HC3 ICR
What is the normal PTT?
25-35 seconds
What are cranial nerves 3,4,6
3- Oculamotor 4-Trochlear 6-Abducens
Slow growing tumors are typically?
Benign
What are indications of increasing ICP?
Decreased LOC, pupillary changes- fixed, impaired extra ocular movements
Which of the following supplies cerebrospinal fluid (CSF) to the subarachnoid space and down the spinal cord on the dorsal surface?
Fourth Ventricle
When caring for an adolescent who's at risk for injury related to intracranial pathology, which action would maintain stable intracranial pressure (ICP)?
Keeping head midline and raised 15-30 degrees
A nurse is completing a neurological assessment and determines that the client has significant visual deficits. A brain tumor is considered. Considering the functions of the lobes of the brain, which area will most likely contain the neurologic deficit?
Occipital
What lab value ranges will exclude a pt from receiving tPa?
PLT <100,000 INR >1.7 PT>15
What is the goal of tx in a hemorrhagic stroke?
Prevent vasospasam and re bleed
What are automatisms?
Repetitive unconscious actions like lip smacking, chewing or swallowing.
What is Nuchal rigidity?
Stiff neck
What is Papilledema?
Swelling of optic disc
The nurse is preparing a client for a neurological examination by the physician and explains tests the physician will be doing, including the Romberg test. The client asks the purpose of this particular test. The correct reply by the nurse is which of the following?
Test for balance
How is a vasospasam treated?
Triple H therapy: And Nimodipine- Ca channel blocker that vasodialates arteries-watch BP Hypertension- withhold antihypertensives Hypervolemia- crystlloids or colloids (albumin) Hemodilution
A newly dx pt with a seizure disorder is prescribed valproic acid and phenytoin. A health care provider should be aware of what potential drug reaction that can occur?
Valroic acid can increase the phenytoin levels in the blood causing toxicity.
Which type of voiding dysfunction is seen in patients diagnosed with Parkinson's disease?
incontinence
What is the normal range for INR on therapy?
2-3
What diet is recommended for management of seizures?
Keto- high fat, low carb, low protein
What is a vasospasam? How many days later should you expect to see this?
Once the anuerisym ruptures the leaking blood places pressure on the artery narrowing its blood flow. this prevents cerebral perfusion Seen 4-14 days later
The area around the dead tissue that is not irreversible damage is called?
Penumbra
What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke?
Pupil Response and size
What are the complications of SAH?
SIADH ARDS MI- check cardiac enzymes and 12 lead ECG's
List the medications given for absence seizures?
*Levetracetam, *clonazepam,lamotrigine, Topiramate
List the meds given for tonic clonic seizures
*Phenobarbital, topiramate, Lamotrigine
With the NIHSS stroke scale explain how the stroke is graded.
0= no stroke 1= minor- 4= severe stroke.
Explain on how brain tumors are graded?
1 being not likely to spread and benign all the way to 4 being the most aggressive.
What is a normal PT?
11-14 seconds
A client is being monitored for transient ischemic attacks. The client is oriented, can open the eyes spontaneously, and follows commands. What is the Glasgow Coma Scale score?
15
Which terms refer to the inability to perform previously learned purposeful motor acts on a voluntary basis?
Apraxia
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
Asterixis
Which of the following are the immediate complications of spinal cord injury? A) Tetraplegia B)Spinal shock C) Paraplegia D) Respiratory arrest
B- spinal shock
What are the manifestations of SIADH and the nursing actions?
Concentrated urine, diluted blood Daily wt, fluid restriction, demecycline - reversible nephrogenic diabetes insipidous
Explain what apraxia is.
Disturbance in planing motor activity- brushing teeth with a comb.
What are the objective s/s of meningitis?
Fever, Chills, n/v altered LOC- confused, lethargic,sleepy Positive Kernig's sign - pain/resis. with extension of leg Tachycardia seizures restlessness and irritability hyperactive deep tendon reflexes Red maccular rash
A patient has been diagnosed as having global aphasia. The nurse recognizes that the patient will be unable to do which of the following actions?
Forms understandable words and understands words spoken - loss of receptive and expressive language skills
Which seizure medications cause either wt gain or loss?
Gabapentin- gain valproic acid- fluctuates
Elevating the patient's legs slightly to improve cerebral circulation is contraindicated in which of the following disease processes?
Head Injury-
A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? Cirrhosis Hepatic encephalopathy Portal hypertension Asterixis
Hepatic encephalopathy
The cushing's triad signals what complication?
Herniation
What are the different types of viral meningitis?
Herpes simplex virus Herpes zoster Mumps measles Entrovirus
List what breaks down the BBB?
Hypertension Infection Increased ICP Development- not complete at birth Hyperosmolitity- use mannitolol to decrease this Microwaves radiation Trauma, Ischemia, Inflammation
A client who is admitted to the health care facility has been diagnosed with cerebral edema. Which of the following intravenous solutions needs to be administered to this client?
Hypertonic solution
With meningitis what should be monitored and type of care should we be thinking about?
ICP- reducing stimuli, fever reduction, checking ICP, neuro assessment, reducing cough and sneezing, elevated bed 30 degrees or more, seizure precautions
What can brain occupying lesions cause?
Increased ICP
What is the term used to describe an occlusion of a small blood vessel?
Lunar Infarct
How often should neuro checks be preformed in a increased ICP pt?
Q2h
The nursing student is studying the reticular activating system (RAS). Which of the following statements indicates to the professor that the student has mastered the information?
The RAS serves to monitor and regulate incoming sensory stimuli.
How is Basilar artery syndrome is different than the other types of CVA?
The basilar artery along the brain stem is affected and the injury (weakness, loss of feeling) is ipsilateral of the side effected.
The emergency department nurse has admitted an infant with bulging fontanels, setting sun eyes, and lethargy. Which diagnostic procedure would be contraindicated in this infant?
The child is exhibiting signs and symptoms of increased intracranial pressure (ICP). A lumbar puncture is contraindicated in children with increased ICP due to the risk of herniation.
A client experiences a head injury in a motor vehicle accident. The client's level of consciousness is declining, and respirations have become slow and shallow. When monitoring a client's respiratory status, which area of the brain would the nurse realize is responsible for the rate and depth?
The pons in the brain stem control rate and rythem of respiration's
Why is SIADH a complication of meningitis?
There is abnormal stimulation to the hypothalmic area of the brain causing excess secretion of anti-diuretic hormone (vasopressin)
Hemaparesis
Weakness on one side
What is the normal range for MAP
minimum of 60 but 70-110 is adequate
How often should a neuro assessment be given after administering tPa?
q15min x 6hrs q30min. for 2 hrs q1hr for 16 hours
What are the 2 surgical options for an aneurysm?
Clipping or a coil
Which microorganism infects the sinuses causing a fungal meningitis ?
Cryptococcus neoformans
After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective in the client does not develop:
Seizures
What is Brudzinki's sign?
Severe neck stiffness when the neck flexes the hips and knees flex as well
What labs and dx would you expect to see in viral meningitis?
Clear CSF elevated CSF, WBC, and protein
Which antiseizure meds need LFT's
Clonazepam, phenobarbitol, phenytoin
What are the associated RF for meningitis?
Close living spaces Immunosuppression Direct contamination of spinal fluid Invasive procedures, skull fracture, or penetrating wound
The nurse is performing a neurologic assessment on a client diagnosed with a stroke and cannot elicit a gag reflex. This deficit is related to which of the following cranial nerves?
Cranial nerve 9- glassopharyngeal
Which of the following pathologic conditions would result in release of ADH by the posterior pituitary? A) allergies B)asthma C)obesity D)hemorrhage
D: hemorrhage- stimulated by decreased blood volume and blood pressure (such as with hemorrhage) or increased osmolarity of the blood.
Structural and motor changes related to aging that may be assessed in geriatric patients during an examination of neurologic function include which of the following?
Decreased or absent deep tendon reflexes
What kind of isolation precaution should bacterial meningitis pt be placed on?
Droplet- Gloves, gowns, N95 Respirators
A nurse is preforming a neurological assessment for a client who has a brain tumor. What assessment finding would indicate to the nurse cranial nerve involvement? A) Dysphagia B)Positive Babinski's sign C)Decreased tendon reflex D)Ataxia
Dysphagia- glasso-pharyngeal and vagus nerve involvement
What do you expect to see regarding labs in bacterial meningitis?
Elevated WBC, protein Cloudy CSF (bacterial) decreased glucose Increased CSF pressure
What are the Subjective S/S of meningitis?
Excrutiating, constant HA Nuchal rigidity (stiff neck) Photophobia (light sensitivity)
What are the s/s of a vasospasam?
LOC Confusion New local motor weakness - treat as emergent
What do the current EBP say regarding blood pressure after CVA?
Let it get to 220/110
A parent of a child with a moderate head injury asks the nurse, "How will you know if my child is getting worse?" The nurse should tell the parents that best indicator of the child's brain function is:
Level of consciousness
How do you calculate a CPP? what is the normal range?
MAP-ICP Normal= 50-70
Which type of brain tumor is the most common?
Meningioma
A nurse is continually monitoring a client with a traumatic brain injury for signs of increasing intracranial pressure. The cranial vault contains brain tissue, blood, and cerebrospinal fluid; an increase in any of the components causes a change in the volume of the others. This hypothesis is called which of the following?
Monroe- Kellie
List the three pathogens involved with bacterial meningitis
Nisseria meningitidis Streptococcus pneumonia Haemophillus influenza
Which antiseizure meds need blood draws and what are their therapeutic levels?
Phenytoin: 10-20 Phenobarbital: 10-40 carbazepine: 4-12 Valproic acid : 50-100
The nurse is observing a client with cerebral edema for evidence of increasing intracranial pressure and monitors the blood pressure for signs of widening pulse pressure. The client's current blood pressure is 170/80 mm Hg. What is the client's pulse pressure? Record your answer using a whole number.
Pulse pressure is difference between systolic and diastolic= 170-80=90
A nurse is reevaluating a client receiving IV fibrinolytic therapy. Which of the following patient findings requires immediate intervention by the nurse?
Altered LOC
A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?
Ask if any Aspirin containing meds were taken: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection.
Which of the following terms refers to the inability to coordinate muscle movements, resulting in difficulty walking?
Ataxia
Cerebral edema peaks at which time frame after intracranial surgery?
24 hrs
Permanent brain injury or death will occur within which timeframe secondary to hypoxia?
3-5 minutes
When assessing ability to swallow which crainal nerves need to be assessed?
9: Glassopharyngeal 10: Vagus 11: Accessory 12: Hypoglossal
The client arrives in the emergency department following a bicycle accident in which the client's forehead hit the pavement. The client is diagnosed as having a hyphema. The nurse should place the client in which position? A) semi-Folwer's B)side-lying on the unaffected side C)supine D)side-lying on the affectected side
A semifowlers
In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning?
Acetylcholine
A patient in the ER has bruising over the mastoid bone and rhinorrhea. The triage nurse suspects the patient has which type of skull fracture?
Basilar Skull fracture- CSF can be seen in this type from the nose and ears as well.
A client has vascular neurocognitive disorder. When teaching the family about the cause of this disorder, which would the nurse expect to integrate into the explanation?
Blood flow in the vessels to the brain are blocked.
In treating exposure to biologic agents, many times, the treatment used manages the symptoms—the disease process must run its course. Which biologic agent exposure requires the use of ventilation support of breathing, possibly up to 2 to 3 months?
Botulism
A nurse has a four-patient assignment in the medical step-down unit. When planning care for the clients, which client would have the following treatment goals: fluid replacement, vasopressin replacement, and correction of underlying intracranial pathology?
Diabetes Insipidious
What does the Cushing's Triad signal a possibility of?
Increased ICP
When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?
Increased ICP
List the complications of Brain Tumors
Increased ICP Bleeding Cerebral edema Seizures VTE
What is the purpose of the bubble study?
It can detect a patent foramen ovale (hole in the heart) as well as show a better visual of the left atrium for clots from afib.
A female patient is receiving hypothermic treatment for uncontrolled fevers related to increased intracranial pressure (ICP). Which assessment finding requires immediate intervention?
Shivering can increase intracranial pressure by increasing vasoconstriction and circulating catecholamines. Shivering also increases oxygen consumption.
A patient diagnosed with a stroke would be expected to exhibit which type of gait?
Spastic hemiparesis
