Term
| What are the functions of the nervous system? |
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Definition
-Direct all physiological, cognitive, and psychological activities
-Maintain homeostasis
-Gather sensory information, integrate it, and respond to it via motor activity |
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Term
| What is the purpose of a lumbar puncture or a spinal tap? |
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Definition
-To obtain pressure readings
-Obtain cerebrospinal fluid
-Check for spinal blockage attributable to a spinal cord lesion
-Inject contrast medium or air for diagnostic study
-Inject spinal anesthetics or other medications, and reduce mild increased intracranial pressure in certain conditions |
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Term
| What should the nurse do during a lumbar puncture procedure? |
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Definition
| Assist with patient (fetal position preferred) |
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Term
| When is a lumbar puncture contraindicated? |
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Definition
| In patients with symptoms suggestive of increased intracranial pressure |
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Term
| What does normal cerebrospinal fluid look like? |
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Definition
| Clear and colorless with few cells |
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Term
| What should the nurse monitor for in a patient who just had an angiography? |
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Definition
| -Bleeding (if bleeding is observed, call the radiologist immediately) |
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Term
| What is multiple sclerosis? |
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Definition
| A chronic autoimmune disease that affects the myelin sheath and conduction pathway of the CNS and is a leading cause of disability in young adults |
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Term
| What are the signs and symptoms of MS? |
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Definition
-Abnormal sensations
-Speech problems
-Tremors
-Bladder problems
-Difficulty walking |
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Term
| What is the goal of care for a patient with MS? |
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Definition
| Maintain maximum strength, function, and independence |
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Term
| What are the functions of the CSF? |
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Definition
-Protects the brain & spinal cord
-Circulates nutrients and removes waste products from brain (no lymphatics in brain)
-Helps maintain special environment that the brain requires |
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Term
| How long can the brain go without blood supply before irreversible brain damage? |
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Definition
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Term
| What is the most effective way to protect the brain during focal and global ischemia? |
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Definition
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Term
| What is the difference between an upper motor neuron and a lower motor neuron? |
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Definition
Upper motor neuron = from brain
Lower motor neuron = from spine |
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Term
| What are the signs of upper neuron damage? |
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Definition
Hyperactive reflexes
Rigidity
Tremor
Twisting irregular movements may be present |
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Term
| What are the signs of lower neuron damage? |
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Definition
Flaccid paralysis
No reflexes
Loss of muscle tone |
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Term
| What does the mnemonic AEIOU TIPS to help recall common causes of altered LOC stand for? |
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Definition
Alcohol
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychiatric
Stroke |
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Term
| What are the 3 types of seizures? |
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Definition
-Grand mal: entire brain depolarizes at once
-Focal: localized
-Status epilepticus: medical emergency |
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Term
| During a seizure, what is priority? |
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Definition
-Protect airway
-Safety precautions |
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Term
| What should you remind patients who receive contrast media or isotopes to do? |
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Definition
| Drink fluids to increase elimination of the material |
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Term
|
Definition
| Person experiences 2 or more seizures |
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Term
| What is the treatment for seizures and what should you teach patients who have seizures? |
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Definition
-Drug therapy: major component of management. Generally introduce one AED at a time.
-Teach pts importance of taking drugs on time and as prescribed. Build up sensitivity, may lead to drug decline. MUST KEEP LAB APPTs!
-Healthy lifestyle: balanced diet, proper rest, stress reduction techniques, seizure diary, driving |
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Term
| What are seizure precautions that should be employed? |
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Definition
-Oxygen
-Suction equipment
-Airway: position patient on side during seizure
-IV access: may become dislodged during seizure
-Siderails up: padded?
-NO TONGUE BLADES |
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Term
| What is status epilepticus and what is the management? |
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Definition
-Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min--medical emergency!
-Establish airway
-ABGs
-IV push lorazepam, diazepam
-Rectal diazepam
-Loading dose IV phenytoin |
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Term
| What is meningitis and what are it's predisposing factors? |
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Definition
Inflammation of the meninges that surround the brain and spinal cord
-PF: Otitis media, pneumonia, sinusitis, sickle cell anemia, brain or spinal surgery, immunosuppression |
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Term
| What is Kernig's and Brudzinski's sign and what do they mean? |
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Definition
Kernig's sign: with the pt in supine and thigh flexed to 90 degree angle, attempts to straighten or extend the leg are met with resistance
Brudzinski's sign: flexion of neck causes involuntary flexion of the knees and hips, or passive flexion of the leg on one side causes contralateral flexion of the opposite leg
-Positive sign means meningitis |
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Term
| What are the lab tests used to diagnosis meningitis? |
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Definition
-CSF analysis
-CT scan
-Blood cultures
-CBC
-Xrays to determine presence of infection |
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Term
| What is the nursing care for a meningitis patient? |
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Definition
-ABC
-VS and neuro check q2-4 hr
-Cranial nerve assessment
-Manage pain
-Record I&O
-Body weight to identify fluid retention
-Monitor labs
-ROM exercises q4hr
-Decrease environmental stimuli
-Monitor and prevent complications |
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Term
| What is encephalitis and what are it's causes? |
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Definition
Inflammation of the brain tissue
-Affects cerebrum, brain stem, cerebellum
-Usually caused by viruses, rarely bacteria, fungi or parasites
-Can be life threatening or lead to persistent neuro problems |
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Term
| What are nursing interventions for encephalitis? |
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Definition
| Same as meningitis--so look at that flashcard! ;P |
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Term
| What is Parkinson's Disease and what are it's causes and treatment? |
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Definition
Progressive neurodegenerative disease that affects 1 million people
-No cure
-No known cause/preventative measures
-Drug therapy
-Priority of care and management: medical and surgical |
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Term
| What are the stages of Parkinson's Disease? |
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Definition
Stage 1: Initial Stage
-Unilateral limb involvement, minimal weakness, hand and arm trembling
Stage 2: Mild Stage
-Bilateral limb involvement, masklike face, slow, shuffling gait
Stage 3: Moderate Disease
-Postural instability, increased gait disturbances
Stage 4: Severe Disability
-Akinesisa, rigidity
Stage 5: Complete ADL dependence |
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Term
| What are the nursing implications for Parkinson's Disease? |
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Definition
-Encourage self management
-Poor nutrition due to impaired swallowing, chewing (small, frequent meals, thickening agent, food records to record timing and amt of meals)
-Exercise and activity
-Impaired sleep
-Impaired cognition
-Financial considerations
-Safety
-Elimination issues - incontinence, constipation |
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Term
|
Definition
Loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgement, and behavior
-Most types are degenerative |
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Term
| What are nursing interventions for Alzheimer's Disease? |
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Definition
1. Maintain cognitive function for as long as possible
-Cognitive stimulation and memory training
-Prosopagnosia: use pictures and reminisce
-Reality orientation: works well in early stages
-Validation therapy: better in later stages
2. Consistent and structured environment
3. Promoting self-management: keep ADL items in same place
4. Encourage nutrition
5. Decrease anxiety
6. Promoting bowel and bladder continence
7. Promoting communication
8. Physical illness can worsen symptoms of AD, focus on illness prevention |
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Term
| What is myasthenia gravis and what is its cause? |
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Definition
Autoimmune disease, characterized by fluctuating weakness of the voluntary muscle groups caused by deficient acetylcholine receptors at neuromuscular junction
-Cause is unknown |
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Term
| What are nursing implications for Myasthenia Gravis? |
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Definition
Assessment
-Muscle strength, vision, respiratory status
N. Diagnosis and Interventions
-Activity intolerance
-Alteration in verbal communication
-Alteration in nutrition
-High risk of aspiration
-Disturbed sensory perception
-Risk for injury
-Ineffective respiratory function
-Disturbed body image
-Self care deficit
-Knowledge deficity |
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Term
| What is Guillain-Barre syndrome and what are its cause and treatment? |
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Definition
Acquired immune-mediated inflammatory disorders of the peripheral nervous system
-Cause is unknown
-No cure, but most patients (up to 85%) with GBS achieve a full and functional recovery within 6-12 months |
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Term
| What are the nursing implications for guillain-barre syndrome? |
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Definition
-Education about vaccination information
Assessment and interventions
-Weakness: acute onset
-Cranial nerve involvement
-Facial droop, Diplopias, dysarthria, dysphagia, opthalmoplegia, pupillary disturbances
-Sensory involvement
-Pain
-Autonomic
-Respiratory weakness |
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Term
| What are the stages of Huntington Disease? |
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Definition
Each last about 5 years
Stage 1: onset of neuro and psychological symptoms
Stage 2: increasing dependency on others for care
Stage 3: Loss of independent function |
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Term
| What are nursing implications for Huntington Disease? |
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Definition
Physical Assessment
-Choreiform movements
-Cognition
Drug therapy
Nursing implications: safety, nutrition, genetic screening
Health teaching: include psychosocial support resources, PT, OT, ST, nutritionist |
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Term
| What is the first indication that central neurological function has declined? |
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Definition
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Term
| What are the 4 stages of LOC? |
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Definition
-Alert: Awake and responsive
-Lethargic: drowsy or sleepy but easily aroused
-Stuporous: Arouse with painful stimuli
-Comatose: Unconscious and cannot be aroused |
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Term
| What is the Glasgow Coma Scale? |
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Definition
An objective and reproducible way to describe a patient's level of consciousness and arousal
-Takes 3-5 minutes
-Scores range from 3 to 15 with lower scores indicating more severe neurological deficiency
-Assesses eye opening, limb movement, and vocalization |
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Term
|
Definition
-Graphically records electrical activity of cerebral hemisphere
-Patient must be sleep-deprived before procedure
-Anticonvulsants may be withheld |
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Term
| How do you assess memory? |
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Definition
-Long-term (remote): birthdate, city of birth
-Recall (recent): Accuracy of medical hx, time of admission, mode of transportation to hospital
-Immediate (new): Give patient 2-3 unrelated nouns, ask to repeat immediately and in 5 minutes |
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Term
| How do you assess patient's attention? |
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Definition
-Number series
-Serial 7's ( count backwards from 100 subtracting 7, stop at 65)
-Higher Intellectual Functions: favorite hobbies, current events
-Abstract reasoning: meaning of proverbs (cultural sensitivity) |
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Term
|
Definition
| Normal blood supply to brain is disrupted by ischemia or bleeding |
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Term
| Causes of ischemic stroke |
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Definition
1. Atherosclerosis
2. Cardiogenic embolus
3. Most commonly due to atrial fibrillation
4. Associated with valvular disease |
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Term
| Where do most clots related to A. Fib originate? |
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Definition
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Term
| What are the symptoms of a left-sided stroke? |
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Definition
-Left gaze preference
-Right visual field deficit
-Right hemiparesis
-Right hemisensory loss, neglect & hemi-inattention |
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Term
| What are the symptoms of right sided stoke? |
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Definition
-Right gaze preference
-Left visual field deficit
-Left hemiparesis
-Left hemisensory loss, neglect & hemi-inattention |
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Term
| Phase 1: Hyperacute phase |
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Definition
-First 3 to 24 hours
-Prehospital:
EMS activation and response
Time symptoms started or last seen "normal"
Rapid transport to stroke center preferred
-ED
Diagnosis of stroke
Cause
Determine plan of care |
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Term
| What are the maximal intervals recommended by NINDS for Potential tPA candidate? |
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Definition
1. Door-to-door first sees patient: 10 min
2. Door-to-CT completed: 25 min
3. Door-to-CT read: 45 min
4. Door-to-thrombolytic therapy starts: 60 min
5. Neurosurgical expertise available: 2 h
6. Admitted to monitored bed: 3 h |
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Term
| What is tissue plasminogen activator (tPA) and what are its contraindications? |
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Definition
Actively dissolves clot
-Contraindications:
Active bleed anywhere in body
Trauma
Bleeding risks and precautions |
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Term
| What statements must be true in order to consider tPA administration? |
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Definition
-Ischemic stroke onset within 3 hours of drug administration
-Measurable deficit on NIH Stroke Scale examination.
-Patient's CT does not show hemorrhage or non-stroke cause of deficit
-Patient's age is >18 years |
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Term
| Do NOT administer tPA if any of these statements are true: |
|
Definition
-Symptoms are minor or rapidly improving
-Patient has had another stroke or serious head trauma within past 3 months
-Patient had major surgery within the last 14 yrs
-Pt. has history of intracranial hemorrhage
-Pt. has symptoms suggestive of subarachnoird hemorrhage
-Pt. has had arterial puncture at non-compressible site within the last 7 days
-Pt. has sustained SBP >185 mmHg or DBP >110 mmHg, and aggressive tx is necessary to lower BP
-Pt. has had GI or Urinary tract hemorrhage within 21 days
-Pt serum glucose is <50 or >400
-Pt has received heparin within last 48 hrs
-Patients PT is >15 seconds or platelet count is <100,000 |
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Term
| What can be done if patient wit ischemic stroke symptoms does not qualify for tPA treatment? |
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Definition
| Can remove blockage mechanically up to 6 hours after onset |
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Term
| What is the ABCD scale (r/t stroke)? |
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Definition
| Used to predict the risk of stroke during the first seven days after a Transient Ischemic Attacks |
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Term
| What is a transient ischemic attack? |
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Definition
| Transient episode of neurological dysfunction caused by focal brain ischemia without acute infarction |
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Term
| Stage 2: Inpatient acute care (for stroke) |
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Definition
-24-72 hours
Nursing Management
-Preventing and monitoring for complications
-Assessing effectiveness of treatment, & improvement or worsening of condition
-Administering treatments
Start rehab ASAP
-Stable cardiac & respiratory status
-PT consult on admission
Prepare patient and family for discharge |
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Term
| What is the NIH Stroke Scale? |
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Definition
| Standardized stroke assessment done on initial assessment, changes of level of care & with change in status for the worse |
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Term
| What is Amyotrophic lateral sclerosis (ALS) aka Lou Gehrig's disease? |
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Definition
| An adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting and spasticity eventually leading to paralysis |
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Term
| What is nursing priority for patient's with ALS (aka Lou Gehrig's disease)? |
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Definition
| Monitor respiratory status carefully in patients with ALS since patient's experience respiratory failure in terminal stages of the disease |
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Term
| What is trigeminal neuralgia? |
|
Definition
| A disease that affects the trigeminal, or fifth, cranial nerve and entails a specific type of unilateral facial pain, which occurs in abrupt, intense spasms |
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Term
|
Definition
| An acute paralysis of cranial nerve VII |
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Term
| What is an occlusive stroke? |
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Definition
| Arterial blockage or narrowing cause ischemia in the brain tissue ultimately leading to infarction of neurons in the involved area of the brain |
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Term
| What is the difference between common onset times for ischemic strokes vs. hemorrhagic strokes? |
|
Definition
| Ischemic strokes often occur during sleep, while hemorrhagic strokes tend to occur during activity |
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|
Term
|
Definition
| Inability to recognize oneself and other familiar faces |
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