Neuro - Med Surg

Front 1

Causes of increased ICP

Back 1

Most common with a head injury

Secondary:
–Brain tumor
–Subarachnoid hemorrhage
–Encephalopathies

Front 2

Cushing’s response

Back 2

the brain’s attempt to restore blood flow by increasing arterial pressure to overcome increased ICP

Front 3

Cushing’s triad:
increased ICP)

Back 3

1. Bradycardia
2. HTN
3. Respiratory changes (Cheyne-Stokes breathing)

----increased temp

Front 4

Most important indicator for increased ICP

Back 4

Change in level of responsiveness/consciousness

ex. Restlessness without cause, Confusion, ↑ drowsiness

This is a medical emergency

Front 5

Give this to dehydrate the brain and reduce cerebral edema

Back 5

Mannitol (osmotic diuretic)
Corticosteroids

Front 6

Nursing diagnosis for increased ICP

Back 6

• Ineffective airway clearance – most will be on the ventilator
• Ineffective breathing patterns
• Ineffective cerebral tissue perfusion
• Deficient fluid volume
• Risk for infection – screw in brain – don’t need to know

Front 7

Management of ICP

Back 7

• Foley catheter to monitor urinary output (monitor osmotic diuretics)
• Serum osmolality levels to assess hydration
• ****Corticosteriods to help reduce edema
• Maintain cerebral perfusion by using fluid volume & inotropic agents
• Reduce CSF & blood volume by draining CSF
• Control fever to ↓ rate at which cerebral edema forms

Front 8

Primary head injury

Back 8

initial damage to the brain (contusions, lacerations, torn bv due to impact, foreign object penetration)

Front 9

Secondary head injury

Back 9

evolves over hours & days after the injury - may not know for days!!!

Front 10

Open skull fracture:

Closed skill fracture:

Back 10

actual tear in the dura

dura is intact

Front 11

Types of Fractures

Back 11

Simple
Comminuted (actually splintered or multiple fracture line)
Depressed (bone fragments are embedded into the brain tissue-needs surgery - all others heal on their own)
Basilar (at the base of the skull) - battle sign is like a bruise behind the ear

Front 12

rinorrhea:

otorrhea:

Back 12

CSF coming out of the nose

CSF coming out of the ear

Front 13

Open head injury:

Back 13

-occurs with skull fracture or penetration of the skull; penetrates the dura
-brain exposed to the outside environment

Front 14

Closed head injry:

Back 14

Blunt trauma

****More serious than open

Front 15

Concussion:

Back 15

-Minor
-No structural damage
-Get over quickly

Front 16

Contusion:

Back 16

-Major
-Brain is bruised
-Can take several months to get over (H.A.s, vertigo, seizures)

Front 17

S/sx of epidural hematoma

Back 17

initial period of unconsciousness followed by a period of lucidness followed by a period of unconsciousness

Front 18

Medical management of epidural hematoma

Back 18

• MEDICAL EMERGENCY!!!!!
***Burr holes through skull to decrease the pressure
• Possible craniotomy
• Drain

Front 19

Causes of subdural hematoma

Back 19

Trauma - most common (acute)
Bleeding disorders
*Ruptured aneurisms

chronic - minor head injuries in elderly, take while to show up

Front 20

Intracerebral hemorrhage
Causes:

S/sx:

Back 20

missile, bullet, stab injuries


Systemic HTN

Front 21

Nurse's Responsibilities for head injuries & increased ICP

Back 21

LOC - Glasgow coma scale
VS - frequently
Motor function - monitor for spontaneous strength
Pupil size - NOT GOOD if one pupil is larger than the other one

Provide a stress free environment et group activities together

Front 22

What does a thrombotic stroke result from?

Back 22

****Narrowing of a blood vessel

DM & HTN at higher risk

Front 23

What is an embolic stroke?

Back 23

An emboli or clot (can come from endocardium)blocks circulation

Front 24

Who's at risk for an embolic stroke?

Back 24

Pts with:
mechanical heart valves
a-fib

Front 25

What's the defining factor in determining if a pt had a TIA?

Back 25

They will have COMPLETE recovery between attacks

Front 26

Deficits and recovery with hemorrhagic stroke:

Back 26

Deficits are severe
Recovery is long - we just have to wait until the blood is slowly slowly slowly reabsorbed

Front 27

What's the window for thrombolytic therapy for a stroke?

Back 27

3 HOURS from onset of s/sx

-have to make sure its not a hemorrhagic stroke

Front 28

Nursing interventions for stroke pts:

Back 28

***Need to be turned et monitored for skin breakdown due to hemiparesis or decreased mobility

Encourage to participate in ADLs as much as possible (ex. dress affected side first

Bladder training - may need to be on a schedule

Facilitate communication (speech therapy)

Front 29

What kind of food does a stroke pt need?

Back 29

Oatmeal consistency - avoid thin liquids, can use a thickener

Front 30

Diff between primary & secondary brain tumors:

Back 30

Primary: originate within the CNS

Secondary: Mets from somewhere outside the brain

Front 31

Most common brain tumor:

Back 31

Glioma - total removal causes considerable damage to vital structures

Front 32

Most common type of glioma:

Back 32

Astrocytoma

Front 33

What type of brain tumor tends to recur?

Back 33

Menigioma

Front 34

Acoustic neuroma:

Back 34

s/sx: hearing loss, tinnitus, dizziness

Usually on the 8th cranial nerve (responsible for hearing and balance)

Front 35

Tx for brain tumors:

Back 35

1) Surgery to get as much as possible (not the whole thing)
2) f/u surgery with radiation
3) corticosteroids - HAs

Chemo doesn't cross the BBB

Front 36

Management for seizures:

Back 36

prevention - enough meds to achive control w/ minimal side effects (drugs control-do not cure)

DO NOT restrain or put anything in their mouth - just make sure they are safe (ex. side rails up)

Front 37

Who are most likely to develop seizures?

Back 37

Older clients due to cerebrovascular disease, metabolic changes, and head trauma

Front 38

Goals for managing status epilepticus (seizure activity longer than 30 minutes):

Back 38

-stop the seizures ASAP
-ensure adequate cerebral oxygenation
-maintain a seizure-free state

Front 39

Phases of migraines:

Back 39

1) Prodrome
2) Aura
3) Headache
4) Recovery

Front 40

Prodrome phase:

Back 40

Hours to days before HA

Depression, irritability, feeling cold, food cravings, anorexia, activity level changes

Front 41

Aura phase:

Back 41

Lasts less than an hour

-scotomas (black spots)
-scitntillations (flashes of lights)
-parasthesias
-motor dysfunctions

Front 42

HA phase:

Back 42

4-72 hours
VASODILATION + decreased serotonin
-Throbbing, pounding, severe, incapacitating pain
-Photophobia
-N/V

Front 43

Recovery phase:

Back 43

-extended sleep
-muscle aches & tenderness
-exhaustion

Front 44

Tx of migraines:

Back 44

Abortive - must be taken during the ONSET (aura) or it will not work

Preventative - taking a med q day

All cause vasoconstriction (because a migraine is vasodilation)

Front 45

Nursing care for migraines:

Back 45

-educate on when to take meds
-educate on precipitating factors (cheese, wine, chocolate)
-provide quiet/dark room
-administer antiemetics

Front 46

Who has the greatest incidence of cranial arteritis (temporal arteritis)?

Complication:

Back 46

>70 y/o


blindness

Front 47

What's the worst kind of meningitis?

Back 47

Bacterial - can be deadly

dx'd w/ a spinal tap

Front 48

S/sx of meningitis:

Back 48

HA, fever
-Nuchal rigidity
-With bacterial; + Kernig's sign: when knee is flexed to stomach they cannot extend their leg
-With bacterial; + Brudzinski's sign: push their neck down and their hip & knee will flex

Front 49

When is the meningitis vaccine recommended?

Back 49

11 y/o well-check

Front 50

What's MS:


How is MS characterized?

Back 50

A disorder of the nervous system causing demyelinization

By periods of remission and exaccerbation

Front 51

Most common type of MS

Back 51

Relapsing-remitting: attack or series of attacks (exacerbations)

Front 52

Early s/sx of MS:

Back 52

***Blurred or double vision - almost always
-tingling/numbness
-loss of balance
-weakness in one or more limbs

Front 53

Medical management of MS:

Back 53

-tx is to delay progression
-manage chronic s/sx
-tx acute exacerbations

s/sx that need tx: spasticity, fatigue, bladder dysfunction, ataxia

Front 54

Nursing interventions for MS:

Back 54

Promote physical mobility
Prevent injury - due to bad coordination
Bladder/bowel training - Q2hours or teach straight cath

MS is aggravated by changes in temp - don't go outside to exercise

Front 55

What's the cause of Myasthenia Gravis?

Back 55

80-90% have ANTIBODIES to acetylcholine receptors and thymus gland problems

Front 56

S/sx of MG

Back 56

-Ptosis
-Bulbar symptoms - muscles that control speech, chewing, and swallowing (weakened)
-Hallmark sign**Waxing & waning s/sx: strong muscles in the morning and weak in the evening

Front 57

What's the diff b/w myasthenic crisis and cholinergic crisis?

Back 57

The difference is the response to the tensilon test

Myasthenic: acute exacerbation (mm weakness) - not enough meds

Cholinergic: OD of cholinergic drugs

Front 58

Nursing & client education for MG:

Back 58

-meds: take on time (BEFORE eating, so they can swallow)
-energy conservation strategies
-ptosis: wear a patch, use artificial tears, tape it shut

Front 59

S/sx of Guillain-Barre Syndrome:

Back 59

-ascending weakness (pks ~14th day)
-starts w/ muscle weakness and diminished reflexes of the lower extremities

Front 60

What's generally the cause of mortality with Guillain-Barre?

Back 60

Respiratory Failure

Usually go ahead and put them on the vent before this happens

Front 61

Cause of Guillain-Barre:


Tx of Guillain-Barre

Back 61

autoimmune attack on peripheral nerve myelin

IVIG (IV Immunoglobulins - removes circulating antibodies

Vent

Front 62

Causes of peripheral neuropathies:

Back 62

-systemic diseases (DM w/ poor control)
-Vit deficiency (B12)
-alcohol

Front 63

What can trigger pain with Trigeminal Neuralgia (Tic Douloureux)?

Back 63

cold
brushing teeth

Front 64

What is Parkinsons associated with?

Back 64

-decreased dopamine
-increase in excitatory neurotransmitters (more than inhibitory) - these effect voluntary movement

Front 65

*****Classic triad for Parkinsons:

Back 65

1) Tremor - first sign; pill-rolling
2) Rigidity - increase resistance to ROM
3) Bradykinesia - slowness of movement; losing ability of automatic motion, stooped posture, shuffled gain, *postural instability (propulsive gait)

Front 66

Nursing dx for Parkinsons:

***focus on what you'd do to fix these

Back 66

Risk for falls - fall precautions
Self-care deficit
Chronic confusion
Impaired physical mobility
Impaired verbal communication - speech therapy
Risk for imbalanced nutrition: less than body requirements - Feed them

Caregiver support/education

Front 67

What is Huntington's Disease?

Back 67

Chronic, progressive, disease of the nervous system that results in progressive involuntary choreiform (dance-like) movement and dementia

Front 68

Can Huntington's be inherited?

Back 68

YES, 50% risk of passing it onto their children

Front 69

S/sx of Huntington's w/ nursing interventions:

Back 69

-constant uncontrollable movement; maintain safety
-chorea, intellectual decline, emotional disturbance; treat physical symptoms
-ambulation becomes impossible, aparthy, suicidal; provide physical and emotional support to pt et family
-chewing/swallowing difficulty, CONSTANT movment; may need 4000-5000 calories/day to maintain body weight

Front 70

Is alzheimers normal to develop as you grow older?

Back 70

NO, it is NOT a normal part of aging

Front 71

Is alzheimers genetic?

Back 71

It can be - its very rare
Called familial alzheimers

Front 72

Alzheimers stage 1

Back 72

– Duration: 1 – 3 years
– Short-term memory loss
– Decreased attention span
– Subtle personality changes
– Mild cognitive deficits
– Difficulty with depth perception

Front 73

Alzheimers stage 2

Back 73

– Duration: 2 – 10 years
– Obvious memory loss
– Confusion
– Wandering behavior
– “Sundowning” – because they’ve been sleeping all day
– Irritability and agitation
– Decreased spatial orientation
– Impaired motor skills
– Impaired judgment

Front 74

Alzheimers stage 3

Back 74

– Duration: 8 – 10 years
– Absent cognitive abilities
– Disoriented to time and place
– Severely altered communication skills
– Impaired or absent motor skills
– Bowel and bladder incontinence
– Inability to recognize family & friends
– Disturbed sleep patterns/increased sleep time - bedridden

Front 75

How's alzheimers dx'd?

Back 75

Mostly s/sx et ruling out all other posibilities (depression, OD of meds, etc.)
CT/MRI show brain atrophy

Front 76

Nursing for alzheimers

Back 76

• Provide socialization – 1-2ppl at a time (not whole family)
• Promote adequate nutrition – make things very simple
• Promote balanced activity & rest – engage in activities during the day (don’t let them sleep)
• Educate on home & community based assistance
– Maintain safety – like baby-proofing the house
– Help maintain functional ability - ADLs
– Help meet personal needs - ADLs

Front 77

ALS (AKA Lugarics Disease)

Back 77

Body deteriorates, but the brain stays the same
– Atrophy of hands, forearms, and legs
– Paralysis
– Death (2-5yrs p onset of symptoms – due to respiratory failure)

Front 78

How is ALS dx'd?

Back 78

***Muscle biopsy
Based on s/sx
MRI

Front 79

S/sx ALS:

Back 79

• Tongue atrophy – tongue shrinks and have weakness of the soft palate (cannot laugh, speak)
• Dysphagia - risk for aspiration - impaired nutrition
• Dysarthria
• Muscle atrophy extending to flaccid quadriplegia
• Eventual respiratory muscle involvement - causes death