Neuro - chapter 48

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  1. Meningitis
    • Inflammation of brain and spinal cord caused by bacterial or viral infection.(strep)
    • Nuchal rigity
    • Headache
    • Photophobia
    • Petechiae
    • Positive Kernig & Brudinski's sign
    • Purulent exudate
    • Late signs are lethargy and seizures
    • Quiet/dark environment. Antibiotics
  2. Kernig's sign
    • Caused by inflammation of meninges and spinal nerve roots
    • Flex hip 90° and try to extend knee. If pain, +
  3. Brudinski's sign
    • Caused by inflammation of meninges and spinal nerve roots. 
    • Positive when flexion of neck causes hip and knee to flex
  4. Encephalopathy
    • Mental status changes with meningitis:
    • Short attention span
    • Poor memory
    • disorientation
    • Difficulty following commands
    • Misinterpret environmental stimuli
  5. Turbid
    Cloudy (as in spinal fluid)
  6. Encephalitis
    • Inflammation of brain tissue
    • Viruses are most common cause
    • Nuchal rigidity
    • Confusion
    • ↓ LOC
    • Ataxia
    • Hemiparesis
    • Complications: Blindness, seizures, ↓ cognition
  7. Normal ICP
    0 - 15 mm Hg
  8. S/S of increased ICP
    Initial: Restlessness, irritability, ↓ LOC

    • Vomiting
    • Headache
    • Dilated pupil on affected side
    • Hemiparesis
    • Decorticate or decerebrate posturing
    • ↑ Systolic BP
    • Increasing, then decreasing HR (widening pulse pressure)
    • ↑ temp
    • Late sign: Cushing's triad (bradycardia, irregular respirations, ⇡ systolic BP)
  9. Nursing care for brain injury
    • Elevate HOB at least 30 °
    • No narcotics, codeine may be used
    • Avoid flexing neck
    • Avoid hip flexion
  10. Tension headache
    • Persistent contraction of scalp and facial, cervical and thoracic muscles can cause. 
    • May be assoc w/PMS, depression, stress
    • S/S - Symptoms develop gradually. Pain to crown of head and base of skull
  11. Migraine headache
    • Caused by cerebral vasoconstriction, then vasodilation
    • Pain on one side. 
    • Classic: has prodromal phase with possible visual disturbances, numbness, difficulty speaking. Nausea, vomiting
    • Common: no prodromal phase
  12. Cluster Headache
    • Causes: vascular disturbance, stress, anxiety, emotional distress. Alcohol may worsen them.
    • Unilateral pain
    • Bloodshot eyes
    • Quiet, dark environment to treat
  13. Acquired epilepsy vs. idiopathic epilepsy
    • Idiopathic: Usually begins before age 20
    • Acquired: caused by traumatic brain injury or anoxic events.

    *New onset seizures after age 20 are usually caused by neurogical disorder
  14. Partial seizures
    • Begin on one side of cerebral cortex
    • S/S: repetitive, purposeless behaviors (automatisms)
    • Simple Partial: Lasts <1min and don't lose consciousness
    • Complex partial: consciousness is lost. Can last 2-15 min. (automatic repetitive movement - lip smacking)
  15. Generalized seizures
    • Affect entire brain
    • Absence seizures: most often in children. Period of staring
    • Tonic-clonic: Tonic: 30-60 sec - rigidity, pupils fixed & dilated, hands/jaw clenched. Clonic: jerky motion of muscles
  16. Postictal period
    • Recovery period after seizure.
    • Disoriented
    • Sleepy
    • Headache
    • Confusion
  17. Most useful test to evaluate seizures
    • EEG
    • Can determine where seizures start
  18. Status epilepticus
    • At least 30 min of seizure activity w/o return of consciousness
    • Usual cause is abrupt discontinuation of anticonvulsants
    • Adequate oxygenation must be maintained
    • Diazepam or Lorazepam
  19. Most common cause of traumatic brain injury
    Motor vehicle accidents
  20. 4 types of traumatic brain injuries
    • Closed Head injury: rapid back and forth of brain, skull intact
    • Open: Break in skull
    • Acceleration: Moving object hitting head
    • Deceleration injury: Head in motion strikes stationary surface
  21. Concussion
    • Mild brain injury
    • Headache, dizziness, nausea/vomiting
    • Amnesia
  22. Contusion
    Bruising of brain tissue
  23. Subdural hematoma
    • Bleeding between dura and arachnoid membranes 
    • Venous blood
    • Older people & alcoholics prone to chronic subdural hematomas
  24. Epidural hematoma
    • Blood between dura and skull
    • Arterial blood
    • CT not MRI
    • Unconscious at accident scene
  25. Complications of ICP
    • Brain herniation
    • Diabetes insipidus
    • Acute hydrocephalus
    • Labile vital signs
    • Post-traumatic syndrome
    • Cognitive and personality changes
  26. Types of brain tumors
    • Primary: from CNS
    • Intra-axial: from glial cells with cerebrum, cerebellum or brainstem (infiltrate brain tissue)
    • Extra-axial: from skull, meninges, pituitary gland, cranial nerves (compress brain)
    • Secondary: Metastasized from elsewhere in body (most common)
    • Patients at risk for seizures
  27. Postop care after intracranial surgery
    • Neurologic assessment every hour for 1st 24 hours
    • CT scan
    • Check for CSF drainage: blood tinged in center with yellowish ring around it
    • Anticonvulsants for up to a year
  28. Craniotomy
    Surgical opening of the skull
  29. Herniated disk
    • disk moves out of position, the nucleus herniates, compressing nerve root
    • S/S:
    • Cervical: pain and muscle spasm in neck. Numbness or tingling. 
    • Thoracic: not common
    • Lumbar: low back pain, pain radiating down leg
    • Severely herniated L5-S1 disk may affect bladder and is emergency
  30. Treatment of herniated disk
    • Rest
    • Physical therapy
    • Traction
    • Medication (muscle relaxants)
    • TENS unit
    • Surgery
    • Teach log rolling technique
  31. Complete spinal cord injury
    No motor or sensory function below level of injury
  32. Areas of spine injured most
    Cervical and lumbar
  33. Quadruplegia
    Paralysis of all 4 extremities
  34. Quadriparesis
    Weakness of all extremities
  35. Injury at C5 or above
    • C3 : usually fatal because breathing muscles are paralyzed
    • C4-5: Usually need ventilator support
  36. Paraplegia
    Paralysis of legs
  37. Spinal shock
    • Immediately after spinal injury:
    • Cord below injury stops working
    • Vasodilation
    • Hypotension
    • Bradycardia
    • Hypothermia
    • Keep patient covered
  38. Dysreflexia
    • Occurs in T6 injury or above.
    • An uninhibited sympathetic response to a noxious stimulus (Bladder distention is most common)
    • S/S: Sudden high BP, bradycardia, headache, pale skin below injury, gooseflesh
    • Place in high fowlers and monitor BP
  39. Assisted cough technique
    Gently push upwards and inward on chest while patient coughs
  40. If patient can't feel pain, what is most important?
    Monitor skin and prevent prolonged pressure
  41. Birth control with spinal cord injury
    • No oral contraceptives because of risk of DVT
    • Norplant and condom Ok
  42. Neurodegenerative
    Disorder that causes wasting of neurons in nervous system
  43. Mild cognitive impairment (MCI)
    • Mild mental status changes that do not interfere with day to day functioning. 
    • People with this are more likely to develop alzheimers
  44. Dementia
    • Recent memories affected first
    • Keep everything simple
    • Routine
    • If albumin is below 3.5 indicates poor nutrition
  45. Parkinson's
    • Arises from basal ganglia in cerebrum
    • Loss of dopamine production, excess acetycholine
    • S/S: Muscular rigidity, bradykinesia, akinesia, changes in posture, resting tremors, shuffling short steps
    • No cure
  46. Huntington's Disease
    • Inherited
    • Progressive loss of normal movement and intellect
    • Involuntary, irregular, jerky, dancelike movements, constant motion
    • Aspiration is primary cause of death
  47. Alzheimer's
    • More common in women
    • Risks: Hypertension, hypercholesterolemia, poorly controlled diabetes
    • Subcortical area of brain left untouched
    • Stage 1: increasing forgetfulness 2-4 years
    • Stage 2: Progressive cognitive deterioration 2-12 years
    • Stage 3: Complete dependency
  48. Spinal injury C1-C3
    Usually fatal
  49. Spinal injury C4
    Quadriplegic, paralyzed from neck down
  50. Spinal injury C5-C6
    Quadriplegic with some arm and shoulder movement
  51. Spinal injury C7-C8
    Quadriplegic with some arm and hand movement
  52. Spinal injury T1 - T6
    Paraplegic, some trunk movement, legs paralyzed
  53. Spinal injury T7 - T12
    Paraplegic, good upper back and abdominal strength, may function well in wheelchair
  54. Spinal injury L1 - L4
    Paraplegic, may learn to walk with crutches or braces
  55. Mannitol
    Osmotic diuretic
  56. Tacrine (Cognex)
    Cholinesterase inhibitor
  57. Tegretol
  58. Decadron
  59. Sinemaet
    Converts to dopamine in the brain
  60. Setting that is therapeutic for agitated patient with head injury
    Seniprivate room with one or two consistent caregivers
  61. Definition of a seizure
    • Abnormal electrical discharge in the brain
    • Not always a sign of epilepsy
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Neuro - chapter 48
CnS disorders
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