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217 Cards in this Set
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- Back
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What is delirium? Can it be treated?
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Acute confusional state, can be treated
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What is dementia?
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Chronic and progressive, think multiple Strokes/degenerative diseases
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Is delirium systemic?
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Yes, through infections, cardiovascular,
Endocrine, or toxic-metabolic |
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If a patient has a disturbance of sleep cycles, is the problem delirium or dementia?
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Delirium- total disruption of the brain and its sleep/wake cycles
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What is the BEST tool to use to distinguish neuro status?
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History and Physical
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What lab tests might be run to help diagnosis delirium?
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Ammonia (backs up in body can cause confusion) CBC, CMP, WBC, UA, Tox Screen, CAT scan, MRI
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What drugs are used to treat delirium?
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Ativan (anti-anxiety drugs)
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What is the number one priority with these patients?
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Keep them safe, they aren’t allowed to hurt themselves
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If a patient has drug induced delirium, what treatment do we offer?
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Time, don’t want to give them more it only adds to the problem. < is better
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How is dementia different than delirium?
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Dementia is gradual decline in memory language, and higher executive fx, interferes with ADL’s and social
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What diseases are related to dementia?
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Alzheimer’s, Huntington, Parkinsonism, Lewy Body, Pick, Cerbrovascular, Intercranial lesions, tumors, subdural hematomas
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In cardiovascular disease, what other factors would play into the diagnosis?
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If patient has PAD or other vascular issues that also would translate to ischemia in the brain
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What is the best we can hope for with dementia?
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To slow it down.
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What condition should be ruled out before diagnosing dementia?
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Depression
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What is one of the signs of depression in dementia patients?
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Forgetfulness
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Can we figure out what part of the brain dementia affects?
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Yes, CT, MRI, or SPECT Scan, some blood work
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What is epilepsy?
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Overabundance of electrical impulses in the brain
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How is it detected?
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EEG
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What part of the brain is affected by Epilepsy?
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Cerebral cortex
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What is the difference between epilepsy and a single seizure?
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Epilepsy is chronic
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How is epilepsy diagnosed?
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Group of recurrence of seizures, unprovoked and unpredicted, alters neuronal activity
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What can cause epilepsy?
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Lack of sleep, strokes, stress, alcohol
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What are the different classes of seizures?
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Partial, generalized, unclassified
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What are partial seizures?
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Simple, complex, partial with generalization
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In a simple partial seizure what happens?
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The person REMAINS conscious, they often can remember what has happened
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In complex partial seizures what happens?
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LOSS OF CONSCIOUSNESS, can resemble daydreaming, or the “not there” effect
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What are the types of generalized seizures?
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Absence, myoclonic, tonic-clonic and atonic
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What is another name for Tonic-Clonic seizures?
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Grand Mal
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In a tonic-clonic seizure what does the “tonic” part mean?
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Rigidity, or the beginning of the seizure
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What does the “clonic”part mean?
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Jerking or the end of the seizure
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Does the seizure cause damage or is it typically a fall that causes physical damage?
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Fall
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What is the term used to classify a single seizure that lasts longer than five minutes or
Repeated seizures? |
Status Epilepticus
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Why are these so dangerous?
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Mostly in infants and elderly, medical emergency, may result in death or permanent brain damage
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Is Epilepsy a disease?
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No, it’s a result of other problems
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What conditions could cause an epileptic seizure?
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Any condition that interrupts electrical activity can cause a seizure
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Is this an inherited trait?
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No, abnormal nerve connections
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How does it work?
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Neurons depolarize, fire more and more. It’s often after a single head injury
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What drugs are used to treat simple and complex partial seizures?
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Carbamazepine (tegratol), phenytoin(dilantin), valproate(depakote), primadone, phenobarital
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What is used to treat primary generalized tonic-clonic, absence, atonic?
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Carbamazepine, phenytoin, clonazepam, levetiraceta(Kepra)
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What is the desired effect of therapy for seizures?
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Eliminate or reduce the frequency of seizures, avoid side effects of drugs used to treat seizure, assist patient with normal psycho/social adjustments
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If drug and therapy aren’t successful in treating the seizure what is another opt?
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Surgery
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What types of surgical procedures are available?
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Anterior temporal lobectomy, lesionectomy, corpus callostomy, hemispherectomy
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What is a postical state?
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Period of confusion after a seizure(non-epileptics don’t have this)
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What is degenerative disc disease?
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Asymmetrical intervertebral disc, or disc that degenerates with age(30-60yrs)
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What is acute low back pain?
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< 3 mos.
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What is chronic low back pain?
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> 3 mos most likely related to DDD
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How does smoking affect healing from this problem?
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Cuts down O2 supply, slows healing
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What is Spondylolysis?
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Structural defect of spine involving lamina in areas that touch, move or articulate
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What does Spondylolysis do to the spine?
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Causes a forward displacement, it’s a heredity issue occurs in the disc and the adjacent vertebral bodies
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What is Spondyloisthesis?
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Causes the vertebra to spinal segments to slide forward
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What is the tx for spondylolysis?
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Differs from patient to pt, but if it is simple….rest and ptherapy. If unstable or pressing on nerves, it require surgery with plates and screw.
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What is spinal stenosis?
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Entrapment of a single nerve root or it could be termed the narrowing of the spinal canal
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How does spinal stenosis happen?
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Can be developmental or acquired by a herniated disc or other abnormality
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What is the tx for spinal stenosis?
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Steroids and surgery
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What is Sciatica?
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Inflammation of the sciatic nerve
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What happens if untreated?
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Flop feet or foot drop
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What are the risk factors for low back pain or sciatica?
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Repetitious lifting, bending forward twisting position…nurses
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What is a lumbar disc herniation?
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Herniated nucleus pulposus
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What does a lumber disc herniation cause?
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Parestesias, pain and limited ROM
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What is radiculopathy?
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Pain along nerve root
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Who is more often affected by radiculopathy?
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Men more than women, 30-60 yrs
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What is a laminectomy?
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Removal of bone between the spinal process and facet pedicle junction to expose the neural elements in the spinal canal; relieves compression of the cord and roots
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What is a discetomy?
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Removal of disc
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Hemilaminectomy?
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One side (see above)
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Discectomy with fusion?
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Removal of disc with bone fusion
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What is a Foraminotomy?
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Removal of intervertebral foramen to increase the space for exit of spinal nerves
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How do we manage patients after neck and back surgery?
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VS q 15 min for 1 hour, then every hour, wound exam(for hemorrhage)
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What is critical to managing these patients?
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Monitor O2 sats, keep them breathing this is motor strength, look for urinary retention, positioning (log roll), and for home care no lifting, bending or twisting
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What is meningitis?
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Inflammation of the pia mater, the arachnoid, and CSF filled subarachnoid space
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How is meningitis classified?
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Septic or Aseptic
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What are the signs of meningitis?
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Headache and fever (initial signs), nuchal rigidity, positive Kernig’s sign, positive Brudzinskis sign, photophobia
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What is nuchal rigidity?
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Stiff neck (Cardinal Sign of Meningitis)
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What is a positive Kernig’s sign?
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Pt lying w/thigh flexed on abd, leg cannot be completely extended
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What is a positive Brudzinski’s sign?
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When pt neck is flexed (w/no neck injury or trauma) flexion of knees and hips is produced. More sensitive indicator of meningeal irritation than Kernig’s
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What are the types of meningitis?
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Septic- bacterial, Aseptic – viral (upper resp), Tuberculus- immunocompromied, Fungal-immunocomppromied
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In septic meningitis what are the common bacteria involved?
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Streptococcus pneumonia and Neisseria meningitides
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What is a feature of N.meningitidis infection?
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Rash, petechial to purpuric lesions to lg areas of ecchymosis
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Where do you see N.meningitidis mostly?
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College campuses – vaccinations are available!~!!!!
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In diagnosing Meningitis what is the BEST way?
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Lumbar puncture
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How is meningitis treated?
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TIMELY treatment is critical with antibiotics that can cross the blood/brain barrier into the subarachnoid space with enough concentration to stop bacteria from producing -penicillin, vancomycin w/rifampin, dexamethasone, fluids and dilantin (for seizures prophylactic
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What is the nursing mgmt for these pts?
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PROTECTION – seizures can cause pts to hurt themselves, need protection
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What should nurses look for to help these patients?
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They are critically ill, watch for changes in LOC. ^ICP will lead to a decreased LOC and focal motor deficits. It this isn’t controlled, the brain can herniated. This is LIFE THREATENING!!
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How do we use the Glascow Coma Scale to access these patients?
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Using the neurological GCS can detect a slight change in LOC, this helps prevent further damage
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What is the best way to prevent meningitis?
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VACCINATIONS!
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What is a Brain Abscess?
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Infection of brain tissue
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While brain abscesses aren’t common in healthy people, where are most infections from?
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Otitis media and sinusitis (ear infection and sinus infection)
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What other conditions can result in brain abscess?
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Intracranial surgery, penetrating head injury, tongue piercing (all of you who that tongue ring was sexy…not looking so hot now huh?)
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What are the signs of brain abscess?
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Headaches (usually worse in AM), fever, vomiting, and focal neurologic deficits
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What is meant by focal deficits?
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Weakness, decreasing vision (tell which part of brain that is involved), If abscess gets bigger, can cause ^ICP and decrease in LOC
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How do we diagnosis brain abscess?
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MRI or CT to determine size and location
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What is the BEST way to diagnosis brain abscess?
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Aspiration of the abscess, to culture and identify
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How do we manage these pts in nursing?
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Assess neurologic status, being alert to changes in ICP, assess responses to meds, lab tests specifically glu and K+ when corticosteroids are admin, pt safety is also key – decreased LOC or falls
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What is encephalitis?
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Acute inflammation of the brain tissue
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What is the most common type of encephalitis?
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Herpes Simplex Virus
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What are the other types of encephalitis?
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West Nile, Fungal, Creutzfeldt-Jakob
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What are the signs and symptoms of Encephalitis?
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Fever, delirium, confusion, seizures, cranial nerve palsies, and paralysis
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In West Nile, who is the carrier? Host? Secondary Host?
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Bird is carrier, mosquito is host, HUMAN is secondary host
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In Creutzfelt-Jakob Disease what is this better known as?
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Mad Cow Disease
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Where does the infection come from?
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Prion – smaller than a virus
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What are the treatments for encephalitis?
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Antiviral agents, steroids, anti-seizure meds
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What is the nursing mgmt of these pts?
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Neuro status, admin meds, assess responses, PROVIDE PSYCHO SUPPORT for family
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In a neuro assessment what is the most important tool?
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Excellent physical and history
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What are the five areas of neuro physical assessment?
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Mental status and speech, cranial nerve fx, sensory fx, motor fx, reflexes
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In the levels of consciousness what is:
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Alert --> awake and responsive
Lethargic --> sleepy but arousable Stuporous --> arousable with difficulty Comatose --> not arousable |
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A change in LOC is the first indication of what?
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Neurological status is declining
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What five things should we focus on with mental status and speech?
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LOC, appearance and behavior, speech, cognitive fx, constructional ability
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What are the three areas of memory loss?
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Long term or remote – BD, mother maiden name schools
Recall or recent – accuracy of medical history Immediate or new memory – president or 3 words to remember eggs milk butter |
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What is dysarthria?
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Difficulty articulating/ assess for volume and clarity
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If a pt is unable to participate in an assessment, what is a RELIABLE tool to assess them?
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Glascow Coma Scale
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Why is Glascow Coma Scale a RELIABLE tool to assess them?
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Addresses 3 areas of neuro fx, LOC responsiveness, neuro status of head injury, evaluates motor, verbal and eye opening, ea response given number, sum gives severity of coma and prediction of possible outcomes
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What nerve pain is so SEVERVE that patients want to end life?
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Trigeminal (V)
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In trigeminal Neuralgia, what is the cause?
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Degeneration of nerve or increased pressure
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What causes the unbearable pain?
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Spasms with stab like pain radiating down nerve pathway
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How is Trigeminal Neuralgia treated?
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Antiseizure meds like Dilatin, severe cases surgery
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In Bell’s Palsy, facial paralysis is r/t inflammation of what nerve?
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7th Cranial nerve
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What do we teach pts with Bell’s Palsy?
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Self care – eye care facial exercises, avoidance of cold
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How many spinal nerves are there?
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31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
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In assessing sensory fx, what do we assess for?
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Pain, light touch, vibration, position and discrimination
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What is stereogenosis?
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The ability to what an object is without seeing it
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In assessing motor fx, what is normal regarding muscle tone
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slight resistance is normal in muscle tone
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In muscle strength testing what gives us triceps strength?
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Cervical nerves
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In assessing motor fx, what does the Romberg test tell us?
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Cerebellar fx
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In the examination of deep tendon reflexes what would a +4 mean?
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Hyperactive impulses (clonus)
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What is a Clonus deep tendon reflex?
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Sudden brief jerking contraction of muscle or muscle group, mostly in seizures ie: tonic-clonic seizures
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What is a Positive Babinski Reflex?
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Abnormal neuro sign, loss of voluntary control increased muscle tone and spaticity, hyperactive related to strokes or injury to spinal cord
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What can CT scans see?
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Bone soft tissue and fluids
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What do CT scans indentify?
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Tumors, infarctions, hemorrhage, hydrocephalus, bone malformations
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What does an MRI see?
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About 5 steps above a CT scan, sees cerebral abnormality earlier, chemical chgs w/in cells
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What does angiography see?
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Blood vessels, areterial and venous malformations
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What is an EEG?
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Electrical activity in brain
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What foods or drinks are omitted before an EEG?
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Coffee tea, chocolate, and cola drinks
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What means are withheld before an EEG?
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Tranquilizers, stimulants for 24-48 hours before test
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Would you omit a meal before an EEG?
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NO!! Brain requires what to work? GLUCOSE
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Where is a lumbar puncture done in the spine?
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Lumbar subarachnoid space usually 3rd and 4th space
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Why would you do a lumbar puncture?
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Spinal fluid for exam, measure and relieve spinal fluid pressure, determine presence or absence of blood- NEVER GOOD TO SEE BLOOD!, to find spinal block and to admin antibiotics
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What kind of technique is used to do a lumbar puncture?
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Strict aseptic- can cause meningitis if germ gets into space
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What would happen if a lumbar puncture was done on a pt with ICP?
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Brain herniates!
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Who is contraindicated for this procedure?
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Clients with skin infections at or near puncture site
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What is done for the pt prior to lumbar puncture?
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Empty bladder and bowel, placed on side with back toward dr, maintain spine in horizontal position
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What color is CSF?
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Clear
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What is CSF made of?
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Mostly sugar
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If it is cloudy what does this indicate?
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Meningitis
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When a CSF specimen is taken, should you just sit around and pick your nose?
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Get off your lazy ass and take it to the lab yourself!!!
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What is the post op care for lumbar puncture?
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Bedrest flat for 4-8 hours, encourage fluids to facilitate CSF production especially CAFFIENE! Admin pain analgesics as ordered, monitor neuro signs if LP done to reduce ICP, watch for signs of chemical or bacterial meningitis
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What test is used to determine changes in LOC?
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Glascow Coma Scale
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What causes a post LP headache?
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Leakage of
CSF at puncture site that continues to escape into tissues by way of the needle tract from spinal canal |
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What sign is a “tell” of a CSF leak?
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Halo- glucose drips out
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What are the classes of nervous system cells
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Nerve cells or neurons, Neuroglial cells, and Schwann cells
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How is information moved on the nerve?
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Dendrite to soma to axon to terminal button to synape
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What are the three types of neurons:
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sensory (afferent), motor (efferent) and interneurons (intrinsic)
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What part of the nervous system are Glial cells present?
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CNS
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Where are Schwann cells?
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PNS
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What is the role of Glial and Schwann cells?
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To support, protect and provide nutrition to CNS/PNS
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In the CNS do cells regenerate?
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NO!
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In the PNS can cells regenerate?
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Only if Schwann cells are undamaged
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Which does better a crushing injury or cut injury?
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Crushing
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What enables the thought process in the body?
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CNS – brain and spinal cord
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Where does CSF come from?
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Blood
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What are the three membranes in the CNS?
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Dura, arachnoid and pia or remember DAP
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What are the three membrane spaces?
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Epidural, subdural and subaracnoid
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What is the most serious spot in the spaces for injury or infection?
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Subarachnoid because it contains CSF
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What makes up the brain stem?
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Midbrain, medulla oblongata, pons
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What is the outer layer of the brain called?
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Cortex
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What color is the cortex?
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Grey – hence grey matter
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What color are axons?
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White – hence white matter….obviously
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What is special about the cerebrum?
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Largest part of brain, controls sensory/motor activities and intelligence
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How many lobes are in the cerebrum?
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4- frontal, temporal, parietal, occipital and the thalamus and hypothalamus
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What is special about the frontal lobe?
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Broca’s Area – speech comes from here….where strokes most often cause damage
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What is in the temporal lobe?
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Wernicke’s area- interepretation of spoken language, also called receptive ephagia. Long term memory is filed here
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What does the hypothalamus do?
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Regulates body temp and endocrine and ANS fx
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What does the Thalamus do?
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Relay ctr of cerebrum, emotional responses like fear, pleasant and unpleasant stimuli
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What is the cerebellum also called?
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Little brain – I thought that was what we called a man’s penis?
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What does the cerebellum control?
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Movement, posture and balance
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So what test reflects that?
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Romberg’s
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In the midbrain, what important fx takes place?
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Auditory and visual reflex centers- this is how we form words
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Why is the Medulla Oblongata important?
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Controls breathing cardiac fx, relay station for crossing motor tracts
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The Vagus nerve comes from what part of the brain?
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Medulla Oblongata – C2
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Where is the Reticular Activating system?
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Brain Stem
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What does the reticular activating system do?
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Maintains wakefulness
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If you have overstimulation of this system what happens?
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Causes it to fatigue = less excitable=ICU psychosis=overload
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How much of the cardiac output does the brain receive?
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15%
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What is the Blood Brain Barrier?
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Anatomical barrier that certain substances can’t penetrate
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How does blood leave the brain in the vascular system?
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Jugular vein
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What does the sympathetic nervous system do?
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“Fight or Flight”
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What does the parasympathetic nervous system do?
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Rest and Relax
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If a patient has a sensory deficit how do they respond?
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To cope with loss they withdraw or avoid situations
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What are the senses?
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Sight, hearing, touch, smell, taste
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What is olfactory?
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Sense of smell
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What is gustatory?
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Sense of taste
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What is presbyopia?
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The decrease in visual accommodation that occurs with age
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What is presbycusis?
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The decreased ability to hear high pitched tones that naturally begins in midlife as a result of irreversible inner ear changes, also consonants t,f,q, z
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Tactile changes occur how for older people?
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Pain isn’t as intense in older patients, also pressure and temp
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What is short arm syndrome?
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People like me….I can’t hold my arms out far enough to see small print…that’s why I can bifocals
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People who have a factor affection sensory fx also have what?
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Lowered self esteem
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What ethnicity has a higher rate of glaucoma?
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African Americans
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What ethnicity has a higher rate of hearing loss?
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Caucasians
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When taking an assessment what should you ask them about sensory?
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To describe nature of sensory deficit
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What is an MMSE?
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Mini Mental Status Examination
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What other factors should a nurse remember in sensory alterations?
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Meds that cause ototoxity
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What does impacted cereunum cause?
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Conductive hearing loss – ear hairs are compacted and can’t vibrate
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Before eating what should be done?
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Good oral care
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What colors are best seen by older pts?
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BRIGHT Red, Orange, Yellow
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If you have a pt who is overstimulated with ICU psychosis, what are you going to do to
Help decrease their stress? |
Organized care, all procedures and care at once to leave them alone for longer periods of time
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What part of the brain works on gait?
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Cerebellum
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What is strabismus?
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A condition in which there is deviation from perfect ocular alignment
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What is sundowning?
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Increased confusion at night
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You are caring for a pt with expressive aphasia. How can you promote communication?
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Use picture chart
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What is the tool that looks into ears?
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Otoscope
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What test is used to determine inner ear problems?
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Cold cholorics
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What is a cold choleric?
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Use of cold water into ear to test for something that I didn’t write in my notes….but I’m gonna darken the dot that says something like this
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What antifungal is used for sensory alterations in the mouth?
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Nystatin
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What is dysphagia?
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Difficulty swallowing- those of you who don’t swallow
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What are the top three risk factors for aspiration pneumonia?
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Dependence on others for feeding, oral care and missing or decaying teeth
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What is Frazier Water protocol?
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Special oral care for patients at risk for aspiration pneumonia or dehydration
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What kind or oral care should be provided with Frazier?
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Vigorous and thorough brushing with tooth brush and 1.5% peroxide solution
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When should this be done?
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First thing am and before an PO
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What is simply thick?
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Exactly what is says….thick
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