Neuro Flashcards
Meningitis
Inflammation of the meninges
Pia mater and arachnoid
Viral meningitis.
Most common type
Aseptic meningitis
Bacterial meningitis
High mortality rate within 24 hours
Highly contagious
High population (college dormitories, military barracks, crowded living areas)
16-21 years old highest rates of getting it
Assessment and clinical manifestations of meningitis
Fever Headache Photophobia Indications of ICP Unchallenged rigidity (stiff neck) Positive Kernigs, Brudzinski's sign Decreased mental status Focal neurologic deficits N/V Cranial dysfunction : CN III, IV, VI, VII, VIII Short attention span Tachycardia Red macular rash
Labatory assessment of meningitis
CSF analysis CT scan Blood cultures Counterimmunoelectrophoresis: presence of viruses Polymerase chain reaction CBC:usually elevated X-ray to determine presence of infection
CSF analysis of bacterial meningitis
Appearance: cloudy WBC: increased Protein: increased GLucose: decreased CSF pressure: elevated
CSF analysis of viral meningitis
Appearance: clear WBC: increased Protein: slightly increased GLucose: most often normal CSF pressure: normal or elevated
Interventions for meningitis
Obtain vaccinations (Hib, pneumococcal, mumps, varicella, meningococcal)
Hand washing
accurately monitor and document their neurologic status
Pupillary. Shape and accommodation to light
Care of a patient with meningitis
ABC's Vs q 2-4 hours Cranial nerve assessment I&O Body weight Positioning Range of motion q 4 hours Decrease stimuli (quiet, dim lights, maintain bed rest, with head elevated 30 degrees) Droplet precautions Prevent complications (ICP, vascular dysfunction, fluid and electrolyte imbalance, seizures, shock)
Encephalitis
Inflammation of brain tissue and surrounding meninges
Affects cerebrum, brainstem and cerebellum
White matter destroyed
Arboviruses
Transmitted to humans through bite of an infected mosquito or tick
West nile virus
Incubation period is 2-15 days
Assessment of encephalitis
High fever Stiff neck N/V Agitation Motor dysfunction (dysphagia) Focal neurologic deficits Photophobia Phonophobia Fatigued decreased LOC Joint pain Headache Vertigo Muscle tremors
Protecting family and patient from West nile
Limit time outside between dusk and dawn
Wear protective clothing long sleeves and pants
Use insect repellent
Remove areas of standing water
Check windows and door screens for holes that need repaired
Keep hot tubs and pools clean and properly chlorinated
Parkinsons disease
Progressive neurodegenerative disease Most common Affecting motor skills Tremors Muscle rigidity Bradykinesia( slow movement) Postural instability Effect on the peripheral and autonomic systems
Genetic and environmental factors of Parkinson’s disease
Exposure to pesticides Herbicides Industrial chemicals and metals Drinking well water Being older than 40 years old Having reduced estrogen levels
Assessment finding of Parkinson’s disease
Stooped posture Slow and shuffling gait Bradykinesia: slow movement Pill rolling movement Mask like face Uncontrolled drooling Dysarthria Echolalia (repetition) Hypophonia (soft voice) Seborrhea Depressed Easily upset Akinesia: no movement
Interventions for Parkinson’s disease
Patient extra time to respond to questions Administer medications promptly Provide medication for pain Monitor side effects to medications PT and OT Perform ADL's Schedule activities late in the morning Teach patient to speak slowly and clearly Provide high-protein, high-caloric foods
Drug therapy for Parkinson’s disease DOPAMINE agonists
most effective during first 3-5 years of use; decrease dyskinesias ----mirapex, Neupro, reequip Orthostatic hypotension!! Hallucinations Drowsiness Avoid operating heavy machinery Wont prescribe very often because of adverse effects Mobility, cognition, quality of life!!
Drug therapy with parkinsons disease
Sinemet: combination- levadopa-carbidopa; give with meals
Less expensive than dopamine agonists
COMTs
MAOIs: avoid foods with tyramine(cheese, smoked, cured foods and sausage, red wine) continue restrictions for 14 days after med is discontinued
Drug toxicity treatment With Parkinson’s disease
Changes in cognition (acute confusion)
Reduction in drug dosage
Change in drug or in frequency
A drug holiday: lasts up to 10 days; recieves no drug therapy for PD
Risks for dementia
Age Women Family history African Americans Herpes zoster Herpes simplex Zinc Copper Head injury
Early stage of dementia assessment
Independent in ADLs No social problems Forgets name Short term memory loss Less engaged in social relationships Decreased performance Unable to travel alone Decreased sense of smell
Middle stage of dementia assessment
Impairment of all cognitive functions Unable to handle money Disorientation to time, place Agitated Gets lost Speech and language deficits Incontinent Wandering
Late stage of dementia assessment
Bedridden Totally dependent in ADLs Motor and verbal skills lost Neurologic deficits Agnosia (loss of facial recognition)
Factors that. Can worsen dementia
Stroke Tumor Decrease in blood supply MI Hypoglycemia Impaired renal and hepatic fxn. Infection Impaired vision or hearing Pain Drugs Restraints Hematoma
Communication with. Patients with. Dementia
Simple direct questions (yes or no) Provide instructions with pictures in a place they can read them Simple, short sentences and one step instructions Gestures to help patient understand Validate patients feelings Limit choices Never assume patient is totally confused Try to anticipate patients needs
Prevent wandering with patients with dementia
Identify patients most at risk Provide appropriate supervision Place patient in area that provides max observation (NOT in nurses station) Use family members to monitor patient Keep patient away from stairs Do not change rooms on them Avoid restraints Assesspain Re-orientation methods Provide frequent toileting Prevent overstimulation
Minimizing behavioral probelms with patients with dementia
Remove small area rugs Replace floors with non-slippery floors Arrange furniture for safety Install night lights Smoke alarms Install bells outside of home Place single date calendar on wall Place complete outfits for days Maintain a routine Crowds be small
Reducing Caregiver stress with dementia
Maintain realistic expectations Take each day one at a time Find positive aspects of each incident Use humor Use resources Explore alternative care settings Establish advanced directives Set aside time each day for rest Seek respite care Take care of yourself-diet, exercise, rest Be realistic Use relaxation techniques
Huntington disease
Hereditary disorder Autosomal dominant trait at the time of conception Inherited by one parent 30-50 begin No known cure
First drug to be approved to decrease chorea associated with HD is
Tetrabenazine
Work by depleting the monoamines
May cause suicide ideations and depression
Care for a patient. With Huntington disease
Speech language pathologist: helps with communication, drooling, and swallowing
Dietician
PT and OT
Nurses or home health who provide support
Case manager and social worker
Help with ADLs
Lumbosacral back pain preventative measures
Good posture Proper lifting Exercise:walking, swimming Ergonomics:prolonged sitting or standing Equipment that can be used: ceiling lifts
Nonsurgical management for lumbosacral back pain
Positioning
Drugs therapy: acetaminophen Or NSAIDS, corticosteroids
Heat therapy:20-30minutes 4 times daily
PT
Weight control: 10%
Complementary and alternative therapies: chiropractic, PT,
Minimally invasive surgery spinal cord
Percutaneous lumbar diskectomy
Thermodiskectomy
Laser-assisted laparoscopic diskectomy
Obese, and people who smoke most likely have pain
Smokers doctors wont let them do back surgery
Conventional open surgical procedure
Diskectomy
Laminectomy
Spinal fusion
Epidural steroid injection
Postoperative nursing car for spinal cord surgery
Assessment of complications Neurologic assessment; VS Patients ability to void Pain control Wound care CSF check: always notify HCP immediately if clear fluid Patient positioning and mobility Discharge teaching
Spinal cord injuries
Hyperflexion: Forced forward; hitting a brick wall in a car
Hyperextension: getting rear-ended
Axial loading or vertical compression (caused by jumping)
Excessive head rotation beyond its range:boxers
Penetration (bullet, knife)
Spinal cord injuries initial assessment
Airway, breathing pattern and circulation
Indication of bleeding
LOC; Glasgow Coma Scale
Level of injury: tetraplegia:3 extremities paralysis
Quadriplegia: all 4 paralysis upper thoracic and cervical
Quadriparesis:weakness of 4 extremities
Paraplegia: paralysis of 2 lower extremities
Paraparesis: weakness of 2 lower extremities
Management of spinal cord injuries
Nonsurgical management Immobilization: assess under skin daily Drugs Surgical Community
Priority problems for long term managment
Difficulty breathing
Impaired physical mobility (safety)
Spastic or flaccid bladder and bowel
Impaired adjustment
Multiple sclerosis
book
Amyotrophic lateral sclerosis
Book
Guillain- Barre Syndrome
Demyelination of peripheral nerves
Result of immune mediated pathological processes
Symptoms of Guillain-barre Syndrome
Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction
Priority nursing care for Guillian Barre syndrome
Respiratory care Pain Communication and emotional Nutritional Involvement of family and other team members Education Medical treatment
Plasmapheresis
Remvoes circulating antibodies, assumed to cause GBS
Blood cells returned to patients without plasma
Plasma usually replaces it self or albumin is transfused
Cholinesterase inhibitor drugs
Enhances neuromuscular impulse by preventing decrease of ACh by enzyme ChE
Administer with food
Tension testing
Onset of muscle tone improvement within 30 minutes-60 seconds after injection
Lasts 4-5 minutes
Prostigmin
Prevention of musculoskeletal injuries when moving objects
Avoid lifting objects 10 pounds or more w/o assistance
Push objects rather than pull
Do not twist during movement
Use handles or grips
Sit in chairs with good support
Avoid shoulder stooping
Do not walk or stand in high heels for long period of time
Prevention of musculoskeletal injuries when moving a person
Build and support a culture of safety
Improve communication
Select equipment that provides safety
Train all staff on equipment
Key assessment findings with spinal cord injuries
Neurologic
Cardiovascular: hypotension, bradycardia, hypothermia
Respiratory
Gastrointestinal:internal bleeding, distention,loss of bowel sounds
Interventions for neurogenic shock
Adequate hydration MONITOR. PULSE OXIMETRY Bradycardia, decreased LOC and urine output Hypotension ASSESS HOURLY
Nursing priority safety for halo fixation
NEVER MOVE OR TURN THE PATIENT HOLIND OR PULLING THE HALO
Do not adjust screws
Check patients skin
Do not. Use sharp objects (coat hangers) to relieve itching
Patient education on halo fixation
Be careful when leaning forward Wear loose clothing Sponge bath Support head with small pillow when sleeping Do not drive Keep active Keep straws available When going outside in cold wrap pins with cloth Observe pin sites Increase fluids and fiber
Key. Features. Of. Autonomic dysreflexia
Sudden rise in BP, bradycardia Profuse sweating (face, neck, and shoulders) Goosebumps Flushing in skin Blurred vision Spots in patients vision field Nasal congestion Throbbing headache Feeling of apprehension Distention of bladder
Immediate interventions for autonomic dysreflexia
Sitting position' Notify HCP Treat the cause: Check urinary retention: check catheter for kinks Anesthetic ointment on catch UTI or bladder stones Fecal impaction Examine skin Monitor BP every 10-15 minutes Nifedipine or nitrate
Multiple Sclerosis
Life long inflammatory disease of unknown cause that effects brain and spinal cord Remission and exacerbation Demyelination and axonal injury Enviromental causes Increase in protein and WBC
Key features of MS
Muscle weakness Fatigue Intention tremors Dysmetria Numbness Hypalgesia (decreased pain sensation Ataxia Dysarthria (slurred speech Dysphagia Diplopia Nystagmus: involuntary rapid eye movement Scotomas Decreased visual and hearing Tinnitus Bowel and bladder dysfunction Changes in cognition Depression
Interventions for. MS
Anti inflammatory
Steroids
Support
Immunoglobulins
Amyotrophic lateral sclerosis
Upper and lower motor neuron disease of adult onset
Assessment of ALS early signs
Tongue atrophy Weakness in hands and arms Muscle atrophy of arms Fasciculations (twitching Difficulty controlling crying Dysarthria Dysphagia Fatigued Stiff clumsy gait Abnormal reflexes
Interventions for ALS
Riluzole: stomach empty s/sx of liver toxicity ALT and AST fxn tests
Guillain Barre Syndrome
Demyelination of peripheral nerves
Works from toe to head
Caused by viruses
Viruses we see with Guillian barre syndrome
Influenza
Campylobacter jejuni
Epstein barr
Cytomegalovirus
Symptoms of GBS
Initial muscle weakness and pain
Ascending paralysis
Autonomic dysfunction
Priority nursing care for GBS
Respiratory
Pain management
Communication and emotional
Nutritional
Plasmapheresis
Removes circulating antibodies Plasma selectively separated from whole blood Blood cells return to patient w/o plasma Plasma replaces itself Weigh pt. Before and after IVIG
TIA
Warning sign
Brief interruption in cerebral blood flow
30-60 minutes
Stroke
Change in normal blood supply to brain
3-4 hours for window from onset of symtptoms to when we would give a thrombolytic
Causative agents of stroke
Hypertension
Arteriovenous malformation
4 types of stroke
Ischemic: lack of oxygen to brain
Thrombolic: a clot in a cerebral artery (a-fib)
Embolic: dislodged Clot (from legs)
Hemorrhagic:
Neuro Assessment for stroke cognitive
Changes in LOC Aphasia: speech Dyslexia: reading problems Agraphia: writing problems Acalculia: difficulty with math
Motor changes
Hemiplagia: paralysis on one side of body
Hemiparesis: weakness on one side of body
Ataxia: gait disturbances
Flaccid paralysis: extremities tend to fall to side
Agnosia: unable to use object correctly
Apraxia: unable to carry out speech
Diagnostic for stroke
PT INR PTT MRI: ischemic brain injury CT:w/o contrast ECG
Thrombolytic therapy
IV thrombolytic therapy
TPA
BP Control Is essential
Drug therapy
Thrombolytics Anticoagulants Lorazepam CCB Stool softeners Analgesics Antianxiety drugs
Nursing interventions for stroke
ICP
Safety
Emotional support
Education
Epidural hematoma
Arterial
Quicker
Subdural hematoma
Venous
Slower
Myasthenia gravis
Autoimmune
Muscle weakness
Distorted acetylcholine receptors (excitatory)
Myasthenia gravis key features
Muscle weakness Poor posture Ptosis: drooping eyelid Diplopia Respiratory compromise Loss of bowel and bladder Fatigue Decrease sense of smell and taste
Cholinesterase inhibitor drugs
Administer with food
Tensilon testing
Onset of muscle ton improvement within 30-60 seconds
Lasts 4-5 minutes
Prostigmin
Tensilon crisis
Atropine sulfate
Cholinergic crisis
Maintain respiratory
Anticholinergic drugs withheld while on ventilator
Atropine: decrease salvation
Myasthenia crisis
Maintain respiratory
Cholinesterase drugs withheld
Health teaching of MG
Avoid overheating, crowds, overeating, erratic changes in sleeping habits, emotional extremes
Warning signs and compliance
