Neuro Flashcards
Neuro assessment
- Onset? Description? Triggers? Note client’s general appearance?
- Mental Status
- Glasgow Coma Scale
- Pupil changes
- Strength?
- Reflexes?
- Onset (when it started); Description (location, how long sx persisted, how severe); Triggers/aggravating factors (did anything help relieve the sx); Note client’s general appearance and behavior (obvious signs of neurological deficit)
- Mental Status - alert, awake oriented x 3 (person, place, time) – x4 (situation); LOC (level of consciousness)
- Glasgow Coma Scale - eye opening, motor responses, verbal response(we like a score of 13-15)
- Pupillary changes (normal pupil size 2-6 mm) – Pupils Equal Round Reactive to Light and Accommodation (PERRLA)
- Hand grips/leg lifts/pushing strength of feet
- Babinski reflex (only normal in infant up to 1 year, abnormal in adult) – fanning of toes when the bottom of the foot is stroked
- Plantar reflex - normal in adults children >1 (curling of the toes when the bottom of the foot is stroked)
- Deep Tendon Reflex Scale
- 0 no response
- 1 hypoactive
- 2 NORMAL
- 3 slightly hyperactive
- 4 hyperactive w/ clonus (abnormal movements of foot)
- Document as 2+/4+
Glasgow Coma Scale
Eye Opening: Spontaneous - 4 Verbal command - 3 Pain - 2 No response - 1
Motor Response: Verbal command - 6 Localized - 5 Flexed Withdraws - 4 Flexes abnormally (decorticate) - 3 Extends abnormally (decerebrate) - 2 No response - 1
Verbal Response: Oriented talks - 5 Disoriented/talks - 4 Inappropriate words - 3 Incomprehensible sounds - 2 No response - 1
_____ is always #1 with neurological assessment
LOC (level of consciousness)
What does it mean if the adult has a Babinski reflex?
Severe CNS problem – tumor or lesion on the brain or spinal cord, meningitis, multiple sclerosis, Lou Gehrig’s disease
CT
a. With/without contrast (dye) – check for allergies
The client will need to sign a consent form prior to the test when using dye.
b. Takes pictures in slices/layers
c. Keep head still
d. No talking
MRI
a. MRI is better than CT
b. dye not usually used
c. magnet is used - no jewelry, credit cards, pacemakers
d. will be placed in a tube where client will have to lie flat.
e. Do fillings in teeth matter? No
f. Do tattoos matter? Old ones do w/ lead–Veterans could have shrapnel from IED’s/bombs
g. Will hear a thumping sound – tell client about this
h. What type of client cannot tolerate this procedure? Claustrophobic
i. Can talk and hear others while in the tube
PET scan
Nuclear image test to view parts of brain/any organ as it’s working
a. dx for Alzheimer’s, brain tumors, CVA (stroke), Parkinson’s, aspects associated w/ mental illness
b. need informed consent
c. client must inhale a radioactive gas or be injected w/ a radioactive substance
d. no contact with children or pregnant women for 24 hrs after scan
Cerebral angiography
X-ray of cerebral circulation using iodine dye
Go through the femoral/brachial artery (like ♡ cath)
a. Pre:
1) Check for allergies to iodine and shellfish
2) Well-hydrated/void/peripheral pulses/groin prepped
• Hydrate client promotes excretion of the dye after.
3) Explain they will experience facial flushing and metallic taste
4) Monitor BUN, Creatinine, UOP
5) Hold metformin
b. Post:
1) Bed rest for 4-6 hours; Monitor BUN, Creatinine, UOP
2) Major complication: Bleeding/hemorrhage (coz femoral artery was used), Embolus
• An embolus can go lots of different places: Arm, Heart, Lung, Kidney
• embolus in brain s/sx – change in LOC, one-sided weakness, paralysis, motor/sensory deficits.
Do a good baseline neuro exam to compare
EEG
a. Records electrical brain activity
b. Helps diagnose seizure disorders; Evaluate loss of consciousness and dementia
c. Screening for coma
d. Indicator of brain death
e. Pre-procedure:
• Hold sedatives - No caffeine
• Not NPO (drops blood sugar)
f. During procedure
• Will get a baseline first with client lying quietly; may be asked to hyperventilate or cough; if they are completely unconscious, clap hands in face, blow whistle in face.
Lumbar Puncture
- puncture site - lumbar subarachnoid space
- Purposes
- obtain CSF fluid to analyze blood, infection, tumor cells
- measure pressure reading w/ manometer and reduce CSF pressure
- administer drugs intrathecally into spinal canal
• Position - propped up over bedside table w/ head down and a lot of arch to the back like an angry cat or fetal position (chin to chest and knees flexed)
- inspect skin for infection
- CSF should be clear and colorless like water
• Post-procedure
- lie flat or prone 4-8 hrs
- increase fluids to replace lost fluids
- common complication: HEADACHE - pain increases when sitting/standing, pain decreases when lying down
- tx for headache - bed rest, fluids, pain meds, blood patch (for leaking–instant seal)
• BIG COMPLICATION:
- brain herniation: known high ICP = no lumbar puncture
- infection: bacteria can get into puncture site and into spinal fluid = cause MENINGITIS
Early Signs of ↑ ICP
- change in LOC - going into coma or subtle change in attention span
- speech slurred/slowed
- delay in response to verbal suggestion (slow to respond to commands)
- increased drowsiness
- restlessness w/o apparent reason
- confusion
Late Signs of ↑ ICP
• change in LOC -> stupor/daze -> coma
• Cushing’s triad (pressure in brain stem) - ↑BP, ↓HR, ↓RR
- systolic HTN w/ widening pulse pressure;
- slow, full, bounding pulse;
- irregular RR pattern (Cheyne stokes or ataxic)
Decerebrate and Decorticate Posturing
- responses to painful or noxious stimuli = indicates motor response centers of brain, mid-brain, brain stem are COMPROMISED
- may posture on one side only
- may have different posturing on each side
Decorticate
arms flexed inward and bent in toward the body and legs extended (GCS score 3 in motor responses)
De “Cor” ticate is towards the “CORE: of the body or inward flexion; think “wakanda” pose
Decerebrate
present with all 4 extremities in rigid extension
WORST (GCS score 2 in motor responses)
Decerebrate is away from the body
Complications of ↑ ICP
- BRAIN HERNIATION - obstructs blood flow to brain leading to anoxia (no O2) = BRAIN DEATH
- DI and SIADH (head things, think ADH)
