EEG: Electroencephalogram

EEG (Electroencephalogram)

• An EEG is a non-invasive diagnostic tool.
• It measures and records the brain's electrical activity through scalp electrodes.
• EEGs diagnose seizure disorders like epilepsy.
• They also evaluate brain death and assess encephalopathies.
• Furthermore, they investigate brain tumors and strokes.
• Nurses prep patients to ensure accurate readings.
• Patients shouldn't consume caffeine, stimulants, or depressants like alcohol 24-48 hours before the procedure.
• Patients should wash their hair the night before, without using oils, sprays, or conditioners.
• Confirm whether to hold antiepileptic medications with the healthcare provider
• During the EEG, patients should remain still, and flashing lights or hyperventilation might induce brain wave activity, especially in suspected epilepsy cases.
• Post-procedure, medications are resumed unless directed and monitor for seizures, particularly if provoked during the test.

MRI (Magnetic Resonance Imaging)

• MRI utilizes powerful magnets and radio waves.
• Produces detailed images of the spinal cord and brain.
• Crucial for diagnosing brain tumors and strokes.
• Diagnoses multiple sclerosis (MS), aneurysms and spinal cord lesions.
• MRI is better than CT for visualizing soft tissues such as MS plaques and brain tumors.
• Patient safety concerning the magnet must be ensured.
• Metal implants or foreign bodies like pacemakers need screening.
• Claustrophobia requires assessment for possible sedation.
• Assess kidney function and check for allergies if contrast is needed.
• Patients must remain still to avoid image distortion and protect ears from loud noises
• If sedated continue to monitor patient until fully awake and stable.

Catecholamines (Epinephrine, Norepinephrine, Dopamine)

• Catecholamines are neurotransmitters secreted by the adrenal medulla and sympathetic nervous system.
• They affect heart rate, blood pressure, and stress responses.
• Catecholamine levels are assessed to check for adrenal tumors.
• Pheochromocytomas cause episodic severe hypertension, headaches, palpitations, and sweating.
• Tests for catecholamines include 24-hour urine collection for metabolites like VMA and metanephrine.
• Plasma catecholamines can also be measured.
• An important nursing responsibility includes ensuring accurate 24-hour urine collection.
• Discard the first void, collect all subsequent urine, and keep it refrigerated.
• Avoid stimulants, stress, and certain medications that could affect results.

Aphasia (Language Impairment)

• Aphasia is the inability to speak, understand, write, or comprehend language.
• Brain damage commonly causes it, from stroke or head injury.
• Nursing interventions include speaking slowly and clearly using short sentences, yes/no questions.
• Alternative interventions are communication aids like picture boards and speech therapy referrals.

Memory (Short-Term & Long-Term)

• Immediate attention recalls recent information.
• Short-term memory recalls events within minutes.
• Long-term memory recalls remote past events.
• Impairment occurs in dementia, delirium, brain injury, and stroke.
• Memory assessments determine neurological and cognitive function.
• Memory is important to evaluate the effectiveness of treatment and potential rehabilitation.

Coordination (Cerebellar Function)

• Coordination showcases cerebellar function and impacts balance, gait, and fine motor skills.
• Assessment tests include finger-to-nose, heel-to-shin, rapid alternating movements, and the Romberg test.
• Ataxia means an unsteady, wide-based gait indicating cerebellar issues or a stroke.
• Dysmetria shows inability to control distance (overshooting) which indicates a cerebellar lesion.
• Intention tremor is associated with performing movement and is common in MS.

Geriatric Neurological Changes

• Neurological function naturally declines with age.
• This happens due to loss of neurons, reduced neurotransmitter levels, and slower nerve impulse conduction.
• Impaired balance and coordination increase fall risk, and short-term memory lapses can occur.
• Nursing considerations: focus on safety and fall prevention.
• Mental stimulation and Physical activity should be encouraged along with support for sensory impairments.

Assess Change in Level of Consciousness (LOC)

• LOC is the earliest and most sensitive indicator of neurological deterioration.
• Changes in LOC occur from increased ICP, stroke, brain injury, infections, metabolic imbalances, or drug overdose.
• Assessment involves checking if the patient is awake and aware of surroundings known as Alertness
• Orientation requires asking name, location, date, and situation where you document if patient is "Alert and Oriented ×4".
• The Glasgow Coma Scale assesses Eye Opening (4 points), Verbal Response (5 points), and Motor Response (6 points).
• GCS score interpretation includes 15 as normal , 9-12 indicates moderate impairment and 8 or less severe coma
• Abnormal findings: decreased responsiveness, disorientation, confusion, agitation, unequal/sluggish/fixed pupils.
• Posturing can show lesions in the cerebral cortex (decorticate) or brainstem damage (decerebrate).

Increased Intracranial Pressure (ICP)

• Normal ICP range is 5–15 mmHg.
• Trauma, tumors, and infection cause increased ICP.
• Additional causes include stroke and hydrocephalus (CSF accumulation).
• Early signs of changes include altered LOC, headache, nausea, vomiting, and sluggish pupils.
• Late signs showing life-threatening conditions include Cushing's Triad, fixed pupils, posturing, and seizures.
• Cushing's Triad includes increased systolic BP with widening pulse pressure, and bradycardia.
• Irregular respirations (Cheyne-Stokes, apnea) also appear.
• Nursing management includes elevating HOB to 30 degrees and keeping the neck neutral to promote venous drainage.
• Avoid activities such as coughing and straining that increase ICP.
• Also limit suctioning.
• Medications: osmotic diuretics like Mannitol reduce cerebral edema; hypertonic saline decreases swelling by pulling fluid out of brain cells. Sedation analgesia, and anti-seizure meds may also be used.
• Monitor ICP through ventriculostomy or other ICP monitor to ensure it is ordered

Seizures (Focal and Generalized)

• Seizures are sudden abnormal electrical activity in the brain leading to involuntary movements or altered consciousness.
• Phases of seizures: Aura, Ictus, Postictal.
• Aura is a warning sign characterized by an odd smell, a visual disturbance or tingling.
• Ictus: Is the seizure itself.
• Postictal: Recovery phase leads to confusion, fatigue, and drowsiness.
• Care during seizure includes protecting the patient by lowering them to the floor, turning to the side, and loosening clothing. Do not restrain or put anything in the mouth while Timing the seizure with suction and oxygen ready.
• Postictal requires reorienting the patient and documentation of length, type of seizure any injuries.
• The HCP will need communicated if the first seizure or any seizure occurs more than 5 minutes

Status Epilepticus (Seizure Emergency)

• Is continuous seizure lasting more than 5 minutes, or recurrent seizures without regaining consciousness between.
• It is life-threatening
• Causes for this medical emergency are abrupt withdrawal from antiepileptic meds, head trauma, and brain infection, stroke along with electrolyte imbalances.
• Clinical manifestations range from prolonged tonic-clonic seizure, cyanosis and hypoxia, cardiac arrhythmias, and hypotension.
• Emergency nursing interventions include ensuring the airway and preparing to suction.
• Administer IV lorazepam or diazepam and load with phenytoin or keppra to monitor vital signs, cardiac rhythm, and oxygen saturation.
• Possible intubation if no response to meds and labs to check glucose, electrolytes and drug levels may be required.
• Protect the airway by side-lying the patient which indicates the first action for the seizure
• First med in status epilepticus is Lorazepam IV.
• The first sign of neuro deterioration shows LOC change and Positioning for ICP shows HOB 30°, neutral neck.

CVA (Stroke): Definition & Overview

• Stroke, or cerebrovascular accident (CVA), occurs when blood flow to the brain is interrupted.
• This leads to brain cell death due to lack of oxygen and nutrients
• Stroke is a medical emergency where the faster you treat it the better the outcome becomes

Types of Stroke

• Ischemic stroke: Clot blocking blood flow to the brain.
• Hemorrhagic stroke: Bleeding in the brain.

Risk Factors for Stroke

• Hypertension is the most common cause for both ischemic and hemorrhagic strokes.
• Atrial fibrillation (Afib) increases the risk of embolic stroke.
• Other risk factors include diabetes, smoking, high cholesterol, obesity, sedentary lifestyle, and family history of stroke.
• Increasing age leads to an increased risk as well as prior TIA (resolves in <24 hours) indicates "warning stroke"

Treatment of Hemorrhagic Stroke

• Involves strict BP control to prevent hypoperfusion risk.
• Manage increased ICP if present as well as surgical interventions such as Clipping or coiling aneurysms or evacuation of hematomas if needed.
• Anticoagulants/ antiplatelet therapies are contraindicated!

Nursing Care and Priorities for Stroke Patients

• Acute Phase (Emergency) priorities: supporting airway, breathing as well as circulation
• Frequent monitoring of neurological status and vital signs as and keep NPO until swallow evaluation.
• Aspiration risk should be monitored and speech therapy should be consulted.
• Fall risk precautions include assisting the weaker side by maintaining mobility.
• Post Stroke Ongoing Care includes physical therapy, occupational therapy with speech therapy should be administered

Complications of Stroke

• Include aspiration pneumonia due to swallowing impairments.
• Falls and injuries from weakness lead to DVT or PE from immobility with depression from loss of function.
• Ulcers from immobility and contractures from spasticity might develop.

Key Priorities for stroke as a nurse

• NCLEX states that It is very important to act FAST for stroke care by checking eligibility for tPA for ischemic strokes and Focus on safety, nutrition, airway and rehabilitation.

Intracranial Hemorrhage

• Intracranial hemorrhage refers to bleeding inside the skull which is usually caused by trauma, hypertension, aneurysm rupture, or clotting disorders.
• Key features of epidural hematoma involve the lucid interval where patient briefly loses consciousness and then wakes up alert which shows to have a rapid deterioration as bleeding increases leading to a sudden headache, vomiting and Ipsilateral pupil dilation (pupil on same side as injury).
• Nursing requires to perform surgery and monitor and prepare for intubation by preventing increased ICP through elevated head

Spinal Cord Injury (SCI)

• Cervical injuries pose the highest risk for respiratory failure from diaphragm control.
• T1 – T6 causes lower body paralysis (Paraplegia) and full arm along with hand movement.
• T6 and above shows Autonomic Dysreflexia symptoms which is life-threatening.
• The initial response to SCI may cause of spinal shock, in which it is temporary the ability to control all reflexes are lost
• Neurogenic shock causes the disruption of sympathetic nervous system which results in hypotension and bradycardia but its TX includes vasopressors and IV fluids.
• Nursing care also contains SCI complications of which will need monitoring ventilator, provide hypotension treatment, provide routine skin care routines.

Infections of the CNS, Meningitis, Encephalitis

• Meningitis life-threatening inflammation characterized by bacterial origin with classic signs of fever and stiff neck with altered LOC. Nursing focuses on droplet precautions with prompt antibiotic medications. Encephalitis, generally virally, causes weakness and high ICP. Treatment focuses on Acyclovir and neuro checks.
• Trigeminal Neuralgia has extreme face pain. It is treated with Carbamazepine and avoiding triggers. Bell’s Palsy causes facial symptoms (drooping), eye care, steroids.

Parkinson’s Disease (PD)

• Is a progressive loss in movement.
• It is Hallmark shows to have a triad of tremor at rest, slow bradykinesia and stiffness.
• Medication requires to provide Levodopa and Carbidopa and support safe measures involving exercise.
• It is important to check that patients with PD avoid fall risks given their challenges

Huntington’s Diseasse

• Is an dominant disorder disorder leading to movement impairment with some risks to mental issues as well.
• Safety concerns should be noted in order to prevent unsafe actions in the pt.

ALS (Amyotrophic Lateral Sclerosis)

• Is caused by a progressive loss in nerve actions.
• Air way assistance may be needed with the help of Riluzole which assist to keep it stable.

Rheumatoid Arthritis (RA)

• Chronic and is caused with Systemic autoimmune response.
• Diagnositc assessments include Anti-CCP antibodies to monitor inflammations
• Care for RA must have joint protections such has warmth and ROMs to keep function consistent.

Systemic Lupus Erythematosus (SLE)

• Is inflammatory issue that leads to renal damage
• One of the signs and Symptoms include Butterfly rashes across the face
• The biggest priority involves teaching sun protects as to prevent more flare from occuring with also avoid kidney infections.

Multiple Sclerosis (MS)

• Is an issue which involves Progressive autoimmune disorder, with visual motor issues.
• Heat exacerbations worsen fatigue and must be treated by teaching bladder training by having fall prevention.

yasthenia Gravis (MG)

• Leads to muscle weakness that prevents them from moving well
• They can have ptosiss where its known as "drooping" eyes.
• Tensisilon Medication can bring in muscle strength
• It is important to assesss respiratory failures with a medication to take before you eat.

Guillian Barre Syndrome (GBS)

• Is an immune response to muscle functions especially those of extremities
• Ascending paralysis that could compromise airway or lungs
• Management includes airway assessments and support with plasma replacements.