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69 Cards in this Set

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Apneustic breathing:


Type of damage
Prolonged inspiratory pahse followed by expiratory pause

Pontine level damage
Ataxic Breathing:


Type of damage
Very irregular w/ irregularly interspersed pauses

RAS lesions of the medulla
Cheynes-Stokes Respirations:


Type of damage
Crescendo-decrescendo w/ periods of apnea

Basal ganglion @ internal capsule
Decorticate posturing
Upper extremeties exhibit flexion

Lower exhibit extension
Decerebrate posturing
Both upper and lower extension

What is it? What is it r/t?
head, neck and spinal column enter into a complete "bridging" or "arching" position

Decerebrate posturing
Unequally sized pupils
Oculocephalic reflex:


What happens?
"doll's eye" response

eyes deviate conjugately in direction opposite to head deviation
Oculovestibular response:
Intermittent conjugate tonic nystagmus deviation of eyes to side of irrigated ear
Normal intracranial pressure:
15 mmHg
What is the Monro-Kellie hypothesis?
Due to lmtd space for expansion within skull, increase in any one component causes change in volume of others
What is the earliest sign of Increased Intracranial Pressure (IICP)? What are the earliest indicators?

altered LOC, restlessness, slowing of speech, delay in response to verbal suggestions
Pupillary changes in IICP?
Fixed, dilated, slowed response, anisocoria
What is the Cushing's triad r/t IICP?
HTN, bradycardia, respiratory irregularity
Other S/S of IICP?
Bradypnea, hyperthermia, HA, N/V, & papilledema
Meds for IICP?
Osmotic diuretics (mannitol), corticosteroids, & analgesics
RN interventions for IICP?
Mntr neuro status, maintain airway patency, elevate HOB 30-45 deg, keep neck straight, institute seizure precautions
What changes are involved in seizure precautions?
Pad side rails, side rails up, w/ a bite block @ bedside
What is SIADH? What condition is it r/t?
Syndrome of Inappropriate Anti-diuretic hormone

Which CN is compressed in a transtentorial herniation?
What are the consequences of a Subfalcine (cingulate) herniation?
Ischemic injury to portions of primary motor and/or sensory cortex
Tonsillar herniation?
Displacement of cerebellar tonsils through foramen magnum

Difference between noncommunicating & communicating hydrocepalus?
Former: obstruction w/i ventricular system

Latter: obstruction outside ventricular system
Most frequent cause of epidural hematomoa?
rupture of meningeal artery r/t skull fracture
Course of epidural hematoma?
First a "lucid interval immediately after injury, followed by progressive loss of consciousness
Cause of subdural hematoma?
Disruption of bridging of veins that extend from surface of brain to dural sinuses
What is a subdural hematoma r/t?
Any condition with rapid changes in head velocity
What is Battle's sign?
Ecchymosis over mastoid bone
What is raccoon's sign?
Periorbital ecchymoses
What are the S/S of a Basal skull fracture (BSF)?
CSF otorrhea or rhinorrhea


Battle's Sign

Raccoon's sign

CN injury
Common manifestation of BSF?
Loss of consciousness, ranging from a few minutes to 1 hr or longer
Two signs of CSF leak r/t BSF?
Positive glucose reading

Halo sign (blood surrounded by yellowish stain)
2 types of CVAs?
Ischemic & hemmorhagic
Which type of CVA is the most common, with about 70-80 % of CVAs?
Ischemic (infarcts)
What will often precede a CVA?
TIA; 1/3 of pts w/ TIA develop infarct w/i 5 yrs
Most common cause of CVA?
cerebral artherosclerosis
Manifestations of a TIA?
Temp loss of consc., double vision, unilateral blindness, ataxic gait, unilateral parasthesias, dizziness, garbled speech
What causes most intracranial hemorrhages?
Rupture of small vessel
Most common etiology of intracranial hemorrhages?
What context do parenchymal hemorrhages occur in?
Findings for an intracranial hemorrhage?
Onset almost always abrupt

Motor loss (hemiplegia & hemiparesis)

Communication loss (aphasia & dysarthria)

Perceptual disturbances (visual-perceptual dysfunction, visual-spatial relations, sensory loss)

Unilateral neglect

Bladder impairment
What is dysarthria?
Slurred speech
What is hemianopsia?
Loss of vision in one side r/t CVA
Manifestations of non-ruptured cerebral aneurysm?

Nonspecific symptoms (HA, blurred vision)
Manifestations of ruptured cerebral aneurysm?

Severe HA, vomiting, loss of consc.

Meningeal signs


Irritability & restlessness

Slight temp
What are meningeal signs?
Nuchal rigidity & pain on neck mvmt
Septic meningitis course? Etiology?
Important cause of morbidity & mortality at all ages

Almost all caused by bacteria which reach CNS via blood after colonizing nasopharynx

Most implicated pathogen is S. penumoniae
Neisseria meinigidites route & epidemiology?
Transx via secretions or aerosol contamination

Denses community groups most at risk (such as college campuses)
LP results for meningitis?
CSF cloudy, turbid, or clear

CSF predominantly Neutrophils (if bacterial) or lymphocytes (if viral)

Nrml or increased protein

Nrml or decreased glucose
Assessment findings for meningitis?
Fever, chills, altered LOC/mental status, S/S of IICP
Signs of meningeal irritation?
Severe HA, nuchal rigidity, positive Brudzinski sign, positive Kernig sign, photophobia
What is areflexia?
spinal shock
Spinal cord injury below C4 =
loss of M&S from neck down (incl resp func)
Spinal injury below T12 =
loss of M&S below waist
S/S of autonomic dysreflexia?
Severe pounding HA w/ paroxysmal HTN, profuse diaphoresis, nasal congestion, & bradycardia
Trigger of autonomic dysreflexia?
distended bladder or bowel, pain stimulation
Immediate intervention for autonomic dysreflexia?
Place pt in sitting position, empty bladder, fecal impaction, other triggers
What to do to maintain joint mobility in pt w/ spinal cord injury?
Passive ROM exercises
Epidemiology of MS?
Most common demyelinating disease

Most common in temperate climates, females
Age of presentation?
Young adults

20-40 yo
Best dx test for MS? Findings?

Presence of demyelinating plaques
Common manifestations of MS:
visual disturbances, parasthesias, spasticity of 1 or more extremity, speech disturbances, gait abnormalities, fatigue, bladder/bowel incontinence
Emotional disturbances r/t MS:
depression, mood lability, inappropriate euphoria
Tx for MS:
Corticosteroids, muscle relaxants, & immunosupressants
Epidemiology of alzheimer's:
Adults over 50

Most common cause of dementia in the old

Incidence increases progressively w/ age
Two known mechanisms of Alzheimer's:
Beta amyloid, prominent component of senile plaques

Hyperphosphorlation of protein tau increases neurofibrillary tangles
Primary Tx for underlying cause of Alzheimer's:

Pharm txs for S/S of Alzheimer's:
Anticholinesterase agts

Antipsychotics & benzos
What is myasthenia gravis?
Progressive disorder of the voluntary muscles r/t an autoimmune response of anti-bodies to the ACH receptors
Difference between myasthenic & cholinergic crisis?
Former is a result of diseases exacerbation, often a result of respiratory infx

Latter is the result of overmedication of cholinesterase inhibitors