Neurological Flashcards
The central nervous system consists of what two components?
- Brain
2. Spinal Cord
The peripheral nervous system consists of what two components?
- Cranil nerves (12)
2. Spinal nerves (31)
The autonomic nervous system consist of what two components?
- Sympathetic “flight or fight” (sweaty palms, increased HR, shaky)
- Parasympathetic “rest and digest”
Neurological Assessment (9)
- family hx (hx of MI’s, strokes, & vertigo)
- level of consciousness/orientation
- memory & attention (one of the biggest assessment features)
- sensory function (taste, feel, touch)
- cerebellar function (Rhomberg test for balance)
- cerebral function (cerebrum is the largest part of the brain & is responsible for intelligence)
- cranial nerves
- motor system
- sensory system
Expected Findings in Aging Patients (5)
- decreased sensation
- decreased taste
- decrease agility & strength
- shuffled gait
- decreased cognitive ability
Diagnostic Testing Performed to Determine Neurological Function
- Glasgow Coma Scale
- Lab Test (blood culture, cerebral angiography, CT scan)
- MRI
- EEG
- Lumbar Puncture
Diagnostic test to measure of how alert & oriented the patient is.
Glasgow Coma Scale
- highest score is 15
- anything most (ex. sternum rub)
Describe decorticate position. (3)
- inward flexion
- plantar feet
- seen post-seizure, had injuries, brain tumors
Describe decerebrate position. (3)
- outward flexion
- deadly for patient
- associated w/ brain stem issues (speech, breathing, regulates temperature-hypothalamus)
-test performed to look for specific microorganisms so that exact treatment is known
Blood Cultures
*drawback is length of time is takes to get results (7-10 days)
-test performed that looks at the blood flow to the head, brain and neck (to assess if there are any blockages or strokes)
Cerebral angiography
*make sure to assess for allergies such as shellfish and iodine
___ ________ are performed on patients that can not have a MRI performed.
CT Scans
- contrast medium causing an increased urine sensation, heart, and possible diarrhea afterwards
- Major Lab Values: BUN & Creatinine to assess kidney function
- Increase fluids with this patients!
- Best test for neurological issues
- Patient has to remain very still during test
- contraindicated for patients with impacts and/or pacemakers
Magnetic Resonance Imagine (MRI)
Electroencephalography (EEG)
- purpose
- use for dx of what
- meds to avoid
- prior to test
- purpose: looking at the electrical activity of cerebral hemispheres
- dx: seizures, most of the time epilepsy
- meds to avoid: CNS depressants (narcotics), seizure meds, stimulants (ex.caffeine)
- prior to test: pt needs to be woken up @ 0200 (needs to be sleep deprived) and hair must be washed before test
A lumbar puncture is performed between _____ & _____ in the spine.
L4; L5
Indications for a Lumbar Puncture (3)
- meningitis
- spinal cord lesions (paralyzed patients)
- pt’s with a lot of back pain
- used for diagnosis and treatment
- empty bladder before procedure
- during procedure- lateral recumbent (side-lying “fetal-like” position) and strict asepsis!!
After a lumbar puncture is important for a patient to ______ ________ to avoid spinal leakage and horrible headache.
Lay flat
-sudden, abnormal, uncontrolled electrical discharge from cerebral neurons
Seizure
*epilepsy- medical disorder characterized by chronic recurring abnormal brain electrical activity
What are the two different classifications of seizures?
- Partial seizures- begin in one part of the brain; simple partial->consciousness remain intact, complex partial->impairment of consciousness
- Generalized seizures- involve the whole brain
Causes of Seizures (6)
- fever (children)
- head injuries
- hypertenson
- brain tumors
- drug & alcohol withdrawal
- allergies
Documentation of Seizure (5)
- length of time
- injuries
- type/movements
- what happened before the seizure
- if patient was incontinent during seizure
Safety Measures During a Seizure (5)
- bed rails up (may be padded if on seizure precaution)
- bed in low position
- patient in chair->move to floor
- nothing in the mouth
- loosen restrictive clothing (if possible)
Interventions After a Seizure
- side-lying position (prevent aspiration & open airway)
- vital signs
- assess for injuries
- may have to reorient patient (pt usually very lethargic)
- documentation
Common side effect of seizure medications.
Gum overgrowth
-oral hygiene important
Surgical Interventions for Seizure Patients (2)
- Vagal Nerve Stimulator (“pace maker” to slow brain activity)
- Surgical removal of brain tissue causing seizure (exact affect lobe is known, pt is awake, EEG monitoring)
-prolonged seizure activity occurring over a 30 minute time frame
Status Epilepticus
**#1 cause is abruptly stopping seizure medications
Complications Associated with Status Epilepticus (2)
- decreased oxygen levels->brain damage
- glucose uptake->metabolic needs not being met
Priorities of Status Epilepticus (3)
- airway!!!
- admin meds (monitor IV patenct; usually given Ativan & Valium)
- after med given, following protocol for “after a seizure” (e.g side-lying, vital signs…)
Meningitis
-definition
inflammation of the membrane and the fluid space surrounding the brain and spinal cord
Assessment Findings of Meningitis (6)
- fever
- headache (hallmark)
- neck stiffness
- positive Kernig’s sign
- positive Brudzinski’s sign
- photophobia (sensitive to light)
_____________ meningitis is contagious, however all patient are put on isolation precautions.
Bacterial
Guillain-Barre
- definition
- recovery time
- major issue
- demyelination of peripheral nerves (the immune system overreacts to the infection and destroys the myelin sheath)
- ascending paralysis that can take 6-12 months to recover from
- major issue: respiratory care (ventilator may be necessary)
- associated with: acute illness, surgery, HIV
Myasthenia Gravis
- progressive autoimmune disease
- severe skeletal muscle weakness
- insufficient secretion of acetylcholine->muscle fibers are unresponsive to acetylcholine
Nursing Assessment of Patient with Myasthenia Gravis (3)
- muscle weakness (heart, respirations, incontinence, drooping eyelids)
- diplopia (double vision)
- difficulty chewing & swallowing
*Tensilon test is performed to diagnosis this disease
Multiple Sclerosis
- definition
- hallmark
- 3 different types
- chronic demyelinating disease affecting myelin sheath of neurons in CNS
- hallmark: extreme fatigue
- relapsing-remitting, secondary progressive, primary-progressive
Relapsing-remitting (MS)
-description
- most common (85%)
- episodes of acute worsening with recovery
Secondary Progressive (MS) -description
- affects about 50%
- develop in 10 years
- period of doing well then get worse
*meds need to be introduced
Primary-Progressive (MS)
-description
- rare (approx. 10%)
- slow, worsening
- no relapse
- patient gradually deteriorates
