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Block 2 Neuro
| Question | Answer |
|---|---|
| glasgow coma scale | assesses eyes, motor, and verbal on scale of 3-15, 3 being comatose |
| CSF | "feeds" the brain. Composed mainly of glucose. Clear, colorless, no blood, no bacteria, may have protein. Creates a halo when outside the brain/spinal cord |
| amount of CSF | 125-150 mL circulating |
| dysarthria | problem with articulation |
| aphagia | trouble speaking |
| intrathecal medicine administration | through access port in head. used to administer antibiotics and chemotherapy and bypass the blood-brain barrier |
| blood-brain barrier | protective covering over blood vessels in brain. does not allow water soluble compounds (antibiotics). does allow lipid soluble compounds (alcohol, nicotine) |
| decorticate posturing | legs and toes extended, arms flexed |
| decerebrate | rigid extension of all extremities |
| x-rays | detect fractures, developmental or degenerative bone abnormalities, increased vascularity |
| CT scan | gold standard. can detect tumors, lesions and swelling. can be done w/ or w/o contrast. |
| myelogram | contrast into the subarachnoid space via lumbar or cisternal puncture. identifies spinal lesions. pt must lie flat for 3h. monitor for h/a, n, v |
| brudzinski's and kernig's signs | test for meningeal irritation |
| decreased glucose in CSF | indicative of bacterial meningitis |
| increased protein in CSF | indicative of viral meningitis |
| lumbar puncture | measures CSF pressure and allows for sampling. make sure pt voids first. NEVER done with brain tumors |
| EEG | brain waves. no caffeine before (false readings). used to detect stroke, seizures, brain death |
| MRI | uses magnets to detect tissue variations. more sensitive than CT. good for soft tissue injury. noisy and small space - pt may need sedation. NO pacemakers! ask about piercings, artificial joints, screws, etc. |
| TIA | transischemic event. s/s go away after 24h |
| CVA | cerebral vascular accident. s/s last longer than 24h and may be permanent. must get CT within 30 min. to determine cause of stroke |
| hemorrhagic CVA s/s | h/a, neck stiffness, sensitivity to light - similar to aneurism or meningitis |
| embolotic CVA | clot moves to brain |
| thrombotic CVA | clot somewhere in body obstructs blood flow to brain |
| ischemic CVA s/s | motor, language, sensory-perceptual, bowel & bladder, cognitive-emotional impairment |
| anticoagulants | prevent formation of clots |
| thrombolitics | dissolve clots, given within 3h of ischemic stroke |
| antiseizure medications | reduce intercranial pressure with strokes |
| HTN medications | reduce blood pressure to reduce damage to vessels |
| stroke and temperature | hyperthermia is normal. maintain temperature control |
| dexamethasone | steroid. reduces brain inflammation |
| homonymous hemianopsia | blindness in one eye or certain parts of the field of view |
| astrocytoma | star-shaped cells that cause brain tumors |
| meningiomoas | tumors from the meninges |
| concussion | mechanical damage to the brain |
| contusion | bruising on the brain. shows on CT |
| s/s of brain tumor | n, v, h/a that wakes pt up |
| battle's sign | postauricular ecchymosis (bruising behind the ears), periorbital ecchymosis (raccoon eyes). do NOT allow pt to blow nose |
| rhinorrhea | fluid dripping from nose. after head injury test for CSF |
| otorrhea | fluid dripping from ears. after head injury test for CSF |
| head injury Tx | airway, monitor for changes in LOC, watch for widening pulse pressure (difference between DBP and SBP), seizures, may need to mechanically hyperventilate pt. |
| CO2 levels in head trauma | should be on lower end of normal - 25-35. causes vasoconstriction, reducing chances of further damage |
| monroe-kellie hypothesis | brain consists of brain tissue, CSF, and blood. when pressure of one increases, the other two must decrease. |
| s/s IICP | decreased LOC, N, V, h/a, seizures, pupillary changes, unilateral weakness, VS changes, loss of all reflexes |
| methods to decrease ICP | maintain airway, oxygen, positioning (high Fowlers), osmotic diuretics, hyperventilation, brain drain |
| simple/focal seizure | occur in a specific area of the brain and may involve motor, sensory, or autonomic phenomena. pts generally don't lose consciousness and event usually lasts less than 1 min. |
| tonic-clonic | grand mal seizure. classic seizure symptoms |
| actions with seizure | protect airway, position on side, loosen clothes, medication IV or IM (Valium or Ativan), EEG, ensure bedrails are padded in case of next event |
| herniated disc | disc leaves capsule and presses on peripheral nerve(s). occurs with age, stress, and trauma. Dx with myelogram, EMG, CT, MRI |
| s/s of herniated disc | pain, numbness, tingling, loss of function down nerve root |
| EMG | electrical stimulation with acupuncture-like needles. not fun procedure. |
| tetraplegia | paralysis of both arms and legs |
| acute care spinal injury | field stabilization (halo), manage spinal shock, airway protection! |
| neurogenic shock | loss of vasomotor tone. hypotension and bradycardia |
| long term management of spinal injury | steroids to reduce inflammation, dopamine to increase HR and B/P, high protein diet, bowel/bladder management, psychosocial issues |
| autonomic dysreflexia | complication of t-6 or higher injury. life threatening! distended bladder or bowel, h/a, n, blurred vision, diaphoresis, nasal congestion, hypertension, bradycardia |
| Tx for autonomic dysreflexia | sit patient up, use lidocaine before Foley insertion to avoid stimulating SNS |
| Meningitis | bacterial/viral/fungal infection of the brain. cloudy lumbar puncture with elevated protein. +Brudzinski's and Kernig's sign |
| Tx for meningitis | resp. isolation for 24h after antibiotic therapy start (or until culture is negative), anticonvulsants, analgesics, keep in dark room, minimize noise and stimuli, ice pack |
| encephalitis | causes degenerative changes to nerve cells, scattered inflammation and necrosis, fever, h/a, seizures, stiff neck, changes in LOC |
| parkinson's disease | disease of the basal ganglia characterized by bradykinesia, rigidity, tremor at rest, and impaired postural reflexes. disruption of dopamineric neurons, loss of balance between dopamine and acetylcholine |
| TRAP | major s/s of Parkinson's - Tremor, Rigidity, Akinesia, Postural instability, chewing and swallowing difficulty, depression, shuffle, flat affect |
| multiple sclerosis | chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord r/t viral infection and/or autoimmune process. remissions/relapses. |
| s/s multiple sclerosis | weakness or paralysis of limbs/trunk/head, diplopia, scanning speech, spasticity of muscles, numbness and tingling, blurred vision, patchy blindness, vertigo, tinnitus, decreased hearing, chronic neuropathic pain, nystagmus, ataxia, dysarthria, dysphagia |
| nystagmus | involuntary, rhythmic movements of the eyes |
| diplopia | double vision |
| myasthenia gravis | autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups, especially those affecting the eyes and eyelids, chewing, swallowing, speaking, and breathing. |
| Dx of myasthenia gravis | EMG, Tensilon test (opposite effect of someone not affected - improved muscle function) |
| Tx for myasthenia gravis | anticholinesterase meds, corticosteroids, immunosuppresants, thymectomy, plasmapheresis |
| glaucoma | obstruction of flow of aqueous humor causing an increase in IOP, progressive loss of peripheral vision, no poo straining, treated with cholinergic eye drops |
| cataracts | cloudy or opaque lens, treated with lens implant surgery, post-op care: NO straining!, lay on back |
| conjunctivitis | Pink Eye, highly infectious, purulent drainage, isolation if in hospital setting, treated with warm compresses and antibiotics |
| retinal detachment | s/s include floaters or curtain across visual field, Tx includes creating inflammatory response, silicone banding, bed rest, cryotherapy, pain meds |
| macular degeneration | aging retina. can be wet (development of abnormal blood vessels in or near the macula) or dry (more common, macular cells atrophy). Tx includes oral zinc or laser therapy |
| aneurysm | weakness and ballooning of vessels |
| right-brain damage | left side hemiplegia, spatial-perceptual deficits, tends to deny or minimize problems, rapid performance, short attention span, impulsive, impaired time concepts |
| left-brain damage | right side hemiplegia, impaired speech/language aphasias, impaired left/right side discrimination, slow performance, cautious, aware of deficits, depression, anxiety, impaired comprehension related to language and math |
| global aphasia | all communication and receptive function is lost |
| carotid endarterectomy | atheromatous lesion is removed from the carotid artery to improve blood flow |
| alteplase (t-PA) | thrombolytic enzyme, for ischemic strokes ONLY! causes all sorts of bleeding s/e. monitor VS, bleeding, ECG, within 3 hours only |
| benztropine mesylate (Cogentin) | cholinergic blocker, antiparkinson's. allows sympathetic response. s/e: confusion, palpitations, tachy, blurred vision, C, paralytic ileus, hyperthermia, heat stroke. contraindicated in glaucoma and myesthenia gravis |
| carbidopa-devodopa (Sinemet) | antiparkinsons, inc. dopamine, used for cerebral arteriosclerosis. s/e: tremors, fatigue, anxiety, orthostatic hypotension, N, V, dysphasia, tachy |
| clopidogrel (Plavix) | platelet aggregation inhibitor. for MI proph. S/E: GI bleed, bleeding, intercrainial hemorrhage, watch hepatic and blood studies |
| diazepam (Valium) | antianxiety anticonvulsant, skeletal muscle relaxant. potentiates GABA. S/E: dizziness, drowsiness, orthostatic hypotention, ECG changes, tachy, blurred vision, resp. dep. |
| interferon beta-1b (Betaseron) | multiple sclerosis agent. decreases inflammatory response. S/E: h/a, fever, chills, mental changes, migraine, hypertension, D, C, V, irregular menses, myalgia, myasthenia |
| mannitol | osmotic diuretic. hypertonic. used for IICP. S/E: rebound IICP, tachycardia, CHF circulatory overload, acidosis, N, V, hyperkalemia |
| pilocar | acts directly on cholinergic receptor sites. used for primary glaucoma. S/E: h/a, tachy, bitter taste. hold tear duct closed to prevent medication from becoming systemic. |
| phenytoin (Dilantin) | alters transport of Na ions to reduce motor cortex activity. for seizures and Bell's Palsy. Tx range = 10-20 mcg. S/E: h/a, confusion, pink/red pee, gingival hyperplasia |
Created by:
steffio316
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