48 terms

Neuro exam Med surg 2

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
Memory, understanding, speech
expressive aphasia
receptive speech
Motor strip
leg, hip, turnk, arm, hand, neck, face
sensory discriminaiton
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
pain when bending legs 90 degrees
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
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
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
smell #1
visual fiels and acuity 2
3 pupil restriction eyelid elevation medial eye movement
4 oblique eye movement, visually follow fingers
5- 3 areas of face sensation. temporal and masseter muscles
6- lateral eye movement
7- taste facial expression, raise and lower eyelids, frown, smile
8-sensory hearing and balance
9-gag reflex, pharynx, parotid gland
10-swallowing, assess for horseness (larynx)
11- turning head and shrugging shoulders
12 stick out tongue ck for deviation
normal ICP
normal ccp
formula for 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