lOMoARcPSD|26582732
lOMoARcPSD|26582732
NUR 265 Exam 3 Review
Advanced Concepts Of Medical-Surgical Nursing (Galen
College of Nursing)
Neurologic
● The meninges form the protective covering of the brain and the spinal cord
● Cerebrospinal fluid (CSF) also circulates, surrounds, and cushions the brain and spinal cord
● The Spinal Cord control mobility; regulates organ function; processes sensory perception
information from the extremities, trunk, and many internal organs; and transmits information to
and from the brain ● Cranial Nerves
0 III (Oculomotor): Midbrain - Motor to eye muscles - eye movement via medial and lateral
rectus and inferior oblique and superior rectus muscles; lid elevation via the levator
muscle
○ IV (Trochlear): Lower midbrain - Motor - eye movement via superior oblique
muscles ○ VI (Abducens): Inferior pons - Motor - eye movement via lateral rectus
muscles ■ Defect may indicate hydrocephalus → excessive accumulation of CSF
○ VII (Facial): Inferior pons - Sensory - Pain and temperature from ear area; deep
sensations from the face; taste from anterior two thirds of the tongue
○ VIII (Vestibulocochlear): Pons-medulla junction - Sensory - Hearing and Equilibrium
Posturing
● Decortication (Flexor)
0 Abnormal motor movement seen in pt. with lesions that interrupt the corticospinal
pathways
○ Pt. arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs
● Decerebration (Extensor)
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, lOMoARcPSD|26582732
0 Abnormal movement with rigidity
characterized by extension of the
arms and legs, pronation of the
arms, plantar flexion, and
opisthotonos (body spasm in which
the body is bowed forward) ○ Usually associated with dysfunction of the brainstem
Diagnostic Testing
● Cerebral Angiography/Arteriography
0 Visualize the cerebral circulation to
detect blockages in the arteries or
veins in the brain, head, or neck that
impair perfusion
○ Pre-op
■ Pt. with known contrast
sensitivity are pretreated
with steroids
■ Assess for presence of N/V - NPO 4-6 hours prior
■ Reinforce:
● Your head is immobilized during the procedure
● Do not move during the procedure
● Contrast dye is injected → feel warm/hot sensation = normal
● You will be able to talk → let them know if you feel any pain
○ Post-op
■ Check the dressing for bleeding and swelling around the site
■ Apply an ice pack to the site
■ Keep the extremity straight and immobilized
■ Maintain the pressure dressing for 2 hours
■ If bleeding is present → maintain manual pressure on the site → PCP/RAPID
● Computed Tomography (CT)
○ Accurate, quick, easy, noninvasive, painless, and the least expensive method of
diagnosing neurological problems
○ Horizontal levels/Slices of the brain
or spinal cord images are taken
○ Distinguish bone, soft tissue, and
fluids
○ Contrast is used especially to
identify and locate tumor types and
abscesses
● Magnetic Resonance Imaging (MRI)
○ Advantages over CT for scanning
the brain, spinal cord, and nerve
roots
○ Does not use ionizing radiation → uses magnetic fields
○ Used to evaluate perfusion and blood vessel abnormalities
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
■ Arterial blockage, intracranial
aneurysms, and AV malformations
○ Contraindicated for: cardiac
pacemakers, implanted pumps or devices, and ion-
containing metal aneurysm clips → any metal
objects need to be removed ●
Electroencephalography (EEG)
○ Records the electrical activity of the
cerebral hemispheres; frequency,
amplitude, and characteristics of the
brain waves are recorded
○ Fasting is avoided → hypoglycemia can alter results
○ Ensure hair is clean
○ Avoid using sedatives or stimulants in the 12 - 24 hours preceding
○ Ensure a quiet room
○ Test will take 45 - 120 mins → can be stopped every 5 mins to allow pt. to move ●
Lumbar Puncture (LP)/Spinal Tap
○ Insertion of a spinal needle into the subarachnoid space between the third and fourth
(sometimes fourth and fifth) lumbar vertebrae
○ Used to:
■ Obtain CSF pressure readings with a manometer
■ Obtain CSF for analysis
■ Check for spinal blockage caused by a spinal cord lesion
■ Inject contrast medium or air for diagnostic study
■ Inject selected drugs
○ NOT done on pt. with severe
increased ICP or in pt. with skin
infections at or near the puncture site
○ VERY IMPORTANT that the pt. does
not move during the procedure
■ If the pt. is restless or cannot
cooperate, two people may
need to assist instead of one
→ the pt. may need to be
sedated
○ Lay the pt. in a fetal side-lying position
– preferably the left side because it
promotes better blood flow
○ Pre-op
■ Have the pt. empty bladder
○ Post-op
■ Semi-Fowlers – increase fluids
– give caffeine to vasoconstrict – lay supine if HA
■ Obtain VS and perform frequent neurological checks
■ MT I&Os
■ MT for complications
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
● Increased ICP → severe HA, vomiting (projectile), photophobia, and
change in LOC
● Brainstem herniation
● Infection
● CSF leakage
● Hematoma formation
■ Observe the needle insertion site for leakage and notify the PCP if it occurs
Meningitis
● An infection of the meninges of the brain and spinal cord, specifically the pia mater and arachnoid
● Bacterial and viral organisms are most often responsible → viral is most common (enterovirus,
herpes simplex virus-2 [HSV-2], varicella zoster virus [VZV], mumps virus, and the human
immunodeficiency virus [HIV])
○ Enter the CNS via the
bloodstream or are directly
introduced into the CNS
○ Direct routes of entry →
penetrating trauma, surgical
procedures on brain or spine, or
a ruptured brain abscess
○ A basilar skull fracture may lead
to meningitis as a direct
communication of CSF with the
ear/nasal passages → otorrhea
or rhinorrhea with CSF
○ Infecting organism may spread to
both cranial and spinal nerves → irreversible
neurologic damage → increased ICP may occur due to a blockage of CSF flow, change in cerebral
blood flow, or thromus formation ● Infections
linked to meningitis
○ Otitis media, acute or chronic
sinusitis, tooth abscess
○ Tongue piercings
● Meningococcal meningitis is a medical
EMERGENCY with a fairly high mortality
rate → often within 24 hours – highly
contagious
○ Outbreaks are likely to occur in
areas of HIGH POPULATION
DENSITY
■ College dorms, military barracks, and crowded living areas
■ Ages 16 - 21 have the
highest rates of infection
● Recognizing Cues
○ Positive Kernig and Brudzinski signs → classic nuchal rigidity (stiff neck)
■ Occurs in only a small percentage of pt. with definitive diagnosis
○ Assess for complications
Downloaded by NELSON KIIRU ()
lOMoARcPSD|26582732
NUR 265 Exam 3 Review
Advanced Concepts Of Medical-Surgical Nursing (Galen
College of Nursing)
Neurologic
● The meninges form the protective covering of the brain and the spinal cord
● Cerebrospinal fluid (CSF) also circulates, surrounds, and cushions the brain and spinal cord
● The Spinal Cord control mobility; regulates organ function; processes sensory perception
information from the extremities, trunk, and many internal organs; and transmits information to
and from the brain ● Cranial Nerves
0 III (Oculomotor): Midbrain - Motor to eye muscles - eye movement via medial and lateral
rectus and inferior oblique and superior rectus muscles; lid elevation via the levator
muscle
○ IV (Trochlear): Lower midbrain - Motor - eye movement via superior oblique
muscles ○ VI (Abducens): Inferior pons - Motor - eye movement via lateral rectus
muscles ■ Defect may indicate hydrocephalus → excessive accumulation of CSF
○ VII (Facial): Inferior pons - Sensory - Pain and temperature from ear area; deep
sensations from the face; taste from anterior two thirds of the tongue
○ VIII (Vestibulocochlear): Pons-medulla junction - Sensory - Hearing and Equilibrium
Posturing
● Decortication (Flexor)
0 Abnormal motor movement seen in pt. with lesions that interrupt the corticospinal
pathways
○ Pt. arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs
● Decerebration (Extensor)
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
0 Abnormal movement with rigidity
characterized by extension of the
arms and legs, pronation of the
arms, plantar flexion, and
opisthotonos (body spasm in which
the body is bowed forward) ○ Usually associated with dysfunction of the brainstem
Diagnostic Testing
● Cerebral Angiography/Arteriography
0 Visualize the cerebral circulation to
detect blockages in the arteries or
veins in the brain, head, or neck that
impair perfusion
○ Pre-op
■ Pt. with known contrast
sensitivity are pretreated
with steroids
■ Assess for presence of N/V - NPO 4-6 hours prior
■ Reinforce:
● Your head is immobilized during the procedure
● Do not move during the procedure
● Contrast dye is injected → feel warm/hot sensation = normal
● You will be able to talk → let them know if you feel any pain
○ Post-op
■ Check the dressing for bleeding and swelling around the site
■ Apply an ice pack to the site
■ Keep the extremity straight and immobilized
■ Maintain the pressure dressing for 2 hours
■ If bleeding is present → maintain manual pressure on the site → PCP/RAPID
● Computed Tomography (CT)
○ Accurate, quick, easy, noninvasive, painless, and the least expensive method of
diagnosing neurological problems
○ Horizontal levels/Slices of the brain
or spinal cord images are taken
○ Distinguish bone, soft tissue, and
fluids
○ Contrast is used especially to
identify and locate tumor types and
abscesses
● Magnetic Resonance Imaging (MRI)
○ Advantages over CT for scanning
the brain, spinal cord, and nerve
roots
○ Does not use ionizing radiation → uses magnetic fields
○ Used to evaluate perfusion and blood vessel abnormalities
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
■ Arterial blockage, intracranial
aneurysms, and AV malformations
○ Contraindicated for: cardiac
pacemakers, implanted pumps or devices, and ion-
containing metal aneurysm clips → any metal
objects need to be removed ●
Electroencephalography (EEG)
○ Records the electrical activity of the
cerebral hemispheres; frequency,
amplitude, and characteristics of the
brain waves are recorded
○ Fasting is avoided → hypoglycemia can alter results
○ Ensure hair is clean
○ Avoid using sedatives or stimulants in the 12 - 24 hours preceding
○ Ensure a quiet room
○ Test will take 45 - 120 mins → can be stopped every 5 mins to allow pt. to move ●
Lumbar Puncture (LP)/Spinal Tap
○ Insertion of a spinal needle into the subarachnoid space between the third and fourth
(sometimes fourth and fifth) lumbar vertebrae
○ Used to:
■ Obtain CSF pressure readings with a manometer
■ Obtain CSF for analysis
■ Check for spinal blockage caused by a spinal cord lesion
■ Inject contrast medium or air for diagnostic study
■ Inject selected drugs
○ NOT done on pt. with severe
increased ICP or in pt. with skin
infections at or near the puncture site
○ VERY IMPORTANT that the pt. does
not move during the procedure
■ If the pt. is restless or cannot
cooperate, two people may
need to assist instead of one
→ the pt. may need to be
sedated
○ Lay the pt. in a fetal side-lying position
– preferably the left side because it
promotes better blood flow
○ Pre-op
■ Have the pt. empty bladder
○ Post-op
■ Semi-Fowlers – increase fluids
– give caffeine to vasoconstrict – lay supine if HA
■ Obtain VS and perform frequent neurological checks
■ MT I&Os
■ MT for complications
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
● Increased ICP → severe HA, vomiting (projectile), photophobia, and
change in LOC
● Brainstem herniation
● Infection
● CSF leakage
● Hematoma formation
■ Observe the needle insertion site for leakage and notify the PCP if it occurs
Meningitis
● An infection of the meninges of the brain and spinal cord, specifically the pia mater and arachnoid
● Bacterial and viral organisms are most often responsible → viral is most common (enterovirus,
herpes simplex virus-2 [HSV-2], varicella zoster virus [VZV], mumps virus, and the human
immunodeficiency virus [HIV])
○ Enter the CNS via the
bloodstream or are directly
introduced into the CNS
○ Direct routes of entry →
penetrating trauma, surgical
procedures on brain or spine, or
a ruptured brain abscess
○ A basilar skull fracture may lead
to meningitis as a direct
communication of CSF with the
ear/nasal passages → otorrhea
or rhinorrhea with CSF
○ Infecting organism may spread to
both cranial and spinal nerves → irreversible
neurologic damage → increased ICP may occur due to a blockage of CSF flow, change in cerebral
blood flow, or thromus formation ● Infections
linked to meningitis
○ Otitis media, acute or chronic
sinusitis, tooth abscess
○ Tongue piercings
● Meningococcal meningitis is a medical
EMERGENCY with a fairly high mortality
rate → often within 24 hours – highly
contagious
○ Outbreaks are likely to occur in
areas of HIGH POPULATION
DENSITY
■ College dorms, military barracks, and crowded living areas
■ Ages 16 - 21 have the
highest rates of infection
● Recognizing Cues
○ Positive Kernig and Brudzinski signs → classic nuchal rigidity (stiff neck)
■ Occurs in only a small percentage of pt. with definitive diagnosis
○ Assess for complications
Downloaded by NELSON KIIRU ()
