Neuro 1-7.txt

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Neuro 1-7.txt
2013-10-20 15:34:30

Neuro 1-7
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  1. Alert
    awake and responsive
  2. Lethargic
    drowsy or sleepy but easily awakened
  3. Stuporous
    arousable only with vigorous or painful stimulation
  4. Babinski’s sign
    Dorsiflexion of the great toe and fanning of the other toes is positive Babinski’s-neuro problems
  5. Positive Brudinski’s
    if lift head then knees go up; meningitis
  6. Positive Kernig’s
    when knee gets brought up, pain in back occurs-meningitis
  7. Normal ICP
    10-15 mm Hg
  8. The leading cause of death from head trauma in patients who reach the hospital alive
    Increased ICP
  9. As ICP increases, what happens
    cerebral perfusion decreases leading to tissue hypoxia, a decrease in serum pH level and increase in CO; these cause cerebral vasodilation, edema and increased ICP
  10. Barbituate coma
    pentobarbital sodium or thiopentone is drug; decrease the metabolic demands of the brain and cerebral blood flow, stabilize cell membranes, decrease the formation of vasogenic edema and produce more uniform blood supply
  11. Complications of barbiturate coma
    decreased GI motility, cardiac dysrhythmias and fluctuations in temp
  12. What med is given for ICP
    Mannitol (bolus) and Lasix to prevent rebound from mannitol; need to draw it up with filter needle because it can crystallize
  13. ICP increases…
    cerebral perfusion decreases
  14. How to calculate CPP
  15. S/S of ICP
    early: restlessness and irritability; late-decorticate/decerb; cushing’s triad, severe HA, N/V, seizures, papilledema
  16. Cushing’s triad
    increased systolic (widening pulse pressure), decreased HR, decreased RR
  17. MGMT of ICP
    meds, neuro check, monitor for fever (cooling blankets to protect hypothalamus), hyperventilate before suctioning if on vent
  18. Intraventricular catheter
    allows accurate measurement of ICP
  19. Complications with IVC
    invasive, infection, CSF leakage around insertion site
  20. Antiseizure med
  21. Cerebral angiography
    show circulation to detect blockages in the arteries or veins in the brain, head or neck; NPO 4-6 before, do not move; post op check for bleeding and swelling, keep extremity straight and immobilized, maintain pressure for 2 hours
  22. MRI
    no metal objects!
  23. PET
    provides function of the brain, 2-3 hour procedure, may be blindfolded or have earplugs
  24. Transcranial Doppler
    uses sound waves to measure blood flow through the arteries; evaluates vasospasm or narrowing of the arteries; safe and can be used repeatedly for the same pt and inexpensive related to angiography.
  25. EEG
    electrical activity of cerebral hemispheres; must be sleep deprived (wave up at like 2 or 3 a.m.) before procedure and anticonvulsants may be withheld
  26. EMG
    electromyography that identifies nerve and muscle disorders as well as spinal cord disease
  27. CSF norms
    pressure of 20 or less, clear, 0-5 lymphocytes, 15-45 protein, 3-12% of protein, 50-75 glucose, 10-15 lactic acid, 6-15 glutamine, 10% of serum lactate dehydrogenase
  28. Because of the danger of sudden release of CSF pressure
    a LP is not done for patients with symptoms of severely increased ICP
  29. Position of pt for LP
    fetal side-lying to separate vertebrae and move spinal nerve roots away from area to be accessed
  30. Opening and closing pressures
    are taken and 3-5 test tubes of CSF are usually collected and numbered sequentially
  31. Complications of LP
    brainstem herniation, infection, CSF leakage and hematoma, headache
  32. Nursing considerations for LP
    may give sedation, assist with cleaning area, hold person still; apply light dressing or bandaid
  33. TIAs resolve…
    within 30-60 minutes
  34. Features of TIA
    blurred vision, blindness, diplopia, tunnel vision, weakness, gait disturbance, numbness, vertigo, aphasia, dysarthria
  35. Modifiable risks for stroke
    smoking, booze, drugs, obesity, sedentary lifestyle, oral contraceptive, PPA (in antihistamines)
  36. Embolic stroke
    sudden development
  37. Aneurysm rupture causes
    bleeding into subarachnoid space, the ventricles and intracerebral tissue; vasospasm results; blood flow to distal parts of brain is markedly diminished
  38. AVM
    tangled malformation of veins and arteries during embryonic development; no capillary network; vessels rupture; thin veins can’t handle pressures arteries can
  39. Left sided stroke
    right sided weakness, aphasia, alexia, dyslexia, agraphia, acaculia
  40. Right sided stroke
    left sided weakness, spatial perceptual deficits; unilateral neglect
  41. Post-op endarterectomy
    2 nite stay, monitor VS, neuro, peripheral pulses, incisional bleeding, cerebraral hyperperfusion
  42. To assess function of frontal lobe
    give math problem
  43. Patients with embolic strokes
    may have afib
  44. Stroke is AKA
    brain attack
  45. Which is more serious? Open or closed head injuries?
  46. Open head injury
    when the skull is fractured or when it is pierced by a penetrating object; integrity of the brain and dura are violated, exposure to environmental contaminants
  47. Closed head injury
    blunt trauma
  48. Linear fracture
    simple, clean break, most common
  49. Depressed fracture
    bone is pressed inward into the brain tissue to at least the thickness of the skull
  50. Two distinct features of basilar skull fracture
    raccoon eyes and battle signs behind ears
  51. Patient with penetrating injury
    at high risk for infection
  52. Acceleration injury
    external force contacting the head
  53. Deceleration injury
    occurs when moving head is suddenly stopped or hits a stationary object
  54. Epidural hematoma
    arterial bleed, have lucid intervals
  55. Subdural hematoma
    venous bleeding
  56. Subarachnoid hematoma
    aneurysm (worst headache ever)
  57. CSF halo sign
    yellowish stain surrounded by bloody drainage
  58. Contusion
    bruising of brain tissue at site of impact (coup) or opposite (contracoup)
  59. Concussion
    shaky movement of the brain and may be mild or more severe
  60. Mgmt/treatment of head injuries
    c-spine precautions, ABCs, VS, LOC, fluids and electrolytes, nutrition, meds, be ready for surgical intervention
  61. What causes subarachnoid hemorrhage?
    AVM or aneurysm
  62. Migraine
    chronic, episodic disorder with multiple subtypes; intense pain on one side of the head and occurs with photo or phonophobia
  63. Topamax
    common antiepileptic drug used for migraines (low doses)
  64. Migraine triggers
    caffeine, red wine, stress, MSG
  65. Cluster headaches
    30 minutes to 2 hours, intense unilateral pain in spring or fall
  66. Treatment for cluster headaches
    percutaneous stereotactic rhizotomy and deep brain stimulation
  67. Ct may be needed
    for pt with headaches over 50 years old
  68. Primary brain tumor
    originates within CNS and rarely metastasize
  69. Secondary brain tumor
    results from metastisis from other areas of body
  70. Supratentorial tumors
    located within cerebral hemisphere
  71. Infratentorial tumors
    area of brainstem structures and cerebellum
  72. Transphenodial surgery
    to remove pituitary tumors (go through nose)
  73. Crainotomy preop care
    check that pt has not had alcohol, tobacco, anticoagulants or NSAIDS for at least 5 days pre surgery; NPO for at least 8
  74. Symptoms of a brain tumor
    early morning headaches, N/V, visual symptoms, seizures, changes in mentation or personality, papilledema
  75. Decadron
    control cerebral edema; check BS with glucocorticoids
  76. Periorbital edema and ecchymosis
    are not ususual and cold compresses are used
  77. Supranatorial surgery
    bed at 30 degrees
  78. Infratentorial surgery
    flat and on either side for 24-48 hours
  79. Complications of trigeminal neuralgia surgery
    h/A, cranial nerve dysfunction and bleeding
  80. Acute maximum paralysis is
    within 48 hours in half of patients and 5 days in almost all (bell’s palsy)
  81. Trigeminal neuralgia patients present
    bursts of pain (excruciating, sharp, shooting, piercing); bouts of pain for weeks or months and then spontaneous remission
  82. Trigeminal intervention
    balloon microcompression-compresses the trigeminal nerve root; surgical is crainiotomy with microvascular decompression (surgical relocation of artery which compresses the trigeminal nerve)