Neuro & Peri-operative Nursing – Exam 1 Review

46 question-and-answer flashcards covering neurologic disorders, increased ICP, stroke, seizure care, and peri-operative nursing responsibilities, safety, and complications.

During an active seizure, what three details must the nurse document?

Start and stop time, duration, and patient behaviors (motor activity, eye deviation, post-ictal status).

What safety position is preferred for a patient actively seizing?

Side-lying in low-locked bed to reduce aspiration and injury risk.

Key nursing responsibility in the post-ictal phase?

Re-orient the patient and maintain a quiet, low-stimulus environment.

Define traumatic brain injury (TBI).

Any direct or indirect insult that damages brain tissue, vessels, or causes skull fracture and secondary injury.

Clear drainage from nose/ears after head injury suggests what fluid and how is it tested?

Cerebrospinal fluid; test for glucose or observe a ‘halo’ sign on gauze.

Damage to cranial nerve VII after skull base fracture produces what finding?

Facial droop or Bell’s palsy on the affected side.

Periorbital ecchymosis (“raccoon eyes”) indicates involvement of which skull area?

Anterior cranial fossa fracture/brain injury.

What is the ‘halo sign’?

Blood spot surrounded by a ring of clear CSF on absorbent material—indicates CSF leak.

Why should the nurse never pack the nose or ear when CSF is leaking?

It increases intracranial pressure and infection risk, potentially leading to herniation.

List three common causes of secondary brain injury.

Hypotension, hypoxia, or increased intracranial pressure following the initial insult.

Concussion definition in one sentence.

Transient functional neurologic disturbance without structural brain damage visible on imaging.

Post-concussion syndrome may persist for how long?

Up to 6–12 months (sometimes longer).

After minor head injury, how often should the patient be awakened for neuro checks?

Every 3–4 hours for the first 24 hours.

Which medications must be avoided after head injury unless ordered by neurosurgery?

Sedatives, alcohol, and narcotic analgesics.

Explain contrecoup (ipsilateral) effect.

Clinical deficits appear on the side opposite the site of impact due to brain rebounding inside the skull.

Name the three most common intracranial hematoma locations.

Epidural, subdural, and intracerebral.

Components of Cushing’s triad indicating rising ICP?

Widened pulse pressure (↑SBP), bradycardia, and irregular or decreased respirations.

At what Glasgow Coma Scale (GCS) score is intubation generally required?

8 or below: “8 = intubate.”

What are the three parts of the GCS?

Eye opening, verbal response, and motor response.

Unilateral dilated pupil often signals what?

Ipsilateral cerebral lesion or herniation compressing cranial nerve III.

First-line osmotic diuretic for reducing acute intracranial pressure?

Mannitol (followed by a loop diuretic if ordered).

Four major modifiable stroke risk factors.

Hypertension, hyperlipidemia/atherosclerosis, smoking, and diabetes mellitus.

Right-hemisphere stroke produces which motor deficit?

Left-sided weakness or hemiplegia with spatial-perceptual deficits.

Left-hemisphere stroke commonly causes what speech disturbance?

Aphasia (expressive, receptive, or global).

What does the FAST acronym stand for?

Face drooping, Arm weakness, Speech difficulty, Time to call 911.

Name two endocrine complications of increased ICP.

Diabetes insipidus (DI) or syndrome of inappropriate ADH (SIADH).

Drug of choice to stop an active generalized seizure in hospital?

Diazepam (or lorazepam) IV.

Primary nursing role regarding surgical consent form?

Witness the patient’s signature after verifying understanding and competence; do not provide procedure details.

If a pre-op patient ate breakfast 6 hours before scheduled surgery, what is the nurse’s first action?

Notify the surgeon/anesthesia provider for possible delay or reschedule.

Define the three urgency categories of surgery.

Elective (planned), Urgent (within 24 h), Emergent (immediate, life-saving).

Example of an emergent surgery mentioned in class?

Active internal bleeding requiring immediate operative control.

Purpose of the surgical ‘time-out’ or checklist?

Confirm right patient, procedure, site, consent, equipment, and allergies immediately before incision.

Nurse action when sterility is breached during surgery?

Identify the break, stop the team, replace contaminated items, and restore sterile field.

Life-threatening reaction to certain anesthetics marked by rapid temperature rise and rigidity?

Malignant hyperthermia.

List three key elements of pre-op teaching for every surgical patient.

Deep-breathing/incentive spirometry, splinting incision when coughing, early leg exercises/ambulation.

Primary responsibility for first dressing change after surgery?

Surgeon or provider (nurse reinforces dressings and monitors drainage).

What is wound dehiscence and how can patients help prevent it?

Separation of surgical incision; prevent by avoiding heavy lifting and splinting with a pillow when coughing or sneezing.

Post-op urinary retention is suspected if the patient has not voided within how many hours?

8–10 hours after surgery.

Early clinical signs of atelectasis after surgery.

Dyspnea, tachypnea, diminished breath sounds, and restlessness.

Three common VTE prevention measures post-operatively.

Early ambulation, sequential compression devices (SCDs), and prophylactic heparin/LMWH.

Classic signs of hypovolemic shock after surgery.

Hypotension, weak thready pulse, cool clammy skin, decreased urine output, restlessness.

If abdominal evisceration occurs, what is the immediate nursing action?

Cover protruding organs with sterile saline-soaked gauze and notify surgeon STAT.

Most sensitive early sign of post-op hypoxia?

Restlessness (often with tachycardia).

When a language barrier exists, how must consent and education be provided?

Through a qualified medical interpreter, not family members.