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Neuro 1
Review:
Age-Related Changes• The number of nerve cells decreases and brain weight decreases
• Increased plaques and tangled fibers in nerve tissue
• Eye pupil often smaller; may respond to light more slowly. Tracking may be jerky.
• Reflexes intact except for Achilles tendon jerk, which is often absent • Lipofuscin and amyloid tangles present
• Reaction time increases, especially complex reactions
• Tremors in the head, face, and hands are common
• Some develop dizziness and problems with balance*****– This is not normal!!
General Neuro Assessment:
LOC- Approach the patientCall their nameTouch themShake themNail bed pressure
Perform Romberg Test:Stand with eyes closedPat knees with palms and back of hands rapidlyTouch fingertipsTouch nose open eyesTouch nose closed eye
Main Neuro Assessment Tool?
Glasgow Coma Scale
Other Neuro Assessment Tools:
Babinski:
Neuro Assessment Tools (Diagnostic):
CT Scan: enhanced ct? use contrast
MRI: complete ck list
EEG: great for seizures
Crebral Angiography: NKA? Fluids after?
PET Scan:
Lumbar PunctureTo obtain specimenMeasure CSF pressureInject anestheticInject air for testing
LP Procedure
Sterile
Position pt on side, knees bent, back arched out
Needle between L3-4 subarachnoid space
Potential complications
Severe HAN/VIrritation / hematomaLeg / buttock painCNS irritationBrain herniation
Nursing Care after LPFlat – horizontalCheck siteOngoing neuro assessPush fluids
ICP
• What is it?– Increase pressure inside that reduces perfusion to
the brain.– Decrease perfusion…decrease oxygen…decrease
oxygen…decrease LOC
ICP• S&S– in consciousness– Headache– The 2 postures– Pupillary changes. • Oculomotor nerve pressure. Fixed and dilated
– Cushings Triad• Bradycardia, HTN, Widening pulse pressure
ICP
• TX– Mannitol– Steroids– HOB at 30 degrees– Remain straight….even head– Limit fluid intake
Seizures
• What is it?– Miss-firing of neurons in the brain– Storm– Common cause?...Not taking seizure medicine2 major types:
Partial (simple and complex)-No LOCGeneralized- Tonic/Clonic Movement-
LOC
Generalized Seizure
• Ictal Phase:Mark time, so you can figure durationMay try to cradle head and or loosen
clothes if safe to do soIf in hospital, pads should already be on
bed!!NOTHING ELSE!!
Generalized seizure
• Post Ictal phase– Aura?– Check mouth– Reassure
Generalized Seizure
• Tx– Dilantin- Perform mouth care– Other anti-convulsants
• Over 30min seizure is status epilepticus– Emergency. Needs IV anticonvulsants
Headaches
• Types:– Migraine– Cluster– Tension
Migraine
• Cause– Intracranial vasoconstriction followed by dilation
• S&S– Unilateral pain– N/V– Photosensitivity
• Tx– Meds (Imitrex, steroids), quietness, low lights
Cluster
• Cause– Stress, anxiety
• S&S– Lacrimation, Rhinorreha, pain unilateral head
• Tx– Meds(Tylenol, Advil), cool compresses
Tension
• Cause– Something else
• S&S– Pain
• Tx– Treat the cause– Non opoid meds, warm compressess
Meningitis
• Cause– Bacterial or viral infection of the Meningies
• S&S– Headache– Nuchal rigidity– Positive Kernig’s sign and Brudzinski’s sign– ICP
Figure 27-16A
Figure 27-16B
Meningitis
– Tx• Antibiotics if…..
Vocab
SynapseSomnolentSemicomatoseComatoseLethargicHemiplegiaHemiparesisIpsilateralDecorticateDecerebrate
Figure 27-5
The End