2014Nursing Assessment and Interventions for the Patient With
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Nursing Assessment and Interventions for the Patient with Altered Neurological Function Fall 2014 Nursing 53 Lewis 8 th Ed
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Transcript of 2014Nursing Assessment and Interventions for the Patient With
Nursing Assessment and Interventions for the Patient with Altered Neurological Function
Fall 2014Nursing 53Lewis 8th Ed
Anatomy, Physiology, and Function of the Nervous System
Neurons Action Potentials
Na (extracellular) K (intracellular)
Neurotransmitters Acetylcholine Norepinephrine Cholinergic Adrenergic GABA Dopamine
Cerebrum, page 1409 Diencephalon Brainstem Cerebellum Parietal Lobe Occipital Lobe Temporal Lobe Frontal Lobe Motor Area Speech Area Motor Speech Area
Brain StemVentriclesCerebrospinal FluidMenigesCerebral Circulation and the Blood –Brain
Barrier, page 1412Limbic and Reticular Formation
Spinal Cord
Functions of the Spinal Cord and Spinal Roots Upper and Lower Motor Neurons Spinal Nerves
Cervical, Thoracic, Lumbar, Sacral, Coccygeal Cranial Nerves
12 pairs page 1411 Reflexes
Autonomic Nervous System
Sympathetic DivisionParasympathetic
Diagnostic Tests of the Neurologic System
CT MRI MRA MRS PET Cerebral Angiogram Carotid Duplex Study EEG EMG LP Myelogram
GlasgowComa Scale, p. 1513
Eyes OpenBest Motor ResponseBest Verbal response
Total score 15
Neurological Assessment
Page 1416, page 1419 box 56-6Reflex Assessment, page 1418Common abnormalities
ALOCAnosognosiaAphasia/dysphagiaDysarthriaAnisocoriaDipolia
Homonymous HemianopsiaDysphagiaOpthalmoplegiaPapilledemaApraxiaDyskinesiaHemiplegiaNystagmusAnalgesia
AnesthesiaParathesiaAsterognosisExtensor plantar responseDeep tendon reflexesBladder dysfunctionParaplegiaTetraplegia
Variations in the Older Adult
Decrease number of brain cells
Slower conduction Slower retrieval of
information Slower response to
balance Less readiness to learn More easily distracted
Needs additional time Forgetfulness Increase risk for falls Set time limits Table 56-4
Seizures
Epilepsy (also called seizure disorder) Sometimes called a convulsion Common affects 2.5 million people Increases dramatically in older adults Not a mental disorder Alterations in the excitability of neurons Scarring Inbalances of excitatory and inhabitory
nuerotransmitters
Manifestations
PartialSimpleComplexGenerilizedAbsence (petit mal)Tonic clonicStatus Epilepticus
MedicationsKee, Chapter 22 7th ed. Anticonvulsants
Anticonvulsants Hydantoins
Phenytoin, Cerebryx Benzodiazepines
diazepam Iminostilbenes
tegretol Valproate
Valpoic acid Iminostilbenes
Carbamazepine Miscellaneous
Keppra,
Nursing Interventions for drugs
Monitor serum drug levels Compliance Monitor CBC, BUN, Creatinine Protect environment Nutrition, anorexia Oral contraceptives nullify History of herbs Check urinary output Oral mucous membranes Phenytoin may inhibit insulin release
Status Epilepticus
ValiumAtivanDilantinPhenobarbVersedDiprivanThen high dose barbituates
Drug Interactions
Valproic acid and phenobarbPhenobarb and coumadinAntabuse and phenobarbCarbamazepine and oral contraceptivesASA, diamox, antacids, folic acid,narcotics
Surgery considerations
Meds held day of surgeryMay give a partial dose, depends on
surgeonMay be ordered parentally until fluids poSteroids for first three days to decrease
cerebral edema
Pathophysiology
Meningitis-inflammation of the pia mater, the archnoid, and the subarachnoid space
Encephalitis-acute inflammation of the parenchyma of the brain or spinal cord
Manifestations
Restlessness, agitation, and irritability Severe headache Meningeal irritation
Nichal rigidity Positive Brudzinski’s sign Positive Kernig’s sign
Chills and high fever Confusion, altered LOC Photophobia Seizures Increased ICP, widened pulse pressure, bradycardia, respiratory
irreg, decreased LOC, headache and vomiting Petichial rash
Causes
Viral vs bacterialNursing care plan, page 1454Collaborative Therapy, 57-17 page 1453
