Neuro

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Author:
Thenordski
ID:
192993
Filename:
Neuro
Updated:
2013-01-15 17:35:24
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nursing neuro
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Description:
Neuro A&P/Disorder study guide
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  1. Cerebral Cortex
    Grey matter; surface of cerebrum
  2. Cerebellum
    Involuntary movements of voluntary movements; ie: coordination, balance, etc.
  3. Brain Stem
    Medulla, pons, mid brain; auto nervous system ie: controls resp, heart rate, b/p, coughing, etc.
  4. Spinal Cord
    transmits impulses to and from brain
  5. Meninges
    Connective tissue that protects CNS. Made up dura mater (outer layer; thick), arachnoid mater (middle layer; web-like), and pia mater (inner layer; thin).
  6. What does Glasgow Coma Score measure?
    Eye opening, verbal response, & motor response.
  7. Best/Worst GCS?
    • - Best=15 (spon. eye opening, orientatedx3 (verbal), follows commands.
    • - Worst=3 (No open eyes, no verbal resp, no respond to stim or pain)
  8. Most reliable indicator of neuro status?
    Level of consciousness (orientatedx3). Can detect changes from neuro baseline much sooner
  9. PEARRLA
    Pupils equal, round, and reactive to light & accommodation
  10. Normal penlight exam
    Normal pupil response to light will be to constrict then return to previous size (adjusts to light)
  11. Nystagmus
    Involuntary, jerking movements of the eyes (typically twitching)
  12. Decorticate posturing
    Protecting core; elbows bent to chest
  13. Decerebrate posturing
    Extremities extended out and away
  14. Seizures
    Interruptions in neuro impulses; chaotic
  15. Partial seizure
    Effects one area/side of the brain
  16. Generalized seizure
    Effects both hemispheres of brain/multiple areas
  17. Seizure nursing interventions (saftey)
    • - Never put anything in pts mouth or restrain pt.
    • - Provide pillow under head and turn pt on side (maintain airway)
    • - Assist to the floor
    • - Remove anything harmful from room
  18. Seizure documentation
    • - Events prior to seizure (possible aura?)
    • - Time seizure started and ended
    • - Type of seizure/pt movement during seizure
  19. Post-ictal nursing priorities
    • - Level of conciousness (is pt orientated, drowsy or difficult to arouse?)
    • - Pt behaviors
    • - Vitals signs
  20. Pt teaching with seizure rx
    • - Meds do not cure seizures and seizures still possible even on meds
    • - Drugs levels will need to be monitored
    • - Never discontinue meds suddenly
  21. Status epilepticus
    Seizure lasting longer than 30 minutes
  22. Causes of ICP
    TBI, cerebral edema, tumors, hydrocephalus, bleeding
  23. Signs of ICP
    Decreased level of consciousness, headace, cushings triad, hypertension
  24. Earliest sign of ICP
    Decreased LOC
  25. Hydrocephalus
    Excessive CSF
  26. Traumatic brain injuries
    • - leads to bleeds (subdural, epidural)
    • - caused by direct trauma to head/brain (car accidents, assaults, falls, etc.)
  27. Cerebral Edema
    Swelling in brain
  28. Cranial bleeds
    • - caused by TBI, CVA, aneurysms
    • - Pt may loose consciousness then regain it
    • - watch vitals signs for increased b/p, bradycardia, and irreg resp.
  29. Cushing's Triad
    • - Widening pulse pressure, irreg resp, and bradycardia
    • - signals possible brain herniation
    • - late indicator of increased ICP
  30. Nursing interventions for decreasing noxious stimuli
    • - Dark , quiet room
    • - stool softners
    • - NO ROM, suctioning, coughing, or straining
    • - NO morphine/narcotics (will mask s/sx of ICP)
  31. Tension headaches
    Caused by stress and muscle contractions of the head &/or neck
  32. Migraines
    Unilateral pain, photophobia, aura, n/v
  33. Causes of meningitis
    Bacterial/Viral organisms within the meninges
  34. S/SX of meningitis
    Fever, nuchal rigidity, brudzinksi sign, kernig's sign
  35. Kernig's sign
    Painful ext of knee when hip bent & knee @ 90 degrees
  36. Brudzinksi's sign
    Pt flexes hips when nurse flexes neck (ie bridge)
  37. Nuchal rigidity
    Neck stiffness
  38. Meningitis Dx
    • - Lumbar Puncture (will increase pressure)
    • - Characteristics of CSF (cloudy due to WBC and organisms)
  39. Lumbar Puncture
    • - Procedure where needle is inserted into subarachnoid space where CSF is withdrawn
    • - Can also be done to admin rx (chemo, epidural)
  40. Proper LP test positioning
    Side-laying; knees to chest (fetal)
  41. Porper post-LP care
    Lie flat on back for 6 hours (prevents spinal headache)
  42. Cerebral, angiogram, MRI, CT Scan
    Assess pt's allergies to contrast, iodine, and seafood/shellfish
  43. 4 Divisions of spinal cord/column
    Cervical (7), thoracic (12), lumbar (5), sacral
  44. Spinal cord injury
    • - Extent of paralysis related to location of injury, partial/full transection of cord, or compression of cord
    • - can cause loss of bowel function
    • - can cause spinal shock
  45. Time limit before bowel function should return after spinal injury
    3 days
  46. Paraplegia
    loss of motor and sensory function to both lower extremities due to spinal cord injury
  47. Quadriplegia
    loss of motor and sensory function to all 4extremities due to spinal cord injury
  48. Spinal cord saftey
    • - Only perform jaw thrust to perform CPR/maintain airway
    • - immobilize column with neck collar
    • - immobilize with Gardener Wells Tongs
  49. Spinal shock
    • - Loss of sensory, motor, reflexive, and autonomic function of nervous sys below the spinal cord injury
    • - can start in 30 min and last for weeks
    • - return of reflexes (involuntary) = end of spinal shock
  50. Gardener Wells Tongs
    • - pins attached to the skull (can be used in traction)
    • - used to immobilize and align cervical vertebrae
  51. Autonomic Dysreflexia
    • - medical emergency
    • - occurs with injuries above T6
    • - exaggerated sympathetic response with no parasympathetic response
  52. Autonomic Dysreflexia s/sx
    • - main: seizures, bradycardia, HTN
    • - secondary: nasal congestion, sweating, skin blotching, nausea, restlessness, goose bumps
  53. Causes of Autonomic Dysreflexia
    • - Noxious stim below the level of the injury
    • - most common cause is overfilling bladder
  54. Tx of Autonomic Dysreflexia
    • - HOB elevated 40 degrees
    • - remove noxious stim
    • - Prn htn rx
  55. Prevention of Autonomic Dysreflexia
    • - Pt teaching of reducing noxious stim
    • - ensure catheter patency and proper drainage
  56. Anticonvulsant RX
    • - Dilatin (mouth care essential due to gingival hyperplasia)
    • - Keppra
  57. Gingival hyperplasia
    Excessive gum tissue
  58. Osmotic Diuretics
    - Mannitol (used to decrease ICP; tanks b/p; A LOT of urine output)
  59. Methylprednisolone
    • - Anti-inflamm steroid
    • - reduces dmg to spinal cord
  60. Cerebral spinal fluid
    • - usually clear
    • - will test positive for glucose
    • - can leak from ears, nose, LP
    • - Blood can be present from LP, but will fade over time¬†

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