neuro Flashcards
neuro assessment
onset:
when did they start?
description:
location
how long?
how severe?
associated factors:
triggers
aggravating factors
anything relieve?
overall appearance:
general appearance
behavior
obvious signs of neuro deficit (speech/physical)
**degree of consciousness:
LOC (may be 1st sign there is a problem)
mental status (alertness, awareness of surroundings, orientated x4, memory)
Glasgow coma scale: pg 194 used for LOC eye opening motor response verbal response we like a high number (13-15)
pupillary changes: pupil size (2-6mm) PERRLA
hand grips/leg lifts/pushing strength of feet
Babinski reflex:
normal up to 1 year of birth (fanning of toes when stroke the bottom of the foot)
***walking toddler should not have
abnormal in adult
normal = curling of the toes when the bottle of the foot is stroked (plantar reflex)
if adult has babinski reflex (central nervous issue that affects upper motor neuron)
deep tender reflex scale
0=no response (absent)
1+ = present, but sluggish or diminished (hypoactive)
2+ = active/expected/normal
3+ = brisk, hyperactive slightly
4+ = brisk, hyperactive, intermittent or transient clonus
**ankle clonus (abnormal reflex movements of foot induced by sudden dorsiflexion
** normal reflex is documented as 2+/4+
neuro diagnostic test
lumbar puncture:
lumbar subarachnoid space
used to obtain CSF to analyze for blood, infection, tumor cells, measure pressure readings using manometer, administer drugs intrathecally (into spinal cord)
*** positioned propped up over the bedside table with head down, arched back to open up space between vertebrae, on side in fetal position (chin to chest and knees flexed)
inspect surrounding skin
CSF should be clear and colorless (looks like water)
post procedure:
lie flat or prone for 4-8hours
increase fluids
headache is a common complication (pain increases when sit up and decrease when they lie down)– treated with bedrest, fluids, pain meds, blood patch
big complication:
brain herniation
infection (can cause meninigitis)
early signs of high ICP
change in LOC is earliest slurred/slow speech delay in verbal suggestion (slow to respond to commands) increase in drowsiness restless confusion
late signs of high ICP
marked change in LOC progressing to stupor then coma VS change (Cushing's triad--immediate intervention, systolic hypertension with a widening pulse pressure, slow full and bounding pulse, irregular respirations)
decerebrate and decorticate posturing
indicates motor response centers of the brain, midbrain, and brainstem compromised
decorticate:
arms flexed inward and bent toward the body
legs extended
decerebrate:
all 4 extremities rigid
WORST
burning cals
miscellaneous ICP signs
headaches
**anytime you have a head injury client that complains of headache think high ICP
change in pupils and pupil response (fixed and dilated)
projectile vomiting
complications of high ICP
brain herniation (obstructs blood flow leading to anoxia and brain death)
DI
SIADH
treatment for high ICP
reduce cerebral edema
reduced CSF
reduce blood volume
maintain oxygenation (decrease O2 cause cerebral vasodilation and high ICP)
don’t want hypotension or bradycardia (decreases brain perfusion)
isotonic and inotropic solutions (Dobutamine, norepinephrine)
**high volume = high CO = high brain perfusion
keep temp below 100.4
elevate HOB
keep head midline so jugular vein can drain
watch ICP when turning
avoid restraints, bowel/bladder distension, hip flexion, valsalva, and isometric, no sneezing, no nose blowing
limit suctioning and coughing
space care
monitor GCS
***if GCS if below 8 think intubate
monitor V for Cushing’s triad
barbiturate induced coma to decrease cerebral metabolism (phenobarbital, thipental, propofol)
osmotic diuretics (mannitol)–pull from from the brain cells and filter through the kidneys
hypertonic saline (pulls fluid from brain to reduce cerebral edema)
fluid restriction
ICP monitoring devices:
ventricular catheter monitor or subarachnoid screw
risk for infection
meningitis
inflammation of the covering of the spinal cord and brain
cause:
viral
bacterial
s/s: chills fever headache disorientation-coma n/v nuchal rigidity (stiff neck) photophobia seizures positive kernig and brudzinki sign kernig (stiff hamstrings, unable to straighten legs when hips flex 90degrees) brudzinki (neck stiffness, hips/knees flex when neck is flexed
meningitis treatment
corticosteroids antibiotics (if bacterial) analgesics anticonvulsants (if seizures) droplet precautions viral (transmitted by feces and requires contact precautions
TBI
closed:
brain injured
skull is not broken
dura is not torn
open:
skull is damaged
dura is torn
location is important
basilar (most serious), see bleeding ear, eyes, nose, and throat
battle’s sign (bruising over the mastoid (bone behind ear)
raccoon eyes (peri-orbital bruising)
cerebrospinal rhinorrhea (leaking CSF from nose)
check CSF by testing positive for glucose
focal injuries
contusions seem with blunt trauma or deceleration and acceleration injuries
brain is bruising and damaged
hematoma:
small & rapid = death
large & gradual = adaptation
epidural hematoma
patho:
rupture/laceration of the middle meningeal artery
injury-LOC-recovery period-bleeding into their head-cannot compensate-neuro changes
knocked out-wake up-neuro changes-then coma
treatment: burr holes to remove the clot stop the bleeding control ICP ask: did they pass out did they pass out, wake up, then pass out again did they just see stars ***emergency
subdural hematoma
patho:
collection of blood between the dura and the brain
venous bleed
treatment:
immediate craniotomy to remove clot and control ICP
