Neurology Flashcards
The most important nursing consideration in the care of a patient with an acute neurological injury
Raised Intracranial Pressure
Symptoms of raised intracranial pressure
Headache, blurred vision, less alert than usual, vomiting, changes in behaviour, weakness, fatigue, difficulty talking or moving
Glasgow Coma Scale
Assesses level of consciousness
Score out of 3-15
Eye opening 1-4
Verbal response 1-5
Motor response 1-6
Cranial nerve assessment
Used to identify problems with the cranial nerves by physical examination
Types of neurological examinations
Neuroimaging (CT, MRI)
Nerve conduction studies (NCS)
Electroencephalogram (EEG)
Electromyography (EMG)
Lumbar Puncture (LP)
What is involved in a lumbar puncture examination?
Spinal needle inserted between L3 and L4 collected CSF fluid to test for meningitis, subarachnoid haemorrhage etc.
What else can a lumbar puncture be used for?
To deliver antibiotics or chemotherapy medication directly to the CSF fluid in your spine
Intracranial infections/inflammation
Meningitis, encephalitis
Meningitis
Inflammation of the meninges - bacterial or viral
Encephalitis
Inflammation of the brain - majority of causes are related to childhood diseases such as measles, mumps, rubella, chicken pox
Meningococcal disease can cause septicaemia, true or false?
True
High risk groups for meningitis
Children under 5 years, teenagers, young adults, students in first year tertiary accommodation
The nervous system is limited in the way in which it can respond to injury, true or false?
True
Like other infections, the causative agent…
Needs to be found
More severe form of meningitis which is a medical emergency
Bacterial meningitis
What is the key to a successful outcome in a patient with bacterial meningitis?
Find the causative agent quickly, administer antibiotics promptly
The infective process of bacterial meningitis
Inflammation, exudation, white blood cell accumulation, varying degrees of tissue damage
What is meningococcal disease caused by?
Bacterium Neisseria meningitidis
What should be suspected in a child with fever, seizures, irritability and decrease in consciousness?
Encephalitis
Mortality rate for HSV encephalitis if untreated
70%, reduced to 20% if treated
High risk groups for encephalitis
Younger children
Multiple sclerosis
Disorder of CNS including brain, spinal cord and optic nerves
Multiple sclerosis refers to multiple scarring scattered throughout the brain and spinal cord, true or false?
True
What is the typical damage in multiple sclerosis referred to as?
Demyelination
In young adults, what age do symptoms of multiple sclerosis usually appear?
Between 20 and 50, peak in early 30’s. New Zealand current average age is 37
Guillain-Barré Syndrome
Autoimmune disorder affecting the nervous system
When does onset of Guillain-Barré syndrome usually begin?
Within 10 days of the primary infection
Guillain-Barré syndrome is a rare condition affecting 40 to 100 New Zealander’s each year, true or false?
True
What are the high risk groups for Guillain-Barré syndrome?
Elderly, more commonly men
Symptoms of Guillain-Barré syndrome
Muscle weakness, loss of reflexes, numbness or tingling in arms, legs, face and other parts of body. Complete paralysis in severe cases
What is the exact cause of Guillain-Barré syndrome?
Unknown, but it seems to occur after a viral or bacterial infection
Pathophysiology of Guillain-Barré syndrome
Inflammation and oedema with rapid demyelination and compression of nerve roots within the dural sheath
What are the three phases of Guillain-Barré syndrome?
Acute, plateau, recovery
If the acute phase lasts too long, what can happen?
The respiratory muscles can become involved and intubation may be required
Is Guillain-Barré fatal?
Yes, your body’s immune system begins attacking your nerves
Epilepsy
Chronic disorder characterised by recurring seizures
What is important to learn if you have epilepsy?
Possible triggers for seizures such as stress, lack of sleep, drugs, alcohol, caffeine, light and sensory stimulation, emotions
What age does epilepsy usually occur?
Often develops in childhood. However, it can occur to anybody at any age
Everyone who has epilepsy was born with it, true or false?
False - it can develop during childhood or adulthood
Epilepsy is genetic, what does this mean?
It is due to changes in the DNA that direct brain cell function
What can epilepsy be due to?
Damage to brain cells such as after a head injury or illness such as a stroke
Cerebral palsy
Damage to the area of the brain that controls muscle tone, affecting movement and posture
Is there a cure for cerebral palsy?
No
Most cerebral palsy occurs as a result of factors prior to birth, however…
Little is known about these factors
For 80% of people with cerebral palsy the cause is…
Unknown
Does cerebral palsy worsen over time?
Generally, no. Some signs can worsen or improve overtime though
People with cerebral palsy can also have
Visual, hearing, speech and intellectual impairments, and epilepsy
Stroke
A disruption of blood flow to the brain
Ischemic stroke
Disruption of blood flow to parts of the brain
Hemorrhagic stroke
Blood vessels in the brain break, flooding the brain and damaging brain cells
What type of stroke is more common in children?
Ischemic stroke
Why is an ischemic stroke more common in children?
Lack of oxygen at birth, heart defect, blood disorders such as sickle cell which destroys blood cells and blocks vessels, genetic disorders like Moyamoya, an infection such as meningitis, dehydration, injury to artery
What is Moyamoya?
A rare disease that affects arteries in the brain
What can cause a hemorrhagic stroke?
An aneurysm, head injury that causes a broken blood vessel, diseases that affect blood clotting such as hemophilia, arteriovenous malformation
What is arteriovenous malformation?
A condition in which the blood vessels in the brain do not connect properly
3 types of nerves that diabetic neuropathy can affect
Sensory, motor, autonomic
Diabetic neuropathy can cause
Pain/numbness, usually to your feet
Difference between a head injury and a traumatic brain injury
Head injury involved skull and scalp, TBI must involve brain
What groups can experience a traumatic brain injury?
Anyone, at anytime
The effects of traumatic brain injuries can be
Temporary or permanent
Traumatic brain injury can range from
A mild concussion to severe (extended period of unconsciousness and/or memory loss after the injury)
