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Med Surg Neuro
Med Surg Neuro
99
Medical
Graduate
10/11/2012

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Cards

Term
What is the function of the Frontal Lobe?
Definition
Behavior & Motor
Term
What is the func. of Parietal Lobe
Definition
Sensory & spatial
Term
Func. of the Temporal Lobe?
Definition
Auditory
Term
Func.  of Occipital Lobe?
Definition
Visual
Term
Func. of Basal Ganglia?
Definition
Fine motor function
Term
Func. of the Brain Stem?
Definition
Cardiac, resp, vasomotor center
Term
Func.  Cerebellum?
Definition
Gait
Term
What are the 3 layers of the Meninges?
Definition
Dura, Arachnoid, Pia Mater
Term
What is in between the Dura & Arachnoid?
Definition
CSF
Term
How much of the total C.O goes to Cerebral Circulation?
Definition
15% of CO
Term
What is the Circle of Willis?
Definition
Where 2 corotid and Veteberal vessels come together at the base.  Site of aneurisims and CVA
Term
The Autonomic NS include what?
Definition
SNS & PSNS
Term
The CNS include?
Definition
Brain, supporting structures, and spinal cord
Term
SNS when stimulated lead to what physiological changes?
Definition
INCREASE HR, INCREASE BP, vasoconstriction
Term
PSNS when stimulated lead to what physiological changes?
Definition
DECREASE HR, INCREASE Intestine peristalsis, INCREASE Glandular activity, relaxes sphincters
Term
What test can be used to see structural damage?
Definition
X ray
Term

What test is used for in emergencies?

To see what?

Definition

CAT Scan

To see vasculature

Could be performed w. or w/o contrast dye

Term
What can MIR be used to look for?
Definition
Too look at Arterial Flow
Term
What can PET scan be used for?
Definition
1. Brain matabolism 2. Blood flow  3. O2 uptake 4. Glucose uptake
Term

What is cerebral angioram used to see?

What cautions you have to take?

Definition

Used to study cereberal circulation.

Cautions:  Contrast dye may be allergic.

Do full neuro-check.  After procedure check for neuro deficits

Term
What is EEG used for?
Definition
Diagnose Seizures, Coma, determine brain death
Term

Describe Lumber Puncture:

What are they looking for?

Definition

Inserting a needle between L3 and L4 of subarachnoid space to extract CSF

Looking for bacteria, protein, cell counts, glucose

Term

What is used to monitor intercranial pressure?

What is normal Intercranial Pressure?

Definition

Monometer is used to check intercranial pressure.

Normal Intercranial pressure= 70-200 mmwater

Term

Why should you lay the patient flat after the procedure?

 How to fix?

How to fix more severe case?

Definition

To avoid spinal headache.  

Fix:  Anogelsics, fluids, and rest.

For more severe case, give blood patch

Term
What are complications of Lumbar Puncture?
Definition
Headache, herniation of the cerebral contents (too much pressure is already inside, cause brain to drop), infection, hematoma
Term
Definte "paresis" and "plegia"
Definition

Paresis means Motor weakness

"Plegia" means paralysis

Term
One side of body weakness/paralysis?
Definition
Hemiparesis/hemiplegia
Term
Both legs & the lower part of the trunk?
Definition
Paraparesis/paraplegia
Term
all 4 extremities?
Definition
quadriparesis/quadriplegia
Term
What is the term for loss of sensation?
Definition
Anesthesia
Term
Neurological dysfunction could be caused from what 2 factors?
Definition
Structural & Metabolic
Term

What are the structural causes?

They lead to the brain to do what?

Definition

Head injury, intracranial hemorrhage, encephalitis, brain abscess, & stroke

Cause brain to swell-->INCREASE intercranial pressure-->DeCREASE Cerebral Blood Flow

Term
What are the metabolic causes?
Definition
Sepsis, hypovolemia, MI, resp arrest, hypoglycemia, electrolyte imalance, drug & alcohol abuse, diabetic ketoacidosis, hepatic encephalopathy
Term
Intracranial Pressure is a refection of what 3 relatively fixed volumes?
Definition

The brain, CSF, & Blood

Increase in one will lead to decrease in the other 2 as compensation mechanism

Term
What can cause Increase Cranial Pressure?
Definition
Increase in any of these: Brain volume, Blood Volume, CSF Volume
Term

How does Hypercapnia cause ICP?

How does Hypoxemia cause ICP?

Definition

PaCO2>45 will DECREASE resp rate

PaO2<50 will cause cereberal edema

Term
What other contribute to ICP?
Definition
Valsalva maneuver, positioning, Isometric muscle contractions, coughping, sneezing, emotional upset, Noxious stimuli, excesive sensory stimuli
Term
What is Lethargic?
Definition
Oriented X 3, sleeps often, speech & thought slow
Term
Confused?
Definition
Disoriented X 1-3
Term
Obtunded?
Definition
Sleep a lot, rousable, awake only w/ constant stimuli, follows simple commands
Term
Stuporous?
Definition
Wakens to painful stimuli
Term
Comatose?
Definition
Does not respond to environmental stimuli
Term
What is the FIRST THING that we see in someone with ICP?
Definition
Change in Level of Conciousness or Behavior
Term
What are other early pictures of ICP?
Definition
Pupils, motor func, constant headache, VS (normal or a bit tachy), Visual disturbance
Term
What are late signs of ICP?
Definition
1.  LOC continues to detriorate 2. Loss of brain stem reflex (pupils fixd, no corneal reflex, loss gag & swallow reflex) 
Term

What motor response do you see in late symptoms of ICP?

What is the worst prognosis?

Definition
Flasid motor response is the WORST!
Term
What is Decorticate?
Definition
Flexed towards the center
Term
Decerebrate?
Definition
Flexed outward arms extended
Term
Which one is worse?
Definition
Decerebrate is worse
Term
What is the #1 Intervention for ICP?
Definition
Monitor ICP
Term
What are other interventions for ICP?
Definition
Decrease cerebral edema, maintain cerebral perfusion, reduce CSF & blood Volume, control fever, reduce metabolic demands
Term

How do you decrease Cerebral Edema?

What kind of drug used?

Definition

Osmotic Diaretics (Mantatol)-->pull fluid from brain tissue intravascularly-->increase urinary output

Corticosteroid (Nethopromytholon)

Term
How do u reduce CSF & Blood Volume?
Definition
Draining off.  Reduce blood volume by hyperventilating the patient-->to lower paCO2 to 30-34 for period of time.
Term
How to control fever?
Definition
Antipyretics (acetometaphine), cooling blanket slowly without shiver, or use dose of Thorzine to stop shivering.
Term
How to Reduce Metabolic Demands?
Definition
Temporarily paralyze patient with Panceronium (non depolarization muscle locker)
Term
How to maintain a patent airway for ICP?
Definition

Suction, hyperoxygenate prior to suctioning.

Do not use PEEP.  Maintain straight airway and head of the bed to 30 degrees-->help improve cereberal venous return.  

Term

Unconciousness =

Coma =

Persistent Vegetative State =

 

Definition

Unconciousness= Unresponsive, unaware of environmental stimuli (last minutes to hours)

Coma = Unconciousness for days, months, years

Persistent Vegetative State = wakeful but no conscious or cognitive mental function

Term
What are causes of unconsciousness & coma?
Definition
1.  Neurological (structural) 2. Toxic (overdoses of exposures to toxin) 3. Metabolic
Term
What are the Nursing Assessments of unconcious patient?
Definition

Airway Breathing Cirulation!

Skull x-rays, CT, MRI/MRA, EEG

 

Blood Work (CBC, electrolytes, ketones, Hydrogen, drug alcohol, ABG)

Term

What is the Glasgow Coma Scale?

When can this not be used?

Definition

Opening eyes, verbal, and motor response to test the Level of Conciousness.  More you can do, the more points.  

CAN'T be used for pts with intubation and anti motor drugs

Term
What kind of respiration can you find in an unconscious patient?
Definition
Cheyne-Stokes, Hyperventilation
Term

What to look for in pupils of unconcious pt?

PERRLA? Unequal? Dilating?

Definition

PERRLA- Toxic or metabolic

Unequal- Localized Neural problem

Fixd & Dilated- ICP or brain injury

Term
What to look for in Corneal Reflex?
Definition
Blink is normal.  Unilateral-Local.  Absent-Deep coma
Term
Facial symmetry?
Definition
Asymmetrical = Paralysis
Term
Swallow?
Definition
Drooling = Coma
Term
Neck?
Definition
Stiff = subarachnoid heme, meningitis
Term
When apply firm pressure on sternum, if no reaction, what is going on?
Definition
Coma
Term
Posters: Decorticate? Decerebrate? Flaccid?
Definition
Decorticate-Cerebral hemisphere midbrain.  Decerebrate-Lower brain stem.  Flaccid-Neuro or Metabolic
Term

What is a negative Babinski?

Positive Babinski?

Definition

When toes curl.

When toes dorsiflex, especially great toe

Term
Nursing diagnosis & goals for Unconcious Patient
Definition
See slides
Term
What are the top risk factors for CVD?
Definition
Cardiovascular Disease, HTN, DM, Smoking, Family HX of CVA, Sedentary lifestyle
Term
What is Transient Ischemic Attack (TIA)?
Definition
Temporary episode of neurological dysfunction with sudden loss of motor, sensory, or visual func.
Term
Assessment for TIA?
Definition
Ausultate Corotid for Brui or diminished flow, Carotid Doppler Study, Carotid angiogram
Term
What procedures are there to correct TIA?
Definition
1. Carotid angioplasty 2. Surgcal carotid Endarterectomy (CEA) 3. Anticoagulation treatment
Term
On the Stroke (CVA) risk card, what score is dangerous?
Definition
3 or >
Term
What is FAST?
Definition

F=FACE (ask the person to smile.  Does one side of the face droop?)

A= ARM Ask person to raise both arms.  Does one arm drift downward?

S=SPEECH Ask the person to repeat a simple phrase.  Does the speech sound slurred or strange?

T= TIME  If you observe any of these signs, CALL 911!

Term
What are Embolic or Thrombotic Occlusion Risk Factors?
Definition
Arteriosclerosis, atrial fibrillation, diesease of heart valves
Term
What are risk factors for Hemorrphagic CVA?
Definition

Hemorrhagic: Rupture of cerebral vessel

Risk factors: Uncontrolled HTN, trauma, arteriovenous malformation, intracranial aneurysms

Term
What tests are done to diagnose stroke?
Definition
CT, Carotid Doppler or cerebral angiogram
Term

What is Neurodeficit of CVA for Visual Field?

Define Hemianopsia & Diplopia

Definition
Hemianopsia- Lose half of visual field, Loss of peripheral vision, Diplopia-Double vision
Term

Motor?

Define Ataxia, Dysarthria, Dysphagia

Definition
Hemiparesis, Hemiplegia, Ataxia-steady gait, Dysarthria-difficulty forming words, Dysphagia-difficult swallow
Term

Sensory?

Define Paresthesias?

Definition

Paresthesias-numb or tingling

Difficulty w. Proprioception-Space orientation

Term

Verbal?

Define Expressive, Receptive, Global

Definition
Expressive-Can't express, Receptive- can't understand, Globa- when both happens
Term
Cognitive?
Definition
Memory loss, decrease attention span, can't concentrate, poor reasoning, altered judgment
Term
Emotional?
Definition
Loss of self-control, emotional lability, decrease tolerance to stress, depression, withdrawl, feeling of isolation, fear, hostility, anger
Term
Describe Left Hemisphere CVA symptoms:
Definition
Right paralysis or paresis, RT visual field deficit, Rt Aphasia, Altered intellectual ability, Slow cautious behavior
Term
RT hemisphere CVA:
Definition
LT paralysis or paresis, LT visual field deficit, Spatial-perceptual deficits, very distractible, Impulsive behavior & poor judgment, lack of awarenss of deficits
Term
What are medical treatments for Ischemic Stroke?
Definition
Thrombolytic Therapy, anticoagulants
Term
Treatments for Hemorrhagic Stroke?
Definition
Manage ICP, Surgery
Term
What are complications from CVA and how to prevent them?
Definition
Cerebral Hypoxia (oxygenation, H&H WNL), Decreased Cerebral Blood Flow (BP & CO WNL, adequte hydration), Extension of the area of Injury (avoid hypo or hypertension)
Term
Pre-op care for Craniotomy?
Definition
Baseline neurological assessment, Prepare client & family for postoperative appearance, teaching, allow questions, consent for surgery
Term
What are pre-op care?
Definition
Antiseptic shampoo, anticonvulsant meds, reduce cerebral edema, prevent infection, pre-op sedation
Term
What are complications from Crainiotomy?
Definition
ICP, bleeding, Fluid & electrolyte imbalances, infection, seizures
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