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