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Complex Neurological Problems

Terms in this set (90)

Patients with decorticate posturing will have arms, wrists and fingers flexed __________.
inward
Patients with decorticate posturing will have ______, _______, and _________ flexed inward.
arms, wrists, fingers
__________ posturing is abnormal motor movement seen in the patient with lesions that interrupt the corticospinal pathways.
decorticate
Patients exhibiting decerebrate posturing will have _________ characterized by ____________ of the arms and legs, ______________ of the arms, plantar ___________ and opisthotonos, which is a body ________ in which the body is bowed __________.
rigidity, extension, pronation, flexion, spasm, forward
Patients exhibiting decerebrate posturing will have rigidity characterized by extension of the _______and ________, pronation of the ______, ____________ flexion, and ____________, which is a body spasm in which the body is bowed forward.
arms, legs, arms, plantar, opisthotonos
____________ posturing is usually associated with dysfunction in the brainstem.
decerebrate
Decerebrate posturing is usually associated with dysfunction in the _______________.
brainstem
The lowest possible score on the Glasgow Coma Scale is ___ and the highest is ___.
3, 15
______________ to pain means the patient withdraws from painful stimuli.
localizing
The GCS assesses __________ ____________, ___________ ____________, and __________ ___________.
eye opening, motor response, verbal response
Spontaneous Eye Opening is worth a ___ on the GCS.
4
Localizing to pain is worth a ____ on the GCS.
5
_____ _______ _________ is injecting ice water into a patient's ear to test for the presence of brain activity.
ice caloric testing
________ __________ is worth a 6 on the GCS.
obeying commands
__________ and ____________ within 20 - 30 seconds is a normal response to ice caloric testing.
vertigo, nystagmus
________ _________ measure the electrical signals to the brain generated by sound, touch or light.
evoked potentials
Evoked potential tests are used to assess _________ nerve problems.
sensory
___________ _____________ ultrasonography uses sound waves to measure blood flow through the arteries in the brain.
transcranial doppler
Injuries _________ on the spinal cord will result in more extensive damage.
higher
Spinal cord injury at the level of ____ or ____ can lead to quadriplegia.
C4, C6
Spinal cord injury at the level of ____ or _____ can lead to paraplegia.
T6, L1
____________ is the sudden movement of head forward with extreme flexion of neck.
hyperflexion
___________ occurs when the head is suddenly accelerated and decelerated towards chin.
hyperextension
__________ __________ is a vertical force that presses the vertebrae together.
vertical compression
__________ ___________ is when the vertebrae is rotated to the side beyond normal range.
excessive rotation
___________ is the force of an object that causes damage directly to spine.
penetration
_______ ______ MVA is an example of an accident that could cause hyperflexion injury.
head on
_______ _______ MVA is an example of an accident that could cause hyperextension injury.
rear end
A _______ __________ could cause vertical compression injuries.
diving accident
__________ ____________ could cause injury to the spine due to excessive rotation.
contact sports
__________ or _________ are examples of penetrating injuries.
stabbing, gunshot
The nursing priority for spinal cord injuries is monitoring the __________ and stabilizing the ________ to prevent further injury.
airway, spine
After a spinal cord injury, the nurse should monitor for _______-_________ and __________ bleeding, especially around fracture sites.
intra-abdominal, thoracic
Spinal shock occurs ___________ after injury to the spinal cord.
immediately
Neurogenic shock is also known as ____________ shock.
distributive
Neurogenic shock is the sudden, life-threatening loss of function in the ____________ nervous system.
sympathetic
Neurogenic shock causes massive ____________.
vasodilation
Treatment for neurogenic shock includes ________, __________ and/or ____________.
fluids, vasopressors, atropine
Signs and symptoms of neurogenic shock include ____________, __________, _____________ cardiac output, and loss of ability to regulate _______ __________.
hypotension, bradycardia, decreased, body temperature
Spinal shock is considered __________, as the injury causes peripheral nervous system to be ____________ to brain stimuli.
temporary, unresponsive
Signs and symptoms of spinal shock include _________ paralysis, ___________ reflexes, loss of __________, and inability to control ________ and _________.
flaccid, absent, sensation, bowel, bladder
Patients exhibiting spinal shock should be assessed frequently for __________ of __________.
return, reflexes
Treatment for spinal shock includes ___________ of the spine, prioritizing _________, placing a ______ _________ to deal with neurogenic bladder, and placing an ______ _______ for decompression and to decrease the risk for aspiration.
stabilization, ABCs, foley catheter, NG tube
Treatment for _______ shock includes stabilization of the spine, prioritizing ABCs, placing a Foley catheter to deal with __________ __________, and placing an NG tube for ____________ and to decrease the risk for _____________.
spinal, neurogenic bladder, decompression, aspiration
___________ __________ is a neurological emergency where the patient experiences sudden onset of excessively high blood pressure.
autonomic dysreflexia
Autonomic dysreflexia is common in spinal cord injuries involving the _______ _________, especially at levels ____ or below.
thoracic spine, T6
In autonomic dysreflexia, the patient is not receiving signals of ____________ from the ___________ or __________, so the body starts sending signals such as headache, bradycardia, hypertension, flushed skin, diaphoresis, anxiety, pallor, and piloerection.
fullness, bowel, bladder
In autonomic dysreflexia, the patient is not receiving signals of fullness from the bowel or bladder, so the body starts sending signals such as ________, ___________, __________, ________ skin,
________________, __________, ___________, and ______________.
headache, bradycardia, hypertension, flushed, diaphoresis, anxiety, pallor, piloerection
Patients with autonomic dysreflexia may need __________ to treat high blood pressure and ________ to treat bradycardia, but the most important treatment to to find the ________ and resolve it.
vasodilators, atropine, trigger
Patients with spinal cord injuries will typically be treated with _____-_____ ________ within ___ hours of the injury.
high-dose steroids, 8
Besides high-dose steroids, pharmacological treatment for spinal cord injuries includes __________, ___________, _____________, __________ _________ __________, _______ ___________, and ______________.
vasopressors, antispasmodics, analgesics, proton pump inhibitors, stool softeners, atropine
In patients with autonomic dysreflexia, _______ the head of the bed immediately to help ________ the blood pressure.
raise, lower
_________ traumatic brain injury is damage that occurs at the time of injury and results in physical distress in the tissue.
primary
________ traumatic brain injury is damage that occurs after the initial injury as a result of vascular or biochemical events.
secondary
Normal ICP is ___ to ___ mmHg.
10, 15
ICP greater than ____ is considered life-threatening to the brain.
20
As ICP increases, cerebral perfusion ____________, leading to ________ and ___________.
decreases, edema, ischemia
The first sign of increased ICP is often __________ LOC.
decreased
Signs and symptoms of increased ICP include _______________ changes, __________, _________ and __________.
behavior, headache, nausea, vomiting
Cushing's triad is severe ____________, widened _______ ________ and _____________.
hypertension, pulse pressure, bradycardia
___________ and __________ posturing indicate increased intracranial pressure.
decerebrate, decorticate
Pupillary changes in patients with ICP include _______ and ________ pupils (aka "blown pupils) or ____________ and ______________ pupils.
dilated, nonreactive, constricted, nonreactive
Interventions to control ICP are intended to ____________ metabolic demand and may include ____________ and ________________,
reduce, sedation, oxygenation
Nursing interventions for increased ICP include _________ the head of the bed, __________ care, keeping the ______ in a _________ position, preventing __________, maintaining ________ ___________, and maintaining normal ________ ____________.
elevating, clustering, neck, neutral, hypoxia, body temperature, blood pressure
____________ therapy is very effective in the treatment of increased ICP, but it has a ______ half-life.
barbiturates, long
Patients with a _________ intracranial aneurysm will complain of "the worst headache of their life.
ruptured
Uncontrolled _________ is a major risk factor for intracranial aneurysm.
hypertension
Monitor patients with unruptured aneurysm for ______ above or behind the eye, a dilated ______, changes in ________, numbness, tingling or paralysis of the ____________, and a ___________ eyelid.
pain, pupil, vision, face, drooping
Surgical treatments for intracranial aneurysm include ________, _________, ______ & _________, and ___________.
coiling, clipping, coil, stent, stent
Therapeutic ______________ is a possible intervention for intracranial aneurysm.
hypothermia
A _____________ hematoma is venous bleeding into the space between the dura and skull.
subdural
_____________ hemorrhage is arterial bleeding into the brain tissue.
intracerebral
__________ is a potent diuretic used to decrease intracranial pressure.
mannitol
____________ _____________ can be used to paralyze patients with increased intracranial pressure, but it has a __________ half-life.
neuromuscular blockades, short
Patients must have a _____ ________ to differentiate between ischemic and hemorrhagic stroke.
CT scan
Blood pressure has to be below _____/______ in order to receive fibrinolytic therapy.
185, 110
Fibrinolytic therapy is only indicated for patients with ___________ stroke.
ischemic
Fibrinolytic therapy is approved for administration within ____ hours of onset of stroke.
3
Fibrinolytic therapy can be adminstered within ____ hours unless the patient is older than ___ years old, taking anticoagulants, more than 1/3 of brain tissue injured, baseline stroke scale greater than ____, and a history of both stroke and diabetes.
4.5, 80, 25
Patients receiving alteplase should have their neurological status assessed every ___ to ___ minutes during infusion and every ___ minutes after that for at least ___ hours.
10, 15, 30, 6
No invasive tubes, such as NG tubes or urinary catheters, should be placed for 24 hours following alteplase therapy, to reduce risk for ____________.
bleeding
Alteplase infusion should be discontinued if the patient reports severe ________ or has severe _______________, _________, ____________ and/or __________.
headache, hypertension, bleeding, nausea, vomiting
________ ________ _________ arise from the cells and structures that are found within the brain.
primary brain tumors
___________ brain tumors originate from outside the brain.
metastatic
__________ brain tumors can still be lethal depending on their location.
benign
The most common feature of cerebral tumors is ___________.
headache
Two types of brain surgery are ___________ and _____________.
craniotomy, craniectomy
In a craniectomy, a ______ ______ is removed and not immediately replaced.
bone flap
An external ventricular drain is a device used to treat _______________ and treat increased _______.
hydrocephalus, ICP
An _______ __________ ____________ diverts fluid from the ventricles of the brain.
external ventricular drain
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