Neuro Flashcards
- neurons are lost, leading to a decrease in the number of synapses and neurotransmitters(results in slowed nerve conduction and response time)
- brain weight decreases
- Ventricle size increases to maintain cranial volume
- temperature regulation is less efficient
- myelin is lost in the PNS resulting in conduction velocity in some nerves.
- VIsual and auditory nerves degenerate
- Taste buds and sense of smell atrophy
- Nerve cells of the vestibular system in the inner ear degenerate
- DTR’s can be decreased
- Overall slowing of ANS responses
- Pupillary responses are reduced or may not appear at all in the presence of cataracts
The older adult
low-pitched clear voice, do not shout
provide auditory and visual aids
Provide instruction at an un-rushed pace
speaking to an older adult
- Educate the patient about lying completely still
- Review relaxation techniques for pt. with claustrophobia
- assess for iodine or shellfish allergy if contrast was used.
- Monitor kidney function for pt. receiving contrast
- Encourage fluid intake
Nursing interventions for CT scan
- Monitor BUN and creatnine
- Keep patient well hydrated up until test
- Instruct patient to void immediately before the test.
- Mark peripheral pulses with a skin marker
- They must lie still and they should expect a brief feeling of warmth in the face as dye is ejected and they may taste a metallic taste.
- Neuro assessment as soon as they come back and check peripheral pulses
- Monitor insertion site for bleeding or hematoma
- Encourage fluids
Nursing interventions for Cerebral Angiography
- Pt. may need to be deprived of sleep the night before
- Anti-seizure meds, tranquilizers, stimulants, and depressants should be withheld 24 to 48 hours before an EEG because they alter the wave patterns.
- Coffee, tea, chocolate and cola are omitted from the meal before the test
- The patient SHOULD eat before the test because an altered blood glucose level can cause changes in brain wave patterns
Nursing interventions EEG
- Have the patient remain prone
- If more than 20 mL of CSF is removed have them positioned supine for 6 hours
- Bed rest, analgesic agents, and hydration
managing a headache for post lumbar puncture
A test used to screen for balance that can be down with the patient seated or standing with feet together and arms at the side, first with eyes open and then with both eyes closed for 20 seconds.
- Stay near them incase they fall
- Swaying is normal but a loss of balance is not
Romberg test
The general loss of ability to recognize objects through a particular sensory system
Agnosia
The absence of reflexes is a significant finding
reflexes
a state of unresponsiveness to the environment in which the patient makes no voluntary movement
Akinetic mutism
a condition in which the unresponsive patient resumes sleep-wake cycles after a coma but is devoid of cognitive or affective mental function
persistent vegetative state
the patient has inconsistent but reproducible signs of awareness.
minimally conscious state
results from a lesion affecting the pons and results in paralysis and the inability to speak, but vertical eye movements and lid evaluation remain intact
locked-in syndrome
This is how the two hemispheres of the brain communicate.
The corpus callosum
has both excitatory and inhibitory actions and is largely responsible for coordination and movement.
the cerebellum
contains areas that control the heart, respiration, and BP
the brain stem
This score on the GCS indicates severe impairment of neurological function, brain death or pharmacologic inhibition of neuro response.
3
This GCS score indicates that the patient is fully responsive
15
The first priority for a patient with altered LOC
maintain patent airway
These are some of the complications that could occur from altered LOC
- respiratory failure
- pneumonia
- aspiration
- pressure ulcer
- VTE
- contractures
complications
The nurse must assume basic responsibilities for the patient until basic reflexes return (coughing, blinking and swallowing)
impaired reflexes in the comatose patient
- Temperature must be controlled because temperatures tend to rise when the person is unconscious
- If temp. rises to high permanent brain damage can occur
- Never take temp of an unconscious person by mouth
Unconcious patient
- Remove all bedding except maybe a light sheet
- Administer acetaminophen as prescribed
- Give cooling sponge baths and allow an electric fan to blow over the patient
- Use a hypothermia blanket (cooling blanket)
- frequent temp.monitoring to assess the patients response to therapy and to prevent an excessive decrease in temp.
reducing fever
Because of limited space for expansion within the skull, an increase in the volume of with brain tissue, blood or CSF causes a change in the volume of the other components.
Monro-Kellie hypothesis
Cerebral perfusion pressure= MAP-ICP
normal range 70-100 mm Hg
CPP
when cerebral blood flow decreases significantly. It can be recoverable if fixed rapidly.
Cushing’s response
bradycardia, HTN, and bradypnea. It is a grave sign
Cushing’s triad
shifting of the brain tissue from an area of high pressure to low pressure
herniation
The earliest sign of ICP
change in LOC. other early indicators agitation, slowed speech, delayed response
This procedure is avoided in patients with increased ICP because it can lead to herniation.
lumbar puncture
complications include brain stem herniation, diabetes insipid and SIADH.
increased ICP
caused by increased secretion of ADH.
-Volume overload, urine output diminishes
(S-I-A-D-H, S-I-A-D-H, S-I-A-D-H,
This hormone stops the PeePee.)
tx- restrict fluids, and monitor electrolytes
SIADH
the result of decreased secretion of ADH.
-Excessive urine output, decreased urine osmolality and serum hyperosmolarity.
(Pee pee give IV’s vasopressin they need.)
diabetes insipidus
- administer osmotic diuretics i.e(mannitol)
- RESTRICT FLUIDS
- drain CSF
- control fever
- maintain BP and oxygenation
- reduce cellular metabolic demands
management of ICP
this med helps to reduce edema surrounding the tumor(if a tumor is the cause of increased ICP)
corticosteroids i.e (Decadron)
frequent pupil checks, assessment of cranial nerves, frequent measurements of vital signs and ICP, and use of the Glasgow Coma Scale
assessment of increased ICP
- keep patient’s head in a natural midline position, maintained with the use of a cervical collar if necessary to promote venous drainage.
- elevate HOB 30-45 degrees
- extreme rotation of head and neck are avoided
- extreme hip flexion is avoided
- avoid valsalvas maneuver(give stool softeners)
- instruct the patient to exhale while moving in bed
- maintain a calm atmosphere(noise and conversation should be minimal)
increased ICP
monitor for these complications for the patient receiving mannitol
heart failure and pulmonary edema
attention should be paid to this post craniotomy because it could indicate CSF trickling down the throat.
salty taste or postnasal drip
a group of seizures characterized by unprovoked, recurring seizures
epilepsy
inability to express oneself aka non-fluent aphasia
expressive aphasia
inability to understand language aka fluent. They can read or speak but can’t understand the meaning of a message
receptive aphasia
- Paralysis or weakness on the right side of the body
- Right visual field deficit
- Aphasia
- Altered intellectual ability
- Slow and cautious behavior
Left sided stroke
- Paraylsis or weakness on the left side of the body
- Left visual field deficit
- Spatial-perceptual deficits
- Increased distractability
- impulsive behavior and poor judgement
- lack of awareness of deficits
Right sided stroke
blindness in half of the eye
hemianopsia
inability to perform previously learned action
apraxia
deficits in the ability to recognize previously familiar objects
agnosia
