Unit 12 ALOA/Seziure Flashcards
Describe the lobes in the brain plus the cerebellum and brain stem.
Frontal Lobe: personality, judgement, speech, body movements
Parietal lobe: Hearing, sensory, pressure, pain
Occipital Lobe: Vision
Temporal Lobe: Understanding language, memory
Cerebellum: Coordinates muscle movements, balance
Brain stem: relay center, performs automatic functions like breathing
What structures protect the brain?
Skull
Meninges
CSF
Blood-Brain Barrier
What do each of the cranial nerves correspond too?
1: Olfactory- Smell
2: Optic- Vision
3,4,6:
3 Occulomotor- pupil contraction
4 Trochlear - eye movement inward
6 Abducens -eye movement outward
5: Trigeminal- Teeth, jaw muscles
7: Facial - Face muscles, taste
8: Auditory -hearing, balance
9: Glossopharyngeal - muscle of throat, larynx
10: Vagus - internal organs
11: Spinal accessory - muscle of neck and upper back
12: Hypoglossal- tongue movements
Describe the motor part of the peripheral nervous system. What neurons involved? What does the tract name end with? What pathway is it? SNS does what? ANS does what?
Called Efferent
Upper and lower neurons
Descending motor pathways
Tract name ends with “spinal”
Somatic nervous system (SNS) directs contraction of skeletal muscles
Autonomic nervous system (ANS): directs the activity of glands, smooth muscle, and cardiac musc
Describe the sensory function part of the peripheral nervous system.
Called Afferent
Posterior column tract
Ascending pathways
tract name begins with “spino”
What does the neuro assessment involve?
Hx Consciousness Pupils Eye movements VS changes Breathing patterns Motor responses Reflexes
Define consciousness.
What is it the function of?
Describe it.
State of general awareness of oneself and the environment
Function of cerebral cortex
Cannot be measured directly, estimated by eliciting responses to stimuli
Change can occur very rapidly or over a period of hours, days, weeks
Measured on a continuum
How would you assess level of consciousness?
What is the acronym for assess consciousness?
Apply stimuli and observe response either (verbal or motor)
Common ways are auditory and tactile
-Auditory stimulus is first one applied (ask question)
-Tactile is tried when PT does not respond to auditory
(nail bed or sternum rub)
AVPU
Alert Verbal Painful Unconscious
What is the most important indicator of a patient’s condition?
Level of responsiveness and consciousness
What is the continuum of consciousness? Describe coma.
Conscious to coma
Coma:
- Unconsciousness
- Unresponsiveness
- Inability to arouse
What does Glasgow Coma Scale measure and what are the categories and numbers/what they mean?
Measure conscious level, 3 categories, lower the score the worst it is.
Eye Opening: 1 none 2 pain 3 voice 4 spontaneous
Verbal Response: 1 None 2 No words, just groans 3 intelligible single words 4 Disoriented conversation 5 Normal conversation
Motor Response: 1 No movement 2 Decerebrate 3 Decorticate 4 Withdraws to pain 5 Localized to pain 6 Normal
What do the GCS abnormal posturing Decorticate and Decerebrate mean?
Decorticate = hugging themselves
Decerebrate = Nothing happen (arms down hands fixed in)
What does PERRLA mean?
Pupils Equal Round Reactive to Light and Accommodation
What do the following Pupil assessment descriptions mean?
Unilateral dilated pupils (Anisocoria) Bilateral dilated pupils Irregular pupils Conjugate gaze deviation (both looking to one side) Smal Pinpoint
Unilateral dilated pupils (Anisocoria) = cranial nerve 3 compression
Bilateral dilated pupils = midbrain injury
Irregular pupils = Orbital trauma
Conjugate gaze deviation (both looking to one side) = Frontal lobe lesion
Pinpoint/small = pontine injury, opiate administration
Describe the follow eye movements.
Dysconjugate Gaze
Nystagmus
Dysconjugate Gaze = one eye different direct then other
Nystagmus = repetitive, uncontrolled movements
What is the Oculocephalic Relfex? Describe normal and abnormal.
What needs to be determined before testing?
Also known as “Dolls eyes”
Tests for brain stem death
Look for this around GCS of 5 or less
Normal if head is rotated and eyes move to opposite direction.
Abnormal if head turned to one direction and eyes follow.
Determine there is NO spinal cord injury before testing.
What is the Oculovestibular reflex?
What are nursing considerations before testing?
Tests brain stem death by injecting 50 100ml of ice cold saline rapidly into ear.
If eyes flutter and move = normal
If there is no movement = negative response/brain death
Make sure no ruptured eardrum or brain tissue coming out
What is Cushing’s triad? What does it indicate?
Bradycardia (decreased HR)
Increased Systolic BP
Apnea
Greater pulse pressure
Neuro dysfunction or ICP
What is hypertension usually associated with in regards to ALOA?
ICP
C1-C4 injuries results in what?
Total respiratory arrest
Describe the following breathing patterns and causes.
Cheyne-Strokes
Kaussmaul’s
Apneustic
Cheyne-Strokes: gradual increases and decreases in respirations with periods of apnea
causes- ICP, brain stem injury
Kaussmaul’s: tachypnea and hyperpnea (deep respirations)
causes- renal failure, DKA, metabolic acidosis
Apneustic: Prolonged inspiratory and shortened expiratory phase
causes - lesions in brain stem
What are abnormal adult reflexes?
Babinski (normal in adult should curl inward)
Clonus (muscle spasms)
Absent Corneal Reflex (5th and 7th Cranial N. cotton swab to the eye)
Absent gag reflex
What are signs indicating Basal Skull Fracture?
CSF from sinus
Raccoon Eyes
Battle Sign (bruising behind ear)
Describe the diagnostic tests for Brain injury.
X-ray: assess for fractures
CT Scan: Assessing bleeds
PET Scan: Radio isotope injection that dx’s cancers, epilepsies
EEG: brainwave activity
MRI (around 45 minutes, ask if PT as claustrophobia)
Cerebral angiography
Transcranial doppler (ultrasound of brain, looks at blood flow)
What are nursing considerations for an EEG exam?
What can it diagnose?
24hrs awake beforehand No seizure meds beforehand Wash hair/ No hairspray No OTC meds Avoid chocolate, caffeine, or alcohol 8 hrs prior 2 hrs before, meal is OK
Epilepsy, psychiatric disorders, brain death
What happens before and after a lumbar puncture?
Where is it placed and what can it dx?
Before: NPO, IV patent
After: Check neurovascular status, flat 1 hr, limit activity for 24hrs
Catheter into 3rd and 4th lumbar vertebre
Can dx guillian barre, MS, meningitis, etc.
What is the pre procedure and post procedure nursing care for a Cerebral Angiography?
Pre-procedure:
- Ask if allergic to iodine
- NPO
- Baseline neuro assessment
- PT education (what to expect)
Post-procedure:
- Bedrest as ordered
- Increase fluids
- Neuro assessment
What are ALOC general nursing interventions?
- Airway maintenance
- Neuro assessment
- Fluid balace
- Nutrition
- Mouth care
- Temperature regulations
- Bowel and bladder function
- Sensory stimulation or deprivation
- Prevent injury and complications such as pneumonia, aspiration, DVT/PE, etc.
What is a seizure?
What are the two kinds?
Episode of abnormal motor, sensory, autonomic, or psychic activity, that results from sudden excessive discharge from cerebral neurons.
Partial
Generalized
What is epilepsy?
Pattern of unprovoked and recurrent seizures
most forms occur in children
What are causes of seizures?
- Most are idiopathic
- Inherited susceptibility
- Head injury
- Birth injury
- Brain tumor
- Brain infection
- High fever
- Stroke
- Drug and Alcohol withdrawal
- Hypoglycemia
What is the classification of a partial seizure and the two kinds?
Abnormal electrical discharges originate from 1 specific area of the brain. (can spread to other parts however)
Simple partial - without loss of consciousness
Complex partial -with impairment of consciousness
What is the classification of generalized seizure?
What are the following types? Absence Tonic-Clonic Myclonic Atonic Tonic
-Whole brain is involved.
Absence- Suddenly, no warning signs (they stare off then come back)
Tonic-Clonic- “grand mal” tonic phase- stiffness, back arches, gargling noises; clonic- muscle spasms, jerking
Myclonic- Muscle jerking
Atonic- Body completely relaxes (numbness and tingling)
Tonic- Initially stiffens then loses consciousness
What is the prodromal phase and symptoms of a seizure?
Emotional symptoms days or hours BEFORE seizure such as:
- Depression
- Difficulty concentrating
- Insomnia
- Lightheadedness
- Mood changes
- Aura
- Cry
What is an aura?
Peculiar sensation, flashing lights, noises, fear, deja vu
before seizure
What are the symptoms of the post-ictal phase of seizure?
What is the post-ictal phase?
Confusion Groggyness Amnesia Headache Muscle pain Dilated pupils
After the seizure
What are is the nursing care for a PT during a seizure?
- Provide privacy
- Maintain airway
- Loosen clothing
- Place PT on side with head flexed forward
- Stay w/PT and observe phases
- Protect from injury by easing head to floor and moving furniture or raising side rails if in bed
- Do NOT restrain PT or or try to force an airway or bite block into seizing PT
What is the nursing care for a PT after a seizure?
- Side lying position to promote drainage or oral secretions and suctioning performed
- Re orient to environment
- Assess for injuries
- Assess VS
What are seizure precautions?
- Padded side rails up
- Bed low
- PT closely monitored with privacy
- Never use restraints
- Loosen tight clothing
- Suction and O2 equipment ready
Why and what would the nurse check in a client with hx of seizures?
To rule out other conditions like liver failure, meningitis, kidney failure, diabetes, etc
Glucose
Infection disease
Drug levels
What is phenytoin (Dilantin)?
What is the therapeutic range?
What are the most common side effects with this drug?
What are the most severe complications?
Seizure med to stabilize neuro membrane and limit seizure activity.
10-20 mg/L
Common side effects: Visual problems, hirsutism, gingival hyperplasia, nystagmus, anemia
Most severe complications: Agranulocytosis, Arrhythmias
What are the special considerations when administering phenytoin (Dilantin) through IV?
Administer slowly (50mg/min)
Mix w/ normal saline
IV tubing w/filter and large vein
VS before administration
Tele monitor
What is status epilepticus?
Series of generalized seizures that occur without full recovery of consciousness between attacks.
5-30 min. episodes, repeating
What are the medical and nursing interventions for status epilepticus?
ABC management
Medication (benzo’s and phenytoin, check resp status after administration)
Protect from injury
Patent IV
Cardiac monitor
For continuous seizures what med would you want to give first and why followed by which and why?
Benzo’s: they are fast acting to stop seizure
phenytoin: to prevent further seizures
