Assessment of Neuro Function Quiz

Assessment of Neuro Function

• CT: X-ray imaging providing cross-sectional brain views. Performed with the patient lying still and motionless. Uses radiation. Important to follow IV contrast precautions.
• MRI: Powerful magnetic imaging, useful for brain tumors, strokes, and multiple sclerosis (MS). Does not use radiation, but procedures may take hours, making it unsuitable for emergencies. All metal objects must be removed.
• PET: Measures organ function, particularly blood flow in the brain. Uses radioactive substances, so patients need pre-procedure screening. May cause dizziness, lightheadedness, or headaches.
• Cerebral angiography: X-ray study of cerebral circulation using contrast. An artery is punctured (carotid, femoral, or arterial) and contrast is administered to visualize blood flow. The injection site needs monitoring.
• Myelography: X-ray of the spinal subarachnoid space after contrast injection via lumbar puncture. Visualizes spinal cord abnormalities and outlines the space. Post-procedure, the patient must be kept elevated to reduce risks.
• Electroencephalography (EEG): Measures electrical activity in the brain. Usually non-invasive with electrodes placed on the scalp. Used to diagnose seizure activity and mental disorders. Standard EEG takes 45-60 minutes.
• Electromyography (EMG): Measures electrical potential in skeletal muscles, used in assessing neuromuscular disorders. Needle insertion is involved.
• Dopplers: Non-invasive ultrasound to evaluate cranial vessel function. Procedure is conducted at the patient's bedside using ultrasound imagery.
• Evoked potential studies: Application of external stimuli to peripheral receptors, using an EEG device to observe responses. Patient needs to remain still.
• Lumbar puncture (spinal tap): Procedure to detect meningitis, syphilis, or malignancies. It is also utilized to measure CSF pressure and administer medication/chemotherapy directly into the CSF.

Increased Intracranial Pressure (IICP)

• Normal ICP: 10-20 mm Hg.
• Pathophysiology: IICP is caused by decreasing blood flow (perfusion) to the brain. Increased intracranial pressure can be from cerebral edema or blood vessels issues.
• Early Signs: Changes in LOC (earliest sign), restlessness, drowsiness, confusion, purposeless movements, changes in PERRLA, weakness or changes in one extremity.
• Late Signs: Cushing's Triad (hypertension, bradycardia, bradypnea), severe projectile vomiting, worsening LOC, loss of brainstem reflexes.
• Nursing assessment for IICP includes assessing mental status, LOC, cranial nerves, Glasgow Coma Scale (GCS), and vital signs, including cause, risk factors, and recent cerebral or head injuries.
• Nursing interventions: Maintaining airway, monitoring neurological status; crucial to avoid procedures such as lumbar puncture. Positioning the patient to reduce pressure, and keep head neutral, and maintain a calm and quiet environment.
• Complications: Brain herniation can be irreversible, leading to brain anoxia and death.

Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• DI: Decreased ADH (antidiuretic hormone), causing excessive urine output (polyuria). Serum is hyperosmolar, and electrolyte replacement is crucial.
• SIADH: Increased ADH, leading to fluid overload, oliguria (low urine output), and dilute urine. Restricting fluids is a treatment.

Treatments for Cerebral IICP (CPP)

• Osmotic diuretics (mannitol): To decrease brain swelling.
• Hypertonic Saline: To decrease brain swelling.
• Fluid Restriction: To control blood volume in the brain.
• Manipulation of cardiac output: This is done by administering or increasing the use of Dobutamine and Norepinephrine to ensure CPP is maintained at a normal range.

Neurological Exams

• Level of Consciousness (LOC) Assessment: crucial to assess a patient's neurological status.
• Cranial Nerve Assessment: Testing cranial nerves to evaluate their functionality.
• Muscle Strength Assessment: Evaluating the strength of muscles.
• Reflex Assessment: Assessing reflexes to evaluate neurological function.

Other Neurological Conditions

• Stroke: Types include ischemic (clot blocking blood flow), hemorrhagic (bleeding in the brain), and lacunar (small vessel ischemic stroke). Includes risk factors, symptoms, and treatments.
• Head Injuries: Includes types (contusions, lacerations, hematomas), symptoms, treatments (controlling ICP), management, and complication (cushing's triad).
• Glasgow Coma Scale: Tool to describe a patient's level of consciousness by assessing their verbal, motor, and eye response. Important tool to indicate the severity of a patient's brain injury and to help determine the risk of complications.
• Basilar Skull Fracture: Fractures at the base of the skull showing symptoms like leaking CSF or bleeding from the nose or ears.
• Meningitis: Inflammation of the membranes surrounding the brain and spinal cord. Includes causes, symptoms, treatments, and tests.
• Brain Abscess: Collection of pus inside the brain.
• Myasthenia Gravis: Autoimmune disease that affects the neurotransmitter acetylcholine. Symptoms such as drooping eyelids (ptosis) and facial muscle weakness.
• Multiple Sclerosis (MS): A chronic inflammatory disease of the brain and spinal cord. Signs, symptoms and treatment are all included. Diseases that have a genetic component.
• Guillain-Barré Syndrome: Immune attack on peripheral nerves, leading to ascending paralysis.
• Parkinson's Disease Progressive neurological disorder associated with dopamine neurotransmission
• Alzheimer's disease: Progressive neurodegenerative disease, memory and cognition are affected.
• Tic Douloureux (Trigeminal Neuralgia): Paroxysmal facial pain, caused by vascular compression of the 5th cranial nerve.
• Bell's Palsy: Temporary paralysis of the facial nerve.
• ALS (Amyotrophic Lateral Sclerosis): Progressive neurological disease with muscle weakness and atrophy. Patient will die.
• Huntington's Chorea: Genetic, inherited neurological disorder presenting with involuntary uncontrolled movements (chorea) and dementia.