sevens, Recent and remote memory, Abstract thinking |
| How would you assess speech and language? | Identify objects, Repeat phrases, Follow commands, Draw a simple object |
| What are the manifestations of neurologic dysfunction? | Altered level of consciousness (LOC) – awareness of self and the environment; Content (thinking, communication, and feeling); Headache, restlessness, irritability, unusual quiet, slurred speech |
| What is decerebrate posturing? | Rigidity of extremities, Extension of arms and legs |
| What is opisthotonos posturing? | usually brain stem pathology, sign of meningeal irritation |
| What is decorticate posturing? | Usually corticospinal pathology, Upper extremities are flexed with internal rotation |
| What does normal CSF look like? | clear, colorless |
| What is a lumbar puncture? | obtain sample of CSF from subarachnoid space |
| What is a possible complication of a LP? | meningeal irritation |
| What should you look for after LP? | Observe for change in neuro stats, Assess vitals, vomiting, restlessness, headaches, Inspect puncture site, Position flat for at least 3hrs, Encourage fluids |
| If headache after LP, what should you do? | administer meds and fluids, keep room dark and quiet, may need blood patch |
| What does an EEG do? | Records electrical activity of brain (Cannot read thoughts) |
| How are electrodes attached for an EEG? | with glue or needles |
| Nursing interventions for an EEG: | No stimulants, Ok to eat, Shampoo immediately, Keep pt awake |
| What does Electromyography (EMG) & Nerve Conduction measure? | electrical impulse as it moves through nerves and muscles |
| What is Electroencephalography? | ultrasound of the brain |
| Narcotics interfere with assessment of what? | pupils and LOC |
| What are normal changes of aging r/t neuro? | decrease in brain size, slower reaction time, decrease short term memory, slower pupils response |
| If dementia it is more difficult to assess. What should you do to aid in assessing this patient? | Include someone who knows pt well, give brief instructions one at a time, consider medication toxicity |
| What can cause increased intracranial pressure? | Brain tumor, Head trauma, Infectious and inflammatory disorders |
| How do you assess for increased intracranial pressure? | Decreased LOC, papilledema, Cushing’s triad, Cheyne-Stokes respirations |
| What is Cushing’s triad? | pulse initially increases, then decreases, systolic increases causing a wide pulse presser, respirations become irregular |
| What are the goals in treatment of increased intracranial pressure? | maintain blood pressure, prevent hypoxia, ensure cerebral perfusion |
| What drugs are used to manage IICP? | Osmotic diuretics, and glucocorticoids |
| How do osmotic diuretics work on IICP and which one is used? | Hyperosmolality draws water from the edematous brain into the vascular system; mannitol |
| What do you want to carefully measure when a patient is on osmotic diuretics? | Measure output carefully |
| How do glucocorticoids work for IICP and which one is used? | Reduce localized (focal) edema from around a mass ; decadron |
| How would you position a patient with IICP? | Head of bed elevated w/head midline, Avoid hip flexion |
| How would you decrease stimuli for a patient with IICP? | Limit movement, move gently, Avoid bright light, loud noise |
| What do you want to prevent in patients with IICP? | constipation, coughing, vomiting |
| What should you restrict for patients with IICP? | fluids |
| What should a nurse do if there is impaired verbal communication due to IICP? | Observe for nonverbal signs of pain (Grimacing, moaning, restlessness), Position comfortably, provide: Paper & pencil, Communication board |
| What are the signs and symptoms of meningitis? | Nuchal rigidity, Photophobia, Kernig’s sign, Brudzinksi sign, Opisthotonos, Petechiae |
| What diagnostic test would confirm a diagnosis of meningitis? | Lumbar puncture and analysis of CSF |
| What is the medical management of meningitis? | Reduction of IICP, IV access, Antimicrobial therapy, Anticonvulsants, Immunizations |
| Who should be immunized against meningitis? | College students, Especially living in dorms |
| What is the name of the meningitis vaccine? | Menomune (Hib offers some protection) |
| What drug is given for close contacts of meningitis? | Rifampin (Rifadin) |
| What do you assess in patients with a neurologic infectious or inflammatory disorder? | Health history, vital signs, neurologic exam |
| Possible problems for patients with meningitis include: | Risk for impaired gas exchange, hyperthermia, acute pain, seizures |
| What are the nursing interventions for patients with hyperthermia? | Administer antipyretics, remove unnecessary clothing and blankets, tepid sponge bath without shivering, maintain hydration, cooling blanket |
| What are the nursing interventions for patients having seizures? | Side rails x 4, padded, Stay with patient during seizure, Turn to side, Do not restrain, Provide privacy, Tongue blade, Observe length and nature of seizure After: Suction, O2, Reorient client, Check for injuries |
| How is encephalitis contracted? | Vector-borne – tic, mosquitoes, birds, Viral infection i.e. West Nile, St. Louis, equine |
| How can encephalitis be prevented? | with vaccination – MMR |
| How quickly do symptoms of encephalitis come on? | hours to weeks |
| What tests are done to diagnose encephalitis? | Lumbar puncture, EEG, MRI |
| What does encephalitis cause? | Severe destruction of nerve tissue, Paralysis, dysphasia, respiratory failure, shock, seizure disorder |
| What is the medical management of encephalitis? | Supportive treatment, Medications |
| What is the nursing management of encephalitis? | Vital signs, LOC, I&O, Assess: bowel elimination, Client education: Avoid exposure to mosquitoes |
| What is Guillain-BarrÉ Syndrome? | Autoimmune reaction; peripheral nerve myelin destruction |
| What are the assessment findings of a patient with Guillain-Barre syndrome? | Tingling, Progressive weakness; paralysis, Ascending; bilateral |
| Diagnostic tests for Guillain-Barre Syndrome: | LP has increased protein, Pressure |
| What is the medical management of Guillain-BarrÉ Syndrome? | Plasmaphoresis; IV immune globulin, Gabapentin, amitriptyline |
| What is the Nursing Management of Guillain-BarrÉ Syndrome? | Monitor respiratory distress, vital signs, Prevent immobility complications, Meticulous skin care |
| What can cause a brain abscess? | Infection – sinusitis, mastoiditis, Intracranial surgery; head trauma; dental surgery |
| Assessment findings of a brain abscess: | IICP; fever; headache; neurolgic changes, Laboratory tests; diagnostic tests |
| Medical and Surgical Management of brain abscess: | Antimicrobial therapy; craniotomy |
| Nursing Management of brain abscess: | Assess LOC, sensory and motor function, signs of IIC, Monitor vital signs, fluid intake and output |
| What causes Multiple Sclerosis? | Autoimmune; genetic; progressive demyelinating disease |
| What can exacerbate symptoms of MS? | Exacerbation r/t infection, stress, heat |
| What are the Signs & Symptoms of MS? | Fatigue, weakness, numbness, tingling, Diplopia, nystagmus, blindness, Ataxia, paraplegia, tremor, Incontinence (neurogenic bladder),Decreased cognitive function |
| What diagnostic tests are done for MS? | Lumbar puncture, CSF with electrophoresis |
| Medical treatment of MS: | Maintain functional capacity, Drug threapy , Antidepressants, steroids |
| Baclofen or dantrolene is used for patients with MS for what? | for muscle spasticity |
| Oxybutynin & bethanechol is used for patients with MS for what? | for urinary symptoms |
| Glatiramer (Copazone) IM daily for patients with MS for what? | Alters T cells to prevent myelin destruction |
| What can you do for a nursing diagnosis of ineffective coping? | Suggest support group, encourage expression of feelings, provide choices to enhance control, facilitate social support, diversional activities for personal achievement |
| What can you do for a nursing diagnosis of Risk for caregiver role strain? | listen empathetically, give permission to meet own needs, develop respite care resources |
| What causes myasthenia gravis (MG)? | Autoimmune, ACh receptor antibodies |
| Assessment Findings for MG: | Muscle weakness; difficulty swallowing, Ptosis; diplopia; mask-like expression, IV: edrophonium (Tensilon); + ACh antibodies |
| Medical & Surgical Management of MG: | Drug therapy; plasmapheresis; thymus removal; respiratory support |
| Nursing Management of MG: | Rest; ventilation; emotional support, Effects of drug therapy and overdose |
| What is Amyotrophic Lateral Sclerosis (ALS? | Degeneration of spinal & brain stem motor neurons, M > F; death within 3-5 years |
| Assessment Findings of patients with ALS: | Progressive muscle weakness, wasting, fasciculations; dysphasia, dysphagia, paralysis, Inappropriate laughing and crying |
| Medical Management of ALS: | Manage respiratory complications; tamoxifen research |
| Nursing Management of ALS: | Comprehensive assessment, assistance with ADLs; caregiver teaching |
| What causes Trigeminal Neuralgia (Tic Douloureux)? | Possible fifth cranial nerve root compression |
| Assessment Findings of Trigeminal Neuralgia (Tic Douloureux): | Severe cyclic pain, Skull radiology; MRI; CT |
| Medical Management of Trigeminal Neuralgia (Tic Douloureux): | Narcotic analgesics; anticonvulsants, Correction of dental malocclusion |
| Surgical Management of Trigeminal Neuralgia (Tic Douloureux): | Surgical division of the trigeminal nerve |
| Assessment of patients with trigeminal neuralgia: | Complete history, Affected area; oral cavity |
| Nursing Interventions for patients with trigeminal neuralgia: | Record weight and ability to eat food, Avoid stimuli that exacerbate attacks, Suppress attacks with Tegretol, alcohol, Injection to nerve, resection of nerve, Avoid rubbing eye, Chew on opposite side of mouth |
| What causes Bell’s Palsy? | Suspected viral link, Inflammation of 7th cranial nerve (motor nerve) |
| What are the assessment findings for Bell’s Palsy? | Facial pain; numbness; decreased blink reflex; ptosis: Diagnostics: symptoms; r/o CVA and tumor |
| Medical Management of Bell’s Palsy: | Short-term steroid w/prednisone, Analgesics; electrotherapy |
| What are the nursing interventions for Bell’s Palsy? | Day: patch, Night: eye shield |
| Patient’s with Bell’s Palsy are at risk for what? | Eye infection; impaired oral mucous membranes, verbal communication |
| What are the goals for patients with Bell’s Palsy? | Understanding eye medication techniques, No infection; unaffected vision, Intact mouth tissue and teeth, Satisfactory verbal communication |
| Extrapyramidal disorders are disorders of what? | Cerebellum and basal ganglia disorders |
| What causes Parkinson’s disease? | Deficiency of dopamine + overactive response to ACh (Slow deterioration, affects > 50 yo ) |
| Assessment Findings for patients with Parkinson’s disease: | Hypophonia (low volume voice), Pill-rolling, tremors rigidity, Drooling – dysphagia, increase in salivation, weight loss, Bradykinesia, Shuffling gait, rigid arms |
| Patients with Parkinson’s are at risk for what? | Risk for falls r/t impaired mobility |
| How is Parkinsons diagnosed? | based on exam |
| Medical Management of Parkinson’s: | Drug therapy – dopaminergic, anticholinergics, Meds for depression, PT, OT |
| What is the Surgical Management (experimental) for Parkinson’s? | Stereotaxic pallidotomy – reduce tremor & movement problems, DBS – deep brain stimulation (brain pacer), Gene therapy – increased GABA production, Stem cell therapy |
| Nursing Management for Parkinson’s: | Drug therapy – many side effects, Level of activity; ADLs (goal is to keep the patient as functional as possible) |
| What causes Huntington’s disease? | Genetic transmission |
| What are the Signs & Symptoms of Huntington’s? | Choreiform movements; intellectual decline; elimination difficulties, Diagnosed: history, PET, genetic testing |
| What is the Medical Management for Huntington’s? | Antiparkinson drugs; genetic counseling |
| Nursing Interventions for Huntington’s: | Preventing complications; counseling, Client education: Exercise, medical regimen, ADLs |
| What is a Seizure? | Brief episode of abnormal electrical activity in the brain |
| What is a Convulsion? | Spasmodic contractions of muscles as a result of seizure activity |
| What is Epilepsy? | Chronic, recurrent pattern of seizures |
| What causes seizure disorders? | Idiopathic or acquired, Fever, lyte imbalance, Uremia, hypoglycemia, Hypoxia, tumor, Substance abuse & withdrawal |
| What causes Epilepsy? | Injury; inborn metabolism |
| Where do Partial/Focal seizures begin? | Begin in specific area of brain |
| What is an elementary focal seizure? | < 1min, without loss of consciousness, Motor – uncontrolled jerking movement of body part (Jacksonian), Sensory – hallucination, mumbling, nonsense words |
| What is a Complex focal seizure? | > 1min, confused afterwards, Automatisms/repetitive movement, Lip smacking, picking at clothes |
| What are the characteristics of generalized seizures? | involve entire brain, lose consciousness, seconds to minutes |
| What are absence seizures (petit mal)? | brief seizures, Stares blankly, eyelids flutter, lips move |
| What are myoclonic seizures? | brief seizures, Sudden jerking of arms, legs, entire body |
| What are tonic-clonic seizures (grand mal)? | Pre-ictal phase: aura, epileptic cry, Jerking, thrashing , Impaired air exchange, Incontinence, Post-ictal |
| What is status epilepticus ? | A life-threatening condition in which the brain is in a state of persistent seizure. |
| Assessment Findings for status epilepticus: | Description by witness, Neurologic exam; EEG; CT scan; MRI; serology; serum electrolyte levels |
| What is the Medical Management of status epilepticus? | Anticonvulsant drugs, serum levels |
| When is Surgical Management done for status epilepticus? | Seizures caused by brain tumor, brain abscess, and other disorders |
| Assessment of patient’s with status epilepticus: | Complete history; head injury; infection, Observer description |
| Nursing Process for status epilepticus: | Knowledge deficit: type, medication, and precaution, Epilepsy Foundation, Risks: Injury; impaired oral membrane; anxiety |
| What causes brain tumors? | Congenital; head trauma; viral infection, Radiation; immunosuppression; mets |
| What percent of brain tumors are malignant? | 50% malignant |
| What are the Signs & Symptoms of brain tumors? | IICP; seizures; neurologic function, Headache AM, nausea, vomiting, seizures, visual changes, dysphasia |
| What tests are done for brain tumors? | CT; brain scan; MRI; angiography |
| What is the Medical Management of brain tumors? | Radiation, chemotherapy, and drug therapy |
| What is the Surgical Management of brain tumors? | Craniotomy; craniectomy , Gamma-knife; radiosurgery |
| Nursing Interventions for brain tumors: | Area; tumor; treatment type, Client and family teaching, Medication regimen; home care, Chemotherapy and its effects, Nutritional support; rehabilitation, Support services |
| Assessment of the patient with a brain tumor: | Health history; neurologic examination, Physical assessment |
| Diagnosis, Planning, and Interventions of the patient with a brain tumor: | Acute pain related to IICP; imbalanced nutrition; grieving, Impaired oral mucous membranes |
| Evaluation of Expected Outcomes of the patient with a brain tumor: | Pain relief; balanced nutrition; intact oral mucosa; post-discharge care |
| What are the nutritional considerations for the patient with a neurological disorder? | Promote normal weight range, avoid: Malnutrition, constipation, aspiration |
| What should a patient on levodopa be aware of nutritionally? | eat high protein foods, B6 decreased effectiveness |
| What should patients on Steroids be aware of nutritionally? | decreased sodium, DM diet |
| What should patients on Anticonvulsants be aware of? | vitamin D and calcium imbalance |
| What is a Ketogenic diet? | high fat leads to ketosis which leads to decrease seizures. Can cause mild dehydration and is not proven to be effective. |
| Client teaching for Drug administration for patients with neurological disordes: | Do not skip doses! |
| What should patients on anticonvulsant therapy wear? | medic alert bracelet |
| Older adults with meningitis have what kind of symptoms? | Atypical signs and symptoms, Altered mental status, minimal fever, No nuchal rigidity or headache, Have higher mortality rates |
| What is the incidence of brain tumors in elderly clients? | It is decreased in the elderly |
| What causes tension headaches? | Prolonged contraction of neck and face muscles, Temporomandibular joint disorder (TMJ) |
| Assessment Findings of tension headaches: | Bilateral mild to severe pain, R/O pathology CT scan; brain scan; radiographs; angiography |
| Medical Management of tension headaches: | Rest; mild analgesia, Stress management; counseling |
| How does a migraine come about? | Constriction, then dilation, then pulsation |
| What are migraines r/t? | familial tendency, certain foods, reproductive hormones |
| Signs & Symptoms of migraines: | Aura; mood change, Fatigue; nausea, vomiting, Vertigo; sensitivity to light, Severe pain unilateral |
| Chemical developments in migraine headaches: | Cerebral blood vessels dilate in response to serotonin from platelets. Peptides released from the trigeminal nerve intensify pain. |
| Medical Management of migraines: | Rest , Drug therapy, Prevent or abort, Biofeedback techniques |
| Nursing Management of migraines: | Client instruction: Self-administration of medications, Measures to abort the migraine, Lying in a dark room, Minimizing noise and other stimuli |
| What causes cluster headaches? | Physiologic biorhythms, Lower-than-normal levels of serotonin |
| Assessment Findings of cluster headaches: | Severe pain on one side of the head, Rhinorrhea; symptoms; thermography |
| Medical Management of cluster headaches: | Corticosteroids; ergotamine derivatives, Vasoconstricting drugs; anticonvulsants, Oxygen; rhizotomy |
| Nursing Process: The Client with a Headache, Assessment: | Location; type of pain; past history; duration, Factors that trigger, worsen, or relieve the headache, Other symptoms |
| Nursing Process: The Client with a Headache, assessment; Clients with chronic headaches: | Complete medical, allergy, and family history, Frequency and description of pain, Vital signs |
| What are the four classes of cerebrovascular disorders? | TIA, Reversible ischemic neurologic deficit, Progressive stroke, Completed stroke |
| What causes TIA? | Impaired blood circulation, common in diabetes mellitus |
| TIAs are sudden and brief. Patients usually get what kind of return of function? | Full return of function |
| Assessment Findings of TIA: | Speech and visual disturbances, Confusion; partial paralysis, Bruit |
| Medical & Surgical Management of TIA: | Antiplatelet and anticoagulant therapy, Drug and diet therapy, Carotid endarterectomy, Balloon angioplasty |
| Nursing Management of TIA: | Complete client history, Vital signs and weight, Capillary blood sugar check, Neuro examination, Client monitoring after carotid artery surgery, Client education, Hydration, Medication, Control DM and HTN |
| What happens in a TIA that’s on the left hemisphere of the brain | Disruption in language and speech 95% of patients (depends on handedness), Slow and cautious behavior style, Motor paralysis on right side, Memory deficits |
| What happens in a TIA that’s on the right hemisphere of the brain? | Left side paralysis, Spatial/perceptual deficits, Quick/impulsive behavior, Memory deficits |
| Diagnosis of CVA: | Exam and history, CT or MRI to differentiate type, Doppler, EKG (r/o cardiac cause of early symptoms) |
| What kind of CVA can be fixed and which kind cannot? | Can fix clot, cannot fix ruptured blood vessel |
| Management of CVA: | Treat predisposing conditions such as hypertension, Anticoagulation, platelet anti-aggregation, Carotid endarterectomy, microvascular bypass, Research into utilizing “clot busting meds” for occlusive CVA is ongoing |
| Nursing diagnosis r/t CVA Risk for ineffective breathing pattern interventions: | HOB elevated 30 degrees, Pulmonary, toilet q2h, O2, Ventilation |
| Nursing diagnosis r/t CVA Risk for aspiration r/t dysphagia interventions: | Suction at bedside, HOB elevated 30 degrees, Prevent aspiration by avoiding solid and liquid foods and providing semisolid foods |
| Nursing diagnosis r/t CVA Impaired physical mobility interventions: | HOB elevated 30 degrees, Position prone 30min per day to prevent flexion contractures |
| Nursing diagnosis r/t CVA Risk for altered circulation interventions | provide anti-embolism stockings |
| Nursing diagnosis r/t CVA Self care deficit interventions: | Suggest clothing one size larger than normal constructed of stretchy fabric, Use mirror to dress |
| Nursing diagnosis r/t CVA Risk for altered nutrition interventions: | weigh weekly initially, Teach patient to chew on unaffected side of mouth, Low salt, low cholesterol diet, Provide supplemental feedings as necessary, Consult speech therapist |
| Nursing diagnosis r/t CVA Risk for constipation interventions: | Bowel regimen |
| Nursing diagnosis r/t CVA Altered urinary elimination interventions: | Indwelling catheter initially, Then institute a bladder program |
| Nursing diagnosis r/t CVA Risk for injury interventions: | Encourage patient to think through steps before initiating activity, Give simple instructions, one step at a time, Careful attention to affected shoulder joint to prevent subluxation, Support arm on pillow, Never lift by affected shoulder |
| Nursing diagnosis r/t CVA Unilateral neglect interventions: | Approach patient from unaffected side, Place items on unaffected side, Encourage patient to scan full visual field by turning head toward affected side, Encourage activities that cause the patient to pass midline i.e. hair brushing with mirror |
| Nursing diagnosis r/t CVA Impaired verbal communication r/t aphasia interventions: | Reduce environmental distraction, Establish eye contact, Speak slowly and clearly using questions that can be answered “yes” or “no”, Utilize picture board or written messages, Consult speech therapy |
| What causes cerebral aneurysms? | Congenital; secondary to hypertension and atherosclerosis |
| Where do cerebral aneurysms usually occur? | Most often in the Circle of Willis |
| Assessment findings for cerebral aneurysms: | Sudden, severe headache (“worst headache of my life”), Dizziness; nausea, vomiting, Loss of consciousness, Cerebral angiography, CT scan, MRI, Lumbar puncture, Hunt-Hess classification system (Grade I-V) |
| Medical Management of cerebral aneurysms: | Complete bed rest, Prevention of rebleeding (prevent fluctuation of blood pressure) , Treatment of complications, Anticonvulsants; tranquilizers, Mechanical ventilation, Careful observation |
| Surgical Management of cerebral aneurysms: | Craniotomy, Ligation of carotid artery |
| What does the nurse assess for cerebral aneurysm? | Neurologic examination; vital signs; history |
| Diagnosis, Planning, & Interventions for cerebral aneurysms: | IICP, Seizures, Pain, Self-care deficit r/t imposed rest and decreased LOC, Risk for ineffective peripheral tissue perfusion; impaired skin integrity |
| Expected Outcomes for patients with cerebral aneurysms: | IICP maintained within a safe range, No seizures, Tolerable level of discomfort, Nutrition, hydration, ventilation, and elimination needs are met, Peripheral circulation is adequate, Skin integrity preserved, Discharge teaching |
| People who gets migraines should journal what? | foods eaten |
| People with migraines should inform physician about what herbal supplement because it can be a trigger? | herbal feverfew |
| What drugs should be taken for the prevention of thromboembolic disorders? | Clopidogrel (Plavix), Dipyridamole (Persantine), ASA given prophylactically for TIAs |
| What is the antidote for oral anticoagulants? | parenteral vitamin K |
| What causes a concussion? | Blow to head that jars the brain |
| What is a concussion? | Temporary neurologic impairment |
| Assessment Findings for concussion: | Brief lapse of consciousness; disorientation, Headache; blurred or double vision, Emotional irritability; dizziness, Skull radiography, CT scan, MRI |
| Medical Management of concussion: | Halting of activity causing concussion, Mild analgesia, Observation for neurologic complications |
| Nursing Management of concussion: | Neurologic assessment, Close observation for signs of IICP, Client instruction: contact MD or return to ER if symptoms of IICP occur |
| Pathophysiology & Etiology of contution: | Coup and contrecoup injury, Cerebral edema |
| Assessment Findings contusion: | Hypotension; rapid, weak pulse, Shallow respirations; pale, clammy skin, Temporary amnesia, Effects of permanent brain damage, Skull radiography; CT scan; MRI |
| Medical Management contusion: | Drug therapy; mechanical ventilation |
| Nursing Management contusion: | Periodically monitor: LOC; neurologic changes; respiratory distress; signs of IICP; vital signs |
| Steps to prevent head injuries: | Seatbelts; infant car seats; protective headgear; neck restraints; no alcohol or drugs while driving |
| What causes cerebral hematomas? | Head trauma, Cerebral vascular disorders |
| What are the types of cerebral hematomas? | epidural, subdural, intracerebral |
| Assessment Findings of cerebral hematomas? | Depends on location, rate of bleeding, size of hematoma, autoregulation , MRI, CT scan, ICP monitoring |
| Indications of surgical emergency r/t cerebral hematomas: | rapid change in LOC, Signs of uncontrolled IICP |
| What surgeries are done for cerebral hematomas? | Burr holes, Intracranial surgery: craniotomy, craniectomy, and cranioplasty |
| All head injuries are how urgent? | All head injuries are emergencies. |
| Nurse’s role r/t head injury: | History; neurologic exam; vital signs; LOC, Movement in limbs; pupil exam |
| What should nurse check in a patient who has had a trauma ? | Head exam, Respiratory status, Neurologic changes |
| Preoperative nursing care r/t cerebral hematoma: | Hair removal; vital signs; neurologic assessment; antiembolism stockings, If indicated: IV, catheter, Restrict: fluids |
| Postoperative nursing care r/t cerebral hematoma: | Supine or side-lying (on unaffected side) position, Regular monitoring; observe for IICP, Control thrombus or embolus; cerebral edema |
| What are the types of head injuries? | open, closed |
| What are the types of skull fractures? | simple, depressed, basilar |
| Signs & Symptoms of skull fractures? | Localized headache, bump, bruise, laceration, hemiperesis; shock, Rhinorrhea, otorrhea, Periorbital ecchymosis, Battle’s sign, Conjunctival hemorrhages, seizures |
| What is the medical management of a simple fracture? | bed rest, observation for IICP |
| What is the medical/surgical management for lacerated scalp? | clean, debride, and suture |
| What is the medical/surgical management of depressed skull fracture? | craniotomy, antibiotics, osmotic diuretics, anticonvulsants |
| Nursing Management skull fracture: | Signs of head trauma, Drainage from the nose or ear, Halo sign, Neurologic assessment |
| What is the neurologic assessment for skull fx? | Hourly: LOC; pupil, motor, and sensory status, Every 15-30min: vital signs, Prepare for the possibility of seizures |
| Pathophysiology & Etiology of SCI: | Accidents (vehicular); violence, Spinal shock (Areflexia): Poikilothermia (inability to regulate one’s own body temperature), Autonomic dysreflexia (hyperreflexia) |
| Assessment Findings of SCI: | Pain, difficulty breathing, Numbness, paralysis, Neurologic exam, Radiography, myelography, MRI, CT scan |
| Medical Management of SCI: | Cervical collar; cast or brace; traction; turning frame, IV; stabilization of vital signs, Corticosteroids, Surgical intervention |
| Surgical Management of SCI: | Remove bone fragments, Repair dislocated vertebrae, Stabilize the spine |
| How long can spinal shock last? | May last several weeks |
| What happens in spinal shock regarding the impulses? | Impulses cannot move past the injured area, Flaccid paralysis below injury |
| What might spinal shock require? | May require vasoactive meds and ventilation |
| What happens with spinal shock? | Urinary and fecal retention occur, paralytic ileus, BP very unstable r/t lost vasomotor tone, perspiration absent below injury, males may have priapasm |
| Autonomic dysreflexia is a life threatening complication that may cause what? | May cause CVA or MI |
| Autonomic dysreflexia is usually related to what? | full bladder or constipation |
| What happens with autonomic dysreflexia? | Massive sympathetic discharge from the autonomic nervous system, Vasoconstriction, Extreme hypertension, Bradycardia, profuse sweating above level of injury, cyanosis below level of injury |
| Autonomic dysreflexia triggers: | Full bladder, Constipation, Drafts, Too hot or too cold, Pain, Injury |
| Treatment of autonomic dysreflexia is to avoid: | triggers or relieve distention |
| Nursing Process: Care of the Client with Spinal Trauma Assessment: | Injury; treatment given at scene, Neurologic assessment: document findings, Vital signs; respiratory status, Movement and sensation below injury level, Signs of worsening neurologic damage, Respiratory distress, Spinal shock |
| Nursing Process: Care of the Client with Spinal Trauma Diagnosis, Planning, & Interventions: | Ineffective breathing pattern, Ineffective airway clearance, Neuropathic pain, Impaired physical mobility, Anxiety, Risks: Impaired gas exchange, Disuse syndrome, Ineffective coping |
| Nursing Process: Care of the Client with Spinal TraumaEvaluation of Expected Outcomes: | Adequate breathing, Pain relief, Mobility using minimal assistive devices, Reduced complications from inactivity, Coping with the challenge of rehabilitation |
| What causes spinal nerve root compression? | Trauma, Herniated intervertebral discs, Tumors of the spinal cord |
| Assessment Findings of spinal nerve root compression: | Weakness; paralysis, Pain; paresthesia, Spinal radiography, CT, MRI, myelography , Electromyography |
| Medical Management of spinal nerve root compression: | Cervical collar or brace; bed rest; skin traction; hot moist packs, Skeletal muscle relaxants; drug therapy; corticosteroids; analgesics |
| Surgical Management of spinal nerve root compression: | Diskectomy, Laminectomy, Spinal fusion, Chemonucleolysis (Inject papain to dissolve disc) |
| Nursing Management of spinal nerve root compression: | Neuro examination, Conservative therapy, Spinal support and alignment, Bed rest in Williams’ position (Knees and head slightly elevated), Tractions, Proper body mechanics, Muscle relaxants and analgesics; moist heat application, eval response to therapy |
| Nursing Management after spinal surgery for spinal nerve root compression: | Monitor vital signs, Hourly deep breathing exercises, Examine the dressing for CSF leakage or bleeding, Assess neurovascular status, Voiding status, Fracture bed pan |
| Why is hypercalcemia a concern for patients with SCI? | The immobilization from SCI stimulates osteoclastic bone resorption. This results in calcium loss from the bones and hypercalciuria. Hypercalcemia results when the efflux of calcium is massive or the glomerular filtration rate of the kidneys is reduced |
| Nutritional considerations for patients with SCI: | Adequate, regular fluid intake, High-fiber diet |
| What does mannitol do after surgery? | reduction of ICP after surgery |
| Older adults Often respond less favorably to therapies for what? | a neurologic deficit |
| Older adults may incur a chronic fluid volume deficit. How much fluid should they be encouraged to take in? | Encourage a fluid intake of 1,500 to 2,000ml per day |
| Phases of a Neurologic Deficit: Acute Phase Medical and Surgical Management: | Stabilization; prevention of further neurologic damage, Drug therapy, Mechanical ventilation, Surgical intervention |
| Phases of a Neurologic Deficit: Acute Phase Nursing Management: | Frequent neurologic assessments: Glasgow coma scale & Mini-Mental Status Examination, Basic rehabilitation measures, Assess vital signs, Maintain BP, Observe: Signs of electrolyte imbalances, Dehydration |
| Phases of a Neurologic Deficit: Recovery Phase Medical & Surgical Management: | Keeping the client stable, Preventing or treating complications |
| Phases of a Neurologic Deficit: Recovery Phase Nursing Management: | Rehab program Planning and implementation, Assess Client’s level of functioning & Potential for improvement |
| Phases of a Neurologic Deficit: Chronic Phase Medical & Surgical Management: | Therapies and treatments, Control of BP, Physical therapy, Dietary management, Treatment of complications, Surgery: Muscle and skin grafts, Contracture deformity correction, Kidney stone removal |
| Phases of a Neurologic Deficit: Chronic Phase Nursing Management: | Preventing physical and psychological complications, Rehabilitation center therapy: Retraining in skills |
| Nursing assessment of the patient with a neurologic deficit: | Thorough history, Vital signs, level of comfort, General neuro assessment (Babinski reflex), Evaluation: airway, breathing, circulation, and LOC, Skin inspection, Bowel sounds, bladder distention, bowel and bladder control, Emotional and mental status |
| Nutritional considerations for the patient with a neurologic deficit: | Adequate fluid intake prevents renal stone formation, Fiber aids in normalizing bowel movements |
| Nutritional considerations for Paraplegics and tetraplegics : | Reduce calories to avoid weight gain, Diet requires nutrient-dense foods to be nutritionally adequate |
| What kind of diet is good for a patient with pressure ulcers? | A diet high in protein, vitamin C, and zinc helps prevent or heal pressure ulcers |
| What do glycerin suppositories do? | soften the stool in the lower rectum |
| What does bisacodyl (Dulcolax) do? | stimulates peristalsis in the terminal section of the colon |
| What are the kinds of enemas? | plain water, glycerin, Fleet brand enema |
| Gerontologic Considerations r.t neurologic deficit: | Involve social services and other agencies to assist with rehabilitation, Aging-related functional problems may complicate recovery, Allow extra time to answer questions, perform activities, Regularly palpate the bladder for distention |
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