Seizures and Epilepsy
A prolonged seizure lasting more than 5 minutes or recurrent seizures without return to consciousness is known as _________.
What is Status epilepticus?
Rationale:
Status epilepticus is a medical emergency that requires immediate intervention to prevent brain damage.
Tissue plasminogen activator (tPA) must be administered within ________ hours from the onset of ischemic stroke symptoms.
What is 3 to 4.5 hours?
tPA is effective if given within 3 to 4.5 hours after the start of symptoms in eligible patients. Beyond this window, the risk of bleeding outweighs the benefits.
Maintaining adequate oxygenation is crucial in managing increased ICP. The target PaO₂ should be greater than ________ mm Hg
What is 60?
Rationale:
Hypoxia can increase ICP. A PaO₂ > 60 mm Hg is generally targeted to ensure brain tissue oxygenation.
The normal range for intracranial pressure in adults is ________ mm Hg?
The Glasgow Coma Scale (GCS) evaluates eye opening, verbal response, and motor response. A GCS score of less than ________ indicates a coma.
What is 8?
Rationale:
A GCS < 8 indicates a severe brain injury and coma. Immediate intervention is needed to protect the airway and prevent further brain damage.
What are the ranges for mild, moderate, severe?
The most serious complication of a cerebral aneurysm is ________.
What is Rupture?
Rationale:
Rupture of a cerebral aneurysm can lead to subarachnoid hemorrhage, a life-threatening emergency.
The first priority in a suspected spinal cord injury is to ________ the spine to prevent further damage.
What is Immobilize?
Rationale:
Spinal immobilization (e.g., with a cervical collar and backboard) is crucial to prevent movement that could worsen the injury.
One of the earliest signs of fluid volume deficit is increased ______________, as the body attempts to maintain perfusion.
Answer: What is heart rate (or pulse)?
Rationale:
Tachycardia is a compensatory response to maintain blood pressure when volume is lost.
A key neurological symptom of hyponatremia is ______________, due to cerebral edema.
Answer: What is confusion?
Rationale:
Low sodium causes water to shift into brain cells, leading to confusion, lethargy, and in severe cases, seizures.
The first-line intravenous medication used to stop an active tonic-clonic seizure is ________.
What is Lorazepam/Ativan (Benzodiazepine)?
Rationale:
Lorazepam (Ativan) is the preferred benzodiazepine for stopping acute seizures due to its rapid onset.
A stroke affecting the left hemisphere of the brain often results in ________, or difficulty speaking.
What is Aphasia?
Rationale:
Aphasia is a common result of left-sided stroke, affecting language and communication centers.
One of the earliest and most sensitive indicators of increased ICP is a change in the patient’s ________.
What is Level of consciousness?
Rationale:
A decreased level of consciousness (LOC) is the earliest sign of increased ICP, due to impaired cerebral perfusion.
The presence of clear drainage from the nose or ears after head trauma may indicate leakage of ________.
What is Cerebrospinal fluid (CSF)?
Rationale:
CSF leakage suggests a dural tear, commonly seen with basilar skull fractures. CSF is confirmed by testing for glucose or a "halo" sign.
Describe what it looks like?
The classic symptom of a ruptured cerebral aneurysm is a sudden, severe ________ often described as "the worst of my life."
What is Headache?
Rationale:
This "thunderclap" headache is a hallmark sign of a subarachnoid hemorrhage from aneurysm rupture.
An injury at or above the level of ________ may impair diaphragmatic breathing and require mechanical ventilation.
What is C4?
Rationale:
The phrenic nerve (which controls the diaphragm) arises from C3–C5. Injuries at or above C4 can paralyze the diaphragm.
A common cause of fluid volume excess is impaired ______________ function, which leads to sodium and water retention.
Answer: What is kidney (or renal)?
Rationale:
The kidneys are responsible for fluid and electrolyte balance. In conditions like chronic kidney disease, fluid retention is common.
A dangerous cardiac effect of hyperkalemia is ______________, which can be fatal if not treated.
Answer: What is arrhythmia (or dysrhythmia)?
Rationale:
Both high and low potassium levels can disrupt the electrical activity of the heart, leading to arrhythmias.
After a generalized tonic-clonic seizure, the patient may enter a _________ phase, characterized by confusion, drowsiness, and headache.
What is Postictal phase?
Rationale:
The postictal phase follows a seizure and may last from minutes to hours, during which the patient gradually returns to baseline.
The mnemonic used to recognize signs of stroke is ________.
FAST or BEFAST
Rationale:
BEFAST stands for Balance, Eye changes, Face drooping, Arm weakness, Speech difficulty, Time to call 911. It's used for early recognition and rapid response.
A classic late sign of increased ICP known as Cushing's Triad includes what symptoms?
What is bradycardia, irregular respirations, and widened pulse pressure?
Rationale:
Cushing’s triad indicates severe increased ICP and imminent brainstem herniation.
A serious risk associated with open or penetrating head injuries is ________.
What is Infection?
Rationale:
Open head injuries can expose brain tissue to bacteria, increasing the risk of meningitis or brain abscess.
What Calcium Channel Blocker is given for aneurysms?
What is Nimodipine?
Rationale:
Pharmacologic therapy includes calcium channel blockers such as nimodipine, which are used to prevent vasospasm, a common and serious complication following subarachnoid hemorrhage.
A sudden rise in blood pressure due to a noxious stimulus in patients with injuries at or above T6 is called autonomic ________.
What is Autonomic Dysreflexia?
Rationale:
Autonomic dysreflexia is a life-threatening condition triggered by stimuli like a full bladder, causing severe hypertension.
What are some other things that can trigger this?
In fluid volume excess, the nurse would expect to find a ______________ jugular vein when the client is in a semi-Fowler’s position.
Answer: What is distended?
Rationale:
Jugular vein distention (JVD) is a key sign of increased central venous pressure due to fluid overload.
The nurse should administer intravenous calcium ______________ slowly and monitor for signs of cardiac arrhythmias in patients with hypocalcemia.
Answer: What is gluconate?
Rationale:
IV calcium must be given slowly to avoid cardiac complications and to stabilize neuromuscular function.
During a seizure, the priority nursing action is to maintain a(n) ________.
What is airway?
Rationale:
Airway protection is the highest priority to prevent hypoxia and aspiration during a seizure.
A stroke caused by a ruptured blood vessel and bleeding into the brain is called a(n) ________ stroke.
What is Hemorrhagic?
Rationale:
Hemorrhagic strokes result from bleeding in the brain and require different management than ischemic strokes.
To promote venous drainage and reduce ICP, the head of the bed should be elevated to ________ degrees.
What is 30?
Rationale:
A 30-degree HOB elevation helps reduce ICP by improving venous outflow without compromising cerebral perfusion.
A mild traumatic brain injury without detectable structural damage on imaging is known as a ________.
What is Concussion?
Rationale:
A concussion is a functional brain injury, typically with no visible abnormalities on CT or MRI.
In patients with aneurysms, maintaining controlled ________ is critical to prevent rupture.
What is Blood pressure?
Rationale:
Tight blood pressure control reduces stress on the vessel wall and helps prevent aneurysm expansion or rupture.
Because of immobility, patients with SCI are at high risk for ________.
What is Pressure ulcers?
Rationale:
Immobility, reduced sensation, and poor circulation increase the risk of pressure injuries. Frequent turning is essential.
One potential cause of fluid volume deficit is excessive ______________, such as from vomiting, diarrhea, or sweating.
Answer: What is fluid loss?
Rationale:
Excessive fluid loss through the GI tract, skin, or kidneys is a common cause of hypovolemia.
In hyponatremia, rapid correction of sodium levels can cause ______________, a serious neurologic condition.
Answer: What is osmotic demyelination syndrome
Rationale:
Correcting sodium too quickly damages nerve cells causing osmotic demyelination syndrome.
Some patients report a warning sign before a seizure begins, known as an ________.
What is Aura?
Rationale:
An aura is a sensory experience (visual, olfactory, auditory) that can precede a seizure, often in focal epilepsy.
In the acute phase of a stroke, the nurse should monitor the patient’s ________ closely, as sudden changes may indicate increased intracranial pressure.
What is Blood pressure (or neurological status)?
Rationale:
Blood pressure is carefully monitored, especially in ischemic stroke, to ensure adequate cerebral perfusion without increasing risk of hemorrhage.
The osmotic diuretic commonly used to reduce cerebral edema and lower ICP is ________.
What is Mannitol?
Rationale:
Mannitol pulls fluid from the brain tissue into the bloodstream, reducing cerebral edema and ICP.
What should be monitored closely with patients taking this medication?
Repeated vomiting after a head injury may indicate increased ________.
What is Intracranial pressure (ICP)?
Rationale:
Persistent vomiting, especially when paired with headache or confusion, may signal rising ICP and requires urgent evaluation.
Ecchymosis around the umbilicus, known as ________ sign, may indicate a ruptured abdominal aneurysm.
What is Cullen’s?
Rationale:
Cullen’s sign is bruising around the navel, a late sign of intra-abdominal bleeding, possibly from a ruptured aneurysm.
An injury to the thoracic and lumbar cord typically results in ________, the loss of motor and/or sensory function in the lower extremities.
What is Paraplegia
Rationale:
Paraplegia affects the legs and is caused by injury to the T1–L5 region of the spinal cord.
The nurse should monitor ______________ to assess fluid balance in a client with FVD.
Answer: What is daily weights?
Rationale:
Daily weights are the most accurate noninvasive way to monitor fluid gain or loss.
In patients with hypermagnesemia, the nurse should assess deep tendon reflexes frequently, as ______________ reflexes may indicate magnesium toxicity.
Answer: What is decreased (or absent)?
Rationale:
High magnesium levels depress neuromuscular activity, leading to reduced or absent deep tendon reflexes.
Driving can be dangerous for clients with seizure disorders, and in many states, they are not allowed to drive unless they have been seizure-free for at least ______________ to ______________ months.
What is six to twelve?
Rationale:
Most U.S. states require individuals with a history of seizures to be seizure-free for 6 to 12 months before regaining driving privileges. This helps reduce the risk of accidents and protects public safety.
A ______________ is often called a "mini-stroke" and serves as a warning sign of a future stroke.
Answer: What is transient ischemic attack (TIA)
Rationale:
A TIA is a temporary blockage of blood flow to the brain that resolves without permanent damage, but it is a critical warning sign.
Mean Arterial Pressure (MAP) is calculated by adding the systolic blood pressure (SBP) to 2 times the ______________ blood pressure (DBP), then dividing the total by ______________.
Answer: What is diastolic; 3?
Rationale:
The formula for calculating MAP is:
MAP=SBP+2(DBP)/3
Abnormal flexion of the arms and wrists in response to a painful stimulus is known as ________ posturing.
What is Decorticate?
Rationale:
Decorticate posturing indicates damage to the cerebral cortex, while decerebrate suggests injury to the brainstem.
What are the most modifiable risk factors for aneurysms?
Hypertension and smoking
Rationale:
Hypertension and cigarette smoking are the modifiable risk factors most often associated with aneurysms because of the potential for endothelial tissue damage and ensuing inflammation
Patients with SCI may experience intense burning or tingling sensations known as ________ pain.
What is Neuropathic?
Rationale:
Neuropathic pain is caused by damage to the nervous system and is common after SCI.
The nurse may expect to administer a ______________ medication to a client with fluid volume excess to help eliminate excess fluid.
Answer: What is diuretic?
Rationale:
Diuretics promote urine output and are commonly used to reduce fluid overload in conditions like heart failure or renal dysfunction.
Hyperkalemia can cause muscle weakness and ______________ paralysis in severe cases.
Answer: What is flaccid?
Rationale:
Excess potassium reduces neuromuscular excitability leading to flaccid paralysis and potentially respiratory failure.