NUR 425, Neuro Part 1 Review Questions and Correct Answers
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Course
NUR 425
Institution
NUR 425
Autonomic nervous system and main neurotransmitters Sympathetic- norepinephrine
Parasympathetic- acetylcholine
First indicator that neurological functioning has declined Decreased LOC
Levels of consciousness Alert: awake and responsive
Lethargic: drowsy or sleepy but easily awakened
(Obt...
NUR 425, Neuro Part 1 Review
Questions and Correct Answers
Autonomic nervous system and main neurotransmitters ✅Sympathetic- norepinephrine
Parasympathetic- acetylcholine
First indicator that neurological functioning has declined ✅Decreased LOC
Levels of consciousness ✅Alert: awake and responsive
Lethargic: drowsy or sleepy but easily awakened
(Obtunded: only stays awake when stimulation is actively occurring)
Stuporous: arousable only with vigorous or painful stimuli
Comatose: unconscious/cannot be aroused
Decorticate posturing ✅Everything drawn in toward the "core"; arms are drawn in
toward chest (flexed at elbows); late sign of brainstem dysfunction
Decerebrate posturing ✅Upper and lower extremities are extended, wrists are flexed,
and neck is extended (and toes fanned out?); late sign of brainstem dysfunction
GCS decrease ✅A decrease of 2 or more points is clinically significant and should be
communicated to the HCP immediately
Wherever a spinal cord injury is... ✅Anything below that level will be affected (function
may be altered or completely lost)
Cervical spine injury C4 or above ✅Risk for decreased spontaneous respiration
Complete vs incomplete spinal cord injury ✅Complete- loss of all voluntary movement
and sensation below level of injury (lesion damage entire diameter of cord is severed)
Incomplete- partial or varying losses below level of injury (lesion damage partial
diameter of cord)
Primary vs secondary mechanisms of injury ✅Primary- injury directly to the spinal cord
(hyperflexion, hyperextension, compression, rotation, penetrating trauma, etc.)
Secondary- injury occurred because of something else (hemorrhage, ischemia,
hypovolemia, edema)
-swelling, etc. makes the tissue not get enough blood flow
Primary intervention for spinal cord injury ✅Stabilize the site immediately (stabilize C-
spine)
-stabilize head with collar, hands, or sandbags; stabilize spine on a board
, -cannot take off devices until spine is cleared
Hold C-spine ✅Holding the patient's neck still so they can't move their head; put your
palms on their ears; if you need to turn them, do a log roll (would need at least 2 people
for this, as one person must hold the C-spine)
-don't try to talk to patients with potential spinal cord injuries unless you're directly above
them (they may try to turn and look at you)
Management of spinal cord injury ✅Respiratory issues are first priority, then
cardiovascular; also assess neurological functioning, sensory/motor ability, and GI/GU
systems
If anything at or above T6 is injured... ✅The chest wall muscles won't work as they
should
-breathing won't be as effective
-patient's body will fatigue quickly because only the diaphragm is working to breathe
-patient at risk for respiratory complications and pulmonary embolus during the first 5
days after injury
Desired blood pressure for perfusion ✅MAP of 60; systolic at or above 90
Proprioception ✅Knowing where your body parts are in space
Lack of impulses to bowel ✅Rectum loses its tone (becomes relaxed if it loses
innervation/impulses); may have bowel incontinence if there is fecal matter in the
rectum
-peristalsis will also stop, so patients are at risk for bowel obstruction (paralytic ileus) or
constipation
Lack of impulses to bladder ✅The bladder requires an impulse to empty, so it cannot
be emptied independently if it loses innervation/impulses; patients with spinal injuries
may have a permanent cath or may self-cath regularly
Priority drug for acute spinal cord injury ✅High doses of steroids as soon as possible
(specifically methylprednisolone)
Baclofen and tizanidine ✅Muscle relaxers; can cause drowsiness; can cause
psychosis (hallucinations) if withdrawn too quickly
Other medications for spinal cord injuries ✅Vasopressors (to increase BP), dextran (to
increase volume/BP), pain meds, DVT prophylaxis, stool softeners
Decompressive laminectomy ✅Removal of part of the laminae of the vertebrae, which
allows for swelling without compression of the spinal cord
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