Neuro 1
What is the difference between a hemorrhagic and ischemic stroke and what is a common cause of each?
Hemorrhagic: bleeding, most often caused by HTN, also aneurysm or AVM
Ischemic: vascular obstruction, thrombi, emboli (vascular disease)
Explain what would cause "racoon eyes" and "battle sign" and where you would expect to see leakage of CSF (if any) with either of these.
Racoon eyes: anterior fracture; rhinorrhea
Battle sign: posterior, occipital or basilar fracture of the skull; otorrhea
Give 3 variables that can lower the seizure threshold in a person with epilepsy.
fatigue, sleep deprivation
emotional or physical stress
menstruation, pregnancy
alcohol and drugs
certain meds
fever
DAILY DOUBLE
Addison's: autoimmune
TB
Explain how negative feedback helps regulate the hormones of the endocrine system.
high levels of a hormone prevent further excretion of hormone, low levels cause increase in secretion
Define lethargic, stuporous, and obtunded
Lethargy: drowsy but follows simple commands when stimulated
Stuporous: Very hard to arouse, inconsistently follows commands
Obtunded: Arousable with stimuli but slow to respond to commands
Name 4 signs of meningeal irritation.
nuchal rigidity
fever
headache
photophobia
positive Kernig sign (pain in neck when thigh is flexed
positive Brudzinski sign (flexion of the hips when neck is flexed)
What is the priority assessment for a person suspected to have a high spinal cord injury?
Airway and respiratory status
What is the side effect of glucocorticoid treatment and give some signs and symptoms (4)
Cushing syndrome
May also cause: diabetes, hypertension, protein wasting, osteoporosis
buffalo hump, moon face, striae, thin extremities, dry/thin skin
sudden weight gain, insomnia, diaphoresis
DAILY DOUBLE
hypertonic solutions (3%) and furosimide
500-600 ml over 3-4 hours
*not too fast
Conivaptan (Vaprisol)-inhibits ADH, may also be indicated
What is the purpose of cerebrospinal fluid? What precautions need to be made if a person has a decreased amount?
Cushion and protect the brain and spinal cord; absorb shock.
Prevent trauma, injury to the head, falls, etc.
Explain the Monro-Kellie doctrine for maintaining intracranial pressure.
The CNS will make adjustments in brain volume (parenchyma is 80% water but does have limited ability to adjust), cerebral blood volume, and cerebrospinal fluid to compensate for change in one.
*shunting CSF into spinal subarachnoid space, increased CSF absorption, decreased CSF production, shunting venous blood out of the skull
Explain 4 symptoms of spinal shock and 4 symptoms of neurogenic shock
Spinal: Massive vasodilation: hypotension, bradycardia, loss of motor and sensation below level of injury with flaccid paralysis, loss of bowel and bladder, loss of temperature control
* how do you know when ended? return of perianal reflex
Neurogenic: loss of sympathetic input so decreases peripheral vascular resistance, hypotension, severe bradycardia, inability to sweat below level of injury, orthostatic hypotension (can't compensate for position changes)
List 4 symptoms of hypoglycemia
headache
personality changes
palpitations
blurred vision
combativeness, confusion, coma, seizures
Give 4 signs of hyperthyroidism.
nervousness
weight loss
excessive sweating, heat intolerance
palpitations
frequent bowel movements
muscle weakness and tremors
What is the initial top priority for a person with a traumatic brain injury?
Airway/respiratory/breathing
What is a top inpatient nursing assessment related to the nervous system? (once airway is managed)
Change in LOC
Explain the circle of Willis. What would a nurse expect to find with brain perfusion if the circle of Willis is intact and there is damage to a carotid artery or basilar artery.
Circle of Willis is an area in the subarachnoid space where the branches of the internal carotid arteries and basilar arteries unite.
A nurse would expect to have limited disruption in perfusion to the brain if the circle if Willis is intact.
What is a typical precursor to Guillain-Barre syndrome and explain it's effect on the body.
usually an infection
inflammatory demyelinating polyneuropathy that results in a flaccid, ascending paralysis.
What is the syndrome that results from deficit in ADH and what would you expect to see regarding urine output?
Diabetes Insipidus
high urine output that are dilute, signs of dehydration
Explain the difference between DKA and HHS and why this difference likely occurs.
DKA cause acidosis because of increased ketone production, HHS is not a state of acidosis.
HHS; Type 2 DM, have some insulin production
Describe ways to decrease intracranial pressure in a intubated patient (give 4 ways).
1. Manage CO2 levels: high is a vasodilator, low is a vasoconstrictor
2. Administer Mannitol: increases serum osmolality and decreases cerebral blood volume and edema
3. Analgesics: often times opioids such as fentanyl and morphine
4. Anesthetics/Induced Coma: Propofol and neuromuscular blockers
5. Blood pressure management: beta-blockers, Ace inhibitors ( if elevated)
6. seizure prophylaxis, craniotomy, HOB elevated and head neutral, minimize environmental stimuli
What are 3 secondary brain injuries following a traumatic brain injury?
cerebral edema: occurs 24-48 hours after injury, up to 7 days; watch for increased ICP
ischemia: occlusion of blood vessels in the brain
herniation syndrome (brain tissue is displaced or compressed)
Coma (disruption of RAS)
Persistent Vegetative state: Sleep wake cycles but do not respond to environment
Explain Autonomic Dysreflexia after a spinal cord injury and immediate interventions.
stimulation below level of injury caused by bladder or intestinal distention, spasticity, ulcer, or other stimulation: causes vasoconstriction and extreme HTN, bradycardia, headache, flushing, vision changes
Treatment: check urinary catheter for kinks, elevate HOB, check for bowel impaction, give sublingual nifedipine.
What is pheochromocytoma and what are the symptoms?
Tumor in the adrenal gland
Severe HTN (headache), palpations, sweating
Explain the difference between diabetes mellitus and diabetes insipidus and what is similar.
DI: lack of ADH
DM: glucose/insulin related (r/t hormone insulin)
Similar: both may cause massive diuresis.