Critical Care Neuro/trauma

Front 1

what are the five major components of a neuro exam?

Back 1

1. level of consciousness
2. motor function
3. resp. function
4. pupillary function
5. VS

Front 2

what is the single best indicator of neurological status?

Back 2

level of consciousness

Front 3

what is the best way that we can test someone's level of consciousness?

Back 3

glasgow coma scale

Front 4

if a pt is unconscious, what is very important to check?

Back 4

the pt's respiratory status: are they breathing or not and is there a regular rate and pattern

Front 5

what is another term of intracranial pressur (ICP)?

Back 5

intracranial HTN

Front 6

what does cushing's triad consist of?

Back 6

high pulse pressure, bradycardia, and change in breathing pattern

Front 7

if a pt has any ischemia in the brain and the systolic pressure is above 160, is this of concern? why or why not?

Back 7

maybe. the body is most likely trying to compensate for the lack of perfusion to certain parts of the brain. The brain will do this without any other changes in VS occurring.

Front 8

if a pt has had a hemorrhagic event or stroke, what would they like to keep the pressure under?

Back 8

160 systolic

Front 9

if a neuro pt has a systolic pressure that is going up, what is important for the RN to do?

Back 9

perform a neuro assessment, ask yourself what is the reason for the pressure increasing

Front 10

what kind of assessment may be done on a pt that has had a spinal cord injury?

Back 10

sensory assessments

Front 11

what are the two components of a persons consciousness?

Back 11

reticular activating system (being awake vs. being asleep) and cerebral cortex (awareness)

Front 12

what does awareness involve?

Back 12

your envrionment and cognitive ability

Front 13

is it possible to have arousal without awareness?

Back 13

yes

Front 14

arousal can include:

Back 14

vocalizations, reflex to pain, and primitive reflexes. does not make them cognitive abilities

Front 15

what does it mean for the eyes to conjugate?

Back 15

the eyes are tracking an object together.

Front 16

what is it called when the eyes don't track an object together?

Back 16

dysconjugate

Front 17

how is it possible for a pt to be in a vegatative state without being on the vent?

Back 17

their body is spontaneously breathing on it's own

Front 18

in regards to categories of consciousness, what is important to know?

Back 18

the pt's response to stimuli and what it was like, then document the findings

Front 19

what is the maximum number of points a pt can score on the glasgow coma scale?

Back 19

15

Front 20

glasgow coma scale:

Back 20

not a very good assessment tool for level of consciousness, but most people know it and has become the standard

Front 21

what are the three major things involved in the glagow coma scale?

Back 21

eye opening- can the pt open them spontaneously?
verbal response- are they oriented to time, place, and event
best motor response- can they spontaneously move and follow commands?

Front 22

when dealing with neuro patients, what is important to remember when giving them commands?

Back 22

never give more than one task at a time. it may be confusing for the patient

Front 23

what is it called when the pt is able to find the pain and remove it?

Back 23

localization

Front 24

what is something that should be checked (aside from the normal neuro checks) while doing a neuro assessment?

Back 24

check both sides of the pt, one side may act differently which could be an indication that something is wrong

Front 25

what is decorticate posturing?

Back 25

Abnormal flexion

Front 26

what is decerebrate posturing?

Back 26

abnormal extension

Front 27

what is noxious stimuli?

Back 27

using some type of stimuli on the patient that may be of a nuisance or painful. this is to check to see how the pt may respond

Front 28

if a pt has an injury in the cerebral cortex, what type of posturing might they exhibit?

Back 28

decorticate

Front 29

if a pt has an injury in the brainstem, what type of posturing might they exhibit?

Back 29

decerabrate

Front 30

what are two signs that can be performed that show meningeal irritation or subarachnoid bleeds?

Back 30

kernig's sign (lifting leg up and bringing knee to chest) and brudzinski's sign (flex head and neck, neck to chest while bringing knees up). These two signs will cause a great deal of pain in a pt if there is any meningeal irritation or subarachnoid bleed

Front 31

how is meningitis typically spread?

Back 31

droplets

Front 32

what is the most common class of organisms responsible for meningitis?

Back 32

neisseria

Front 33

how do you check a pt's corneal reflex?

Back 33

touch a kleenex at the bottom of a pt's eye or eyelashes.

Front 34

how can a pt's gag relex be check?

Back 34

when putting things in the patients mouth towards the back of the throat, assess for the pt's cough/gag reflex to be intact. the best way to perform this is to suction the pt after suctioning the ET tube

Front 35

the babinski reflex is done how? why is this not done very often?

Back 35

take a pen or semi-sharp object and run it along the bottom of the patients foot. start from bottom going up and across just below the toes. this isn't done often because it isn't very specific

Front 36

deep tendon reflexes aren't done very often. what is the only reason we normally check these? what can it be a sign of?

Back 36

to see if a pt has too much Mg or too little Ca. It is usually an electrolyte problem.

Front 37

what is anisocoria?

Back 37

when a pt has one pupil larger than the other. this is common half of the population

Front 38

what is hemianopsia?

Back 38

when one half of a pt's visual field is gone (left or right).

Front 39

what is it called when a pt won't do things for one side of their body? what is the most likely cause for this?

Back 39

unilateral neglect; hemonymous hemianopsia

Front 40

what is important for a pt that has hemonymous hemianopsia?

Back 40

physical or occupational therapy

Front 41

what are brainstem reflexes and why do we use them?

Back 41

a set of tests used to asses if a pt is brain dead

Front 42

what does it mean to be brain dead?

Back 42

there is cardiac and respiratory function occurring, but there isn't any brain activity

Front 43

what are a couple of ways to test extraocular eye movements (EOM)?

Back 43

oculocephalic reflex (doll's eyes) and oculovestibular (cold caloric test)

Front 44

what happens when an oculocephalic (doll's eyes) test is done?

Back 44

a pt's head is turned from the midline position to either side very quickly and the eyes should go in the opposite direction of the head being turned. it's good if this is present. if it's not present, pt is most likely brain dead.

Front 45

what happens when an oculovestibular (cold caloric test) is done?

Back 45

if the brainstem is intact, the patient will vomit and eyes go to the side of the ice water. the patient should also develop nystagmus. it's good if this is present.

Front 46

a pt can only be an organ donor if they are:

Back 46

apnic

Front 47

what do you always want to assess, especially with neuro pt's?

Back 47

airway and breathing, but making sure to be careful of the neck

Front 48

what do cheyne-stokes respirations look like?

Back 48

increased rate and depth of respirations with brief episodes of apnea. there is usually some type of abnormality with the cortex.

Front 49

what can happen to a neuro pt that has hyperventilation?

Back 49

muscle contractions that can be painful

Front 50

what is central neurogenic respirations?

Back 50

a highly increased amount of respirations from an increased amount of pressure or injury to the pituitary gland and hypothalamus

Front 51

what is apneusis breathing?

Back 51

the pt will take a breath and hold it, then exhale with a period of apnea

Front 52

what is cluster breathing and where is the injury at that will cause this?

Back 52

deep breaths that get smaller until period of apnea; occurs from injury at the pons or medulla

Front 53

what is ataxic breathing?

Back 53

apnea, breathing with irregular little breaths, apnea

Front 54

how does the brain herniate when injury is present?

Back 54

typically from the top down in the path of least resistance. This is typically on top of the respiratory center

Front 55

what is important to know about the four stages of decompinsation of the brain?

Back 55

mental status, pupils, breathing, and VS all begin to deteriorate as each stage progresses stage 1 is least problematic and stage 4 is the worst

Front 56

what is a higher pulse pressure, bradycardia, and change in breathing pattern called?

Back 56

cushing's triad

Front 57

what are some rapid neurological assessment things that can be done to a pt?

Back 57

-LOC
-facial movements
-sensory assessment (have them let go of hand, wave, stick out tongue)
-pupillary function

Front 58

if you notice a change or deterioration in your pt's neuro status, what needs to be done?

Back 58

call the doctor and let them know (know which doc to call) and document

Front 59

if a pt is unsonscious, what is important to document in the chart when attempting to use stimulus on the pt?

Back 59

make sure you document what stimulus was used to try and wake the pt.

Front 60

since C7 isn't very well on xray, what is the best way to position the pt to get a better visualization of it?

Back 60

put the pt in the simmers position or do a CT

Front 61

what are a couple of reasons a pt can't have an MRI?

Back 61

the pt has a pacemaker or they have metal somewhere on their body

Front 62

what happens to the brain as we age?

Back 62

we get cerebral atrophy (it shrinks)

Front 63

what should the brain look like on a CT scan?

Back 63

everything should look symmetrical bilaterally.

Front 64

what type of test is done when we want to see the vasculature of the brain?

Back 64

cerebral angiogram (MRA)

Front 65

what is myelography?

Back 65

a test that gets pictures of the spinal cord. it shows the spinal canal, subarachnoid space, and spinal nerve roots. it will show perfusion of the spinal cord or compression of the nerves.

Front 66

what is a perfusion CT done for?

Back 66

to evaluate blood perfusing to the tissues

Front 67

what is the definitive way to diagnose a bruit?

Back 67

use of a doppler

Front 68

what else can the doppler be used for in reference to the nervous system?

Back 68

bloodflow of the brain

Front 69

what type of test is the EEG similar to, but in the brain?

Back 69

it is similar to an EKG, but for the brain and not the heart. It is noninvasive and needs to be quiet during the test.

Front 70

what are evoked potentials?

Back 70

the use of different types of sensory stimulation to view brain activity and what part of the brain is responding

Front 71

where are lumbar puctures typically performed?

Back 71

in the ER or on the neuro floor

Front 72

what are the two major reasons for performing a lumbar puncture to obtain CSF?

Back 72

1. check for infection
2. check intracranial pressure

Front 73

how should the patient be positioned after an LP?

Back 73

flat and NPO until the pt shows they are ok from the procedure

Front 74

what do you want to monitor with a pt that just had an LP?

Back 74

monitor their breathing and check for herniation

Front 75

where is a lumbar puncture usually done?

Back 75

around the L4-L5 area

Front 76

aside from the lumbar are, where can CSF be obtained from?

Back 76

the cystern of the brain (cysterna magna)

Front 77

what are the four types of intracranial pressure monitoring?

Back 77

intraventricular, subarachnoid space, epidural space, intraparenchymal

Front 78

how is the epidural ICP monitoring done?

Back 78

go along a hair line on the right side. it's done blindly. sits on top of dura mater. can only monitor pressure

Front 79

how is an intraventricular catheter done?

Back 79

penetration of all meninges into the lateral ventricle. a great deal of force is needed to push through the dura mater.

Front 80

what are some advantages of intraventricular ICP monitoring?

Back 80

it's diagnostic and therapeutic. you can measure ICP and drain off CSF

Front 81

what is an important thing to remember about intraventricular ICP monitoring?

Back 81

place it in the non-dominant hemisphere in the event of brain damage occurring. ie. if a person is right handed, put it in the left side

Front 82

how is a subarachnoid bolt placed?

Back 82

bolt is literally screwed into the skull and it sits in the subarachnoid space (just outside the brain). piece of skull is removed and thrown out

Front 83

how is the intraparenchymal placed?

Back 83

straight into the cerebral tissue

Front 84

what should your intracranial pressure be?

Back 84

keep the ICP below 15

Front 85

what is the biggest risk for patients that have ICP monitoring in place?

Back 85

infection. CSF is full of glucose and bacteria thrive on this glucose. pts may develop an abscess

Front 86

why is a brain abscess difficult to treat?

Back 86

most antibiotics don't cross the blood brain barrier

Front 87

are administering intraventricular antibiotics part of the role of the nurse?

Back 87

no

Front 88

how is cerebral perfusion pressure calculated?

Back 88

MAP-ICP. needs to be between 70-150.

Front 89

what does it mean of the CPP is less than 70?

Back 89

the brain isn't getting enough oxygen and isn't perfusing properly

Front 90

with a neuro pt, why is it important to have as little stimulus as possible?

Back 90

any stimuli may cause spikes in electrical activity, which may cause further complications

Front 91

if the pt continues to spike their electrical waves, what can it lead to?

Back 91

herniation

Front 92

what is cerebral metabolism monitoring tell us?

Back 92

it tells how ischemic the brain is and how to treat it.