CC Neuro

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Author:
julianne.elizabeth
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294973
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CC Neuro
Updated:
2015-02-06 17:16:18
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complexcare nursing LCCC
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For Gordon's exam 1
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  1. What makes up the central nervous system? What make up the peripheral nervous system?
    • Central nervous system: brain, spinal cord
    • Peripheral nervous system: cranial nerves, spinal nerves, autonomic nervous system
  2. Describe cerebral circulation
    • Blood supplies oxygen, glucose, and nutrients
    • Brain receives 15-20% of cardiac output
    • Arterial supply from the internal carotid arteries and vertebral arteries
    • Venous return through the jugular veins
  3. What are the aspects of a neuro assessment?
    • Subjective data from the patient
    • Physical exam including reflexes, bilateral strength, PEARLA¬†
    • Glascow coma scale
    • Mental status (a+ox3)
    • Cranial Nerve testing (Especially sticking out tongue)
  4. How do you calculate the Glasgow coma scale?
  5. What are some ways to stimulate a person during a GCS assessment?
    • Call name
    • Try to sit up
    • Needle prick
    • Trapezius muscle pinch
    • Sternal Rub
  6. What is the difference between decorticate and decerebrate posturing? What does each posture mean?
    • Decorticate: arms flexed, legs straight
    • -caused by hemorrhage or lesion interrupting corticospinal pathways
    • -brain tumors, CVA,TBI
    • Decerebrate: extension of arms and legs
    • -caused by a dysfunction or hemorrhage in the brain stem
    • -brain stem tumor, cerebral CVA, TBI
  7. What is a lumbar puncture? What is being assessed? What abnormal findings would indicate trouble?
    • Lumbar puncture: insertion of a spinal needle into the lumbar space to extract and assess CSF
    • May also be used to inject contract dyes (assess for allergies prior to procedure)
    • Increased protein: infection, viral infection, guillan-barre syndrome, hyperthyroidism
    • Decreased glucose: bacterial infection
    • CSF should be clear and colorless
  8. What is the nurse's role in a lumbar puncture? What complications should you monitor for?
    • Position the patient in a side-lying fetal position
    • Instruct and assist patient to remain still during puncture
    • Send collected CSF to lab with pt info
    • Instruct pt to lay flat after LP to keep lumbar spine closed
    • Complications: infection, hematoma, spinal leak causing spinal headache and possible brain herniation (Esp for increased ICP)
  9. What is a migraine HA and what are the S/S? What are some possible triggers?
    • A unilateral throbbing headache
    • N/V
    • Photophobia or phonophobia
    • Motion sickness
    • May occur with diplopia and aura, even upon waking
    • Triggers include stress, caffeine, redwine, MSG, and hormonally induced
  10. What treatments are available for migraine HAs?
    • NSAIDs
    • Beta Blockers
    • Ergotamine Preps
    • Triptan Preps
  11. Describe cranial edema and the normal ICP
    • Swelling of the brain or meninges
    • Fluctuations of blood flow
    • Increase in CSF
    • Normal ICP: 0-15mm Hg
  12. What are some causes of intracranial edema?
    • TBI: crushing, blunt force trauma, GSW
    • Ischemic Stroke: blood clot or blockage
    • Cerebral Hemorrhage: hemorrhagic stroke (HTN)
    • Brain Infections: meningitis, encephalitis
    • Tumors: golf ball, pancake
  13. What can cause fluctuations in ICP?
    • Vomiting
    • Defecating
    • Coughing and sneezing
    • Valsavas maneuver
    • Stress or emotional response
    • Exercise, lifting
  14. What are the clinical manifestations of increased ICP? What serious complication should you monitor for?
    • Decrease in LOC
    • Changes in vital signs- widening pulse pressure
    • Changes in vision or pupils
    • Changes in motor function
    • HA and vomiting
    • Serious complication is brain herniation leading to brain death!
  15. What nursing interventions can be performed for a client at risk for increased ICP?
    • Monitor vitals
    • Monitor neuro status
    • Monitor ICP
    • Maintain airway
    • Assess ABGs for changes
    • Maintain pt's head in a neutral position, reposition q2h
    • Daily weights for fluid maintenaince
    • Monitor I/O and electrolytes
    • Nutritional support (dietary)
    • Admin medications as ordered
  16. What are the difference mechanisms of head injury? What is a primary brain injury?
    • Closed head injury
    • Open head injury
    • Acceleration-deceleration injury (at coup and contrcoup)
    • Rotational injury
    • Primary brain injury: direct injury that occurs to the brain from impact
  17. What are the different types of skull fractures?
    • Linear: most common, clean break
    • Depressed: bone pressed inward
    • Comminuted: bone fragments into the brain tissue
    • Basilar: at base of skull, results in CSF leakage into ears and nose with black raccoon eyes. HR for nerve damage
  18. What are the different types of brain injury?
    • Concussion (widespread)
    • Contusion (localized bruising)
    • Penetrating injury
    • Hematomas
    • Intracerebral hemorrhage
  19. What are some clinical indications for cranial surgery?
    • Tumors
    • Infection
    • Vascular abnormalities
    • Trauma
    • Epilepsy
    • Parkinson's disease
  20. What is stereotatic surgery?
    • Precision (computer guided) apparatus to assist the surgeon to a precisely targeted area of the brain
    • May use a burr hole or bone flap to access brain
    • Involves closed skull destruction of an intracranial target using ionized radiation
  21. Describe the different types of seizures
    • Generalized seizures
    • Tonic- decreased LOC, stiffening of arms/legs
    • Clonic- rhythmic jerking
    • Tonic/clonic
    • Absence- blank stare with possible automatisms
    • Myclonic- stiffening/jerking of a muscle system
    • Atonic/Akinetic- sudden loss of muscle tone & consciousness, often resulting in falling
    • Status Epilepticus- continued or back to back seizures without recovery
  22. What is the nurse's responsibility during a seizure?
    • SAFETY!
    • Remove restricting clothing, move to floor if necessary and protect head if possible
    • Put into side lying position to avoid aspiration
    • After seizure, apply O2, saline lock, suction, and pad siderails for seizure precautions
    • Document what you saw, if anything occurred prior to the seizure (aura, smell), vital signs, and postictal state
    • Allow for quiet during postictal state
  23. What medications are commonly used for seizure disorders?
    • Phenytoin (Dilantin): Can be used for all seizure types. Side effects include gastric distress, gingival hyperplasia, ataxia, and nystagmus. Therapeutic levels must be drawn
    • Gabapentin (Neurontin): Used for partial seizures. SE include weight gain and increased appetite, ataxia, irritability, dizziness and fatigue
  24. What is Parkinson's disease? What are some common clinical manifestations?
    • A progressive, neurodegenerative disease caused by heredity or environment
    • Decreased dopamine in the brain allows an increase in acetycholine
    • Dopamine is responsible for fine, voluntary movement
    • S/S include tremors (chorea), rigidity, shuffled gait, bradykinesia and akinesia. Behavioral changes can also occur
  25. Describe the different stages of Parkinson's disease
    • Stage 1: weakness, trembling,
    • Stage 2: mild, mask-like face, difficulty swallowing/chewing
    • Stage 3: Moderate, can't stand, poor gait, bladder/bowel incontinence
    • Stage 4: Akinesia, rigidity
    • Stage 5: total dependence
  26. What medications are often used to treat Parkinson's disease? What other treatment may be effective in interrupting tremors?
    • Dopamine agonists: very effective during the first 3-5 yrs.
    • Stimulates dopamine receptors in the brain
    • Ropinirole (Requip)
    • Can exacerbate orthostatic hypotension
    • Hallucinations
    • Drowsiness
    • "Wearing off" effect where there is a loss of response to drug
    • Patch: Neupro
    • Sinemet: a levodopa-carbidopa combo given before meals
    • Deep Brain stimulation: electrodes implanted in the brain interfere with tremor cells
  27. Describe the progression of Alzheimer's disease
    • Early (mild): short term memory, pt may attempt to hide symptoms
    • Middle (mod): cannot recognize familiar objects or know people
    • Late (Severe): cannot communicate ¬†
    • Apraxia- inability to use words correctly
    • Aphasia- inability to speak
    • Anomia- inability to think of words
  28. What changes of behavior can occur in alzheimer's disease?
    • Aggression-physical, cursing
    • Sudden mood swings
    • Sundowning
    • Wandering
    • Hoarding
    • Suspicious
    • Delusional
    • Hallucinations
    • *Risk for Injury
  29. What treatment is available for alzheimer's?
    • Structured, consistent environment
    • Perpetual orientation in early stages, validation theory in later stages
    • Promote ADLs and keep items in designated places
    • Keep family pictures
    • Locked unit
    • Cholinerase inhibitor: Donepezil (Aricept)- slows down but does not stop disease
  30. What are some common causes/types of Spinal Cord Injuries (SCI)?
    • Fractures, often from MVA
    • Dislocation
    • Subluxation
    • Penetrating trauma (GSW, knife)
    • Contusion (bruise)
    • Compression from falls
    • Rotation leading to tearing and stretching
    • Axial Loading from vertical compression
  31. How can you assess a SCI?
    • ABCs
    • GCS
    • Level of Injury:
    • -Quadriplegia- all four extremities
    • -Paraplegia- lower extremities only
    • -Spinal shock lasts 48 hrs, motor, sensory, reflex
  32. What are halo fixation devices and what nursing care should be provided?
    • Four screws into the skull using sedation or general sedation, has a jacket/collar to keep in place
    • Halo keeps the cervical spine in place
    • Check the jacket for pressure points
    • Assess points for loosening and provide pin care
    • Methylprednisone (solu-medrol) may be prescribed to decrease inflammation
  33. What is autonomic dysreflexia? What the the S/S and causes?
    • An excessive, uncontrolled sympathetic output usually occurring when theres an SCI above T6
    • S/S include acute, uncontrolled HTN, HA, bradycardia, flushing
    • Caused by distended bladder, impacted feces, goosebumps
    • This is a nursing emergency! Put pt in sitting position and call MD
    • Remove case and treat HTN with Apresoline
  34. What the different kinds of CVAs?
    • Ischemic: thrombus or embolus
    • Hemorrhagic: Aneurysm
    • PE: sudden onset, large clot from DVT
    • Fat Embolism Syndrome: gradual onset, multiple small fat droplets, surgical complication from long bone fracture
  35. What are the S/S of a CVA?
    • Memory Impairment
    • Contralateral hemiparesis
    • Aphasia, Anomia
    • Facial Palsy (unilateral)
    • Impaired swallowing

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