Acute Neuro Concise
Left side Stroke CM review
- Difficulty understanding spoken and written language - Difficulty expressing spoken and written language - Changes in speech - Verbal memory issues - Impaired logic - Sequencing issues
Right Side Stroke CM review
- Impairment in attention - Memory issues - Decreased awareness of deficits - Loss of "big picture thinking" - Altered creative/music perception
Most common RIGHT sided stroke s/s:
- Impulsiveness - Vision affected - Emotional state
normal range of glucose in CSF? lower glucose may indicate?
40-70 Lower may indicate bacterial meningitis
The nurse should maintain CPP above how many mm Hg to preserve cerebral perfusion?
60 Normal CPP range 70-100
MAP perfusion WNL
>70 for adequate perfusion in the brain (70-150)
CM right side stroke?
A patient who sustains a stroke on the right side of the brain shows impulsiveness. Paralyzed left side. Impulsivity, left-sided neglect, and short attention span are all manifestations of right-sided brain damage
Which patient does the nurse suspect may have a lesion in the medulla of brain?
A patient with cluster breathing
Major arteries of the brain & area of function
ACA - Frontal MCA - Frontal, temporal, parietal PCA - Occipital, Cerebellum They all connect in circle of willis
When assessing a patient with a traumatic brain injury, the nurse notes uncoordinated movement of the extremities. How should the nurse document this assessment?
Ataxia
autonomic dysreflexia (hyperreflexia) CM
Autonomic dysreflexia is characterized by sudden headache, severe hypertension that can lead to stroke, sweating and flushing above the level of injury, and cool pale skin with gooseflesh (piloerection) below the level of injury.
A patient is suspected of having disruption of motor fibers in the midbrain after sustaining a head injury. What clinical manifestation does the nurse anticipate finding as a result?
Decerebrate posturing
Which part of the spinal cord carries impulses for muscle movement?
Descending tract
Sympathetic nerves "Fight or flight" FUNCTIONS
Dilate pupils Inhibit salivation Increase heartbeat Relax airways Inhibit activity of stomach Stimulate release of glucose Inhibit gallbladder Inhibit activity of intestines Relax Bladder Promote ejaculation and vaginal contraction Secrete epinephrine and norepineprine
The nurse is performing a two-point discrimination test. What will this help the nurse assess for?
Diseases of the sensory cortexDiseases of the peripheral nervous systemIt evaluates the cortical integration of sensory perception, which occurs in the parietal lobes
BP during acute stroke note
Elevated BP is a protective response to maintain cerebral perfusion, and antihypertensives should be started only if the BP is markedly increased
Frontal lobe
Emotional control. Reasoning and thought. Decision making, Judgement
Two common options for treating the aneurysm
Endovascular therapy (aneurysm coiling) and Surgical clipping.
Very detailed glascow breakdown?
Eye 4 Spontaneous 3 To speech 2 to pain 1 No response Verbal 5 AOX3 4 Confused 3 Inappropriate 2 Incomprehensible 1 No response Motor 6 Obeys 5 Localized pain 4 Flexion from pain 3 Abnormal Flexion (decorticate) 2 Abnormal Extension (decerbrate) 1 No response 8 or less = comatose
The nurse is caring for a patient with meningitis that has a fever. Which parameter should be monitored to prevent complications for this patient?
Fluid intake
A patient has Broca's aphasia. Which lobe of the brain does the nurse anticipate to have been affected by a stroke?
Frontal lobe The frontal lobe of the brain is related to reasoning, planning, parts of speech, movement, emotions, and problem solving
The nurse is reviewing the laboratory results for a patient with bacterial meningitis. Which does the nurse anticipate observing in cerebrospinal fluid analysis?
Glucose levels in the CSF are decreased in a patient with bacterial meningitis Neutrophils, lymphocytes, and protein levels are increased.
A patient is reported to have a brain abscess in the occipital lobe. When assessing the patient, which symptoms would the nurse expect to find?
Headache and fever Nausea and vomiting Visual impairment and hallucinations
Midbrain
Heartbeat, digestion
The patient has a sudden onset of symptoms including headache and vomiting. The nurse observes that the patient is also drowsy. Which condition may this patient be experiencing?
Hemorrhagic stroke
Glioblastoma multiforme
Highly malignant and invasive disease and one of the most devastating forms of primary brain tumor
Hypothalamus
Homeostasis Controls and regulates: Circadian rhythms, temperature, appetite, water balance, blood vessel constriction and dilation Emotional role in Anger, fear, pleasure, pain, affection.
Complications from SAH due to aneurism?
Hydrocephalus Cerebral vasospasm Seizures
A nurse is caring for a patient who has increased intracranial pressure and diabetes insipidus. When monitoring urine output, for what is the nurse assessing the patient?
Hypernatremia Hypernatremia is a symptom of diabetes insipidus, so the nurse must monitor this patient's urine output carefully
Upper vs lower motor neuron injuries
Hyperreflexia is associated with upper motor neuron (UMN) lesions. Areflexia or hyporeflexia, denervation atrophy, and decreased muscle tone are associated with lower motor neuron (LMN) lesions.
Inter-cerebral hemorrhage is usually a result of
Hypertension
Which are components of a secondary intracranial injury?
Hypoxia Ischemia Hypotension Increased intracranial pressure
The nurse is caring for a patient in the neurologic intensive care unit with increased intracranial pressure (ICP). What nursing actions will promote the most positive outcome for the patient?
ICP monitoring Elevating the head of the bed 30 degrees Maintaining a systolic arterial pressure of 100-160 mm Hg
A patient who sustained a stroke is having a severe headache, vomiting, dysphagia, dysarthria, and eye movement disturbances. What type of stroke does the nurse determine to correlate with these clinical manifestations?
Intracerebral hemorrhage
When a patient has meningeal irritation from bleeding, what signs may present?
Kernig's sign (leg thigh to abd flex) Brudzinski's sign (hip knee w/neck)
Temporal lobe
Language, hearing, memory
Why is an older adult patient who falls at a high risk for a chronic subdural hematoma?
Larger subdural space Chronic subdural hematomas are more common in older adults because of the potentially larger subdural space as a result of brain atrophy
With a basilar skull fracture, Which of the following observations are relevant to this diagnosis?
Leakage of cerebrospinal fluid (CSF) from the nose or ear Raccoon sign Battle's sign
The nurse observes that a patient's eye jerks while looking to the left. What could be the reason for this symptom?
Lesions in the brainstem Lesions in the cerebellum Nystagmus is a jerking or bobbing of the eyes as they track a moving object. Nystagmus can be caused because of lesions in the cerebellum, brainstem, or vestibular system
A patient is unable to recognize the form of an object by touch. What could be the cause of this disorder?
Lesions in the parietal cortex The inability to recognize an object by touch is known as astereognosis. The parietal cortex plays an important role in producing planned movements, and lesions in the parietal cortex result in astereognosis
What artery feeds all lobes and is the most common artery for ischemic stroke?
MCA - Medial cerebral artery Artery that feeds frontal lobe? ACA
Cerebral vasospasm can cause a variety of signs and symptoms such as
Neurological deficits Raresis or paralysis Restlessness, Motor weakness, Speech difficulties, Increase in ICP
A patient with a brain tumor presents with symptoms of visual disturbances and seizures. When evaluating the patient, the nurse knows that this tumor is most likely located in which area of the brain?
Occipital lobe
What tumors (the lobe) cause vision disturbances and seizures?
Occipital lobe
Which type of nerve helps the client's pupil constrict?
Parasympathetic-motor
A patient with a brain tumor reports speech disturbances and inability to write. Which part of the cerebral hemisphere may be affected by the tumor?
Parietal lobe
The nurse is caring for a patient that has developed hydrocephalus. Which surgical procedure does the nurse prepare the patient for?
Placement of a ventriculoatrial shunt
The nurse is assessing a patient's facial nerve (CN VII) integrity. What should the nurse ask the patient to do?
Raise eyebrows Purse lips together Close eyes tightly
Somatic Nervous System (CNS)
Responsible for carrying motor and sensory information Composed of nerves that connect to skin, sensory organs, and skeletal muscles. Responsible for nearly all voluntary muscle movements Processes sensory information from external stimuli (hearing, touch, sight)
Pons
Responsible for certain reflex actions: chewing, tasting, saliva production
Subarachnoid hemorrhage is usually a result of
Ruptured aneurysm
Parietal lobe
Sensation, sensory input (environmental). Motor sensory function. (dexterity, left vs right)
The nurse is performing a pupillary assessment in an unconscious patient. Which functions will the nurse be able to accurately assess?
Size Shape Reactivity
Thalamus
Sorts dataSits on top of brain stem. Directs sensory impulses to the cerebrum
Spinal shock
Spinal shock involves loss of all motor activity (both voluntary and reflex) below the level of spinal injury. It is reflected in a flaccid paralysis. In addition, loss of reflex sympathetic vasomotor tone causes vasodilation and peripheral pooling that results in a neurogenic shock, with hypotension, bradycardia, and warm dry skin.
The nurse is performing a neurologic assessment. Which test would the nurse use to assess cortical sensory function?
Stereognosis Graphesthesia Two-point discrimination
The nurse is attempting to elicit the brachioradialis reflex in a patient during a neurologic assessment. What technique will the nurse use that will be most effective?
Strike the radius 3 to 5 cm above the wrist while the patient's arm is relaxed
high doses of NSAIDs increase risk of
Stroke
Most common LEFT sided stroke s/s:
Sudden trouble speaking or understanding— aphasia. Sudden trouble seeing the right side of the world from both eyes—homonymous hemianopsia. Sudden lightheadedness Trouble walking, loss of balance, or coordination. Sudden severe headache with no known cause
Clinical manifestations with different tumor locations
Temporal - Dysphagia Occipital - Diplopia Frontal - Unilateral ataxia; cognitive changes
Tumors in what lobe cause seizures and dysphagia?
Temporal lobe
Which test is used to diagnose diseases of the vestibular system?
The caloric test stimulus is used to check for nystagmus, nausea and vomiting, falling, or vertigo. These conditions are associated with diseases of the vestibular system.
What is the function of spinocerebellar tracts?
The spinocerebellar tracts carry information about muscle tension to the cerebellum to coordinate movement
A patient is being evaluated for an ischemic stroke. The patient tells the nurse that the primary health care provider indicated that a narrowing of blood vessels caused the stroke. Which type of stroke does the nurse explain that the patient has?
Thrombotic
A patient with a lesion in the central nervous system has developed spasticity with hyperreflexia, weakness, paralysis in the lower extremities, and disuse atrophy. Where does the nurse suspect this lesion may be located according to the clinical manifestations?
Upper motor neurons Upper motor neurons influence skeletal muscle movement. Upper motor neuron lesions generally cause weakness or paralysis, disuse atrophy, hyperreflexia, and spasticity
"Triple H" therapy
Used to treat cerebral vasospasm, with the aim of preventing stroke: Hypertension Hypervolemia Hemodilution
A nurse elicits the gag reflex in a patient. Which cranial nerve is the nurse assessing with this technique?
Vagus nerve Glossopharyngeal nerve
What is the gold standard for measuring intracranial pressure (ICP)?
Ventriculosotomy
Which condition may be associated with a positive Romberg sign?
Vestibulocochlear dysfunction Disease in posterior columns of the spinal cord
Occipital lobe
Vision. Long term memory
abscesses of the temporal lobe may cause
Visual field defects and psychomotor seizures
The nurse is assessing a patient with a recent stroke and observes that they do not appear to understand spoken words. What part of the cerebrum does the nurse recognize is damaged?
Wernicke's area (werickes is understanding, brocas is expression)
Diabetes insipidus r/t neuro
When this occurs, water reabsorption from the renal tubules is decreased, and a profound diuresis of extremely dilute urine (low urine osmolality) occurs. This results in systemic dehydration (high serum osmolality)
Hypertonic saline treatment
Works similarly to mannitol in treating increased ICP. Provides massive movement of water out of swollen brain cells The nurse should frequently monitor the blood pressure and sodium levels
SubArachnoid Hemorrhage (SAH) may be due to
a cerebral aneurysm that has ruptured and resulted in bleeding. Sudden severe headache ("worst headache ever") with few neurological symptoms is a common presentation
Autonomic dysreflexia (hyperreflexia) can be a life-threatening complication of spinal cord injury. The most common precipitating cause is:
a distended bladder or rectum
Lesions on mid or lower pons cause
apneustic breathing
SAH resulting from a cerebral aneurysm is characterized by
arterial bleeding into the subarachnoid space
percussion wave
arterial pulsations
What part of the brain coordinates voluntary movement and maintains trunk stability and equilibrium?
cerebellum
Cytotoxic cerebral edema results from
disruption of the integrity of the cell membranes from lesions or trauma
Autonomic dysreflexia is characterized by
exaggerated sympathetic nervous system responses
Possible harmful effects of high-dose steroids include
gastrointestinal bleeding and infection
A patient with a left-sided stroke may exhibit
has hemiplegia on the right, is more likely to have communication problems, and needs mobility assistance
Secondary SAH increases what?
intracranial pressure (ICP) and may result in greater neurologic damage and more symptoms. Rebleeding frequently occurs within the first 24 hours of an initial bleed and may be fatal.
Solu-Medrol (methylprednisolone)
minimize post-injury spinal cord damage
Osmitrol (mannitol) is administered. In response to the administration of Osmitrol (mannitol), you expect which results?
ntracranial pressure (ICP) to decrease Cerebral edema to decrease Urine output to increase
Dilantin (phenytoin) adverse effect?
onset of cardiac dysrhythmias
Venous pooling contributes to
orthostatic hypotension
Tidal wave and rebound waves
represent relative brain volume
Temporal lobe tumors cause
seizures and dysphagia.
A patient with a right-sided stroke may exhibit
spatial-perceptual deficits, tends to minimize problems, has a short attention span, is impulsive, and may have impaired judgment. Safety is the biggest concern for this patient. Hemiplegia occurs on the left side of this patient's body
A positive Dextrostix test indicates
that CSF is leaking from the nose or ear. The fluid from the nose generally leaks due to a cerebrospinal leak and results in CSF rhinorrhea
Atrial fibrillation increases the risk of a
thrombotic stroke
dicrotic wave
venous pulsations
Occipital lobe tumors cause
vision disturbances and seizures
Autonomic Dysreflexia Symptoms
•Flushing, diaphoretic •Pounding headache •Sudden increase in BP •Vision changes •If possible place patient in sitting position to increase blood flow to extremities and lower BP •Remove noxious stimuli
Interventions to optimize ICP and CPP
•HOB elevated appropriately (30) •Prevent extreme neck flexion •Turn slowly•Avoid coughing, straining, Valsalva •Avoid hip flexion
Autonomic dysreflexia (hyperreflexia) description and interventions?
Autonomic dysreflexia is characterized by sudden headache, severe hypertension that can lead to stroke, sweating and flushing above the level of injury, and cool pale skin with gooseflesh (piloerection) below the level of injury.When possible, head elevation should be implemented immediately when autonomic dysreflexia occurs. This measure helps reduce blood pressure by encouraging pooling of blood in the legs. If worn by the patient, graduated compression stockings should be removed to allow venous pooling. Remove the noxious stimuli
A patient presents with a shunt malfunction related to increased intracranial pressure (ICP). On examination, which findings would the nurse observe?
Blurred vision Headache and vomiting Decreased level of consciousness
A patient presents with a head injury and is suspected to have a temporal fracture. Which manifestations should the nurse assess further?
Boggy temporal muscle Cerebrospinal fluid (CSF) otorrhea Oval-shaped bruise in the mastoid region
A patient has an alteration in sleep-wake transitions causing extreme fatigue. Which part of the central nervous system (CNS) is responsible for this?
Brain stem The brain stem includes the reticular activating system (RAS), which is responsible for regulating arousal and sleep-wake transitions.
slurred speech indicates that
Broca's motor speech area of the brain is affected. It can be a sign of increasing ICP
A patient with a suspected spinal cord infection is admitted to the hospital. What diagnostic tests should the nurse anticipate for the patient?
Cranial myelogram Measurement of cerebrospinal fluid pressure
A patient with meningitis developed loss of the corneal reflex. Which cranial nerve irritation would have led to the loss of the corneal reflex?
Cranial nerve V
A patient states that he or she is having involuntary blinking. Which nerves should the nurse should evaluate?
Cranial nerve V Cranial nerve VII
The nurse is caring for a patient with altered function of the lungs and digestive system. Which cranial nerve should the nurse assess?
Cranial nerve X, the vagal nerve, transfers information from the heart, lungs, and the digestive system.
A patient demonstrates a lack of coordination in articulating speech. What could be the cause of this symptom?
Cranial nerve lesion Antiseizure medications Lack of coordination in articulating speech is called dysarthria. Cranial nerve lesions may be responsible for this because of their association with the regulation of speech. Slurred speech can also be a side effect of the long-term use of antiseizure medications
A patient sustains a skull fracture and has loose fragments of bone. For which procedure will the nurse prepare the patient?
Craniotomy A skull fracture with loose fragments of bone requires a craniotomy to elevate the depressed bone and remove the bone fragments. A craniectomy will be performed when large amounts of the bone are destroyed
A patient is diagnosed with a brainstem tumor. When assessing the patient, which symptoms would the nurse expect to find?
Crossed eyes Facial muscle weakness Headache on awakening
When intracranial pressure increases dramatically, what s/s are exhibited?
Cushings triad
Dilantin (phenytoin)
Anticonvulsant, is used to prevent seizures. Seizures may occur as a result of primary brain injury or secondary injury associated with increased intracranial pressure (ICP).
Medulla oblongata
Center for respiration Regulates:- Heart and blood vessel function, Digestion, Respiration, Swallowing, Coughing, Sneezing, BP
A nurse is teaching a group of caregivers how to assess patients for facial nerve palsy. Which methods of assessment of facial nerve palsy should be included in the teachings?
Ask the patient to whistle Ask the patient to shut his or her eyes as tightly as possible
A patient with meningitis is scheduled for a lumbar puncture. When is the appropriate time for the nurse to prepare the patient for the procedure?
After the blood culture test Before starting the antibiotic therapy After the computed tomography (CT) scan A lumbar puncture is performed after a blood culture test because it may help assess infection. Antibiotic therapy should be given after a lumbar puncture, while awaiting the results of cerebrospinal fluid analysis. Computed tomography (CT) and magnetic resonance imaging (MRI) scan reveal increased intracranial pressure (ICP) and cerebral edema. If there is increased ICP, a lumbar puncture cannot be performed
A patient with meningitis has seizures, cranial nerve (CN) III palsy, and bradycardia. What is the most likely cause for the development of these symptoms?
Acute cerebral edema is a complication of meningitis that causes seizures, cranial nerve III palsy, and bradycardia
A patient experiences a head injury in a motor vehicle crash. Which priority actions does the nurse anticipate providing when planning the care of the patient?
Administering oxygen. Maintain neck alignment Establish intravenous (IV) access.
Oligodendroglioma
Benign tumors
After head injury, if ICP increases, the increase is usually a result of
Bleeding Inflammation
The nurse receives a patient suspected of injury to the basal ganglia. What functions would be affected in the patient due to the injury?
Blinking Swallowing saliva Swinging the arms while walking
A patient with meningitis has a weakness of the left upper limb and lower limb, blurred speech, and reduced vision. The symptoms did not resolve after treatment. What does the nurse infer from these symptoms?
Cerebral abscess Weakness of the left upper limb and lower limb (hemiparesis), blurred speech (dysphasia), and reduced vision (hemianopsia) are symptoms that typically resolve after meningitis treatment. If these symptoms persist, cerebral abscess is suspected
A nurse is caring for a patient for whom the health care team suspects cerebral death. Which diagnostic procedure will the nurse prepare the patient for that will confirm this suspicion?
Cerebral angiography
A patient is suspected of having a subarachnoid hemorrhage. For which diagnostic test will the nurse prepare the patient, as the most reliable diagnostic study to identify the source of subarachnoid hemorrhage?
Cerebral angiography
Bilateral hemispheric disease causes
Cheyne-Stokes pattern of breathing
An older adult patient fell and hit their head on a coffee table 2 weeks previously. What type of hematoma should the nurse suspect may have occurred in this patient?
Chronic subdural hematoma
Abnormal CSF
Cloudy. The presence of more than five white blood cells/μL in the cerebrospinal fluid indicates infection. The presence of red blood cells in the cerebrospinal fluid indicates bleeding
Anisocoria
Condition where the client's pupils are unequal in size and constricted
Parasympathethic Nerves "rest and digest" FUNCTIONS
Constrict pupils Stimulate saliva Slow heartbeat Constrict airways Stimulate activity of stomach Stimulate GI activity Inhibit release of glucose Stimulate gallbladder Contract bladder Promote erection of genitals
CM left side stroke?
Impaired speech, slow performance, and a paralyzed right side occur when a patient has stroke on the left side of the brain Right hemiplegia, impaired speech/language, impaired right/left discrimination, and slow and cautious performance
A nurse is caring for a client with a tumor of the cerebellum. What clinical manifestation does the nurse expect the client to exhibit?
Inability to execute coordinated movements
After assessing the patient, the nurse declines to administer mannitol to the patient. Which condition supports this nursing intervention?
Increased serum osmolality
Which intervention should be implemented for a paralytic ileus?
Insert a nasogastric tube and set the siphon drainage to a low, intermittent suction
Which of the following nursing interventions are aimed at preventing/controlling increases in ICP?
Maintaining head of bed elevation Avoiding neck flexion Spacing physical activities Maintaining a relaxed physical and emotional environment
During the acute phase of stroke management, the most important nursing intervention to decrease risk of aspiration is what?
Maintaining nothing by mouth (NPO) status.
The nurse is monitoring a patient who has undergone a craniotomy. What is the priorityaction by the nurse?
Monitor the patient for increased intracranial pressure (ICP). A hemorrhage will cause an increase in ICP if it is cerebral.
Basal Ganglia
Motor control
Cerebellum
Motor control Muscle coordination Balance Posture
concussion
Movement of brain tissue in the skull
A patient is suspected to have a spinal lesion. What diagnostic test will the nurse prepare the patient for?
Myelogram Myelogram is a radiation technique that helps detect spinal lesions in patients
Signs and symptoms that would reflect increasing intracranial pressure
Nausea, vomiting, and seizure
