Neuro

Delirium vs dementia

1. Delirium- Acute, dramatic onset, common causes= illness, toxin, withdrawal, usually reversible. Poor attention and fluctating arousal level. 2. Dementia: Chronic, insidious onset, usually not reversible, attention usually unaffected and normal arousal level.

A patient was diagnosed with cauda equina syndrome and neurosurgery has been consulted. What is the NP responsibility in anticipation of surgery? A. discuss the MRI results and how the nerves are affected B. discuss rehab after surgery C. order small freq meals to prevent nausea D. explain the surgery to the pt

A

What is the most important assessment finding in determining pts mental status? A. orientation level B. attention C. memory D. affect

A

Your patient had suffered a spinal cord injury. What sign indicates recovery has begun? A. increase in DTRs B. bradycardia C. edema D. moderate rr

A

Your patient has had a CVA and is now having trouble feeding himself. Who do you consult? A. OT B. PT C. social work D. case management

A

Your patient is s/p craniotomy and is about to d/c home. You notice ataxic gait and holding the wall while walking. What is your action? A. consult PT B. d/c home C. make outpt PT appt D. 2nd guess the RNs assessment

A

Your patient presents to the ED with ischemic stroke-like symptoms. Her BP is 160/90 and she is on norvasc. Symptom onset was 4 hours ago. Which of the following is a contraindication to fibrinolytic tx? A. time B. PMH C. age D. BP

A

Your patient has a severe closed head injury. VS are listed. Which value is crucial in evaluating him for brain death? A. pt had a gag and cough reflex B. pt is not normothermic C. pt is not normotensive D. documenting family opinion on whether the pt is brain dead

B

60yo M presents to the ER and his child reports that he passed out in the car while driving, regained consciousness and was drooling and out of It. Pts HR and BP are decreased. You give nimodipine. What is the rationale for administering nimodipine?

CCB counteracts vasospasms s/p CVA

What CN are you testing when: hands on the side of the pt face and ask them to chew

CN V, trigeminal nn

Initial action in a pt with new onset seizures?

CT scan

Change in LOC: what test to order?

CT wo contrast

CVA tPA contraindication

CVA two months ago

Your patient has a closed head injury and is ventilated. ABG 7.48 ph, 35 pco2, fio2 40%, po2 60. What is the recommended action? A. increase fio2 to 60% B. decrease TV C. decrease RR D. leave as is

D co2 in head trauma goal = 35, permissive hypocapnea

CN that are SENSORY only

I, II, VIII

What is the pathology of parkinson's disease?

Imbalance between ACH and dopamine in the corpus striatum

Latest sign that you missed a herniation?

Pupil change and positive babinski (toes fan UP/out)

Pt with a 50% Right sided carotid artery occlusion, right sided weakness that went away. Meds?

TIA- ASA, plavix

CN that are BOTH sensory and motor

V (trigeminal) VII (facial) IX, (glossopharyngeal) X (vagus)

s/s of left middle cerebral aa infarct

aphasia

You are performing a MMSE on a pt and the wife is in the room, what do you do?

ask wife to leave

Patient has a hip fracture, carotid bruit, weakness, and confusion. What do you order?

carotid US

What CSF values are characteristic of bacterial meningitis?

high opening pressure high protein high WBC low glucose

Status epilepticus- meds not working, low sao2/desating, family can't decide... what is your first action?

intubate

Pt with TBI and increasing hypercapnia/lethargy. The NP is worried about ICP, what should she considered?

intubation to control CO2

homonymous hemianopsia definition

loss of L or R visual field in BOTH eyes

Cauda Equina Syndrome MEDICAL EMERGENCY 18 nn roots of the cauda equina at base of the spine s/s? s/s at specific points of the spinal cord? causes?

pain, numbness, tingling and low back pain radiating into leg (s) S1-S2: weak plantar fxn with loss of ankle jerks, foot drop S3-S5: loss of bowel/bladder, mm weakness, sensory loss in the dermatomal distribution of the affected nn roots causes: tumor, spinal stenosis, herniated disc, cancer, infection, inflammation

MG patho, s/s, and tx?

patho: reduction of the # of Ach receptor sites at the neuromm jxn s/s: ptosis, diplopia, extremity weakness worse w/ exercise, resp difficulty tx: anticholinesterase drugs like prostigmin, plasmapharesis, immunosuppressives, vent may be needed in crisis

What is the number 1 cause of death in dementia pts?

pneumonia (think aspiration)

Which muscle moves the eye from center to side and back?

rectus

MSE test on an older pt, the test is?

reliable

Chronic subdural hematoma: s/s? management?

s/s: insidious onset of HA, light-headedness, cognitive impairment, apathy, somnolence, and occasionally seizures management: surgical evac in pts with potential for recovery if there is evidence of mod-severe cognitive impairment, if progressive neurologic deterioration, or if clot thickens >10mm or midline shift >5mm

A patient has hyperactive reflexes of the lower extremities. The AGACNP assess for ankle clonus by?

sharply dorsiflexing and maintaining the foot in this position, while supporting the knee

MS, tx for flare up? patho?

steroids patho- autoimmune dx, immune system attacking myelin

You are examining a pt with PMH of seizures. Pt sustains a seizure lasting around 1 min. What is the most appropriate intervention?

valium 5-10mg IV