Neuro

What are some s/s of left hemispheric stroke?

Aphasia, slow, cautious behavior (aware of deficits), depression, right-sided weakness and altered intellectual ability are symptoms of a stroke on this side.

What issues can cerebral angiography detect?

This diagnostic test can detect aneurysms, arterial blockage, some tumors and presence of arterial spasm.

Neurological issues account for this amount of hospital admissions:

25% of hospital admissions include these type of issues.

A potential complication of a hemorrhagic stroke is interference with the ability of the arachnoid villi to absorb CSF. Therefore, fluid in the ventricles increase beyond the amount that is usually absorbed daily, which is:

350 to 375 mL of this is usually absorbed daily.

If a MRI is contraindicated, a nurse may see an order for this:

Myelogram with xray may be used when this is contraindicated.

If NOT contraindicated, when should neuro sign assessments generally be performed and assessed: frequently or over time?

Both of these are appropriate frequencies for neuro sign assessments if not contraindicated by the patient's condition such as a pt w/ increased ICP (overstimulation can further increase it). Assessing them frequently monitors for acute, quick changes, and assessing them over time monitors for slower, progressive changes.

A pt sustains whiplash in a car accident. What type of brain injury might you see?

Coup-Contracoup bruising of the brain may occur with this type of accident. This is a contusion affecting 2 sides of the brain.

This neurological diagnostic procedure is used to visualize innervation of skeletal muscle:

EMG is used for this. This includes monitoring the speed of impulse to the limbs, etc. via peripheral nerves to see if damage has occurred.

This neurological diagnostic procedure is used to visualize electrical activity associated with nerve conduction:

EPR is used to detect this. This includes diagnosis of optic-neuritis, acoustic neuromas (tumors) and MS.

A client with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client?

Hydration and fluid restriction may be necessary if the client develops cerebral edema and hypervolemia from SIADH.

What are some s/s of right hemispheric stroke?

Impulsiveness, short attention span, poor eye/hand coordination, spatial-perception deficits and left neglect are symptoms of a stroke on this side.

Nursing interventions following cerebral angiography include:

Interventions after this procedure include monitoring of vital signs, including cap refill and pulse in affected extremity, monitoring for insertion site bleeding, LOC, pupillary response, orientation, muscle strength and tone.

Interventions for a pt with increased ICP include:

Interventions for this condition include administering stool softeners to reduce strain during BMs, try and prevent pt coughing, keep pts head in midline position and avoiding neck flexion, positioning HOB >= 30 deg, minimizing stimulation (if suctioning, don't do it vigorously) and minimizing noxious stimuli. Hyperoxygenation may be indicated in emergent situations to prevent vasodilation.

What osmotic diuretic is most commonly used to reduce ICP?

Mannitol is used to accomplish this. Can't be used if pt is hypovolemic or if it contains crystals. IV bolus of hypertonic saline (3%) is an alternative measure if mannitol is contraindicated.

A patient has signs of increasing ICP. What is an early indicator of deterioration in the client's condition?

One of the first signs of this is a decrease in LOC. Changes in LOC, such as irritability or restlessness may be subtle. It is the most sensitive indicator.

This diagnostic test visualizes O2 uptake in the brain:

PET scans can visualize the brain to monitor uptake of this and other metabolic activity, including glucose metabolism.

What can cause a TIA?

Temporary blood clot or cerebral arterial spasm.

What is the gold standard tool for ICP monitoring and CSF drainage?

The gold standard tool for these 2 things is an EVD (External Ventriculostomy Drain). This should be level to the tragus of the ear. If it is too high, may result in UNDER drainage and ICP remains ELEVATED. If it sits too low, can result in OVER drainage and HEMORRHAGE. Notify MD if drainage exceeds 30 cc/hr!

Which is the initial diagnostic test for a stroke?

The initial diagnostic test for this is nonconstrast computed tomography, performed emergently.

What is normal cerebral perfusion pressure?

The normal level of this is 70 - 100 mm Hg. This measurement is more important than ICP alone (normal ICP <15), because it incorporates ICP, as well as mean arterial pressure, to quantify how well O2 and glucose are perfusing into brain tissue.

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. Why?

The primary reason for this is that thrombolytic therapy has a time window of only 3 hours.

The nurse is caring for a patient postoperatively after intracranial surgery for the treatment of a subdural hematoma. The nurse observes an increase in the patient's blood pressure from the baseline and a decrease in the heart rate from 86 to 54. The patient has crackles in the bases of the lungs. What does the nurse suspect is occurring?

These symptoms suggest an increase in blood pressure and decrease in pulse with respiratory failure, which may indicate increased ICP (Cushings Triad).

How would you characterize decerebrate posturing?

This is characterized by an arched back, rigid extension of all 4 extremities, pronation of arms.

How would you characterize decorticate posturing?

This is characterized by internal rotation and adduction of the arms, with flexion of the elbows, wrists and fingers. The lower extremities are extended.

Decerebrate posturing is an indication of injury where?

This is indication of injury in the upper brain stem, midbrain or pons. This pt gets a Glasgow Coma motor score of 2.

Decorticate posturing is an indication of injury where?

This is indication of injury to the corticospinal tracts and cerebral hemispheres. This pt gets a Glasgow Coma motor score of 3.

What is Cushing's Triad?

This presentation includes hypertension, bradycardia and abnormal respirations (e.g. Cheyne-Stokes) and can occur in late stages (brain stem compression) of increased ICP. Other late stage sx include bilaterally fixed and dilated pupils, posturing, loss of motor/sensory function and loss of reflexes.

Lumbar puncture is contraindicated in which patients?

This procedure is contraindicated in patients with elevated ICP.

Ultrasound is a diagnostic tool that can be used in transcranial doppler studies to visualize this:

This tool can be used in studies to monitor blood flow of intracranial vessels and used to visualize vascular occlusions or reductions in blood flow.

Under normal circumstances, what 3 things affect ICP?

Under normal circumstances, 1) brain tissue (around 78% of vol), 2) blood in the vessels (12% of vol) and 3) CSF (10% of vol) affect this. The Monroe-Kellie hypothesis theorizes that the total sum of these must remain constant, so an increase of one requires compensation via a decrease in another.