Nervous System & Neuro Assessment Quiz

Nervous System & Neuro Assessment

• Sympathetic Nervous System ("Fight or Flight"): Responsible for physical stress responses, including elevated heart rate, dilated pupils, increased breathing, and adrenaline release.
• Parasympathetic Nervous System ("Rest and Digest"): Responsible for decreasing heart rate, promoting steady breathing, and aiding digestion.

Glasgow Coma Scale (GCS) and AVPU

• GCS Components: Includes eye opening, verbal response, and motor response.
• AVPU Mnemonic: A (Awake), V (Responds to verbal stimuli), P (Responds to painful stimuli), U (Unresponsive).

Neuro Status & ICP Monitoring

• Assessing Pupils (PERRLA): Pupils Equal, Round, Reactive to Light, and Accommodation.
• ICP Influences: Brain tissue, cerebrospinal fluid (CSF), and blood are the three components affecting intracranial pressure.

Best Position for ICP Management

• Head of Bed (HOB): Semi-Fowler's position to facilitate venous return and reduce intracranial pressure.
• Oxygen Requirements: Hypoxia and hypercapnia lead to cerebral vasodilation, increasing ICP. Management of oxygen requirements is crucial.
• Mannitol (Osmotic Diuretic): Reduces brain swelling by drawing fluid into the bloodstream. Careful monitoring of electrolytes, especially sodium, and kidney function is necessary.

Traumatic Brain Injury (TBI) & ICP

• TBI Definition: External force disrupting normal brain function.
• Symptoms: Range from mild (brief mental changes) to severe (unconsciousness, memory loss).
• Concussion Symptoms: Sensitivity to light, headache, dizziness, nausea/vomiting, tinnitus, and loss of consciousness (<30 minutes).

Autonomic Dysreflexia (AD) & Spinal Cord Injury (SCI)

• AD: Concern arises after stabilization, typically days to months later.
• Triggers: Full bladder, bowel impaction, pain from wounds, pressure sores.
• Nursing Action: Monitor and manage severe hypertension (<150 systolic) with medications. Remove the noxious stimulus.

Neurogenic Shock

• Etiology: Loss of sympathetic nervous system control, leading to hypotension and bradycardia.
• Key difference: Bradycardia is a significant differentiating factor in neurogenic shock compared to other types of shock.

Meningitis

• Risk Factors: Direct CSF contamination, skull fractures, or invasive procedures on immunocompromised patients contribute to meningitis.
• Clinical Manifestations: Fever, nausea/vomiting, altered level of consciousness, Kernig's sign, Brudzinski's sign, tachycardia, seizures, red macular rash.
• Nursing Considerations: Isolation, droplet precautions, fever reduction, and quiet environment. Monitor for increased ICP.
• SIADH: Syndrome of inappropriate antidiuretic hormone in meningitis, which can result in hyponatremia and worsened ICP.

Stroke Types & Management

• Ischemic Stroke (Embolic vs. Thrombotic):
  • Embolic Stroke: Clot forms elsewhere and travels to the brain.
  • Thrombotic Stroke: Clot forms within the brain's artery.
• Hemorrhagic Stroke: Artery or aneurysm bursts, causing bleeding within the brain.

Clinical Manifestations of Stroke

• Left Brain: Aphasia, right-side weakness.
• Right Brain: Impulsive decisions, left-side weakness, neglect.

NIH Stroke Scale

• Used for rapid bedside assessment to evaluate stroke severity.

tPA (Alteplase)

• Use: Standard treatment for ischemic strokes.
• Contraindications: Blood pressure >185/110 mmHg, recent surgery, active bleeding.

Pulmonary Embolism (PE)

• Risk Factors: Prolonged immobility, pregnancy, oral contraceptives, smoking, obesity, and heart failure contribute to the risk of pulmonary embolism.
• Clinical Manifestations: Subjective complaints of chest pressure, shortness of breath, anxiety, and feelings of impending doom, with objective signs like tachycardia, hypotension, diaphoresis, cyanosis, and decreased oxygen saturation.

Chest Tube & Pneumothorax Management

• Tension Pneumothorax: Air entering the pleural space increases pressure on the lungs and heart. A sudden decrease in SpO2 and respiratory distress after chest tube insertion can indicate tension pneumothorax.

  • Normal Chest Tube Drainage: 100 to 300 mL in the first 1-2 hours.
  • Concern: Output of >200 mL/hr or a change in fluid color (sanguineous, serosanguineous, or serous).

• Thoracentesis: Procedure to remove fluid from the pleural space, used to address hemothorax.

• Positioning: Semi-Fowler's or sitting at the edge of the bed, leaning forward.

• Pain Management: Mild pain expected post-insertion. Encouraging breathing exercises crucial for lung rehabilitation.

Respiratory and Oxygenation Management

• Respiratory rehabilitation: Importance after chest tube insertion, for improved lung function, enhanced breathing capacity, and promotes respiratory muscle recovery.

Acute Respiratory Failure (ARF)

• ARF: A symptom of either ventilation or oxygenation issues, like hypercapnic (inability to remove CO2 from the blood) or hypoxemic (inability to get sufficient oxygen into the blood).
• Symptoms: Restlessness, agitation, confusion, shortness of breath, hypotension, hypoxemia (low blood oxygen), tachycardia.

Risk Factors for ARDS (Acute Respiratory Distress Syndrome)

• Direct or indirect lung injury leads to systemic inflammation, with causes like sepsis, shock, trauma, near drowning, aspiration, and pulmonary embolism.

Priority Nursing Interventions for ARF

• Treat the underlying cause of ARF to prevent ARDS. Provide oxygen and support oxygenation.

Causes of ARDS

• Sepsis is the most common cause of ARDS

Effects of Poor Perfusion

• Inadequate oxygenation worsens respiratory distress, potentially leading to organ failure.

What is Atelectasis?

• Collapse or partial collapse of a lung or portion of a lung.

Pulmonary Edema

• Fluid buildup in the alveoli of the lungs. This makes breathing difficult.

Pleural Effusion

• Excess fluid accumulating in the pleural space, impacting lung function.

Positive End-Expiratory Pressure (PEEP)

• Improves oxygenation & gas exchange. Prevents lung collapse and decreases work of breathing

Intubation & Ventilation Methods

• Confirm endotracheal tube (ET) placement: capnography/colorimetric CO2 detector, chest X-ray, auscultation.
• Monitor for these post-intubation changes: asymmetrical chest rise/fall, decreased PaO2, lack of color change in CO2 detector, changes in tube depth, reduced breath sounds.

Traumatic Brain Injury (TBI)

• Classification: Mild TBI (GCS 13-15), moderate TBI (GCS 9-12), severe TBI (GCS 3-8).

Arterial Blood Gas (ABG) Interpretation

• Examples of ABG interpretations are used to understand a patient's acid-base status and oxygenation levels. Various examples are included of ABG interpretation to demonstrate variations of compensation.

Key Concepts to Review

• Acute Respiratory Failure (ARF): Symptoms including confusion, shortness of breath, hypotension, tachycardia, and hypoxemia.
• ARDS (Acute Respiratory Distress Syndrome): Caused by conditions like sepsis, shock, and trauma. Management includes oxygen provision, supporting the respiratory system, and addressing the underlying causes.
• Chest Tubes: Management focuses on pain control, complication monitoring (e.g., tension pneumothorax), and encouraging respiratory exercises.

Nursing Exam Study Guide

• Nervous System: Includes the sympathetic ("Fight or Flight") and parasympathetic ("Rest and Digest") nervous systems.
• Glasgow Coma Scale (GCS): Components include eye opening, verbal response, and motor response.

Test your knowledge on the nervous system and neuro assessments with this quiz. Topics include the sympathetic and parasympathetic nervous systems, Glasgow Coma Scale, AVPU mnemonic, ICP monitoring, and best positioning for ICP management. Enhance your understanding of neuro assessment protocols and terminology.