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Complex: Neuro Adult
Terms in this set (265)
oxygen, glucose, nutrients
What 3 things must the cerebral circulation provide to the cerebral tissues?
vertebral arteries, internal carotid arteries
Blood supply to the CNS is derived from which 2 major sets of arteries
circle of Willis
The vertebral arteries and the internal carotid arteries interconnect at the ______________ and provide cerebral circulation.
cerebral blood volume
The amount of blood in the cranial vault at any point and time
mental status, LOC, cranial nerve functioning, motor status, sensory functioning
5 things the nurse should focus on during a neurological assessment
Glasgow Coma Scale
A tool that is used to guide in assessing a patient with neurological injuries or problems
The Glasgow Coma Scale only tells ________ and _______ but doesn't say what area of the brain is affected.
eye opening, verbal response, motor response
3 components of the Glasgow Coma Scale
When using the Glasgow Coma Scale, a score of ____ indicates a deep coma, and a score of ____ indicates normal functioning.
medications, spinal cord injury
2 things that can affect the accuracy of the Glasgow Coma Scale
Occurs when patient can comprehend language and follow commands but may have complete loss of verbal or written communication skills
Occurs when patient is unable to comprehend language and follow commands but can speak spontaneously
consciousness, language skills, memory
3 things that should be checked to test mental status
If you ask a patient to move his arm and nothing happens, he gets a ____.
If you ask a patient to move his arm and you see or feel a flicker in the muscle, then the patient would receive a ____.
If you ask a patient to move his arm and he moves or twists a joint but cannot life the extremity off the bed, he gets a ____.
If you ask a patient to move his arm and the client lifts the extremity but drops it immediately, he gets a ____.
If you ask a patient to move his arm and the client can raise and hold but is unable to resist the resistance applied, he gets a ____.
If you ask a patient to move his arm and the patient can move the muscle and hold the position against gravity as well as maintain a position of resistance, he gets a ____.
Can muscle strength be assessed in an unconscious patient?
The patient is asked to close his eyes and stretch out arms with palms up for 20-30 seconds; downward movement of arm or pronation of palm on one side may indicate mild paresis of the involved extremity
Should the Babinski's reflex be seen in an adult?
With a moderately sharp object, stroke the lateral aspect of the sole from the heel to the ball of the foot curving medially across the mall; use the lightest stimulus that provokes a response
Normal response when performing Babinski's reflex
When performing the Babinski's reflex, ___________ of the great toe and _______ of other toes indicates upper motor neuron lesion and/or damage to the spinal tract.
Coordination is controlled by the _________.
cerebral hemispheres, brain stem
Abnormal posturing (flexion posturing or extension posturing) in response to noxious stimuli indicates a dysfunction of either the ____________ or the ________.
Indicates cerebral hemispheric dysfunction; in response to painful stimuli, the upper arms move up toward the chest with the elbows, wrists, and fingers; flexed legs extend with internal rotation and feet flex; outcomes vary but may have permanent damage
Indicates brain stem dysfunction; more ominous sign; the neck extends, the jaw clenches, arms pronate and extend straight out, and feet plantar flex; usually leave ICU still unresponsive
Can different posturing be noted on each side of the body? (For example, one side may have extension posturing and the other may have flexion posturing.)
Elicited by lightly stroking the superior and medial (inner) part of the thigh regardless of the direction of stroke; normal response is an immediate contraction of the cremaster muscle that pulls up the testis on the side stroked; reflex may be absent with testicular torsion, upper and lower motor neuron disorders, as well as spine injury of L1-L2
Nonreactive pupils in the midposition indicate damage to the ________.
pons lesion, opiate drug overdose
Pupils that are nonreactive to light and pinpoint indicate __________ or ___________.
thalamus, hypothalamus, metabolic coma
Pupils that are small but reactive to light may indicate a bilateral injury to the ________ or _________ or a _____________.
Are pupil changes seen on the same side as the lesion?
When both pupils are dilated and nonreactive (fixed), emergency reaction is required and may be caused by severe _______ or _________.
2 drugs that can dilate the pupils
In an unresponsive patient, _________ eye movement is lost, and the patient is unable to perform _________ eye movements.
oculocephalic reflex (doll's eye movements)
Hold the patient's eyes open and briskly turn the head from side to side pausing at each side; with an intact brainstem, the examiner will see conjugate eye movement opposite to the side the head is turned; if brainstem injury is present, the eyes will remain fixed in midposition as the head is turned (doll's eyes absent); test contraindicated in patients whose cervical spine has not been cleared of injury
oculovestibular reflex (cold caloric test)
Performed by a physician when determining brainstem functioning; instilling cold water into the ear canal causes nystagmus (lateral tonic deviation of the eyes) toward the stimulus; reflex lost when brainstem function is lost; test contraindicated if CSF or purulent drainage leaking from the ear or if there is a perforation or tear in the tympanic membrane
Assessed by touching the cornea from side to side with a wisp of cotton; the eye blinks rapidly if the reflex is in intact
Assessed by touching the posterior tongue with a tongue blade; if intact, the patient gags; can also be assessed while suctioning an intubated patient
corneal, gag, cough, swallow
4 protective reflexes that assess brainstem functioning
When the cough gag, swallow, and cough reflexes are absent, the patient is at high risk of ________.
Performed when the ventilator is turned off to see how the patient responds
Breathing characterized by rhythmic variations in intensity that occur in cycles; rhythmic waxing and waning in depth of respirations followed by a period of apnea
central neurogenic hyperventilation
Respirations that have an increase in depth, are rapid (greater than 24 because compensating for increase PaCO2), and are regular
Prolonged inspiration with a pause at the point where the respiration is at its peak lasting 2-3 seconds; this may alternate with an expiratory pause
Cluster of irregular breathing with periods of apnea that occur at irregular intervals
Respirations are completely irregular with deep and shallow random breaths and pauses
vasodilate, increased, increased, increased
Increased PaCO2 causes blood vessels to _________ which results in ________ blood flow, _______ cerebral blood volume, and _________ ICP.
vasoconstrict, decreased, decreased
Decreased PaCO2 causes cerebral arteries to __________ which results in ________ blood flow, and _________ perfusion causing a secondary brain injury.
increased, vasodilation, increased
With PaO2 less than or equal to 50, hypoxia and vasodilation will be seen causing ________ cerebral blood flow. If the PaO2 is not raised, lactic acid accumulates causing more ___________ in the brain and ________ ICP.
_________ HR may indicate poor cerebral oxygenation. _________ HR is present in the late stages of increased ICP.
Cerebral trauma produces systemic ___________.
Increasing SBP/widening pulse pressure, bradycardia, irregular breathing
Components of Cushing's triad
Cushing's triad is activated when _____ rises to a point where it equals or exceeds _____.
Injury to or dysfunction of the __________ produces alterations in body temperature.
Occurs as a result of spinal shock, metabolic coma, drug overdose (especially depressants), and destructive lesions of the brainstem or hypothalamus
Occurs as a result of CNS infection, subarachnoid hemorrhage, hypothalamic lesions, or hemorrhage of the hypothalamus or brainstem
_________ must be treated promptly because of increased metabolic demands placed on the body and brain.
Caused by disorders such as head injury, stroke, tumor, hydrocephalus, infection, cerebral edema, hematoma formation, and anoxia
Normal ICP in a healthy adult
20, 5 minutes
ICP of _____ or greater persisting for ________ or longer is abnormally elevated and life-threatening.
changes in LOC
First sign of increased ICP
nausea, vomiting, headache, LOC changes, dilated pupils, Cushing's triad
6 signs and symptoms of increased ICP
Is Cushing's triad an early or late sign of increased ICP?
Increased ICP is a sign of impending ________.
cerebral perfusion pressure (CPP)
The pressure at which the brain is perfused
cerebral blood flow, ICP
Cerebral perfusion pressure depends on what 2 things?
cerebral perfusion pressure
Defined as the pressure necessary to supply adequate amounts of blood to the brain
CPP = MAP - ICP
How to determine cerebral perfusion pressure
MAP = (SBP + 2DBP) / 3
How to determine MAP
Cerebral perfusion is _________ when ICP is high or MAP is low.
Cerebral perfusion is _________ when ICP is low or MAP is high.
Cerebral perfusion pressure of _____ or less should be reported immediately; it's a critical value.
If ICP rises to the level of MAP, brain perfusion ______ and brain ________ results.
intraventricular, subarachnoid, epidural, intraparenchymal
4 sites for monitoring ICP
Which is the best and most accurate device used to measure ICP?
Which method of monitoring ICP can also remove CSF?
shorter than, equal to
ICP monitoring devices allow observation of ICP waveform pattern. In a normal waveform, P2 waves are _________ P1 waves. In a waveform that shows increased ICP, P2 waves are _________ P1 waves.
Inadequate oxygen levels or excess carbon dioxide causes cerebral blood vessels to _______ and ICP to ____.
In increased ICP patients, assess neurological status every _________.
Decrease in LOC is ______ indicate of increased ICP.
HOB 30 degrees, midline head positioning
How should patient be positioned to prevent venous outflow obstruction?
Suctioning, bathing, position changes, noises, pain, anxiety, and hip flexion are activities that ________ ICP.
Cerebral blood flow _________ to supplement oxygen supply in response to increases in metabolic demands such as fever, pain, stimulation, seizures, and physical activity.
What technique should be used to reposition a patient because flexion at hips or knees could cause Valsalva maneuver which causes an increased ICP?
Limit endotracheal suctioning to no longer than _______.
(T/F) Therapeutic hypothermia may be ordered in some causes of increased ICP.
Diuretic of choice in neurological patients
increased CPP, decreased ICP, increased urine output
3 things that should be seen when using mannitol in a patient with increased ICP
What is needed to administer mannitol?
If mannitol can't be given, what diuretic is administered?
Steroid that has a stabilizing effect on the cell membrane and decreases inflammation; usually give a loading dose and then administer doses at regular intervals for several days; need to discontinue gradually
Dexamethasone decreases the effectiveness of what 2 types of drugs?
brain tumors, post-craniotomies
Steroid are not used in increased ICP patients but are used in patients with ___________ or ____________ to decrease swelling.
Steroid usually used in spinal cord injuries in high doses
Gastric acid pump inhibitor that suppresses gastric acid production and decreases stress response after neurological injury and steroid use
Beta blocker to decrease blood pressure; doesn't cause vasodilation in the brain
Calcium channel blocker that is effective in tight BP control; doesn't cause vasodilation in the brain
Calcium channel blocker that is formulated as a lipid emulsion so triglycerides must be monitored; doesn't cause vasodilation in the brain
Ace inhibitor to decrease blood pressure
Powerful calcium channel blocker that reduces poor outcomes of vasospasms following a subarachnoid hemorrhage (SAH)
Inhibits glutamate release and causes cerebral vasodilation; experimental stroke models have demonstrated that it's neuroprotective
When administering seizure prophylaxis, what for ___________ and ________.
First line drug for seizures; anticonvulsant and sedative
Fosphenytoin is what type of drug?
Diazepam is what type of drug?
anticonvulsant, bradycardia, normal saline
Phenytoin is what type of drug and what should be watched for? It can only be diluted with ___________.
Barbituate used for certain types of seizures
PO medications that depresses seizure activity
morphine, hydromorphone, fentanyl
3 pain medications
Sedative/anesthetic; induces sedation and coma
nembutal sodium (Pentobarbital)
Short-acting barbituate that slows down brain activity
Barbituate that works by depressing the CNS
Facilitates sedation without neurological or respiratory depression; good for agitated patients who require reliable serial neurological testing to monitor course after traumatic brain injury
neuromuscular blocking agents
Complications of ______________ include prolonged paralysis that can cause DVTs, constipation, and flaccid bladder as well as losing the ability to do clinical examination.
Complication of using ____________ to get rid of PaCO2 is vasoconstriction-related ischemia (which would be reflected in a low PaCO2)
Complication of using ICP monitoring is ________ and also _______ in intraventricular space (trauma from inserting catheter).
Complications of using ________ include watching for volume depletion and electrolyte imbalances as well as long-term use signs of CHF and pulmonary and peripheral edema.
Complications of using ____________ (given in SIADH) include hypervolemia, rebound fluid overload, CHF, pulmonary edema, etc.
Complications of using ________ include losing ability to perform clinical examination, hypotension, and respiratory depression.
Complications of using _________ include bradycardia (long-term use can lead to asystole), hyperlipidemia and fatty liver, and rhabdomyolysis
Complications of ________________ include electrolyte abnormalities (hypokalemia, hypocalcemia), cardiac suppression/dysrhythmias, coagulation problems, and decreased immune suppression.
With ______ head injuries, the scalp is torn or a fracture extends into the sinuses or middle ear; the meninges can be penetrated.
traumatic brain injuries
Closed head injuries are also called _______________.
_______ head injuries occur when there is no break in the scalp.
The _______ is very vascular and bleeds profusely.
loss of consciousness
With a scalp laceration, ask the patient if he/she experienced _____________.
Most common type of skull fracture that does not lead to significant complications unless it extends into the orbit or sinuses; patient may be admitted for observation to assess for any signs and symptoms of intracranial bleeding or hematomas
Skull fracture in which the dura may be intact, bruised, or torn; if torn, direct contact between brain and environment (meningitis risk); compressed and bruised brain beneath the depressed fracture site is source of focal neurological deficit and may become a seizure focus; may have leaking of CSF fluid from nose and ears if dura is torn
Skull fracture that occurs from multiple linear fractures with a depressed area at the site of impact; known as "eggshell fracture" because of appearance of skull
Skull fracture that occurs at base of cranial vault and can extend into anterior, middle, posterior fossae; difficult to confirm on x-ray, often diagnosed by clinical presentation; dural tears often associated with this type of fracture so CSF may drain from nose or ear; assess for infection if tear is dura
Battle's sign, raccoon eyes
2 main signs of a basilar skull fracture
Bruising behind the ear, bilateral periorbital edema and bruising, cranial nerve deficits such as decreased hearing, and bruising at base of neck indicate what type of skull fracture?
With a dural tear, all tubes should be inserted through the _______ to avoid penetrating the brain.
A ________ brain injury is a direct injury that occurs to the brain from an impact that moves the brain around inside the skull. There is an interruption of normal neuronal pathways and this can lead to cerebral edema and ischemia.
Types of ______ brain injuries include concussions, contusions, diffuse axonal injuries, penetrating injuries, hematomas, and intracerebral hemorrhage.
diffuse axonal injury
Widespread white matter axonal damage from tearing and shearing forces that cause disruption to the brainstem and cerebral hemispheres; injury results in vasodilation and increased cerebral blood flow that causes increased ICP; patients have only minimal signs of recovery if any
Result from forces such as gunshots, knives, or sharp objects; deep laceration of brain tissue and damage to the ventricular system causing a great concern for bleeding and infection; gunshots can create extensive damage because bullets spin irregularly and make paths and shock waves
Collection of blood in space between skull and dura; high impact to temporal areas of brain can induce epidural bleed; patient may have experienced brief loss of consciousness immediately following injury followed by episode of being alert and oriented and then loss of consciousness again (classical presentation); may see fixed and dilated pupil on same side as impact; surgical evacuation with possible placement of ICP monitor
Collection of blood in subdural space and arachnoid layers of meninges; occur less than 48 hours from injury or up to several weeks after an injury; common in the elderly who fall and hit their head; symptoms include drowsiness, headache, confusion, slowed thinking, agitation, vomiting; more serious symptoms include seizures, stiff neck, pupil changes, or hemiparesis; medical management includes surgical evacuation of hematoma and possible placement of subdural drain; nursing priorities include monitoring LOC and performing regular and frequent focused neurological assessments
Large hemorrhage into brain; can occur anywhere in brain; result from uncontrolled HTN, ruptured aneurysm, or trauma with high-impact blow to the head; symptoms depend on where the bleed is located and how severe the bleed is; may have headache along with decreasing LOC, dilation of one pupil, and hemiplegia; surgical evacuation usually not possible because bleed is deep in brain tissues; medical management is monitoring and treating ICP and CPP
A _________ brain injury occurs after the initial trauma and causes damage to the neurons as a result of hypoxia, hypotension, anemia, uncontrolled increased ICP, cerebral edema, infection, and fluid/electrolyte imbalances.
Management of a primary brain injury is to maintain ________________ to avoid secondary injury.
Can secondary brain injuries be enough to herniate a brainstem?
Uncontrolled seizures and not controlling ABGs can lead to a __________ brain injury.
Elevation of the head of the bed 30 degrees in patients with severe closed-head injury leads to consistent reduction of ________ and improvement in _______.
_____ magnesium levels lower the seizure threshold, thus making patients more prone to seizures, which could cause secondary brain injury.
hypokalemia (potassium moves into cells out of vascular system)
The body's release of epinephrine after trauma acts on the beta adrenergenic receptors causing which potassium imbalance?
Brain trauma, subarachnoid hemorrhage (SAH), brain tumors, and meningitis can cause _________ and worsen brain swelling/injury.
SIADH, DI, CSW
3 potential complications with neurological injury
In _______, the body secretes excessive ADH unrelated to plasma osmolality.
dilute, retention, dilutional
Results of SIADH include inability to secrete _______ urine, fluid _________, and ___________ hyponatremia.
free water restriction, fluid overload
The treatment of choice for SIADH is _______________ when increased fluid intake will worsen the hyponatremia and also treatment of _________.
What solution may be ordered when treating SIADH? It is used to increase sodium, but watch for fluid overload and heart failure.
Major complication of SIADH
cerebral salt wasting
In __________________, there is low blood sodium due to excessive sodium excretion from the normal functioning kidneys due to a brain disorder.
2 complications of cerebral salt wasting
first, 2-4 weeks
Cerebral salt wasting usually develops the _____ week after a brain injury and lasts _________.
Cerebral salt wasting requires fluid replacement with _______ solutions and ___________ to increase sodium levels.
Fludrocortisone is a _______________.
Potent mineralcorticoid used in the treatment of cerebral salt wasting; 0.1-1 mg per day; exerts its effects by stimulating reabsorption of sodium and water into the distal tubule leading to expansion of the extracellular fluid volume
When giving fludrocortisone, assess for what electrolyte imbalance?
In treating cerebral salt wasting, sodium tablets can be given at doses of up to ____ grams per day. Rapid correction of sodium should be avoided.
Condition that occurs when the kidneys are unable to conserve water; results from insufficient production of antidiuretic hormone (ADH); normally ADH controls the kidneys' output of urine
excessive thirst, excessive dilute urine production, dehydration
3 most common symptoms of diabetes insipidus
Treatment of choice in diabetes insipidus
fluid replacement, electrolyte correction, desmopressin
3 treatment components in diabetes insipidus
focal neurological symptoms
The hallmark of a stroke is the sudden onset of ________________ associated with changes in blood flow to the brain resulting from either a blockage of flow or a hemorrhage. Symptoms may occur immediately or evolve over several hours.
Defined by neurological deficits lasting 24 hours or longer
How long do brain cells survive when they are deprived of blood and oxygen?
Type of strokes caused by occlusions such as large artery atherosclerosis, cardioembolic events, and small artery occlusive disease; make up approximately 85% of strokes
Strokes from small vessels that are caused by hypertension and diabetes (these disease states cause a lipid material to coat the small cerebral arteries within the brain); high risk of recurrence
less than 220, less than 120
In ischemic strokes, the goal is to have systolic BP _____________ and diastolic BP ___________.
Strokes such as intraparenchymal hemorrhage, ruptured cerebral aneurysms, arteriovenous malformations, and secondary causes such as over-anticoagulation, vasopressor drugs, drug abuse, and hematological disorders
Caused by uncontrolled hypertension, blood vessel ruptures
Peak years for an aneurysm to occur
Do you see increased ICP symptoms more in ischemic or hemorrhagic strokes?
ruptured cerebral aneurysm
Localized dilation of cerebral artery wall that causes the artery to weaken and become susceptible to rupture; usually asymptomatic unless there is a leak
Congenital abnormality; tangled, dilated vessels that form an abnormal communication network between the arterial and venous system; arterial blood is shunted into venous system and predisposes the vessels to rupture
Arteriovenous malformations can be picked up on _______.
increases, seizures, phenytoin
When bleeding occurs in the brain, the ICP _______, which may result in ________. What medication can prevent this?
In hemorrhagic strokes, keep MAP less than _____.
In _________ strokes, ideally surgery will be performed in 24 hours if patient is stable, treat pressure in the brain, and manage BP.
Signs and symptoms of _______ include weakness or numbness on one side of the body, slurred speech, inability to comprehend what is being said, visual disturbance (one or both eyes), dizziness, incoordination or ataxia, double vision, vertigo, nausea and vomiting, and severe headache.
In stroke patients, the goal is to keep the MAP around ____.
In stroke patients, try to avoid _______ solutions.
In stroke patients, oxygen should be administered for any O2 sat less than _____.
_______ an aneurysm ruptures, the patient may complain of a localized headache, stiff neck, pain above or behind the eye, and photophobia.
________ an aneurysm ruptures, the assessment findings may include dilated pupils, extraocular deficits, ptosis, horrible headache (if patient is conscious), increased ICP, altered cerebral blood flow, and rebleeding.
In patients with aneurysms (SAH), what is a potential complication that is the narrowing of the arteries adjacent to the aneurysm that results in ischemia?
In stroke patients, what is the first test performed?
It is important to quickly identify whether a patient is a candidate for thrombolytic therapy if he just had what type of stroke?
Medication that lyses clots and restores blood flow to the ischemic area which limits secondary brain damage and improves overall neurological function; does not affect the infarcted area but revitalizes the ischemic area
onset of symptoms < 3 hours, age > 18, CT scan diagnosis, deficit using NIHSS scale
4 inclusion criteria for thrombolytic therapy with a patient who had an ischemic stroke
In a patient who had an ischemic stroke, thrombolytic therapy cannot be used in a patient who had a systolic BP > _____ or a diastolic BP > _____ on 2 readings.
In a patient who had an ischemic stroke, thrombolytic therapy cannot be used in a patient whose glucose is < ____ or > ____.
0.9 mg/kg, one minute, 60 minutes
When administering ateplase, give __________ IV. Bolus dose (10%) given over ________, then give remaining dose (90%) over the next _________.
When giving thrombolytic therapy, __________ are held for 24 hours after administration to prevent bleeding complications.
hemorrhage, managing BP
Most common complication after ateplase administration; what can reduce this?
every 15 minutes for 2 hours, every 30 minutes for 6 hours, every hour for 16 hours
Vital sign monitoring schedule for first 24 hours after administration of thrombolytic therapy
In stroke patients, implement _________ precautions if patient has dysphagia.
transient ischemic attacks
Defined as stroke symptoms that resolve in 24 hours
What can be given to patients who have transient ischemic attacks to prevent a stroke from occurring?
Transient ischemic attacks are commonly caused by stenosis of the _______ arteries.
Can be used in managing patients with transient ischemic attacks to remove the plaque clogging the carotid arteries
small, nondominant, 3 cm, deteriorating
In an intraparenchymal stroke, _____ clots usually resolve without surgery. If surgery is considered, it is usually for bleeding that has occurred on the _________ side to prevent major complications. Surgery is considered for hematomas larger than ______ or with patients who are __________ neurologically.
Calcium channel blocker used in patients with subarachnoid hemorrhage to reduce incidence of vasospasms (acts by vasodilation)
volume expansion, hypertension, 150, 160
Vasospasms can be treated with ____________ to increase CPP (crystalloids, colloids, albumin) and also __________ keeping the systolic BP between ____ and ____.
Can be performed to treat cerebral vasospasm but is associated with risk of vessel rupture and requires anticoagulation
Increases the diameter of the vasospastic blood vessel and lasts less than 24 hours
How is an aneurysm diagnosed?
In patients who have had an aneurysm, early surgical intervention if recommended for patients in good neurological condition whose aneurysm is surgically _________. Patients with severe neurological compromise after a ruptured aneurysm may benefit from emergency ___________.
15-30 minutes, hour
In postoperative neurological surgery, neurological assessments are done every _________ for the first 12 hours, then every ______ while the client is in the ICU setting.
no (tongue can fall back into airway)
Should unconscious patients be placed on their back?
Postoperative ___________ include cerebral hemorrhage, increased ICP, hydrocephalus, seizures, and vasospasm (especially with subarachnoid bleed).
decline, increasing, CT scan
Intracerebral hemorrhage is detected by a _______ in neurological status and signs of _______ ICP and is confirmed by _________.
7 days, anticonvulsants
Seizures can occur and are most common in the first ______ after surgery. Therefore, most patients after brain surgery are on ___________.
Patients who have had brain surgery, have brain tumors, or have increased ICP need ________ prophylaxis.
Seizures that usually begin in one cerebral hemisphere and cause motor activity to be localized to one area of the body (such as arm or face); considered complex is patient is unconscious; considered simple is patient is conscious
Seizures that involve both cerebral hemispheres and cause altered consciousness, motor manifestations occur bilaterally
When seizures occur in close proximity to each other, they have the potential to lead to a life-threatening medical emergency known as ______________.
Seizures that last for 30-45 minutes can lead to neuronal necrosis, which may result in _________ neurological deficits.
Can status epilepticus cause dysrhythmias?
benzodiazepines (lorazepam, diazepam, midazolam)
In status epilepticus, after the nurse ensures a patent airway and maintains breathing and circulation, what medications are given first?
In status epilepticus, if benzodiazepines fail to stop the seizure within 10 minutes or if intermittent seizures persist for longer than 20-30 minutes, ________ or _________ are usually the next drugs administered.
propofol, nembutal (Pentobarbital)
If a patient continues to seize after benzodiazepines, phenytoin, and fosphenytoin are given, then ________ or __________ is administered. Patient may need ventilation at this point.
Is it common to see lethargy and sleepiness when a patient has just been started on seizure medications?
spinal cord injury
Occurs when force is exerted on the vertebral column resulting in damage to the spinal cord
A sign of ___________ of spinal shock is the return of the reflex activity below the level of the injury.
Spinal cord injury that results in total, permanent loss of motor and sensory function below the level of the injury
Spinal cord injury that results in the sparing of motor and sensory function below the level of the injury
The _______ the level of the spinal cord injury, the greater the functional impairment.
Patients with complete lesions at vertebral levels C1-C3 are ________ dependent.
Patients with complete lesions at vertebral levels C4-C5 experience ____________ damage.
Patients with complete lesions below C5 have ______ diaphragmatic breathing and ________ degrees of impaired intercostal and abdominal function.
Injury to what levels can cause rapid fatality?
2 priorities with spinal cord injuries
Patients with a complete lesion at C5 or above have difficulty controlling _________.
Injury to what level causes respiratory difficulty and paralysis of all four extremities?
Injury to what level causes partial shoulder function and partial elbow function?
Injury to what level causes partial shoulder, wrist, and elbow function?
Injury to what level causes partial shoulder, elbow, wrist, and hand function?
Injury to what level causes some hand weakness but should maintain normal arm function?
Injury to what level causes paralysis below midchest?
Injury to what level causes paralysis below waist?
Injury to what level causes paralysis in lower extremities, lower legs, ankles, and feet?
Injury to what level causes ataxic paralysis of rectum and bladder as well as paralysis of feet and ankles?
decreased BP, marked bradycardia
2 classic symptoms of neurogenic shock
When treating neurogenic shock, usually treating the _____ fixes the _____.
What is given to spinal cord injury patients to decrease the edema around the spinal cord causing increased blood flow to the spinal cord?
vasodilation, decreased, decreased
The usual hemodynamic response in injuries above C5 is a decrease of loss of sympathetic innervation causing ___________, _______ venous return, and ________ BP.
Medical emergency that occurs when the brain and spinal cord don't communicate
Occurs after spinal shock and is an exaggerated response of the sympathetic nervous system to a variety of stimuli (stimuli to bladder by a kinked Foley catheter, bladder distension, infection, stimuli to bowel by fecal impaction, rectal exam, stimuli to skin by bed linens, temperature extremes)
Autonomic dysreflexia can be an ongoing problem for a patient with a spinal cord lesion above _____.
Signs and symptoms of _______________ include sudden severe pounding headache, elevated uncontrolled BP, bradycardia, nasal congestion, blurred vision, profuse sweating above level of lesion, flushing of face and neck, pallor, chills, and vasoconstriction.
identify stimulus, remove it
Treatment of autonomic dysreflexia
If symptoms of autonomic dysreflexia persist even after removing the stimulus, give ____________ drugs and _______ HOB.
With increased ICP, do you see dilated or constricted pupils?
A Glasgow Coma Scale score of ____ usually means the patient is unconscious.
supraorbital pressure, sternal rub using knuckles, nail bed pressure, twist trapezius muscle
4 ways to apply painful stimulus to patient
No response in any extremity to noxious stimuli
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