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118 Cards in this Set
- Front
- Back
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measures level of consciousness.
is the most sensitive indicator of change in neuro status |
Glasgow Coma Scale
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Glasgow Coma Scale measure what three areas?
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1. eyes open
2. best verbal response 3. best motor response |
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with the glasgow coma scale you can score between 3-15.
a score of 8 or better means what? |
semicomatose
High score of 8 or better you have a good prognosis score of 3-4 = high mortality score of 3-7 = coma |
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____________= an increase in intracranial bulk due to blood, CSF, or swelling of brain tissue or tumors.
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ICP
increased intracranial pressure |
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Increased pressure impedes cerebral circulation, absorption of _____, and function of nerve cells
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CSF
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With ICP there is increasing pressure that is transmitted downward toward the brainstem with eventual tentorial herniation, brainstem compression which affects ____________and ___________ function and eventually death.
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respiratory and cardiac
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With ICP- ___________________ is the ability of the brain to alter the diameter of its blood vessels to maintain a constant blood flow of oxygen and glucose to its tissue. In ICP this is lost.
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autoregulation
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Factors that increase ICP- make it worse:
_____PCO2 decrease in PO2 valsalva maneuver body position (prone flextion of the neck, hip) isometric muscle contractions coughing, vomiting, sneezing emotional upset |
increase
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Assessment of ICP- evaluate level of consciousness (most sensitive indication of increasing ICP) changes from restlessness to _________ to declining level of consciousness and coma.
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confusion
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With assessment of ICP- Evaluate vital signs- watch for ___________ pulse pressure, reflex slowing of pulse, abnormalities in respiration, especially periods of apnea (cushings triad) and temperature elevation.
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Widening pulse pressure
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Goal with ICP is to decrease intercranial pressure and prevent damage to brain cells by maintaining adequate blood flow with adequate oxygenation and glucose and reduction of the buildup of _________________.
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carbon dioxide
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___________- decadron (dexamethasone) decrease cerebral edema by their antiinflammotory effect; decrease capillary permeability in inflammatory process, thus decreasing leakage of fluid into tissue.
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Steriods
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___________- Lasix, Mannitol- decrease cerebral edema; action by carrying out large volume of water through the nephron; complication of therapy are fluid and electrolyte imbalance.
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diuretics
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In treating ICP you need to:
-normalize body temperature -fluid balance, IV fluids, daily weights, I&O -prevent seizures -Elevate head of bed 30 degrees and avoid the ___________, keep head in neutral position. -increase oxygenation to prevent brain cell death, administer oxygen -decrease stimuli -prevent straining -pulmonary toilet -avoid meds that may mask changes in neurological status like morphine |
Trendelenburg position
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Pavolon, and Norcuran are _____________
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Paralyzing agents
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Interventions for the confused client:
____________- -repetition - written memory aids - appeal to several senses directed at the same activity -small steps- simple to complex |
Decreased memory
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Interventions for the confused client:
____________- -place by window, day and night -clock, calendar, photographs, television, room with other people -structure environment, use consistency -face to face contact - short sentences, simple words - simple commands- one step at a time |
Lack of orientation
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Interventions for the confused client:
______________- -maintain calm, firm attitude - use 2 to 3 people to give care, rotate care among staff -avoid overstimulation- regulate visitor, tv, quiet environment -provide stuctural, safe environment -set limit on behavior and be consistent -reinforce appropriate behaviors |
Aggressive behavior
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Nursing care of the aphasic client- alterations in _______________.
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communication
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Nursing care of the dysphagic client- alteration in _______________
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nutrition
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Nursing care of the incontinent client- alteration in ___________.
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elimination
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Medication used for flaccid bladder?
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Urecholine
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Medication used for spastic bladder?
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Ditropan, Pro-Banthine
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__________- physical manifestations of paroxysmal and abnormal electrical firing of neurons.
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Seizures
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_____________ is a chronic disorder characterized by recurrent unprovoked seizure activity.
Highest incidence in older adults and children. May be inherited |
epilepsy
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type of seizure that is bilaterally symmetrical, throughout entire brain.
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Generalized seizure
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type of grand mal seizure that is characterized by stiffening and relaxing of the body.
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tonic- clonic
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Tonic-clonic seizure lasts _________.
-cry out, jaws clamp shut -body stiffens -body jerks -loss of consciousness -respirations may stop -ends with a sigh -incontinent |
1-5 minutes
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during the ________ stage of a tonic-clonic seizure the patient will be:
-sleep, confused -irritable -don't touch -decrease stimuli -quiet environment - calm gentle reassurance |
Postictal stage
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_______- petit mal. common in children.
brief period of loss of consciousness, staring |
absence
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__________- abrupt increase in muscle tone, loss of consciousness
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Tonic
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_________________- muscle contraction and relaxation.
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Clonic
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__________- brief jerking, stiffening
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Myoclonic
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________-(drop) sudden loss of muscle tone.
seen with cerebral palsy and brain tumors -no warning |
atonic
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__________seizures- focal area of brain, one part of the brain.
consists of both complex and simple seizures. |
Partial
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________ partial seizure-
-loss of consciousness - automatisms (lip smacking, picking) -post seizure amnesia |
Complex
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_______partial seizure-
-no loss of consciousness -aura -unilateral movements -sensory, autonomi symptoms |
simple
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____________- seizure activity lasting 30 minutes or more without regaining consciousness (potential complication with all types)
-medical emergency (may cause irreversible brain damage and death) -IV Valium (activan or Depacon) followed by Dilantin |
Status Epilepticus
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Post seizure care:
- Vital signs with ____________ -keep on side -allow to rest -document (onset, duration, type of motor movements, incontinence, pupil changes, respiratory status, skin color and moisture, and precital and postictal states. |
neuro checks
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Type of infection that has inflammation of the arachnoid and pia mater of brain and spinal cord and cerebrospinal fluid
-can be bacterial or viral |
Meningitis
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Assessment for ____________includes:
-nuchal rigidty -positive Kernigs, brudsinski (bacterial) -signs of ICP -Vascular dysfunction -CSF analysis |
Meningitis
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_________- inflammation of brain tissue, mostly viral cause (arbovirus, HSVI, amebas)
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Encephalitis
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Assessment of ____________includes:
-fever, N&V, stiff neck -LOC changes -Motor weakness, tremors, seizures -focal deficits -with severe causes- s & sx increased ICP |
Encephalitis
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use ____________ for HSV I infection
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cyclovir
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With ______________-
-client usually over age 50 -no gender preference -rare in blacks -not genetic -no acute exacerbations -no cure |
Parkinsons
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3 possible causes of _______________-
1. degeneration of substantia nigra causing a decrease in dopamine and excess acetylcholine- loss in ability to refine and control voluntary movement 2. some cases associated with encephalitis and exposure to toxic chemicals (carbon monoxide) 3. effect of medication- extrapyramidal effects- Haldol, Thorazine |
Parkinsons
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clinical manifestation of _________-
-begins insidiously(usually unilateral) with a mild tremor, slight limp and progresses over a gradual declining course. The triad of symptoms include: Tremor Rigidty Bradykinesia |
Parkinsons Disease
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Symptom of Parkinson include:_________-
-hand, small handwriting, pill rolling -head, neck, face, jaw, feet |
Tremor
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Symptom of Parkinsons include:__________
-increase in muscle tone -movement is jerky, like a cog wheel -results in muscle soreness and aching |
Rigidty
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Symptom of Parkinsons include_________-
-delay in starting movement, slowness while moving and inability to stop movement. -results in stooped posture, masked face, drooling, difficulty in balance, dysphagia, blinking, dysarthia -shuffling propulsive gait |
Bradykinesia
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Symptom of Parkinsons include__________-
-increased perspiration flushing or orthostatic hypotension. |
ANS symptoms
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Drug therapy for Parkinson's - aim is to increase __________ and decrease acetychonline (use individually or combination tolerance and toxicity problematic)
-sinemet (effective 3-5 years) -artane, cogentin -parlodel -COMT inhibitors- Comtan -Tricyclic antidepressants (equanil, trofranil) |
Dopamine
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Management for Parkinsons-
__________- probe into pallidum destroys hyperactive neurons- 5% effective 2 years later |
Pallidotomy
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Management for Parkinson's-
____________- thermocoagulation of brain cells to decrease tremors. Implanted electrical stimulators, brain pacemaker- delivers electrical impulses |
Thalamotomy
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Amantadine (symmetrel) and Levodopa- carbidopa (sinemet) are in what drug classification?
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Dopaminergics
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________- release dopamine from storage sites; permits peripheral and central accumulation of dopamine.
-helps movement but not tremors; mild to moderate disease |
Dopaminergics
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Bromocriptine (parlodel) and Pergolide (permax) are in what drug class?
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Dopamine Receptor agents
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__________-stimulates dopamine production
-used with sinemet to lower dosage -used with patient who experience end of dose failure using levodopa alone. |
Dopamine Receptor agents
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Trihexyphenidyl (artane) and Benztropine (cogentin) are in what drug class?
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Anticholinergics
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__________-
-blocks or inhibits effects of acetycholine -most effective against tremors -use with caution in the elderly |
Anticholinergics
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Diphenhydramine (benadryl) is in what drug class?
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Antihistamine
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Deprenyl(eldepryl) is in what drug class?
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Monoamine Oxidose inhibitor
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__________-
-enhances and prolongs effect of dopamine -used frequently as first drug of treatment |
Monoamine Oxidose inhibitor
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Generic name- clonazepam
Trade name___________ Type of seizure drug is most commonly used to control: -absence (petit mal), atonic, myoclonic |
Clonopin
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Generic name- Valproic acid
Trade name-__________________ Type of seizure the drug is most commonly used to control: absence (petit mal), generalized tonic-clonic (grand mal) |
Depakene
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Trade Name_______________
Generic name- divalproex sodium seizure the drug is most commonly used to control: -absence (Petit mal), generalized, tonic-clonic (grand mal) |
Depakote
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Trade Name________________
Generic name- phenytoin seizure the drug is most commonly used for: any seizure except absence (petit mal) |
Dilantin
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Trade Name_______________
Generic Name- primidoine seizure the drug is most commonly used to control: complex partial (psychomotor, temporal lobe), generalized tonic-clonic (grand mal), simple partial |
Mysoline
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Trade Name_________________
Generic Name- phenobarbital seizure the drug is most commonly used to control: most types of seizures |
no trade name commonly used
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Trade Name_____________________
Generic Name- carbamazepine seizure the drug is most commonly used to control: complex partial (psychomotor, temporal lobe) generalized tonic- clonic (grand mal), simple partial |
Tegretol
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Trade Name______________________
Generic Name- clorazepate dipotassium seizure the drug is most commonly used to control: complex partial (psychomotor, temporal lobe) |
Tranxene
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Trade Name______________________
Generic Name- ethosuximide seizure the drug is most commonly used to control: absence (petit mal) |
Zarontin
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_____________- progressive, debilitation, fatal neurological disease
-occurs as early as mid-life; however, most are over 65 -fourth leading cause of death, after heart, cancer and stroke |
Alzheimers Disease
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Warning signs of _____________________:
-recent memory loss that affects job skills -difficulty performing familiar tasks -problems with language -disorientation of time and place -poor or impaired judgement, abstract thinking -loss of initiative -misplacing things, short attention span -changes in mood, or behavior, personality -wandering |
Alzheimers disease
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_______________- deficit in the brains cholinergic system of neurotransmitters ( a decrease in acetycholine)
-cause unknown -structural changes in the brain: 1. neurofibrillary tangles 2. neuritic plaques 3. excessive loss of neurons, cerebral atrophy (normal aging changes) -genetic disposition |
Alzheimers disease
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This disease has a genetic disposition- a defect of chromosone 21, which is the genetic marker that produces the chemical found in neurofibrin tangles and plaque.
-also will have selective cell death provoked by a slow virus or autoimmune response. -abnormal protein (amyloid) |
Alzheimers disease
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3 stages of alzheimers disease are
1. 2. 3. |
1. early
2. progressive cognitive, physical, emotional decline 3. total dependence |
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medications used to treat alzheimers disease are called_______________
ex: Reminyl, aricept, exelon, cognex also can use tranquilezers to lessen agitation such as valium antipsychotics such as haldol for behavioral disturbances |
acetylcholinesterase
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type of back pain that is caused by:
-trauma, degenerative disc, obesity, smoking, congenital conditions, poor posture and body mechanics assessment of: -pain -posture/ gait -presence of paresthesia non surgical -mobility |
Lumbosacral
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Type of injury most common in areas of maximum mobility result of sudden violent external trauma
level of dysfunction depends on location of injury and degree (quadriplegia, paraplegia) |
spinal cord injury
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________-- the entire cord below the level of the injury falls to function; temporary; symptoms appear 30-60 minutes after injury; can last several months. Will see:
-flaccid paralysis -loss of reflexes -hypotension, bradycardia -as cord heals, reflex activity occurs, hyperreflexia and reflux emptying of the bladder. This does not mean function is returning, only that ________ is subsiding. |
Spinal shock
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_______________- loss of autoregulatory control of B/P; usually seen in injuries above T6 after spinal shock subsides. Triggered by stimuli below level of injury- Medical emergency.
Symptoms seen are: -hypertension -bradycardia -flushing -severe Headache -sweating above injury, cool, mottled below injury -nausea -blurred vision |
Autonomic dysreflexia
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With Spinal cord injury, the goal is
________________. Treated with medications such as solumedrol, dextran, atropine |
Prevention
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Spinal cord injury above ______, respiratory difficulty, and paralysis of all four extremities
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C-4
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Injury to C_____- usually rapidly fatal
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C2-3
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injury to C___- involves shoulder (partial) and elbow (partial)
-needs adaptive devices |
C-5
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Injury to C____- shoulder, elbow, wrist (partial)
Propel wheelchair equipped with knobs on wheel rims |
C-6
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Injury to C____- shoulder, elbow, wrist, hand (partial)
Propel wheelchair outside transfer. drive car with special adaptations. |
C-7
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Injury to C_____- Normal arm, hand weakness.
transfer wheelchair into car. Vocational and recreational goals can be achieved. |
C-8
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Injury to T________- wheelchair ambulation; walk with braces
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T1-T10
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Injury to T________- wheelchair not essential
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T11 and below
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The _______ the injury, the more serious, more debilating
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Higher
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The _________the injury- the quicker to resume ADL's
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Lower
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____________- chronic, progressive, degenerative disorder of the CNS. prevalence in females 20-40 yrs, familial tendency, cold climate, frequent remissions and exacerbations.
-damage to myelin sheath causing inflammation, scarring, and dimished nerve impusle transmission. |
multiple sclerosis (MS)
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Clinical manifestations of ___________ are gradual and vague:
motor- weakness of limbs, stiffnessm spasticity, intention tremor, unsteady gait, increased reflexes. sensory- tingling, paresthesia, diplopia, vision changes, tinnitus, vertigo, increased reflexes Cerebellar- ataxia, dysarthria, dysphagia, vertigo, bowel and bladder constipation- frequent UTI due to retention of urine. Cognitive changes- late symptoms personality / behavior changes |
MS- multiple sclerosis
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Factors that aggravate symptoms of ___________ are:
fatigue stress overactivity temperature fluctuations |
MS- multiple sclerosis
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Medications used for MS:
Exacerbations Methylpredinosolone (______) - ACTH, immunosuppressant (cytoxan, Immuran) |
solumedrol
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Medications used for MS to stabilize disease process include:
___________, Immuran plus solu-medrol |
Cytoxan
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Medications used for MS to decrease number and severity of relapses include:
Betaseron, ____________, Capaxone |
Avonex
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Medications used for MS to lessen spasticity include:
_______ Lioresal Valium |
Dantrium
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Medications used for MS for spastic bladder to correct urinary frequency include:
____________ Pro-Banthine |
Ditropan
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Medications used for MS for flaccid bladder include:
__________ to correct urinary retention |
Urecholine
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____________- 3rd leading cause of death, increased frequency in males, those over 65 years.
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Stroke
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Heredity, gender, age and race are risk factors that can or cannot be controlled?
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No control
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HTN, CAD, DM, hyperlipidemia, lifestyle factors, obesity, smoking, and alcohol are risk factors that can or cannot be controlled?
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Can control
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Causes of decreased blood flow to the brain:
__________- 85% of all strokes either thrombosis or embolism. |
Ischemic
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Type of Ischemic that has narrowing of the blood vessel due to plaque build up with eventual occlusion- HTN, and DM accelerate this process.
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Thrombosis
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Type of stroke that is bleeding into the brain tissue from rupture of blood vessels due to HTN, aneurysm, and congenital abnormalities (berry aneurysm, AV malformation)
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Hemorrhagic
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Type of Ischemic stroke where you have occlusion of the blood vessel by a clot
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Embolism
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Type of Ischemic stroke where it has the following characteristics:
-oldest median age -men more than women -TIA 30-50% of time -often during sleep -stepwise progression -usually some improvement; recurence in 20-25% of survivors |
Thrombotic
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Type of Ischemic stroke that has the following characteristics:
-men more than women -TIA 30-50% of time -unrelated to activity -SINGLE ATTACK -usually some improvement; recurrence common unless underlying pathology treated afressively. |
Embolic
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Type of Hemorrhagic stroke that has the following characteristics:
-slightly higher in women -Headache about 25% of time -often during activity -progressive over 24 hours -poor, if accompanied by coma, fatality more likely |
Intracerebral (ICH)
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Type of hemorrhagic stroke that has the following characteristics:
-youngest median age -slightly higher in women -headache common -often during activity (very sudden onset) -Usually single sudden attack -coma and fatality more likely |
Subarachnoid (SAH)
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Warning signs of ___________-
-brief episode of neurologic deficit without residual effects -lasts a few minutes to 24 hours; brain tissue is damaged; multiple episodes increase risk of major stroke Common sign- loss of vision, hemiparesis, dysarthia, dysphagia, numbness, vertigo, diplopia, ptosis |
Transient Ischemic Attack (TIA)
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RIND_________________-
-deficit remains after 24 hours but less than a week -leaves no residual signs and symptoms after days to weeks but brain tissue is damaged. |
Reversible Ischemic Neurologica Deficit
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Drug therapy for Stroke:
_______________ agents (recombinant tissue plasminogen activator)- rtPA |
thrombolytic agents
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Drug therapy for stroke patients:
______________- such as aspirin, heparin, lovenox, coumadin |
anticoagulants
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Drug therapy for stroke patients:
____________- ticlid, plavix, persantine also can use: -antipeleptics -calcium channel blockers |
antiplatelet
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