HSCO 506 Exam 3 Questions And Answers
Dura mater - ANSWER: -Hard double layer contains epidural space and venous sinus
- Subdural space (between dura and arachnoid) contains small bridging veins
Arachnoid - ANSWER: - Web-like structure covers brain loosely
- Subarachnoid space (between arachnoid and pia) contains CSF
Pia mater - ANSWER: - Thin inner layer adheres to brain and spinal cord
Cerebrospinal Fluid (CSF) - ANSWER: - Clear and odorless
- Glucose 60% of serum glucose
- Protein 15-45 mg/dL
- Usually no RBC/WBC
- Opening pressure 5-20 cm H2O (age dependent)
- Infants produce 1 mL/hr; adults 30 mL/hr
- Infant total volume 50 mL; adults 150 mL
brain metabolic considerations - ANSWER: - Brain receives up to 25% of cardiac
output
Requires constant supply of oxygen and glucose
- Cytotoxic cerebral edema results within seconds of anoxia (Hypoxic-Ischemic
Encephalopathy)
- Kids tolerate hypoglycemia poorly anyway
- Seizures can result from hypoxia and/or hypoglycemia
brain Auto-regulation - ANSWER: - Supply must equal demand
Cerebral blood vessels will auto-regulate to maintain adequate supply
- Hypertension causes cerebral arterial constriction
- Hypotension causes cerebral arterial dilation
- Hypoxia causes cerebral arterial dilation
- Hypercarbia causes cerebral arterial dilation
neurological assessment components - ANSWER: - Health History
- Observation
- Glasglow Coma Scale (LOC)
- Vital signs
- Physical exam
- Cranial Nerves
- Reflexes/Cerebellar fxn
- Labs
- Diagnostic studies
Glasglow Coma Scale (LOC) - ANSWER: - Eye Opening
,HSCO 506 Exam 3 Questions And Answers
- Verbal Response
- Motor Response
Health History - ANSWER: - History of Present Illness: "Tell me the story of what
happened..."
Past history
- antenatal/perinatal/post-natal history in infants and toddlers
- Timing and onset of developmental milestones (including play and school
performance)
- Childhood illnesses
- Head/spine injuries
Current history
- Immunizations
- Significant or chronic conditions
- Medications
- Substance use/smoke exposure/lead exposure/toxins
Family history: think outside of the head!
- Neuro: static/progressive, acquired/congenital
- Endo: diabetes, thyroid, hormone imbalances
- CV: congenital heart disease, arrhythmias, aneurysms
- Congenital: neural tube defects, metabolic disorders
- Genetic disorders: chromosomal, epilepsy, migraines
- Liver/Renal
nursing observation for neuro assessment - ANSWER: Interaction with
environment/caregiver
- Key: What is baseline?
- Acute vs. gradual change
- Degree of alertness, irritability
- Response to painful stimulus
- Growth/development (Remember: you must know "normal" to detect "abnormal!"
- Abnormal movements (incl. seizures)
- Asymmetrical movements
- Cry—the "neuro cry"—unusual giggle/laughter, etc.
Cranial Nerves/Reflexes/Cerebellar Function - ANSWER: - Test for symmetry
- Challenges: age and clinical condition
Labs - ANSWER: Urine
- Sodium
- Osmolarity
, HSCO 506 Exam 3 Questions And Answers
- Toxicology screen
CSF
- Culture
- Gram Stain
- Glucose
- Protein
- Cell Count
- Other cytology/serology
Serum (blood)
- Sodium
- Osmolarity
- Glucose
- Drug levels
- Toxicology screen
- Arterial blood gas
CT Scan - ANSWER: Best for bone, bleed, abscess, ventricular size (bone, blood,
pus, contrast show up white). Can also do 3D bone reconstruction.
- Pro: Quick, can be with or without contrast (IV and/or PO), less expensive
- Con: Radiation, not as detailed, iodine contrast allergy, need good IV for contrast, PO
contrast-yuck!
- Nursing Implications: lead protection, IV access, distraction, consider renal function
MRI Scan - ANSWER: Best for tumor and tissue detail (low-fluid volume shows up
dark)
- Pro: Much more detailed, no radiation, can view in multiple planes, can be with or
without contrast
- Con: Lengthy, expensive, claustrophobia, noisy, metal contraindications, gadolinium
contrast allergy, may need IV and sedation
- Nursing implications: Plan ahead, metal screening
Lumbar Puncture - ANSWER: - AKA "spinal tap"
- Pressure measurement, CSF sample, therapeutic drainage, chemo administration
- Con: headache, painful, sedation risks, injury
- Nursing implications: consent, pain management, safe positioning, patient, monitoring,
specimen labeling, keep flat, monitor site
EEG - ANSWER: - Capture electrical seizure activity
- Can be done with simultaneous video
- Can be done via surgically placed internal grids
- May do awake, asleep, or sleep-deprived
- Con: activity limitations, messy glue!
- Nursing implications: safety, know how to use marking system!
Dura mater - ANSWER: -Hard double layer contains epidural space and venous sinus
- Subdural space (between dura and arachnoid) contains small bridging veins
Arachnoid - ANSWER: - Web-like structure covers brain loosely
- Subarachnoid space (between arachnoid and pia) contains CSF
Pia mater - ANSWER: - Thin inner layer adheres to brain and spinal cord
Cerebrospinal Fluid (CSF) - ANSWER: - Clear and odorless
- Glucose 60% of serum glucose
- Protein 15-45 mg/dL
- Usually no RBC/WBC
- Opening pressure 5-20 cm H2O (age dependent)
- Infants produce 1 mL/hr; adults 30 mL/hr
- Infant total volume 50 mL; adults 150 mL
brain metabolic considerations - ANSWER: - Brain receives up to 25% of cardiac
output
Requires constant supply of oxygen and glucose
- Cytotoxic cerebral edema results within seconds of anoxia (Hypoxic-Ischemic
Encephalopathy)
- Kids tolerate hypoglycemia poorly anyway
- Seizures can result from hypoxia and/or hypoglycemia
brain Auto-regulation - ANSWER: - Supply must equal demand
Cerebral blood vessels will auto-regulate to maintain adequate supply
- Hypertension causes cerebral arterial constriction
- Hypotension causes cerebral arterial dilation
- Hypoxia causes cerebral arterial dilation
- Hypercarbia causes cerebral arterial dilation
neurological assessment components - ANSWER: - Health History
- Observation
- Glasglow Coma Scale (LOC)
- Vital signs
- Physical exam
- Cranial Nerves
- Reflexes/Cerebellar fxn
- Labs
- Diagnostic studies
Glasglow Coma Scale (LOC) - ANSWER: - Eye Opening
,HSCO 506 Exam 3 Questions And Answers
- Verbal Response
- Motor Response
Health History - ANSWER: - History of Present Illness: "Tell me the story of what
happened..."
Past history
- antenatal/perinatal/post-natal history in infants and toddlers
- Timing and onset of developmental milestones (including play and school
performance)
- Childhood illnesses
- Head/spine injuries
Current history
- Immunizations
- Significant or chronic conditions
- Medications
- Substance use/smoke exposure/lead exposure/toxins
Family history: think outside of the head!
- Neuro: static/progressive, acquired/congenital
- Endo: diabetes, thyroid, hormone imbalances
- CV: congenital heart disease, arrhythmias, aneurysms
- Congenital: neural tube defects, metabolic disorders
- Genetic disorders: chromosomal, epilepsy, migraines
- Liver/Renal
nursing observation for neuro assessment - ANSWER: Interaction with
environment/caregiver
- Key: What is baseline?
- Acute vs. gradual change
- Degree of alertness, irritability
- Response to painful stimulus
- Growth/development (Remember: you must know "normal" to detect "abnormal!"
- Abnormal movements (incl. seizures)
- Asymmetrical movements
- Cry—the "neuro cry"—unusual giggle/laughter, etc.
Cranial Nerves/Reflexes/Cerebellar Function - ANSWER: - Test for symmetry
- Challenges: age and clinical condition
Labs - ANSWER: Urine
- Sodium
- Osmolarity
, HSCO 506 Exam 3 Questions And Answers
- Toxicology screen
CSF
- Culture
- Gram Stain
- Glucose
- Protein
- Cell Count
- Other cytology/serology
Serum (blood)
- Sodium
- Osmolarity
- Glucose
- Drug levels
- Toxicology screen
- Arterial blood gas
CT Scan - ANSWER: Best for bone, bleed, abscess, ventricular size (bone, blood,
pus, contrast show up white). Can also do 3D bone reconstruction.
- Pro: Quick, can be with or without contrast (IV and/or PO), less expensive
- Con: Radiation, not as detailed, iodine contrast allergy, need good IV for contrast, PO
contrast-yuck!
- Nursing Implications: lead protection, IV access, distraction, consider renal function
MRI Scan - ANSWER: Best for tumor and tissue detail (low-fluid volume shows up
dark)
- Pro: Much more detailed, no radiation, can view in multiple planes, can be with or
without contrast
- Con: Lengthy, expensive, claustrophobia, noisy, metal contraindications, gadolinium
contrast allergy, may need IV and sedation
- Nursing implications: Plan ahead, metal screening
Lumbar Puncture - ANSWER: - AKA "spinal tap"
- Pressure measurement, CSF sample, therapeutic drainage, chemo administration
- Con: headache, painful, sedation risks, injury
- Nursing implications: consent, pain management, safe positioning, patient, monitoring,
specimen labeling, keep flat, monitor site
EEG - ANSWER: - Capture electrical seizure activity
- Can be done with simultaneous video
- Can be done via surgically placed internal grids
- May do awake, asleep, or sleep-deprived
- Con: activity limitations, messy glue!
- Nursing implications: safety, know how to use marking system!
