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48 terms

Neuro exam Med surg 2

STUDY
PLAY
components of basic neuro assessment
loc, orientation, motor response (weakness, tremmors, paresis, speech)
Normal vs Abnormal findings
Mores stimulation required to elicit response
Loosing orientation
Frontal lobe
Affect, intellect, judgment
Temporal
Memory, understanding, speech
Broca's
expressive aphasia
Wernickes
receptive speech
Motor strip
leg, hip, turnk, arm, hand, neck, face
Parietal
sensory discriminaiton
occipital
registers visual images and interpretation (writing)
function of brainstem and complications with injury
deep coma, decerbrate posturing and death
care of pt post lumbar puncture
prone, pillow under abd 1 hr, remain flat 4 few hrs, inc fluids to replace csf
critera for cerebral death
eeg flat line, no cerb blood flow, no response to pain, flaccid muscles, no brainstem reflexs, pupils fixed
S/S of ICP
dec loc, pupillary changes from brisk 2 sluggish 2 non reactive (fixed and dilated),
NI's for ICP
improve ventilation: mild hyperventilation keeps slightly alkalatioc to help constrict bv's
meds used for ICP
manitol-osmo diuresis, lasix- lowers csf prod and diuresis, dilantin-antio convulsant, phenobarb-anti seiz
epidural hemotoma
bleeding btwn skull and dura. Brief loss of loc then alertness regained for a few 2 24 hrs then coma and death
subdural hemotoma
bleed btw dura and arachnoid usally venous symptoms with in a few days
S/S of subarachnoid hemmorage
severe HA, phototobia, nuchal rigidity, Kernig and Brudzinskis signs
Kernig
pain when bending legs 90 degrees
Brudzinski's
bend neck hip will flex
S/S of autonomic hyperflexia
profuse sweating, flushing and blotchiness above injury, inc B/P, HA, nasal stuffiness. pale and cool below level of inj
What is spinal shock
sympathetic NS pathways are blocked by the injury unable to vasoconstrict below level of inj, vessels vasodilate causing vasogenic shock
TIA
transient ischemic attach-episodes of ischema lasting 5-30 mins up to 24 hrs
Symptoms of Right CVA
left paralysis, socially innappropriate, poor judgment, impulse motor performance, denies deficits, left side neglect
Left CVA symptoms
intellect & language impairment, thought process not imparied just mechanics, Right side neglect and weakness, depression, frustration
positioning and support for hemipalegia
unaffected side first
support affected side
hemianopsias
vison impaired on affected side need to turn head
TIA meds
antiocoags, thrombolytics, ccb, nimodipine (lowers vasospasam and infarcts)
complications of caratoid endarterctomy
cerebral embolus, neck hemotoma, crainal nerve damage and rupture
S/S od meningitis
nuchal ridigity, HA, dec loc
olfactory
smell #1
optic
visual fiels and acuity 2
oculomotor
3 pupil restriction eyelid elevation medial eye movement
trochlear
4 oblique eye movement, visually follow fingers
TRIGEMINAL
5- 3 areas of face sensation. temporal and masseter muscles
abducens
6- lateral eye movement
facial
7- taste facial expression, raise and lower eyelids, frown, smile
acoustic
8-sensory hearing and balance
glossalpharyngeal
9-gag reflex, pharynx, parotid gland
vagus
10-swallowing, assess for horseness (larynx)
assessory
11- turning head and shrugging shoulders
hypoglossal
12 stick out tongue ck for deviation
normal ICP
0-15
normal ccp
70-80
formula for ccp
map-icp=ccp
acute phase of aids
1-3 wks after exp flu like symptoms developing antibodies to hiv
early chronic phase of aids
aprox 11 yrs, cd4= greater than 500, asymptomatic, low grade fever, night sweats
late chronic phase of aids
cd4 count less that 200, fungal, viral and bact infect, pneumonia, k. sarcoma, wasting syndrome