Neuro Disorders Flashcards
Cerebral lobes
- Frontal
- Parietal
- Temporal
- Occipital
Frontal lobe function
- Motor cortex, voluntary movement
- Broca’s expressive speech center
- Personality
- Behaviors: social, sexual, judgement, problem solving
Parietal lobe function
- Sensation interpretation & perception
- Social relationships such as body position
- Integration of sensory input, especially visual input
Temporal lobe function
- Auditory sensation and perception
- Long term memory
- Wernicke’s receptive speech center
Occipital lobe function
- Process visual information
- Perception of color and shapes
CT or CTA
- Assess for bleed, edema, masses
*Suspected ischemic stroke: CT rule out hemorrhagic stroke which would be contraindication to thrombolytic therapy
CT/CTA nursing implications
- Pt education about procedure
- Noninvasive and painless
- Patient IV (if giving contrast)
- Iodine allergies (shellfish or dye)
- Monitor BUN/Cr
- DM? Taking Metformin? If yes, Metformin held 48 hrs prior
- IV/PO fluids post-procedure to enhance excretion of dye
- Monitor for allergic rxn
Lumbar puncture
- Obtain CSF for analysis
- Measure ICP
- Spinal anesthesia, intrathecal meds
- Remove CSF to reduce pressure
- Performed between L3 and L4 (below level of spinal cord)
LP nursing implications
- Pt education about procedure
- Hold antiplatelet/anticoag drugs prior (decreased risk of bleeding)
- Check coagulation studies prior
- Informed consent
- Flat bedrest for 4-6 hrs to prevent CSF leakage
- Leakage can cause severe HA
- Encouraging fluids post LP
- Blood patch can seal CSF leak
Secondary headache
- Caused by underlying pathology
- Typical presentation: sudden onset, severe pain (not alleviated w meds)
Secondary headache work-up
- CBC and blood culture (infection)
- CRP and ESR (inflamm)
- CT and MRI (masses, cysts, vessel, osseous skull abnormalities)
- EEG (electrical activity: seizures, tumors, inflamm, brain injury)
- Sleep studies (fatigue, sleep apnea)
Primary brain tumor
Malignant:
- Glioma: from glial cells
- Oligodendroglioma: from oligodendrocyte
Benign:
- Meningioma: most common form
- Acoustic neuroma / schwannoma: from Schwann cell
- Pituitary tumor: hormone hypersecretion
Metastatic (secondary) brain tumor
Occurs at:
- Brain parenchyma
- Spinal cord
- Leptomeninges
Most common cancers resulting in CNS metastases:
- Lung, melanoma, renal, breast, CRC
Brain tumor medical management
- Chemotherapy
- Gliadal wafers: impregnanted w chemotherapy and put in surgical bed at time of surgical resection
- Radiation therapy
- Cyberknife: radiation directed to specific area of brain to spare normal tissue
Brain tumor surgical management
- Craniotomy: section of skull (bone flap) removed
- Debunk: removing as much of tumor as possible if not completely removable
Seizure nursing assess
- Airway and breathing: maintain airway patency during sz & postictal state
- VS: O2 sat & resp status, HR and BP may increase
- Sz activity: careful observation and document
- Presence of aura
Seizure nursing intervention
- O2 at bedside
- Suction equipment at bedside
- Safety measures: bed in low position, L side lying position during sz to prevent aspiration, do not restrain movements
- Place IV per orders, administer meds if needed
Seizure pt education
- *Medication regimen: therapeutic level monitor, possible SE
- *Understand triggers, aura
- Medic alert bracelet
- Driving restrictions
Parkinson’s clinical manifesations
- Resting tremors
- Muscle rigidity
- Bradykinesia
- Postural instability
- Unilateral weakness, upper extremity tremors
- Slow shuffling gate, postural instability, stooped posture, rigidity, generalized tumor, masklike face
Parkinson’s diagnosis
2 or more observable sympts w asymmetry on presentation:
1. Bradykinesia
2. Resting tremor
3. Rigidity
4. Postural instability
Herniated disc
Vertebral disk rupture or tearing that causes leaking into vertebral area resulting in back pain
Parkinson’s
Decreased level of dopamine in brain –> slow, tremor, etc.
Herniated disc conservative medical treatment
Most pt improve in 1-2 mos
- Pain management: NSAIDs, gabapentin, tramadol, pregabalin
- Physical therapy to increase strength, improve function, and prevent future injury
Herniated disc nursing assess
- *VS: pain, infection
- *Level of function/ability
- *Muscle tone/ strength
- *Surgical incision: signs of infection
- *Urine output: postoperative urinary retention d/t anesthesia
- Bowel elimination: constipation secondary to opioids
Herniated disc nursing intervention
- Pain meds
- *Corticosteroids as prescribed for inflamm
- *Comfort w positioning: HOB 30-45 degrees w legs bent
- ROM exercises
- Increase fluids/fiber: constipation
Herniated disc pt teaching
- Exercise and mobility
- Good posture
- Avoid bending at waist and lifting
- Review dz process & prognosis
Amyotrophic Lateral Sclerosis
Gradual degen and death of upper (brain) and lower (spinal cord) motor neurons
ALS complications
- Aspiration
- Resp failure, pneumonia
- Pressure injuries
- DVT and PE
ALS nursing assess
- *Airway and O2 sat
- Motor strength
- *Ability to swallow
- Skin
- Coping skills
ALS nursing interventions
- *Elevate HOB while eating, drinking or brushing teeth
- *Turn, cough, and deep breath to promote gas exchange
- *Reposition and turn every 2 hrs to prevent skin breakdown
- *Emotional support
- ROM to prevent contractures and strengthen affected muscles
- Administer meds to manage sympts
ALS pt teaching
- Report increased difficulty swallowing or breathing
- *Dz prognosis and process; ventilation support
- *Communication strategies
Spinal cord injuries
Direct injury to spinal cord or indirect injury to surrounding bones, tissues, vessels resulting in loss of function
Spinal cord injury clinical manifestations
Lvl of injury predicts what part of body is affected
Cervical injuries:
- Quadriplegia
- C4 and above –> inability to breathe, phrenic nerve innervates diaphragm at this level
Thoracic injuries:
- Paraplegia, poor trunk control
Lumbar & sacral:
- Leg control, bowel and bladder function, sexual function
Other effects:
- Hypotension
- Chronic pain
- Decreased temp control
Spinal cord medical management
No way to reverse spinal cord damage. Acute stages of injury focuses on:
- *Maintaining airway patency
- *Adeq breathing and oxygenation
- Prevent and monitor spinal shock
- Restore and maintain BP
- Prevent further cord damage
- *Spinal immobilization
- Avoid possible complications
Spinal cord injury nursing assess
- Resp function: hypoventilation (intercostal muscle paralysis), C4 and higher (no diphragmatic innervation)
- VS: loss of sympathetic input, spinal shock, neurogenic shock, respirator or cardiac arrest, autonomic dysreflexia, can’t regul temp
- Increased pain above injury level
- I&O
- Surgical sites: infection, bleeding, CSF leak
- GI: decreased blood flow, peristalsis and paralytic ileus
