--Hi all! I hope these help all of you that were looking out for these. I just finished them tonight. There are like 180 flippin questions, but since there were 182 sides, I thought this sounded about right. I went straight off the notes and book. –Enjoy!-Elizabeth
Neuro Med- Surg Practice Questions
1. What are the three components of the cranial vault?à Brain tissue, blood, CSF. The Monro-Kellie Hypothesis states that an increase in any of these components causes a change in the volume of others by displacing or shifting CSF, CSF absorption increases and blood volume decreases.
2. What is the normal ICP?à 10- 15mmHg
3. What is increased ICP commonly associated with?à head injury
4. Give some examples of secondary conditions that could cause increased ICP?à brain tumors, subarachnoid hemorrhage, encephalopathies
5. How long would it take for irreversible brain damage to occur r/t ischemia?à >3-5 min.
6. What changes pertaining to vital signs might you see in the first stage of cerebral ischemia?à Slow bounding pulse, respiratory irregularities
7. Define the Cushing’s Response to increased ICP.à the brain’s attempt to restore blood flow by increasing arterial pressure to overcome increased ICP. Remember that pressure is increasing because the body detects ischemia to the brain (decreased blood flow). This is considered to be the decompensation phase
8. What are the triad of symptoms seen in the Cushing’s Response?à Widening pulse pressure (HTN), respiratory changes and bradycardia. She also mentions that the temp. increases
9. Cheyne- Stokes respirations may be seen during the decompensation stage of increased ICP. Describe Cheyne- Stokes respirationsà A breathing pattern marked by a period of apnea lasting 10-60sec, followed by hyperventilation. –Taber’s Dictionary
10. What is the most important indicator of increased ICP and what are the other s/s?à Change in LOC; restlessness without a cause, increased drowsiness and confusion. These changes warrant immediate intervention including notifying CN and Dr.
11. What is the goal of mgmt for increased ICP?à Decrease cerebral edema and decreasing blood volume while maintaining cerebral perfusion
12. What are 2 osmotic diuretics given to dehydrate brain and reduce cerebral edema?à Mannitol and glycerol
13. What could cause the risk for infection in increased ICP?à An ICP sensor insertion
14. What are the nsg interventions appropriate for increased ICP?à insert foley catheter to monitor output, serum osmolality to assess hydration, give corticosteroids to reduce edema, maintain cerebral infusion with IV fluids and inotropic agents, give stool softeners to avoid straining, maintain a calm environment, control fever with anti- pyretics to decrease rate of cerebral edema
15. What are primary examples of head injuries?à contusions, lacerations, torn blood vessels, foreign object penetrations
16. When does an acceleration injury occur?à when the head is in motion
17. When does a deceleration injury occur?à when the head is stopped
18. Skull fractures can be open or closed. What is difference between these two?à A tear in the dura is seen in an open fracture, and the dura is intact ina closed fracture
19. What are the types of skull fractures?à simple (simple clean break) comminuted (splintered fracture), depressed (bone depression that are depressed into the brain), basilar ( fracture at the base of the skull). X rays are needed for diagnosis
20. What are manifestations are commonly seen in basilar skull fractures?à hemorrhage, CSF leakage, Battle’ s sign seen (bruising to lower skull behind ear)
21. What might bloody CSF suggest?à brain laceration or contusion
22. Where could CSF leak from?à from ears (otorrhea) from nose (rhinorrhea). I f CSF leaking, pressure should not be put in these sites to block leakage (this might increase cerebral pressure). Instead we could catch a sterile CSF sample for the lab, then get sterile gauze strip and tape it lightly over the leakage site. Teach pt not to blow nose.
23. What are some nsg interventions seen in skull fractures?à HOB 30 degrees,
24. IV abx (if depressed fracture has imbedded in the brain), monitor for CSF leakage, observe closely if pt not surgical
25. What is the main difference between a concussion and contusion?à In concussion, you may or may not lose consciousness, and in a contusion, the client does lose consciousness
26. What should we observe in persons that have had a concussion?à make sure no difficulty speaking, vomiting, dizziness, and to arouse LOC. This may take several days to get over.
27. A contusion is a medical emergency when the brain gets bruised. What might we see in a pt with a contusion?à decreased BP and respirations, loss of bowel and bladder, may have HA or seizures. These patients are very hyperactive and this might take several months to get over
28. What type of hematoma results from arterial bleeding in the space between the dura and the inner surface of the skullà Epidural hematoma. These can be caused by fractures in temporal bones
29. What are clinical manifestations seen in an epidural hematoma?à Initial unconsciousness, brief period of lucidity, then decreased LOC
30. This is a medical emergency that could result in CNS failure within minutes. What are some medical interventions that can be done for this?à Create burr holes through, possible craniotomy, drain blood that is causing the hematoma
31. What type of hematoma results from venous bleeding into the space beneath the dura and the arachnoid spaceà subdural hematoma; She also says that most subdural hematomas are from venous bleeds, but they could be from arterial bleeds. If so, the condition greatly accelerates
32. What could cause subdural hematomasà bleeding disorders, or ruptured aneurysms, trauma
33. There are 3 types of subdural hematomas: acute (major head traumas in 24-48hrs), subacute (less severe contusions 48hrs-2wks), and chronic (3 wks –3 months). What s/s are seen in acute and subacute: changes in LOC, pupil changes, increased BP
34. What type of hemorrhage is caused by a tear in the small arteries and veins in the white matter?à Intracranial hemorrhage
35. What are some causes of intracranial hemorrhage?à Direct trauma such as GSW, missile injuries, stab wounds, tumor and bleeding around tumor, HTN crisis, anti- coagulant therapy and bleeding problems
36. What is involved in the medical mgmt of brain injuries?à physical and mental exams, CT & MRI scans, possible vent. Support, seizure prevention, F&E maintenance, nutritional support, mgmt of pain and anxiety
37. What are nsg responsibilities in a neurological assessment?à Assess baseline and/or any changes in LOC, VS, pupil size, motor function.
38. There are 2 types of stroke, ischemic and hemorrhagic. What are the 3 sub-types of ischemic stroke?à TIA, thrombotic and embolic
39. What occurs in a thrombotic stroke?à A blood clot clogs vessels in the brain which leads to narrowing of the vessel lumen or ischemia
40. What occurs in an embolic stroke?à A blood clot or plaque has traveled from another area in the body and has occluded a cerebral artery
41. Where do most embolic strokes originate from?à the endocardial layer of the heart. These may come from a Hx of MI, endocardial disease, valve placement, A-fib
42. What occurs in a hemorrhagic stroke?à Bleeding occurs in the brain tissue, ventricles or the subarachnoid space. This can be caused by HTN, or ruptured aneurysms
43. How long can a TIA last?à 15min to 24hrs
44. What is the most important thing to know about a TIA?à this serves as a WARNING SIGN or precursor to a CVA in the future
45. Do people that have TIAs experience a full recovery between attacks?à yes
46. What are some motor deficits that may come with strokes?à hemiparesis (numb on one side), hemiplegia (paralysis on one side), ataxia (defective voluntary m. coordination)
47. What are some communication deficits that may come with strokes?à dysarthria (clumsiness in articulating words r/t CVA disease, no aphasia), aphasia (inability to communicate r/t to CVA), receptive aphasia (saying words that have a backward meaning). Dysphagia (difficulty or inability swallowing) may also be present.
48. What cognitive impairments may come from a stroke?à memory loss, decreased attention span, poor reasoning, altered judgement, apraxia (inability to perform a familiar act i.e., picking up a fork)
49. What psychological impairments may come from a stroke?à loss of self control, emotional lability, depression
50. What perceptual disturbances may one experience in a stroke?à homonymous hemianiopia, loss of peripheral vision, diplopia, difficulty judging distances
51. What tests could be used to diagnosis a stroke?à CT without contrast, hx, assessment, neuro exam, cerebral angiogram, transcranial doppler, TEE (to check the back of the heart for any broken off clot pieces
52. If someone is diagnosed as having a hemorrhagic stroke, are clot-busters or anti-coagulants an option for treatment?à NO!
53. Thrombolytic therapy should be started within 3 hours of s/s of CVA. What should be taken into consideration before starting thrombolytic therapy?à Bleeding studies, Hx of GI bleed in 3 days? Surgery in past 2 wks? Results of the noncontrast CT (what type of stroke did it show?)
54. What sx interventions could prevent a CVA?à carotid endarectomy, carotid stenting, aneurysm clipping or coiling, AVM resectioning.
55. What is an AVM?à arteriovenous malformation (when a vein and artery mesh up and cause clots)
56. The key to CVA medical mgmt is prevention. What are some modifiable risk factors?à HTN, smoking, increased lipids, sedentary lifestyle, A-fi (with coumadin), obesity, excessive alcohol consumption, DM Type 2, carotid stenosis
57. What meds could help prevent CVAs?à antihypertensives, coumadin (for A-fib), Plavix, ASA, statins
58. What is focus of care when CVA pt is in an acute care setting?à recovery and maintaining a calm environment
59. What is the focus of care when CVA pt is in a rehab facility? à getting back to ADLs. think BOOTCAMP!!!
60. What are the nsg interventions for a CVA pt?à Monitor for constipation, skin breakdown, normal bladder function, Monitor CV function, nutritional status, arrange client’s environment within perceptual field, give explanations to pt and family about situations and procedures
61. What is spasticity?à a motor disorder that demonstrates velocity-dependent increased muscle tone, exaggerated tendon jerks, and clonus
62. Read the goals of care for CVA pts. Too much to type…
63. What could help achieve self- care in CVA pts?à start with the affected side, encourage personal hygiene as soon as pt could sit up, use clothing that is focus, dressing in a seated balanced position. Pt’s morale is greatly improved if they are fully dressed.
64. How can we attain bladder control?à offer urinal or bedpan on schedule. Upright posture and standing position for males
65. What would be helpful in when modifying the home of a CVA pt?à having an OT assess it and make recommendations, using a shower stool, long handled bath brush, portable shower hose, handrails
66. Where could secondary brain tumors stem from?à from structures outside the brain such as lung, breast, lower GI, pancreas, kidney, skin
67. What is the most common type of brain neoplasm?à Gliomas, which spread by infiltrating into surrounding tissues
68. When attempting to remove a glioma, what should we understand?à Total removal causes considerable damage to vital structures
69. What is the most common pituitary tumor?à adenoma. Symptoms are caused by pressure on adjacent structures or hormonal changes
70. What are some characteristics of menigiomas?à they are encapsulated, globular, and are demarcated (have boundary or limit) These also tend to recur
71. An acoustic neuroma usually occurs on the 8th cranial nerve. What are some common symptoms of this?à hearing loss, tinnitus, dizziness
72. S/S of brain tumors mimic s/s of increased ICP. What are these symptoms?à Headache, vomiting, papilledema, personality changes, focal deficits (motor, sensory, cranial nerve dysfunctions)
73. What is papilledema?à edema and inflammation of the optic nerve at the entrance point into the retina
74. What tests could diagnose a pt with a brain tumor?à CT, MRI, PET scan, cerebral angiography, EEG, steriostatic biopsy, cytologic study of CSF
75. What are the surgical intervention options for a person with a brain tumor?à transphenoidal (through nose) microsurgical removal, gamma knife radiation(no incision), external beam radiation, stereotactic laser or radiation therapy, and brachytherapy.
76. What is brachytherapy?à surgical implantation of radiation sources
77. What should be done for nsg mgmt of these pts whom have undergone surgical trt?à Monitor for increased ICP, monitor for/prevent aspiration and check swallowing ability (may need suctioning equipment), monitor for seizures, assess speech and motor function, assess pupils, may need frequent reorientation
78. What percent of intracranial tumors are metastatic?à 10%
79. What are the s/s of metastatic brain tumors?à HA, paralysis, seizures, aphasia (inability to communicate), focal weakness, altered mentation (mental activity), personality changes
80. Is chemotherapy use the first line of trt for brain tumors?à No, because chemo does not cross the blood brain barrier. It may be given as a last effort via the CSF along with radiation ‘wafers’ that dissolve over time.
81. What is the definition of a seizure?à sudden, abnormal excessive electrical activity within the brain
82. The primary cause of a seizure may not have an identifiable cause, and these account for ½ of all seizures. What secondary conditions could cause a seizure?à hypoxemia, fever, head injury, CNS infections, metabolic/toxic conditions, brain tumors, drug or –ETOH withdrawal, allergies
83. What are the 6 types of seizures?à tonic, clonic, tonic-clonic, myoclonic, absence, atonic or akinetic
84. Briefly describe these 6 typesà (I got these answers from the Taber’s dictionary)
85. Tonic- muscle tension seen
86. Clonic- alternately contracting and relaxing the muscles
87. Tonic- clonic aka ‘grand mal’-… both tonic and clonicJ These may last 2-5 min. and pt may lose continence. Muscle spasms seen.
88. Myoclonic- twitching or clonic spasms of a muscle or group of muscles
89. Absence aka ‘petit mal’- starring off for a few seconds
90. Atonic- loss of muscle tone may occur and pt may fall down
91. What are pts that experience seizures at risk for?à hypoxia, vomiting, pulmonary aspiration, and persistent metabolic abnormalities
92. What is the goal of trt for seizure pts?à controlling the seizure and cause of seizure. Mgmt must meet the individual’s needs, and drug therapy should be used to achieve seizure control (not cure) with minimal side effects