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Exam III Neuro

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Question
Answer
Pts with seizure has what injury to what part of the brain?   Temporal  
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interventions with pts with increased ICP?   Elevate HOB. Put head in neutra position. Hyperventilate with PaCo2 low end or 35.  
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Pts eye remain in a fixed position after 10mls of ice water is instilled into left the ear. The nurse interpretes this reflex as?   Abnormal oculvestibular reflex  
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Glascow of 11, unconscious for 1hr, and no memory of event for the past 2 days after the car accident. this indicates...?   moderate traumatic brain injury  
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Post ruptured subarachnoid hemorrhage (SAH)... drowisiness with occassional inability to state place and time and nuchal rigidity. Which grade is this SAH according to Hunt and Hess?   Grade III  
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Calculate CPP?   MAP - ICP = CPP  
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Pt with ICP of 28...nurse doea what intervention to optimize cerebral perfusion pressure?   Administer dopamine to increase MAP  
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Pt with a head injury had an imediate loss of consciousness, followed by regain consciousness, then loss of consciousness again... Pt has?   Epidural hematoma  
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Purpose of HHH after aneurism clipping is to prevent   Vasospasm  
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Pt recovering from head injury has excess thirst and increase UOP...Which endocrine gland was affected?   Pituitary gland  
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Pt post-ops for transsphenoidal hypophysectomy (TPH)... nursing intervention?   Educate on mouth breathing  
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Pt with post-op craniotomy has blurred vision...nursing intervention?   Monitor for alteration in cranial nerve II (Optic nerve)  
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Pt with brain tissue coming out of the skull has?   Transcaverical herniation  
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Pt with inability to drink through a straw has alteration of which cranial nerve?   Facial (VII)  
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Pt diagonosed with brain death is getting an EEG test. The nurse makes sure?   CORE TEMPERATURE IS > 32 DEGREES CELCIUS (89.6F)  
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What drives cerebral blood flow?   Cerebral perfusion pressure (CPP)  
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Which part of the brain controls life essentials such as breathing, heartbeat and articulate speech   Brainstem  
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the Brainstem consists of what?   – Midbrain – Pons – medulla Oblangata  
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cerebellum is responsible for?   Maintaining overall balance, motor coordination, learning repetitive asks, muscle tone and sens of equilibrum  
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Damage to the cerebellum will result in what?   Atxic gait  
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CSF is secreted by what structure of the brain?   Cortex plexus  
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CSF serves as what?   Shock absorbers to the brain  
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Blockade of the CSF @ any pathway will lead to what?   Hydrocephalus  
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Non-convolution/smotthness of the brain indicates what?   ICP  
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CFS is produced @?   20ml/hr  
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Circulating volume of CSF at anytime should be?   135 - 150ml  
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Volume of CSF produced in a 24 hr window is?   500cc/24hrs  
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Smokey colored CFS indicates what?   RBC present  
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Cloudy colored CFS indicates what?   Infection  
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Yellow colored CSF indicates what?   Increased protien present  
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What is pathological reflex   A return of reflexes that one had when a baby such as sucking, babinski etc)  
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Name the five components of neuro assessments?   LOC (first & foremost in neuro checks), Motor functions, pupilliary/eye movement, respiratory patterns, vital signs.  
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What causes a pt to have partholigical reflex?   Brain damage. Baby reflex may returns when there is a brain damage  
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An oval eye shape indicates?   Pressure in the brain  
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Define localizing pain?   Application of cubital pressure on the rt hand, the lt habd reaches over to stop the pain  
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Define generalizing pain?   Trying to get away from the painful stimuli by moving arm away from the stimuli  
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No motor response to pain   1  
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extensor posturing to pain   2  
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flexor posturing to pain   3  
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Generlaized withdrawal to pain   4  
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Localizing response to pain   5  
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obeys command   6  
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No speech   1  
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Incomprhensible speech   2  
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inapropriate conversation   3  
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Confused conversation   4  
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oriented   5  
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no eye opening   1  
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eye open to pain   2  
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eye open to speech   3  
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spontaneous eye opening   4  
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If pt has noting in GCS, the score will be   3  
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if the pt is oriented and good, the GCS score will be   15  
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What drives cerebral blood flow?   CPP  
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What are The four factors we try to control to improve autoregulation?   Hypoxia, Hypercapnia, Hypotension, Hypovolemia.  
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What is ICP   The combination of the pressure exerted by brain tissue, blood and CSF  
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Normal range of ICP   5 - 15 mmHg  
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We typically treat ICP when it...?   > 20 mm Hg that is sustained for 5 minutes  
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Care of pt with ICP   DOn't cluster cares @ one time. Provide adequate rest periods. Do one thing @ a time. Don't do position change & suction all the time.  
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Nurses will help ICP pts avoid what?   Bearing down for BM, cough, vomit, blow their nose, - Valsalva maneuvers, coughing, suctioning, noxious stimuli, seizure activity,  
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Normal CPP range   70 - 95 mmHg  
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CPP < 60 mmHg indicates what?   Hypoperfusion  
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CPP < 40 mmHg indicates what?   Brain ischemia  
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In early rescusicitation, what do you use?   100% FiO2  
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Hypoxia + hypotension in ICP pts has...?   75% mortality  
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If pt have sudden increase in ICP... nurse knows to?   hyperventilate (breath faster) to decrease CO2. This is for a short time so pt do not develop CPP problem  
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Etiology of Increased ICP?   Disorders of brain substance. Mass lesion with local edema. Ischemic brain injury with cytotoxic edema. Increased cerebral metabolic rate.  
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We use tripple H therapy to prevent what in SAH?   Vasospasm  
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CSF is produced in which part of the brain?   Choroid plexus  
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Resorbtion of CSF is done by?   Arachnoid villi  
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What is cushing's triad?   Bradycardia, systolic HTN (widened pulse pressure) and abnormal respiration.  
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early sighn of ICP   Decrease in LOC  
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late sign of ICP   Cushing's triad  
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When pts get to cushing's response, it is close to what?   Irreversible damage  
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Periorbital edema & scleral edema is not due to what?   ICP  
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Periorbital edema & scleral edema is due to what?   Fluid overload  
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Periorbital edema & scleral edema is not thesame thing as what?   Papilledema.  
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Uncal herniation   Unilaterally (one side) expanding mass of lession  
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Central herniation   Bilaterally expanding mass of lession  
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singulate herniation   An expanding lession of one hemisphere shifts laterally across midline an forces the singulate gyrus ubder the falx cerebri  
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Types of ICP monitor   Intraventricular catheter. Subarachnoid bolt. Subdural or Epidural ctheter and fiber optic transducer.  
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Which of the following is not a determinant of brain dead?   Vestibulocular reflex  
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TBI classification: Mild (Grade I)   Altered or LOC <30 min with normal CT &/or MRI, GCS 13-15, PTA < 24 hrs. (post-traumatic amnesia)  
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TBI classification: Moderate (Grade II)   LOC < 6 hrs with abnormal CT &/or MRI, GCS 9 - 12, PTA < 7 days.  
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TBI classification: Severe (Grade III)   LOC > 6hrs with abnormal CT &/or MRI, GCS <9, PTS > 7 days.  
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Sign of Frontal or orbital fracture and Anterior fossa?   Racoon eye.  
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Sign of Basilar skull fracture?   Battle sign.  
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describe battle sign   ecchymosis overlaying the mastoid process behind the ear  
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describe racoon eye?   Black eye, subconjuctival and periorbital ecchymosis  
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Fossas of the skull can cause what during trauma?   damage to the brain tissue  
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hallmark sign of concussion is?   Retrograde amnesia  
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What two things does brain not store?   O2 and glucose  
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TBI: Nursing management?   Stabilization of vital signs. Prevention of secondary injury. Reduction of elevated intracranial pressure. Hemodynamic management. Fluid management. Cerebral perfusion pressure 70 mmHg or more. Aggressive pulmonary care. Reduce environmental stimul  
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Types of aneurysms   Berry or saccular & Fusiform  
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describe berry or saccular aneurism   Looks like berry, handgs down fron a vessel like a berry  
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describe fusiform aneurism   an outpouching of vessel all around  
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define focal deficit?   eyelid drooping, rt arm weaker than left side  
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Define Global deficit?   not as awake as used to be  
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Differenciat between rebleeding & vasospasm?   REBLEED is sudden onset of HA, increases in BP, RR, & N/V. VASOSPASM is gradual in onset, an ischemich event, U see changes over a period of hrs and days  
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What is embolisation used for?   The securing of an aneurism that is surgically inaccessible because of size, location, type or medical instability of pt  
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