Neurological Assessment & diagnostics Flashcards
GCS is what?
A scale that measures the degree or LOC
GCS is used to assess the LOC in a client who already has altered _____ or has the potential for it
Altered consciousness
Three responses of the GCS?
Eye opening (4) Verbal response (5) Motor response (6)
We like a high number ranging from ____ for the GCS
13-15
What is always #1 with neurological assessment
LOC
Factors that can alter the GCS?
Drug use
Alcohol intoxication
Shock
Hypoxia
Normal pupil size is ?
2-6 mm
Hang grips/lifts legs/pushing strength of ___
Feet
Babinski reflex is normal in a child up to ___
1 year (depends when child starts walking)
Babinski is abnormal in ___
Adult (or basically anyone who walks)
The adult or child greater than one year should have a normal reflex or ___ of the toes when the bottom of the foot is stroked
Curling
What does it mean if the adult has a present Babinski reflex or fanning of the toes when you stroke the bottom of the foot?
A severe problem in CNS
- tumor or lesion on brain or SC
- MS
- Lou Gehrig disease
A normal reflex response would be documented as ?
2+/4+
General diagnostic tests: CT
Dye?
With or without —if it has dye then need consent form
General diagnostic tests: CT
Take pictures in ___
Slices
General diagnostic tests: CT
Head
Keep head still
No talking
General diagnostic tests: MRI
What is better: CT or MRI?
MRI
General diagnostic tests: MRI
Dye?
Not usually used
General diagnostic tests: MRI
Radiation?
No..magnet used
General diagnostic tests: MRI
Position?
Will be placed in a tube where client will have to lie flat
General diagnostic tests: MRI
What can you not have on
No jewelry
No credit cards
NO PACEMAKERS
General diagnostic tests: MRI
Tattoos ?
Old tats may contain medal
General diagnostic tests: MRI
Teeth fillings
Don’t matter
General diagnostic tests: MRI
What client can’t tolerate this?
Clausterpobic
General diagnostic tests: MRI
Can talk and hear others when in tube?
Yes
Cerebral angiography
Consent form?
What is it?
What artery does it go through
Yes, because dye used
X-ray of cerebral circulation
Go through the femoral artery
Cerebral angiography-Pre procedure
Well hydrated/void/peripheral pulses/groin prepped ….Explain
Anytime an iodine based dye used, client will need to be well hydrated to promote excretion of the dye
Watch: BUN and Cr, UO, and hold metformin
Cerebral angiography-Pre procedure
What drug to hold?
Metformin
Cerebral angiography-Pre procedure
Explain what?
Will feel warmth in face and a metallic taste
Cerebral angiography-Pre procedure
Allergies?
Cannot have allergies to shellfish or iodine
Cerebral angiography-Post procedure
Bed rest
4-6 hours
Cerebral angiography-Post procedure
Monitor for?
Bleeding/hemorrhage!!!
Cerebral angiography-Post procedure
Possible complication?
Embolus
*get baseline data because an embolus could go to arm, heart, lung, kidney, or brain
Cerebral angiography-Post procedure
Embolus to brain s/s?
Change in LOC
One sided weakness
Paralysis
Monitor/sensory deficits
EEG
Does what?
Records activity of the brain
EEG
Used for what?
- Diagnose and evaluate seizures
- Evaluates LOC and dementia
- Screening procedure for coma
- Sleep disorders (narcolepsy, cerebral infarct, brain tumor or abscess)
EEG
Use this for an indicator of ___
Brain death
EEG-Pre-procedure
Sedatives?
Caffeine?
NPO?
Hold sedatives (sedatives decrease electrical activity in brain; alters test)
NO caffeine (changes electrical activity of brain)
Not NPO!!! (drops blood sugar)
EEG
Beginning of procedure get what?
May be asked to do what?
Baseline first with client lying quietly (resting EEG)
May be asked to hyperventilate to assess brain circulation, assess photo stimulation for seizures, or sedate for sleep study
*if someone unconscious then pain response or noxious stimuli may be introduced to stimulate brain wave (strong smell/bright light)
Puncture site?
Lumbar subarachnoid space
Lumbar puncture
Purpose? (3)
- Obtain SF to analyze for blood, infection, and tumor cells
- Measure pressure readings with manometer
- To give drugs intrathecally (brain, SC)
Lumbar puncture
Position
Back arched (side lying fetal or arched over)
Lumbar puncture
Inspect?
Normal CSF?
Insect surrounding skin at puncture site for infection
CSF should be clear and colorless (looks like water)
Lumbar puncture: Post procedure
Position?
Fluids?
Most common complication?
Lie flat or prone for 2-3 hours so seal can form
Increase fluids to replace lost spinal fluid
Most common complication: HA
Lumbar puncture: Post procedure
HA pain increases when the client ___ and decreased when the client ____
Increase when sit up
Decrease when lie down
Lumbar puncture: Post procedure
How to treat HA?
Bed rest
Fluid
Pain med
Blood patch
Lumbar puncture: Post procedure
Life-threatening complications?
Brain herniation
Meningitis
Lumbar puncture: Post procedure
Never do LP with someone who has ____
Known increased ICP—this is life threatening to do on this client!!!!
Lumbar puncture: Post procedure
Meningitis
Bacteria can get in puncture site and into SF and cause meningitis
