Neuro 9-15.txt

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  1. Post op crainiotomy
    monitor for excessive amounts of drainage
  2. Supratentorial surgery
    if large tumor has been removed, place pt on nonoperative side
  3. Pt care with infratentorial surgery
    keep pt NPO for 24 hours, check head dressing every 1-2 hours for signs of drainage; monitor for hypovolemic shock and let surgeon know if drainage ism>50 ml/8 hr
  4. With crainiotomy…
    assess every 15-20 minutes for first 4-6 hours and then every hour
  5. What is seen most often after supratentorial surgery
    diabetes insipidus, especially procedures involving the pituitary gland or hypothalamus
  6. Failure of posterior pituitary gland to release ADH…
    leads to failure of renal tubules to reabsorb water
  7. CSW is believed to be the primary cause of
    hyponatremia in the neuro population and is charactereized by hyponatremia, decreased serum osmolality and decreased blood volume
  8. CSW is treated by
    Na replacement and isotonic fluid volume
  9. Post op crainiotomy complications
    increased ICP, subdural hematoma, intracranial hemorrhage, severe headache
  10. What may be placed as an emergency procedure to drain CSF for rapidly deterioration for neuro function?
    Ventriculostomy (IVC)
  11. After transphenodial surgery…
    nasal packing is inserted after the incision is closed and a mustache dressing is applied
  12. What to avoid after transphenodial surgery
    watch for nasal drip, do not cough or anything else that might cause pressure, sneeze through mouth, don’t bend at waist, can’t brush teeth, don’t strain for poop
  13. Secondary seizures can be caused by
    metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, high fever, stroke, head injury, substance abuse, heart disease
  14. Drug for status epilepticus
  15. Drug therapy for seizures
    main component of mgmt.; teach pts to take their drugs on time to maintain therapeutic drug levels and manimum effectiveness
  16. Seizure precautions
    O2 and suctioning are always available
  17. At the completion of tonic clonic seizure or complete partial seizure
    take VS, neuro check, keep pt on side, allow pt to rest, document seizure
  18. Priority for status epileptcus
    airway (may need to intubate), O2, IV access
  19. Status epilepticus
    medical emergency and prolonged seizure lasting longer than 5 minutes or repeated seizures over 30 minutes
  20. Causes of status epilepticus
    sudden withdrawal from antiepileptic drugs, infection, booze or drug withdrawal, head trauma, cerebral edema, metabolic distrurbances
  21. Tonic-clonic seizure
    lasts 2-5 minutes; tonic=stiffening or ridigity; clonic=jerky movements
  22. What may happen post tonic clonic seizure
    fatigue, acute confusion and lethargy
  23. Absence seizure
    blank stare, kids, may have automatisms (involuntary behaviors such as lip smacking or picking at clothes)
  24. Atonic seizure
    sudden loss of muscle tone lasting for seconds followed by post seizure confusion; pt usually falls; this seizure is most resistant to drug therapy
  25. Partial seizures
    focal or local (one part of cerebral hemisphere)
  26. Complete partial seizures
    may cause loss of consciousness
  27. Seizure precautions
    oxygen, suction, airway, IV, siderails up, no tongue blades
  28. What drug does not mix well with warfarin
  29. Meningitis
    inflammation of the meninges that surround the brain and spinal cord caused by bacterial and viral organisms
  30. Bacterial meningitis
    usually life threatening and there is exudate (pus) produced by the organism as it travels through the CNS; treat bacterial
  31. Most severe presentation of meningitis
  32. Drugs for viral meningitis
  33. Precautions for bacterial meningitis
    droplets (if N, meningitides and H. influenza)
  34. Symptoms of meningitis
    fever, HA, photophobia, indications of increased ICP, nuchal ridigity, +Kernig and Brudinski’s, decreased in mental status, focal neuro deficits, N/V
  35. CSF for bacterial meningitis
    cloudy, increased WBC, increased protein, decreased glucose, elevated CSF pressure
  36. CSF for viral meningitis
    clear, increased WNC, slightly increased protein, varied CSF pressure
  37. Lab for meningitis
    CT, LP, blood, polymerase chain reaction, xrays
  38. Drugs for meningitis
    broad spectrum anti, hyperosmolar agents, anticonvulsants, maybe steroids, prophylaxis
  39. Encephalitis
    inflammation of the brain and often surrounding meninges that affects cerebrum, brainstem and cerebellum; usually caused by virus
  40. Menin and enceph difference
    no exudate with encephalitis but does have demyelization
  41. Herpes encephalitis
    antiviral like acyclovir
  42. Complications of enceph
    increased ICP resulting from cerebral edema, hemorrhage and necrosis
  43. Mental status changes are more noticeable in enceph than menin
  44. West Nile is associated with
  45. Types of spinal cord injuries
    hyperflexion (head on collision), hyperextension (hit from behind), vertical compression (jumping), excessive head rotation, penetration
  46. Secondary spinal cord injuries
    hemorrhage, ischemia, hypovolemia, neuro shock, trauma (leading cause of SCI)
  47. Mgmt of SCI
    nonsurgical, immobilization, drugs, surgical mgmt., community resources
  48. Nursing DX for SCI
    difficulty breathing, potential for neuro shock, potential for further SC injury, impaired physical mobility, bowel and bladder, impaired adjustment
  49. SCI risk for neuro shock
    monitor pt for severe bradycardia, warm dry skin and severe hypotension; patients above T6 within 24 hours potential for neuro shock
  50. Complete spinal cord injury
    eliminates all innervation below level of injury
  51. Incomplete spinal cord injury
    injury that allows some function or movement below the level of the injury and are more common
  52. Halo device
    don’t pull on it, do not adjust screws, check pt’s skin, make sure one finger can be easily inserted, monitor neuro status
  53. Tetraplegic cough
    place his or her hands on either side of rib cage; as pt inhales, push upward to help expand the lungs and cough
  54. How to fix flaccid bladder
    perform valsava maneuver or tighten ABD muscles; not always successful; may have to do bladder ultrasound
  55. T5 injury with flushed face
    elevate (sit them up)
  56. Autonomic dysreflexia
    excessive, uncontrolled sympathetic output; severe HTN, bradycardia, severe HA, nasal stuffiness and flushing; usually caused by distended bladder or constipation
  57. Spinal cord tumor
  58. Intramedullary tumor
    small number of SC tumors but are usually cancerous
  59. Plan of care for pt with spinal cord tumor
    emotional support
  60. What med helps with inflammation for SPI
  61. Characteristics of restless leg
    burning, prickly sensation associated with irrestible urge to move; incidence is higher in patients with DM and chronic kidney disease
  62. RLS symptoms can occur
    worse in evening, night, and when pt is still for a period of time
  63. Nursing for peripheral nerve disorders
    risk for falls, thermal injuries, skin breakdown
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Neuro 9-15.txt
2013-10-20 19:35:33
Neuro 15

Neuro 9-15
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