Neuro Flashcards
2 Nervous System
Central and Peripheral Nervous System
CNS is about
Brain and Spinal Cord
2 Types of PNS
Somatic and Autonomic Nervous System
Voluntary Movements
Somatic Nervous System
2 Types of Autonomic Nervous System
Sympathetic
Parasympathetic
Basic functional unit of The Nervous System
NEURONS
Extension that carry the impulses toward the cell body.
Dendrite
Transmits impulses away from the cell body
Axon
Allows impulse to transmit
Myelin Sheath
Types of Neurons
Sensory Neurons (Affarent)
Motor Neurons (Efferent)
Interneurons
Transports impulse from receptors to the CNS
Sensory Neurons
Transports impulse from CNS to the receptors
Motor Neurons
Found entirely within the central nervous system
Specialized to transmit sensory / motor impulse
Interneurons
Communicate message from one neuron to another or from a neuron to a specific target tissue
Neurotransmitters
Excitatory
Control movements, motivation, and cognition
Regulates emotion response
DOPAMINE
Excitatory
Causes sympathetic stimulation
Causes changes in attention and learning
NOREPINEPHRINE
Excitatory
Control fight or flight response
EPINEPHRINE
Inhibitory
Controls emotion (happy and sad)
SEROTONIN
Inhibitory / Excitatory
Signals muscles to be alert
Controls wakefulness and sleep cycle
ACETYLCHOLINE
Inhibitory
Relaxation hormone
GABA
Excitatory
Responsible for relaying messages between MOTOR neurons
GLUTAMATE
CENTRAL NERVOUS SYSTEM
CEREBRUM
CEREBELLUM
BRAIN STEM
DIENCEPHALON
Cerebrum Lobes
Frontal
Parietal
Temporal
Occipital
Personality
Attention / Focus
Speech: Brocha’s Area (Expressive)
Thinking / Judgment
Frontal Lobe
Touch
Taste
Temperature
Parietal Lobe
Memory of sound
Hearing and Smelling
Speech: Wernicke’s Area (Receptive)
Temporal Lobe
Vision
Memory
Occipital Lobe
Balance and Coordination
Cerebellum
Brain Stem
Mid Brain
Pons
Medulla Oblongata
Auditory and Visual REFLEX
MId Brain
Pattern of Breathing
Pons
Controls heart and respiratory rate, coughing and vomiting
Medulla Oblongata
Diencephalon
Hypothalamus
Thalamus
Controls BP and Temperature
Hormone release
Hypothalamus
Pain threshold
Capable of suppressing minor sensation
Thalamus
Peripheral Nervous System
Cranial Nerves
CN
Sense of Smell
Sensory
Assessment: With eyes closed, patient is asked to identify familiar odors (Coffee, Cinnamon)
Abnormal: Anosmia – Loss of sense of smell
I - OLFACTORY
CN
Sense of Sight / Vision
Sensory
Assessment: Snellen’s Chart (Normal: 20/20)
Abnormal: Hemianopia, Blindness
II - OPTIC
CN
Pupillary constriction & dilation
Motor
Assessment: PERRLA
Abnormal: (-) PERRLA
III – OCULOMOTOR
CN
6 Cardinal Gaze movement
Motor
Assessment: Cardinal Field of Gaze Assessment
Abnormal: Nystagmus
IV - TROCHLEAR
CN
TriCHEWminal – For chewing
Facial SENSATION
Both
Assessment: Wisp of cotton
Abnormal: Absent of sensation and jaw weakness
V - TRIGEMINAL
CN
Eye movement side-to-side (AbduSIDE-TO-SIDE)
Motor
Assessment: Test for bilateral eye movement
Abnormal: Double Vision
VI – ABDUCENS
CN
Facial MOVEMENT
Anterior 2/3 of tongue sensation
Both
Assessment: Ask patient to smile and wrinkle forehead
Abnormal: Facial weakness
VII - FACIAL
Sense of hearing, balance, and coordination
Sensory
Assessment: Weber’s / Rinne Test and Romberg Test
Abnormal: Deafness and Impaired balance
VIII - VESTIBULOCOCHLEAR
CN
Swallowing
Posterior 1/3 of the tongue sensation
Both
Assessment: Food tasting
Problem: Augeusia / Dysphagia
IX – GLOSSOPHARYNGEAL
CN
Movement of Uvula / Gag Reflex
Parasympathetic sensation
Both
Assessment: Tongue Depressor
Abnormal: Absent Gag Reflex
X - VAGUS
CN
Neck movement
Motor
Assessment: Ask the patient to turn head and shrug shoulders
Problem: Weak / Absent Shoulder Shrug
XI - ACCESSORY
CN
Tongue movement
Motor
Assessment: Ask patient to move tongue side to side
Problem: Dysphagia / Slurred Speecj
XII - HYPOGLOSSAL
31 PAIRS SPINAL NERVES
CERVICAL – C1 – C8
THORACIC – T1 – T12
LUMBAR – L1 – L5
SACRAL – S1 – S5
COCYX - 1
DACALGG
C1 – C4 – Diaphragm
C5 – T1 – Arms
T2 – T6 – Chest
T7 – T12 – Abdomen
L1 – L5 – Legs
S1 – S3 – GI & GU
S4 – S5 – Genitals
Fight or Flight Response
Increase Everything; Decrease GI & GU
SYMPATHETIC NERVOUS SYSTEM
Dominates during relaxed situations
Decrease Everything; Increase GI & GU
PARASYMPATHETIC NERVOUS SYSTEM
Neuro Assessment
CEREBRAL FUNCTION
Assess degree of wakefulness / alertness
Note the intensity of stimulus to cause a response
Apply a painful stimulus over the nailbed with a blunt instrument
Ask questions to assess orientation to person, place, and time
GLASGOW COMA SCALE
3 Areas:
Eye Opening
Verbal Response
Motor Response
Scores Interpretation:
15 = highest score; patient is fully oriented and alert
<7 = comatose patient
3 = Deep coma
DIAGNOSTIC TEST
SKULL AND SPINAL X-RAY
Identifies fracture, dislocation, compression, and spinal cord problem
Nursing Care:
1. Provide support for the confuse of combative client
2. Remove metal items
3. Maintain immobilization
CT - SCAN
Used for diagnosing neurological disorder of the brain or the spine
Can detect:
1. Hemorrhage
2. Tumors
3. Abscess
Nursing Care:
1. Assess for iodine allergy
2. Instruct to lie still on a movable table
3. Inform the patient of possible discomforts
4. Remove any metallic object
MAGNETIC RESONANCE IMAGING
Used for diagnosis of degenerative diseases, intracranial and spinal abnormalities
Not useful when looking bony abnormalities
ELECTROENCEPHALOGRAPHY (EEG)
Graphic recording of electrical activity of the brain by placing electrodes to the scalp
Unilateral inflammation of CN 7 (Facial)
Cause:
Infection
Autoimmune
Viral Infection (Herpes simplex)
Signs and Symptoms:
Drooping of the eyelid (Ptosis)
Inability to close eye completely
Unilateral facial weakness (temporary)
BELL’S PALSY
Management:
1. Facial Massage (Moist Heat Massage)
2. Artificial tears
3. Antibiotics / Antiviral Drugs
4. Corticosteroids
5. Eye patch on affected side / sun glasses
6. Soft diet - Chew on the unaffected side
7. Avoid hot fluids / food
8. Facial Exercise (grimacing, wrinkling, puffing of cheeks, blowing of air
Bell’s Palsy
Other name: Tic Douloureux
Problem in CN 5 (Trigeminal)
Cause:
Chronic compression and irritation of CN 5
Degenerative changes in the Gasserian Ganglion
Pressure from surrounding tissue
Risk factors:
Patient with multiple sclerosis (Damage to myelin sheath around trigeminal nerve
Men with MS > Women with MS
Signs and Symptoms:
Sudden severe unilateral facial pain
Sensitive to extreme changes in temperature
Difficulty chewing
TRIGEMINAL NEURALGIA
other name of TRIGEMINAL NEURALGIA
Tic Douloureux
Medical Management:
1. Pharmacologic Therapy
Anti-seizure (Carbamazepine) – To manage pain by decreasing electrical impulse on trigeminal nerve
Alcohol / Phenol injection of the Gasserian Ganglion – To make the nerve numb
2. Surgical Treatment
Microvascular Decompression of the Trigeminal Nerve
Percutaneous Balloon Micro-Compression
3. Radiofrequency Thermal Coagulation
Nursing Management:
1. void extreme changes in temperature
2. No facial massage / teaching
3. Pat dry to cleanse face
4. Chew on unaffected side
5. Soft diet
6. Post op care:
Instruct not to rub the eye
Assess the eyes for redness
Artificial tears
TRIGEMINAL NEURALGIA
Autoimmune diseases that damages the myelin sheath and would lead into delayed impulse transmission
Demyelination Disorders
Demyelination of CNS nerves
Has remission and exacerbation
Common cause:
Autoimmune
Post Viral Infection
Common in: 20-40 years old (female)
MULTIPLE SCLEROSIS
Signs and Symptoms:
-Visual Disturbances:
Scotoma -white patches in vision (EARLIEST SIGN)
Diplopia
Blurred Vision
-Respiratory Depression
-Cerebellum/Basal Ganglia Involvement:
Tremors
Muscle Weakness (descending) MS (Mataas Simula)
Ataxia
-Sensory Nerve Disturbances:
Paresthesia
Pain
-Cognitive Disturbances:
Memory Loss
Decrease Concentration
Dementia
-Bowel and Bladder Dysfunction
-Lhermitte’s Sign
Multiple Sclerosis
Is an electric shock sensation that radiated from the back of your neck down your spine.
Lhermitte’s Sign
MS
Due to impaired cerebellar function
Intentional Tremors
Scanning Speech
Nystagmus
CHARCOAT’S TRIAD
Medical Management:
1. Corticosteroid (Methylprednisolone)
2. Baclofen – Muscle relaxant
3. Oxygen and Mech Vent - If (+) respi involvement
Nursing Management:
1. Warm pack application – To minimize spasm
2. Avoid hot baths – Due to head intolerance
3. Moderate exercise (swimming, stationary biking)
4. Unilateral eye patch
5. Promote regular elimination:
- Increase fluid and fiber intake
- Stool softener
6. Priority: SAFETY due to impaired muscle control
7. WOF: UHTHOFF’S SIGN
- Transient worsening of symptoms after exposure to hot environment
Multiple Sclerosis
Demyelination of PNS nerves
Cause: Autoimmune
History of GI or Respi Infxn (Campylobacter Jejuni)
Signs and Symptoms:
Dyskinesia (Leg weakness / Clumsiness ) – Early Sign
Paralysis of Diaphragm
Dec. GIT and GUT function
Numbness & Spasticity
Ataxia
GUILLAIN – BARRE SYNDROME
Complications:
Respiratory failure
Cardiac dysrhythmias
Orthostatic hypertension
Medical Management:
1. Plasmapheresis
2. Corticosteroids
3. Dantrolene Sodium – Muscle relaxant
Nursing Management:
1. Maintain adequate ventilation
2. Perform range-of-motion exercises
3. Assess gag reflex prior to feeding
4. Assistive devices
5. No to hot baths
6. Priority: SAFETY
7. Promote regular elimination:
- Increase fluids and fiber intake
GUILLAIN – BARRE SYNDROME
Nurse Marty is monitoring a client for adverse reactions to Dantrolene Sodium. Which adverse reaction is most common?
Excessive tearing
Urine retention
Muscle weakness
Slurred speech
Muscle weakness
Nurse Kim is assessing a 37 year old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?
Vision changes
Absent deep tendon reflex
Tremors at rest
Flaccid muscles
Vision changes
The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to:
Take a hot bath
Rest in an air-conditioned room
Increase the dose of muscle relaxants
Avoid naps during the day
Rest in an air-conditioned room
A male client with Bell’s Palsy asks the nurse what caused this problem. The nurse’s response is based on an understanding that the cause is:
Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem
Unknown, but possibly includes long term tissue malnutrition and cellular hypoxia
Primary genetic in origin, triggered by exposure to meningitis
Primary genetic in origin, triggered by exposure to neurotoxins
Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem
Although an adverse reaction to Tensilon is considered rare, which medication should be readily available to give as an antidote in case a patient should experience complications?
Protamine Sulfate
Narcotic Analgesic
Atropine Sulfate
Regitine
Atropine Sulfate
Cranial Nerve Disorders
Bell’s Palsy
Trigeminal Neuralgia
Demyelination Disorders
Multiple Sclerosis
Guillain-Barre Syndrome
Neurotransmitter Disorders
Myasthenia Gravis
Parkinson’s Disease
Amyotropic Lateral Sclerosis
Huntington’s Disease
Defect in transmission of nerve impulse at myoneural/neuromuscular junction
Cause: Autoimmune that will attack acetylcholine receptors
Antibody will bind to acetylcholine receptors
Acetylcholine can’t bind anymore
Acetylcholine accumulates in the synapse
Cholinesterase will kill acetylcholine in the synapse
POOR MUSCLE MOVEMENT
Myasthenia Gravis
Diagnostics:
TENSILON TEST (Confirmatory)
- Cholinesterase inhibitor (Endrophonium) is injected
- (+) MG = Temporary (5 mins) improve in muscle movement
- Prepare Atropine Sulfate (Symphatomemitics) for possible side effects.
Signs and Symptoms:
Descending Paralysis (Mataas Galing)
Diplopia & ptosis – Early Sign !
Muscle weakness in the afternoon
Dysphonia (voice impairment)
Myasthenia Gravis
Management:
1. Priority: Airway
2. NGT feeding
3. Plasmapheresis to remove excess antibody
4. Mechanical Ventilator Stand-by
5. Tracheostomy Set at Bed Side
6. Medications: (anticholinesterase/Cholinergics)
Neostigmine (Prestigmine)
Pyrastigmine (Mestonin)
Steroids
Myasthenia Gravis
MYASTHENIA GRAVIS Complications (CHOLINERGIC CRISIS VS. MYASTHENIC CRISIS)
CHOLINERGIC CRISIS
Overmedication
Tensilon Test: Muscle weakness
Parasympathetic effects
Prepare: Atropine Sulfate
MYASTHENIC CRISIS
Undermedication
Tensilon Test: Temp. Relief
Sympathetic effects
Prepare: Cholinergics
Slowly progressing neurologic movement disorder caused by Decrease Dopamine Level
Causes:
Idiopathic
Degenerative
Viral infection
Head trauma
Use of antipsychotic medications
Pathophysiology:
Damage to Substantia Negra
Decrease dopamine production
Abnormal muscle movement
Parkinson’s Disease
Signs and Symptoms:
Cog-wheel rigidity
Pill-rolling tremors
Resting tremors – Early sign!
Stooped posture – Osteoporosis like
Bradykinesia – Dec. Muscle Movement
Shuffling gait – Dragging 1 foot when moving
Mask – Like appearance
Dysphagia
Decrease GIT and GUT function
Respiratory depression
Parkinson’s Disease
Medical Management:
1. Pharmacologic treatment:
Antiparkinsonian Drug
- Levodopa
- Carbidopa
Antiviral drugs
- Amantadine
Dopamine Agonist
- Bromocriptine
- Pergolide
Antihistamines
- Benadryl
Anticholinergic Agents
- Cogentin
- Artane
- Akineton
Parkinson’s Disease
NursingManagement:
1. Activity: Anything that involves fingers
2. Priority: Safety
3. Mobility: Marching walk ; if they freeze, move to opposite side
4. Diet: Puree diet because of dysphagia
5. Aspiration precaution
Parkinson’s Disease
Other name of Amyotropic Lateral Sclerosis
Lou Gehrig’s Disease
AKA: Lou Gehrig’s Disease
Progressive, degenerative condition that affects MOTOR NEURONS
Causes:
Unknown
5-10% Genetically transmitted
Increase GLUTAMATE in the brain
Pathophysiology:
Increase Glutamate in the brain
Voluntary muscle problem
FINE MOTOR
Fasciculation
- Twitching of muscle
- Earliest Sign
Tremors
Dysphagia
GROSS MOTOR
Respiratory Depression
- Common cause of death (2 years)
AMYOTROPIC LATERAL SCLEROSIS
AMYOTROPIC LATERAL SCLEROSISMedical Management:
1. Riluzole (Rilutek)
– To decrease glutamate in the brain
- Can delay symptoms for as long as 3 months
2. Mechanical ventilator stand-by
AMYOTROPIC LATERAL SCLEROSIS
Nursing Management:
1. Maximize functional abilities:
- Prevent complications of immobility
- Promote self care
- Maximize effective communication
- Promote use of assistive devices
2. Ensure adequate nutrition
3. Prevent respiratory complications:
- Promote measures to maintain adequate airway
AMYOTROPIC LATERAL SCLEROSIS
Progressive atrophy of basal ganglia and some parts of cerebral cortex
Basal Ganglia – Helps to control muscle movements
- Produces GABA
Pathophysiology: Decrease GABA
Impaired muscle relaxation
Overactivity of muscle
Cause: Autosomal Dominant
- Only takes 1 parent to pass the gene
- 50% transmission to child
HUNTINGTON’S DISEASE
Neurotransmitter abnormalities:
Decrease GABA
- Increased voluntary movements
- Chorea – Sudden muscle jerking
- Impaired chewing and swallowing
Increase Dopamine
- Psychosis
- Personality changes
Abnormal Serotonin
- Depression / Manic
HUNTINGTON’S DISEASE
Nursing Management:
1. Foster independence in ADL
2. Reinforce use of assistive devices
3. Aspiration precaution
4. Provide safe environment
5. Genetic counseling
Huntington’s Disease
NEURO - INFECTIOUS DISORDERS
Meningitis
Inflammation of meninges in the brain and spinal cord
Causes: Bacterial, Viral, or Protozoan Infection
Signs and Symptoms:
Increase ICP
Hearing loss
Photophobia
Projectile vomiting
Nuchal Rigidity - Neck Stiffness
Kernig’s Sign - Knee
Brudzinki’s Sign - Batok
Meningitis
Management:
1. Droplet precaution
2. Antibiotics within 24 hours para dili na contagious
3. Isolate the patient
4. Place in private, non-stimulating room to prevent seizure
5. WOF: Aspiration
Meningitits
SEIZURE – RELATED DISORDERS
Seizure
Abnormal transmission of impulse at motor complex of the brain.
Cause:
Information overload
Infection
Trauma (Brain)
Autoimmune
Heredity
Vegan diet – Vitamin B12 deficiency
Seizure
Types of Seizure
Epilepsy
Status Epilepticus
Petit Mal
Grand Mal
Myoclonic
Akinetic
Symptomatic
Simple Partial / Focal Awareness
Complex Partial / Focal Impaired Awareness
Chronic, recurrent episodes of seizure that is unprovoked
Epilepsy
- A continuous seizure that last 5-30 minutes
- Risk for hypoxia:
3-5 mins – Normal tolerance
6-8 mins – Cerebral damage
>8 mins – Brain stem damage
Status Epilepticus
- Absence seizure
- Blank facial expression
- “Blank Stare”
- Common in pedia
Petit Mal
- Tonic – Clonic Seizure (Preceeded with Aura)
- Tonic – Stiffening
- Clonic – Involuntary muscle jerking
- Generalized seizure
Grand Mal
- Brief, involuntary muscle jerking of the body
- 1– 2 seconds
Myoclonic
- Drop attack seizure
- Sudden loss of postural tone & consciousness
Akinetic
- Benign seizure
- Temporary until the cause will be addressed
- ex: Febrile (convulsion)
Symptomatic
- Conscious seizure
- Purposeless behavior
Simple Partial / Focal awareness
- Preceded with Aura
- Impaired consciousness
- Cannot remember what happened
Complex Partial / Focal Impaired awareness
Pre - Ictal Phase
- Aura:
Flashing lights
Smells burning wire
Metallic taste
Dizziness
- Loss of consciousness:
1. Protect the head and neck then lay down
2. Turn to sides
3. Loosen constrictive clothing
4. Clear the area
- Priority: SAFETY ! ! !
Seizure
What phase:
- Aura:
Flashing lights
Smells burning wire
Metallic taste
Dizziness
- Loss of consciousness:
1. Protect the head and neck then lay down
2. Turn to sides
3. Loosen constrictive clothing
4. Clear the area
- Priority: SAFETY ! ! !
Pre-Ictal Phase
Management:
1. Turn patient to side (Left lateral side lying)
2. Remove objects that may harm the patient
3. Loosen restrictive clothing
4. Raise 2-3 side rails
5. Do not put anything inside the patient’s mouth
6. Remove pillow if seizure on bed; Put pillow if happens on the floor
7. Suction machine at bedside
8. Medications: Anticonvulsants
Seizure
Seizure: Anticonvulsants
PhenyCarDiLaToDe
PHENYtoin
CARbamazepine
DIazepam
LAmotrigene
TOpamax
DEpakene
SEIZURE anticonvulsant:
First line in the hospital; given via IV
Fast acting
Sedative / Relaxant: Can induce sleep
HIGHLY ADDICTIVE
Antidote: Flumazenil
Diazepam (valium)
SEIZURE anticonvulsant:
For maintenance due to its least toxic effect
Side effect:
GINGIVAL HYPERPLASIA
- Have a good oral hygiene
- Massage gums
- Use soft bristle toothbrush dip in warm water
Adverse effct: AGRANULOCYSTOSIS – Dec. WBC
Don’t discontinue abruptly because it may lead to Status Epilepticus
Therapeutic level: 10 – 20 mg/dL (DilanTEN – PhenyTOINte)
PHENYTOIN (DILANTIN)
Monro – Kellie Hypothesis:
“Skull is incompressible”
Brain – 80%
CSF - 10%
Blood - 10%
Normal: 0-15 mmHg
Causes:
Brain abscess
Brain Hemorrhage
Brain edema
Hydrocephalus
Initial Sign: Altered Level of Consciousness (Cerebrum will be the first affected)
- Restlessness
- Confusion
- Disorientation
- GCS alteration
Late Sign: - Decrease Level of Consciousness (Lethargy)
- Seizure
- Projectile Vomiting - Indicates medulla oblongata damage
- Cheyne – Stoke Respiration – Indicates pons damage
- Decerebrate Posture
- High - pitched cry (newborn)
- Bulging fontanels (newborn)
- Cushing’s Triad – Indicates brain stem damage
Increased Intracranial Pressure
- Medications:
IV mannitol - For cerebral edema
- Check BP before administration
- Check urine output during therapy
Dexamethasone - Steroids for cerebral inflammation - DON’TS:
Valsalva Maneuver
Routine suctions
Lumbar puncture
Coughing / Sneezing
Increased Intracranial Pressure
Disruption of blood supply to the brain
Causes:
Thrombus Formation
Hypertension
Atherosclerosis
Diabetes Mellitus
Aneurysm
Risk Factors:
Age: 45 years old and above
Obesity
Estrogen Therapy – Increases clotting ability
Hereditary
Sedentary lifestyle
Smoking
Alcoholism
CEREBROVASCULAR ACCIDENT
2 types of CEREBROVASCULAR ACCIDENT
Ischemic
Hemorrhagic
2 Areas affected:
Left Hemispheric Stroke
- Paralysis to the right side of the body
- Right visual field deficit
- Aphasia
- Altered intellectual ability
- Slow, cautious behavior
Right Hemispheric Stroke
- Paralysis to the left side of the body
- Left visual field deficit
- Increase distractibility
- Lack of awareness of deficits
What to assess:
Facial drooping
Arm defect
Slurred speech
Time – To measure the severity of brain damage and for the drug administration
CEREBROVASCULAR ACCIDENT
Signs and Symptoms:
Aphasia:
- BROCHA’S APHASIA – Unable to speak fluently
- WERNICKE’S APHASIA – Unable to comprehend
- GLOBAL APHASIA – Combined
- Management:
1. Short, one at a time task
2. Independence promotion
3. Make simple direction
4. Alternative communication style
5. Provide time to verbalize concerns
-Paralysis (Hemiparesis)
Weakness of 1 side of the body
Management:
1. Quad cane on the AFFECTED SIDE
2. Slipping Tub Bath
3. Electric wheel chair
4. Avoid - Roller Walker
Foot drop (Plantar Flexion)
- Management:
1. High topped sneakers
2. Foot board
Neglect Syndrome (Unilateral Neglect)
- Inability to identify for weak side
- Management:
1. Instruct the patient to touch the weak side
2. Offer a mirror
Homonymous Hemianopia (Half Vision)
-Management:
1. Scan the environment
2. Move side-to-side
3. Initially; Approach from unaffected side
4. Latter; Approach from affected side
Drug Management:
-Striptokinase
-Thrombolytics (for ischemic stroke)
-Ideally given within 4-8 hours
-NOt given in Hemorrhagic stroke
-Antihypertensives
Cerebrovascular Accident
Intracranial Hemorrhage Types:
Epidural
Subdural
Subarachnoid
Intracerebral
Type of Intracranial Hemorrhage:
Location: Between skull and dura mater
Blood Vessel Affected: Middle Meningieal Artery
Hallmark: Lucid Interval
Epidural
Type of Intracranial Hemorrhage:
Location: Between Dura and Arachnoid
Blood vessel affected: Cortical vein
Hallmark: Gradual Deterioration
Subdural
Type of Intracranial Hemorrhage:
Location: Between Pia Mater and Arachnoid
Blood Vessel Affected: Berry Aneurysm
Hallmark: Thunder drop headache (worst headache of his/her life)
Subarachnoid
Type of Intracranial Hemorrhage:
Location: Brain parenchyma
Blood vessel affected: Hemorrhagic stroke
Hallmark: Sudden onset
Intracerebral
Management:
1. Craniotomy
-Supratentorial - superior to tentorium cerebelli
- Post op position: Semi-Fowlers
-Infratentorial - Inferior to tentorium cerebelli
- Post op position: Flat
INTRACRANIAL HEMORRHAGE
2 types of Traumatic Brain Injury
Closed
Open (Skull Fracture)
Types of CLOSED traumatic brain injury
Concussion
Contusion
Jarring of the brain
Concussion
Bruising of the brain
Contusion
Types of Contusion
Coup
Counter-Coup
Coup-Counter-Coup
Same side of the site of injury
Coup
Opposite side to the site of injury
Counter-coup
Bouncing Back traumatic brain injury
Coup-Counter-Coup
Types of OPEN (Skull fracture) traumatic brain injury
Linear
Depressed
Comminuted
Basal-Skull
Fine line on the skull
most common
Linear
Skull is driven inward
Depressed
skull is fragmented
comminuted
Signs and symptoms:
Raccoon’s eye - Periorbital Edema
Battle sign - Ecchymosis of Mastoid Bone
CSF leakage
Open skull fracture
Injury to the spinal cord which characterized by a decrease or loss of sensory and motor functions below the level of injury
, Causes:
. Motor vehicle accidents
• Gunshot injuries
• Falls
• Sports injuries
• Whiplash injury - Neck
•
Transection - Due to sharp objects
• Hyper rotation
Risk factors:
Young age
Alcohol and drug base
Male
Spinal Cord Injury
types of spinal cord injury
Cervical SCI
Thoracolumbar SCI
Paralysis: Quadriphlagia
Priority: Respiratiory
Cervical SCI
Paralysis: Paraphlagia (Lower body)
Priority: Elimination
Thoracolumbar SCI
Management
1. Stabilize the airway (Jaw Thrust Maneuver)
2. Immobilization (Flat, firm surface)
3. Cervical collar
4. Transport client as a unit
5. Do not attempt to realign body parts
6. Suctioning may be indicated, but with caution
7. Position change q 2 hours
8. Intermittent catheterization for bladder distention
9. Anticoagulants
10. Anti-embolic stockings
Spinal Cord Injury
Complication of Spinal Cord Injury
Autonomic Dysreflexia
Complication: AUTONOMIC DYSREFLEXIA
- Life threatening condition that occurs in patients with SCI above T6 level.
- Impairs the normal equilibrium between sympathetic and parasympathetic divisions
• Causes:
Bladder distention (Most common)
•
Bowel impaction
.
UTI
.
Pressure ulcers
Spinal Cord Injury
Manifestations:
• Hypertension
• Throbbing / Pounding headache
• Diaphoresis
• Piloerection
• Bradycardia
• Blurring of vision
• Warm and flushed - Above the level of injury
• Cold and Pale - Below the level of injury
Spinal Cord Injury
Management:
1. Position the patient in sitting position to decrease BP
2. Catheterization
3. Check for fecal impaction
4. Monitor blood pressure
5. Antihypertensive medication: HYDRALAZINE
Spinal Cord Injury
Antihypertensive medication in spinal cord injury
HYDRAZALINE
