Neuro (2) Flashcards
Most common cause of spinal cord injuries
Trauma
Nursing issues for spinal cord injuries include
rehab and community care and acute admissions for event and complication
You are in the ED. A patient is brought in due to a spinal cord injury, what are your first actions?
Assess respiratory pattern and airway
Once respiratory pattern and airway is assessed, what is also important to assess?
mental and psychological status, check for autonomic dysreflexia
What are s/s of Autonomic dysreflexia?
HTN, bradycardia, flushed face and neck, dilated pupils, nasal congestion, blurred vision, SWEATING & NAUSEA
Meds commonly given for spinal cord injury include
stool softeners, H2 antagonists or antacids, low-dose anticoagulant therapy, vasopressor drug if hypotensive, corticosteroids, antispasmotic, NSAID or analgesics, and/or antidepressants
How do you prevent and treat autonomic hyperflexia?
prevent fecal impaction, bladder distention, or other triggering stimuli by raise HOB immediately and remove SEQ if pt. experiencing s/s. Straight cath and remove impaction. Give HTN med and then monitor BP.
How often should you do a neuro check on a patient with spinal cord injury?
Check motor and sensory level hourly or as prescribed. Sensory level may be marked on client’s skin
Major problems associated with immobility
skin breakdown (pressure sores), muscle atrophy, bone density, UTIs, constipation, respiratory infection, venous stasis (ulcers), and hypercoagulability (DVT & PE)
To prevent contractures and physical impairments, what should the nurse do?
reposition Q 2 h, P-ROM ( teach family too)
What can nurses do to prevent PE/DVT?
low-dose anticoagulation therapy and SEQ/Stockings
What can nurses do to prevent skin breakdown?
Inspect skin, lubricate bony prominences, reposition Q 2 h. apply skin barrier ointment to perineum before irritation starts. Teach family and patient how to prevent pressure ulcers
How can we optimize bowel function/prevent constipation?
offer a high-calorie, high-protein, high-fiber diet as tol. Initial a bowel retraining program (use stool softeners, rectal suppositories with digital stimulation prn after meals)
Outcomes for Impaired physical mobility; self care deficit
Free from complications (pressure ulcers, venous thrombosis, contractures, and fractures) and able to perform basic physical tasks, ADLs with or without assistive devices
What meds would you expect a patient with impaired mobility to be on?
anticoags (long-term= Coumadin), aspirin, muscle relaxants (baclofen), stool softeners, pain meds, antibiotics
Major care needs of immobilized patient?
risk of infection, discomfort, ineffective airway, hyperthermia, fluid deficits, social isolation, muscle atrophy
What will you do if patient develops a pressure ulcer?
change position, maintain dressing, monitor the progress, and appropriate skin treatment
Outcomes for impaired urinary elimination and/or constipation
voids > 150 ml each time, empties bladder completely, no urinary incontinence, no urinary infections (urine culture neg, voids clear & yellow urine), bowel control and ease of stool
Interventions for impaired elimination and/or constipation
foley (intermittent straight cath at regular intervals), bladder training, stimulate voiding (e.g. run water, warm compress to abdomen), drink 2-2.5 L/day, valsalva maneuver, massage, rectal stimulation, manual disimpaction, stool softener
Impaired adjustment, body image, self-esteem Outcomes
set realistic goals, reports feeling useful, verbalizes optimism regarding future, and identifies effective coping strategies
Interventions for impaired adjustment of body image
encourage pt. to discuss perceptions and feelings, answer questions openly and honestly, refer to provider for questions regarding prognosis/recovery, and refer to spiritual advisors, psychiatric personnel, support groups for pt. and family
What health teaching might a person with impaired immobility need?
teaching about mobility, activity, skin care, Ads skills, medication regimen, and sexuality education
Degeneration of substantia negra leads to a decrease in dopamine, a neurotransmitter that helps to control voluntary movements as a neuron impulse inhibitor describes what disease?
Parkinson’s Dz? *remember, when you want to do DOPE you have to PARK?
True or False, more dopamine and normal acetylcholine (Ach) leads to more excitation of neurons
False, Less dopamine and normal Ach = more excitation of neurons. Which can also affect SNS and norepinephrine levels (Hypotension)
What is diminished in a patient with Parkinson’s Dz?
substantia nigra
Etiology of Parkinson’s Dz
Genetic , environment (toxins, agriculture, meds)
What drug constantly causes PD?
thorazine (chlorpromazine)
5 Cardinal signs of Parkinson’s Dz
tremor (usually resting), rigidity (or muscle stiffness), akinesia (slow, sometime frozen movements), postural instability, cogwheeling (start and stop)
Other s/s of PD?
micrographia, drooling, constipation, excessive sweating, greasy skin, depression, slowness of thought (bradyphrenia), cognitive problems and dementia possible later
What med is given to a PD patient?
Levodopa- crosses the blood-rain barrier and presumably is converted to dopamine in the brain, which is how symptoms are relieved
Major side effect of Levodopa
Dyskinesia= sudden, brief, “shock-like” muscle contraction
Besides Levodopa, what are 2 other classes of drugs that are given to PD patients?
Anticholinergic drugs and dopamine agonists
This class of drugs mimics the effect of dopamine by stimulating the same cells as dopamine
Dopamine agonists
This class of drugs inhibits or blocks the physiological action on Ach at a receptor site, thus stopping tremors
Anticholinergic drugs
4 surgical procedures for PD patients if drugs do not work
thalamotomy, pallidotomy, deep brain stimulation, and striatal grafting of dopaminergic fetal tissue? Gene therapy also an option
7 nursing dx for PD patients
impaired physical mobility, risk for injury- falls, self care deficit, impaired communication, nutrition, altered thought processes- confusion, and ineffective coping r/t emotional lability
How can you provide a safe environment for you patient?
remove throw rugs and excess furniture, grab bar in bathroom, handrails with all stairs, and ensure adequate lightening
How can promote a well-balanced diet?
first assess client’s nutritional status and ability to feed self and swallow. Consult with dietician, speech, and occupational therapy. Provide food at proper consistency, stabilized dishes and utensils, flexible straw for drinking, small frequent meals and snacks, encourage high fiber diet with 3,000 mL of water unless contraindicated
