Neuro surgion

NEURO EXAM #1-MED SURG
QUESTIONS WITH CORRECT ANSWERS

Pt.kiskgointktokhavekmyeologram,kwhatkthe knursekneedsktokdoktokgetkthekpatientkreadykforkthekprocedure?k-
kCORRECTkANSWER--Obtain kankinformed kconsent



-Have kthe kclientkemptykthe kbladder-Verifykallergies-
especiallykthosektokiodinekandkshellfishkandkanykpreviouskreactionsktokcontrast

-explainkthatkprocedure kwillktakekaboutk2khourskandkpuncturekwill kbe kmaidkinkthe klumbarkarea.

-Assesskbaseline klower-extremitieskstrengthskandksensation

-Procedure kinvolveskslightkdiscomfortkandkheadachekiskverykcommonkpost-
procedure.kNauseakandkvomitingkarekpossiblekaskwell.

-postkprocedure kpatientkneedsktokremainkflatkforkakseveralkhours.

tokwithholdkMetforminkifkiodinatdkdye kiskgoingktokbekused,kbecausekof kthe kriskkofkMetformin-
inducedklactickacidosis.



Pt.khaskICP,kwhatkiskthe kbestkpositionktokputkthemkinto?k-kCORRECTkANSWER--
Elevate kthe kheadkof kthe kbedktok30ktok45kdegreesktokpromotekvenouskreturn

-Place kthe kneckkinkakneutralkpositionk(tokflexedkorkextendedk) ktokpromotekvenouskreturn

-
Positionkthekpatientktokavoidkflexionkofkthekhips,kthekwaist,kthekneckkandkrotationkofkthekhead,kespeciallykt
okthe kright.

-
Avoidkextremekhipkflexionkbecausekthiskpositionkcauseskincreasedkintraabdominalkandkintrathoracickpress
ure,kwhichkcankcausekrisekinkICP.



Whatkare kthe ks/skof kICP?k-kCORRECTkANSWER-Clinicalkmanifestations:

-
Askthe kpressurekincreaseskwithinkthekcranial kcavity,kitkiskfirstkcompensatedkforkbykvenouskreturnkandkCSFkdi
splacement.

-
Askthe kpressurekcontinuesktokrise,kthekcerebralkbloodkflowkdecreaseskandkinadequate kperfusionkof kthe kbrai
nkoccurs.

,-Thiskcycle kcauseskPco2ktokincrease kandkthe kPo2kandkPhktokdecrease.

-
These kchangeskcausekvasodilationkandkcerebral kedemakwhichkleadsktokincreasedkcompressionkofkneuralktis
sue kandkincreasedkICP

-
Whenkthe kpressurekbuildupkiskgreaterkthankthekbrain'skabilityktokcompensate,kpressure kiskexertedkonksurro
undingkstructureskwhere kthe kpressurekisklower

-Thiskmovementkof kpressure kiskcalledkSupratentorialkshiftkandkcankresultkinkherniation

-Thiskcankleadktokalterationkinktheklife-
sustainingkmechanismsksuchkaskBloodkpressure,krespirations,ktempeerature,kpulse

-
Late ksigns:Therekiskakrisekinksystolickpressure kwithkunchangedkdiastolickcausingkakwideningkpulsekpressure,k
bradycardia,kabnormal krespirationskwhichkindicate kthatkthere kiskherniationkinkthekbrain.



Subjectivekdata:

-Visual kchangesksuchkaskDiplopia-doublekvision

-Changeskinkpersonalitykandkabilityktokthink

-
Nausea,kpain,kheadachekthatkincreaseskinkintensitykwithkcoughing,kstraining,kstooping.kUsuallykpresentkinkt
he kearlykmorningkandkmaykawakenkthekpt.kfromksleep.



Objective kdata:

-Earliestksign:kChangeskinkLOCk(disorientation, krestlessness,klethargy)

-Pupillaryksigns,ksluggishkreaction,kthekoculomotorknervek(III)kiskcompressed

-Fixedkandkdilatedkpupil-calledkblownkpupil-OminousksignkthatkmustkbekreportedktokthekphysiciankASAP.

-Ipsilateralkpupilkthatkiskunable ktokconstrictkandkremainskdilated

-ChangeskinkBPkandkpulse.kRisingksystolickandkwideningkpulsekpressure

-Cushing'skresponse-wideningkpulse kpressure,kincreasedksystolickBPkandkbradycardiaktogether.

-Respiratorykproblemsk(Cheyne-Stokeskorkdeepkandkstertorus).kAtaxic



Ataxia?k- kCORRECTkANSWER-Impairedkabilityktokcoordinatekmovement.

,Aphasia?k-kCORRECTkANSWER-
Aphasiakiskankabnormalkneurologickconditionkinkwhichkthe klanguage kfunctionkiskdefectivekorkabsentkbecaus
e kbecause kofkankinjuryktokcertainkareaskofkthekcerebralkcortex-
Broca'skareakinkthe kfrontalklobekandkWernicke'skareakinkthekposteriorkpartkofkthe ktemporal klobe.

Aphasiakincludeskallkarekofklanguagge,kincludingkspeech,kreading,kwritingkandkunderstanding. kAphasiakhask
beenksubdividedkaskfollows:

-
Sensorykorkreceptive kaphasia:kInabilityktokcomprehendkthekspokenkwordkorkwrittenkword.kWernicke'skarea
kinkthe ktemporal klobekiskassociated kwithklanguage kcomprehension.



-
Motorkorkexpressive kaphasia:kInabilityktokuseksymbolskofkspeech.kBroca'skareakinkthe kfrontalklobekmediate k
motorkspeech.

-Global kaphasia:kInabilityktokunderstandkthe kspokenkwordkorktoksspeak-
PathologickconditionskinkbothkBroca'skandkWernicke'skareas.



Anomiakiskakformkof kAphasiakcharacterizedkbykinabilitykytokname kobjects.



Dysarthriakiskdifficult,kpoorlykarticulatedkspeechkgenerallykcausedkbykinterference kinkcontrol koverkthe kmusc
leskof kspeechkandkdamagektokcentralkorkperipheral knerve.



Agnosia?k-kCORRECTkANSWER-
Agnosiakiskthektotalkorkpartial klosskofkthekabilityktokrecognizekfamiliarkobjectskbyksight,ktouchkorkhearing,kork
tokrecognize kfamiliarkpeople kthroughksensorkstimulikaskakresultkof korganickbrainkdamage.



Whatkare kthe kLate ksymptomskof kICP?k-kCORRECTkANSWER-Late ksigns:

-Cushing'skressponse-widenedkpulsekpressurekwithkincreasedksystolickBP,kbradycardia

-DilatedkPupils

-Abnormal krespirations

-Hyperthermia

-PositivekBabinski'skreflex

-Posturingk(Decorticate korkDecerebrate)

-Changeskinkmotorkfunctionkfromkweaknessktokhemipledgia.

, Whatkpositionkthe kpatientkshouldkbe kinkforklumbarkpuncture korkspinal ktap?k-kCORRECTkANSWER-
The kpatientkiskusuallykpositionedkonkthe kside kwithkthee kknee kandkheadkflexedkatkankacutekangle.kThiskallow
skforkmaximumklumbarkflexionkandkseparationkofkthekinterspinouskspace.kCSFktapkiskdone kbetweenkthekL4-
L5korkL5-S1kinterspace.

Afterkthe kprocedurekthekpatientkliekflatkforkseveral khours.



Whatknursingkpost-procedure kactionkwouldkbe kappropriatekrightkafterkthekpatientkhadkmyelogram?k-
kCORRECTkANSWER--MonitorkpunctureksitekforkbleedingkandkleakingkofkCSF



-applykpressure ktokthekpuncture ksite

-Positionkpatientkflatkforkseveralkhours

-Assesskthekstrengthkandksensationkof kthe klowerkextremities
-Headache,knauseakandkvomitingkarekcommon

-Prepare kpt.kforkCTkscan,kusuallykdonek4-6khourskpost-myelogram

-Encourage kfluids

-MonitorkVS,kI&O's



Pt.kiskpost-
lumbarkpuncture, kwhatkfinding/observationkwouldkbekofkconcernkandkwouldkrequirektokcallkthekMD?k-
kCORRECTkANSWER--LeakagekofkCSF



-ChangeskinkLOC

-Decreasedkstrengthkandksensationkinklowerkextremities

-bleedingkfromkpunctureksite



Whatknursingkinstructionskare kgivenktokpt.kwhokiskgoingktokhavekCTkofkthekhead?k-kCORRECTkANSWER--
Obtainkankinformedkconsentkifkakdyekiskgoingktokbekused

-AssesskforkallergiesktokIodine,kshellfish,kcontrastkdyes

-Instructkclientkonkthekneedktoklie kstillkandkflatkduringkprocedure

-instructkthe kclientktokremove kanykmetalkobjectsksuchkaskjewlery,khairpins,kwigs

-Instructktokholdkbreathkwhenkindicated

-Initiate kankIV kline