AND ANSWERS GRADED A+
✔✔What is the biggest complication associated with high cervical spinal cord injuries? -
✔✔BREATHING-- the diaphragm is innervated by C3-C5 levels
C4-diaphragm
will likely need mechanical ventilation mgmt
✔✔signs and symptoms of increased intracranial pressure? - ✔✔-altered LOC
-headache
-bradycardia
-decreased respirations
-acute HTN with widening pulse pressure
-N/V
-worsening neuro deficits
-pupils that are nonreactive
✔✔What are the components of a neuro exam? (7) - ✔✔1. LOC
2. mental status and cognitive function
3. cranial nerves
4. motor
5. sensory
6. coordination
7. reflexes
✔✔What are the three components of the glasgow coma scale? - ✔✔1. eye opening
2. motor
3. verbal
✔✔What is a negative and positive babinski reflex? what do each indicate? -
✔✔negative (normal) response: toes curl downward
positive (pathologic) response= toes curl upward
a positive babinski in adults indicates dysfunction in the motor pathways of the brain or
spinal cord
✔✔what is the initial dosing of tpa? - ✔✔-0.9 mg/kg
-10% as a bolus over 1 minute and 90% as continuous infusion over 60 minutes
✔✔What are the requirements for receiving tpa? - ✔✔-onset of stroke was within 3-4.5
hours
-CT negative for bleed or lesion
, -glucose >50
✔✔During the thrombolytic infusion of tpa, neuros need to be assessed every ___
minutes - ✔✔15
✔✔What are the frequency of neuro checks after receiving thrombolytic tpa infusion? -
✔✔-VS and neuro checks every 15 min for 1 hour
-every 30 min for 6 hours
-then every hour for 16 hours
✔✔what are possible complications of rTPA? - ✔✔-signs of ICH or ICP
-systemic bleeding (wait 6 hours before inserting devices like foleys, etc)
-angioedema of airway
✔✔for patients receiving rTPA or IA therapy, treat prn for SBP > ____ mmHg or DBP >
____ mmHG - ✔✔treat for SBP >180 or DBP >105 mmHG
we want to manage hypertension!!!
✔✔Acute mgmt measures for ischemic stroke patients? - ✔✔1. aspirin within 24 hours
2. NS (Avoid hypotonic IV solutions)
3. blood glucose maintain less than or equal to 150 mg/dL
4. surgical consult
5. no indication for steroids or anticonvulsants
6. rehab (PT/OT/SLP consults)
✔✔in HEMORRHAGIC stroke patients, what do we want to keep their blood pressure
at? - ✔✔SBP >150 mmHG and DBP >105
✔✔what do we want to keep ischemic stroke pt's BPs who have not received tpa? -
✔✔Treat PRN if SBP >220 mmHg, DBP >120 mmHG or MAP >130
✔✔what is the main complication with IV dilantin? - ✔✔must ONLY be combined with
NS
✔✔what occurs in SIADH? - ✔✔too much ADH!!!
✔✔what are some neuro causes of SIADH? - ✔✔TBI
SAH
stroke
CNS infection
brain tumors
Guillian-Barre (GBS)
MS