Neuro Flashcards
When beginning a neuro assessment what is most important to confirm?
Airway
Breathing
Circulation
Neuro assessment
general survey
LOC
orientation
subjective data
mental status
gait
reflexes
sensation
coordination
proprioception
GCS/EMV
pupils
visual fields
muscle strength
speech
swallowing
gag reflex
Who would need a focused neuro assessment?
bc of neuro disease
changes in neuro status
trauma
drug induced states
neuro complaints
4 Hs
hypoxia
hypoglycemia
hypotension
hypoventilation
Alert
awake
responsive
easily aroused
receptive and responsive
Lethargic
not fully alert
drifts off to sleep when not stimulated
drowsy
awakes to NAME
responds appropriately
slow to respond
Are lethargic patients airway ability intact?
yes
Obtunded
sleeps most of the time
doesn’t arouse to name
SHAKE to awake, LOUD shout
confused when aroused
mumbled speech, incoherent
requires constant stimulation
Are obtunded patients airway ability intact?
concerning, don’t feed for aspiration precautions
Stupor/Semi comatose
spontaneously unconscious
responds only to SHAKE or PAIN
groans, mumbles
Are stupor patients airway ability intact?
no, high concern
don’t feed, aspiration precautions
Comatose
completely unconscious
no meaningful stimuli
no motor response
GCS/EMV
graded 3-15
<7-9 comatose
objective assessment
What EMV score is the airway protection a concern?
7-9
What EMV score is unresponsive?
3
What is an exception to a low EMV score?
trach patients, who have no verbal ability
11T- appropriate and airway is protected
Proprioception
recognize where your limbs are in space
Coordination
rapid alternative movements
What is the goal for neuro patients?
protect status and maintain safety
assist patients in gaining independence
protect airway!
Skin care for neuro patients
monitor and assess skin
q2 turns
pressure distribution
mobility
elimination needs
Neuro Dx
x-ray
CT scan
contrast
MRI
EEG
What is the least invasive way to diagnose?
x ray
X ray
skull
spinal
no NPO
keep c collar on
remove metal objects
painless
CT scan
3D images of organs, bones, tissues
detects hemorrhage, vascular abnormal, tumor, cysts
no NPO
identify allergies to iodine
NPO for some
claustrophobic
Contrast
PO, IV, rectal
helps distinguish selected body parts from surrounding tissues
*blood flow through brain
can be iodine based-allergies
MRI
more detailed than CT
no exposure to radiation
expensive
screen for metal-remove it!
remove medicated patches
Who should you call if you are questioning if a MRI is safe for the patient?
radiology
Electroencephalogram EEG
monitors brain activity
helps diagnose seizures
confirms brain death
electrodes places on skull with conduction paste
Factors influencing sensory function
age
meaningful stimuli
amount of stimuli
social interaction
enviromental factors
cultural factors
Who is at risk for for sensory alterations?
farmers
outdoor laborers
night shift workers
nuns, monks
OA
confined environments
acutely ill
Common visual deficits
presbyopia
cataracts
computer vision syndrome
dry eyes
glaucoma
DM retinopathy
macular degeneration
Receptive aphasia
inability to understand written or spoken language
trouble to UNDERSTAND
Expressive aphasia
inability to name common objects or express ideas in words or writing
trouble to TALK
can still understand
Care for visual deficits
announce self
stay in visual field
speak in warm, present tones
explain care prior
keep paths clear
orient to room
What is the technique with ambulating a patient with visual deficits?
pace of patient
1/2 step in front of patient
walk beside patient
have them hold your arm
What size and color of text should you supply with visual deficit patients?
red and yellow
large text
Care for hearing deficits
check for cerumen impaction
amplify sounds
add flashing lights for safety
slow/normal tone
short sentences
communication boards
face patient when speaking
Care with taste deficits
well seasoned food
several textured food
stimulate smell with aromas
serve most appealing foods
use plate as clock
don’t bland or blend food
Care with smell deficits
smoke detector
check food dates and appearance (teach)
danger with cleaning chemicals
no gas appliances
Care with tactile deficits
touch therapy
turning, repositioning
hyperesthesia, minimize irritation, avoid loose linens
adapt with water temp, ice/heat, shoes
When are yes/no questions appropriate?
common communication deficits
Sensory deprivation causes
isolation
loss/impairment of senses
confinement
emotional disorders
brain injuries
Nursing care for sensory deprivation
slow opportunity for stimuli
interaction
tactile stimulation
reorientation
assistive devices
**meaningful stimuli
For sensory deprived patients, is constant visitors or small 1-1 visits more appropriate?
small 1-1 visits
Care for community dwelling deprivation
encourage community agencies
programs, rehab, OT clinic
Sensory overload
excessive stimuli
often confused with mood swings
Causes of Sensory overload
pain
lack of sleep
ICU care
visitors/ staff
Care for Sensory overload
orient
control stimuli
uninterrupted periods
schedule
visitor control
Migraine types
tension headache
migraine headache
cluster headache
Migraine
recurring headache characterized by unilateral throbbing pain
Who are migraines more common in?
women
Who are cluster headaches more common in?
men, 25-55 years
What are premature sx of migraines?
aura, hours to days before
Care for migraines
rule out intracranial or extracranial disease, meningitis
meds-NSAIDS, tylenol, aspirin, excedrin, caffeine
high flow O2 for cluster headache (no rebreather 6-8L/10 min)
CYP 450 pathway
substrates: 2nd drug
Inducers: speed up, less absorbed, DECREASE effects
Inhibitor: slows down, substrate stays in body longer, more toxic
