neuro Flashcards
glasgow coma scale
eye opening
motor response
verbal response
ideal: 13 - 15
normal pupil size
2 - 6 mm
babinski reflex
normal up to age 1 / walking = no babinski
should have plantar reflex (toe curl) when foot stroked
toe splay = severe problem in central nervous sytem
CT scan
can be with dye
pics in slices, no talking
MRI
picks up on pathology earlier than CT
magnet, thumping sound, tube, can talk
cerebral angiography
x ray of cerebral circulation, through femoral artery
consent needed
neuro assessment before (baseline)
iodine based dye nursing considerations
monitor: BUN/creat, uop
hold metformin
hydrate to excrete
iodine/shellfish allergies!
EEG
records electrical activity of brain
- diagnose seizure disorders, sleep disorders, cerebral infarct, brain tumor, abscess
- eval: seizure types, LOC, dementia
- coma screening, indicates brain death
hold sedatives before! (decrease activity)
lumbar puncture
site: lumbar subarachnoid space
obtain spinal fluid to analyze for blood, infection, tumor cells;
pressure readings with manometer;
administer drugs intrathecally (brain, spinal cord)
post-lumbar puncture
lie flat OR prone (preferable, seal forms) - 2 to 3 hours
- increase fluids (replace)
- common: headache with pain increasing if sitting up
lumbar puncture positioning
1) propped over bedside table, head down
2) side lying fetal - arch back max
contraindication for lumbar puncture
ICP - brain herniation can result
early s/s ICP
earliest: change in LOC
- drowsy, randomly restless, confusion
speech: slurred, slowed
response: delayed
late s/s ICP
marked change in LOC (stupor to coma progression)
cushing’s triad
posturing
cushing’s triad
1) systolic htn (widening pulse pressure)
2) slow, full, bounding pulse
3) irregular respirations
posturing
response to painful/noxious stumuli, indicates motor response centers of brain are compromised; rigid, tight, burning calories
- decorticate
- decerebrate
decorticate posturing
arms flexed inward, bent in toward body and legs extended
decerebrate posturing
all four extremities in rigid extension
WORST
CSF circulates in which space
subarachnoid
lumbar puncture goes into
subarachnoid space
ICP tx
- O2
- adequate cerebral perfusion
- T under 100.4/38 (metabolic demand)
- elevate HOB
- head midline (jugulars drain)
- limit suction/cough
- space interventions
- barbiturate induced coma (phenobarb)
- osmotic diuretics (mannitol)
- steroids (dexamethasone) decrease cerebral edema
GCS: 8
intubate!
meningitis
inflammation of spinal cord or brain
(meninges lining of brain/spinal cord)
causes viral (fecal trans) or bacterial (resp trans)
bacterial meningitis: nursing considerations
very contagious, medical emergency; high mortality
droplet precautions (respiratory transmission)
viral meningitis: nursing considerations
transmitted by feces, common infants kids
contact precautions
seizures
symptom of underlying disorder rather than disease
- not considered epilepsy if resolves with disease ending
partial seizure
aka focal; limited to specific local area of brain
- aura may be only manifestation
- s/s: simple to complex
partial seizure simple s/s
without loss of consciousness, numbness, tingling, prickling, pain
partial seizure complex s/s
impaired consciousness, confused, unable to respond
generalized seizure
aka non-focal; involves entire brain
- loss of consciousness initial manifestation
tonic clonic seizures
formerly grand mal
- entire brain, convulsive
myoclonic seizures
sudden, brief contractures of muscle or group of muscles
absence seizures
formerly petit mall
- brief loss of consciousness
- behavior change very little, maybe short memory loss
status epilepticus
continuous seizure without returning to consciousness between seizures
rapid acting anticonvulsants
lorazepam, diazepam
long acting anticonvulsants
phenytoin, phenobarbital
anticonvulsants nursing considerations
monitor for toxicity
use smallest dose necessary
abrupt withdrawal can cause seizure
how do you tell CSF from other drainage
glucose + halo test (blood spot with ring around)
neurological hematoma nota bene
small that develops rapidly may be fatal, massive that develops slowly may allow client to adapt
epidural hematoma
rupture of the middle meningeal ARTERY - fast bleed under high pressure
injury -> LOC -> recovery -> can’t compensate (ICP max) -> neuro changes
agitation, restlessness, pupil changes, seizures, posturing
EMERGENCY
subdural hematoma
usually VENOUS
acute (fast), subacute (med), chronic (slow; s/s drunk, stroke-like)
myasthenia gravis
acquired autoimmune disease of neuromuscular junction
- fatigue, weakness primarily in muscles innervated by the cranial nerves (eye, swallow), also skeletal and respiratory muscles, gu
- progressive loss of muscle strength
- cause unclear, thymus and hyperthyroid associations
myasthenic crisis
sudden exacerbation, sometimes post-infection
- oropharngeal weakness: upper airway obstruction, loss of gag, dysphagia + aspiration
- respiratory failure (muscle weakness)
- VS increase, dec uop, incontinence, hypoxia
HOLD cholinesterase inhibitors temporarily
cholinergic crisis
too much cholinesterase inhibitor (anticholinergic): SLUDGE BAM
hard to distinguish from myasthenia gravis
rare
differentiate myasthenic vs cholinergic crisis
tensilon test (increases ACh by inhibiting breakdown)
myasthenic: temp improvement
cholinergic: gets worse
parkinson’s
progressive, neurodegenerative
t remor
r igidity (cogwheel, plastic, lead pipe)
a kinesia
p ill rolling
give dopamine (agonist)
guillain barre
acute autoimmune disorder assoc w pns demyelination; hypothesis - response to virus
- varying degrees of motor weakness, paralysis, sensory abnormalities
- ascending (most common), pure motor, descending
- give immunoglobulin, plasmapheresis
multiple sclerosis
chronic autoimmune disease affecting myelin sheath, conduction pathway of cns,
remission and exacerbation (ex more freq as severity, duration progresses)
FATIGUE!
amyotrophic lateral sclerosis
aka lou gehrig’s; adult-onset upper/lower motor neuron disease
- progressive weakness, muscle wasting, spasticity - eventually leads to paralysis
myelogram
insertion of contrast medium into subarachnoid space of spine via lumbar puncture
pre: fluids, allergies; anti-psych/dep/coag can be held for several days; valium ok to give
post: supine with head elevated, several hours
