AH Exam 4 Neuro Study Guide PDF

AH Exam 4 study guide-neuro portion Chapter 60: assessment of neuro function Diagnostic tests- CT- xray imaging that shows cross sectional views of the brain. A machines rotates and scans around the patients head. The procedure is painless and quick and the patient must lie very still. No talking o...

AH Exam 4 study guide-neuro portion Chapter 60: assessment of neuro function Diagnostic tests- CT- xray imaging that shows cross sectional views of the brain. A machines rotates and scans around the patients head. The procedure is painless and quick and the patient must lie very still. No talking or moving of the face. Radiation is used! Remember your IV contrasts precautions and aftercare! MRI- powerful magnetic imaging used to obtain images. MRI is particualrly useful in the diagnosis of brain tumors, stroke, and MS. No radiation is used. MRI may take an hour or longer so it is not used in emergenices usualy. Remove all metal objects including medication patches, earrings, etc. internal metal may also be inactivated. Pts need to be screened before hand PET- organ function images! Pt inhales or is injected with radioactive gas. PET measures blood flow and brain function. It can also indenfiy alzheimers, tumors,lesions etc. complications of radiaoctive gasses are: dizziness, lightheadedness, and headache. Cerbral angiography- an xray study of cerebral circualtion with a conrast agent injected into a selected artery. This is a valuable tool in diagnosis of vascualr disease. This is exactly like a heart cathter procedure, puncture is through cartoid, femoral,or arterial arteries. Contrast is used so assess alllll kidney things! Mark your injection site pre op and montior it and compare with opposite extremity. Myeolography-an XRAY image of the spinal subrachnoid space taken after the injection of contrast through lumabr puncture site. A water based contrast goes into the CSF and outines the spinal subaeachnoid space and shows any spinal cord abmormalities (tumors, discs, lesions,cysts, etc) post-procedure the patient needs to lie with HOB eevated 30-45 degrees. Remain still for 4-24 hours. Drink lots of fluids to rehydrated, replace csf, and prevent lumbar puncture headache. Complications include: N/V, headache, fever, stiff neck, sexiures, paralyssi of one side, and changes in LOC Electroencepahlography- EEG! These are electrodes placed on the outside of the scalp or into the brain tissues, usally noninvasive is chosen. This is an assessment of cerebral electrival activity. Some uses of an EEG are for analyzing seizure acitvity, diagnosing mental disorders, or determination of brain death. This does not shock the patients brain! It is painless. Standard EEG takes 45-60 mins. No caffeine or other brain stimulating items before hand Electromyography- EMG needles are inserted into the skeletal muscles to measure elctrical potential. Determines presence of neuromuscular disorders. The insertion of needles feels like an IM injection Dopplers- noninvasive ultrasound imagery to evaluate cranial vessel function. The doppler with be rolled over the neck and the eye orbits. Performed at pts bedside Evoked potential studies- application of external stimuli to specific peripheral receptors. (example is flashing lights) an EEG device is used ot observe during these studies. Remain still throughout procedure Lumbar puncture: pre duriung and post procedure interventions Lumbar Puncture (spinal tap) is used to detect syphilis, meningtis, infection, and malignancies It can also be used to reduce CSF pressure, determine pressure readings, instill contrast for diagnositc tests or admin chemo or meds directly into csf Complications: brain herniations (esp in IICP pts) Intraprocedural: ensure sterility! Pt will lay in “cannonball” position or lean over the table. Postprocedural: lay flat for several hours to decrease risk of post-lumbar headache and clots Normal acitvites are resumed after bed rest is over How to do a neuro focused assessment (1982 60-6) Level of consciousness (#1 neuro assessent), PERRLA, mentall status, Glasgow coma scale, DTR including babinski/plantar reflex, muscle strength, cranial nerves, How to grade muscle strength; 5 being full power and 0 indicates no movement at all Reflexes: graded on a scale of 0-4+ with 2+ being normal. 0 is no reaction and 4+ is hyperreflexia Types of reflxes: bicep, tricep, bracioradialis, patelalr, achilles Clonus: this is when a reflex is so hyperreactive that it keeps bobbling after you hit it Chapter 61: Increased ICP: s/s, nsg interventions, complications, treatment. Know everything abt it ! LEARN THIS ALL Normal ICP 10-20* ICP is the pressure within the rigid confines of the skull. When you have increased intrcranial pressure (IICP), you have compression of brain tissues and blood vessels. Making this a serious potential to brain damage from decreased perfusion, ischemia, and cell death Patho incldues 1) decreased blood flow 2) cerebral edema from autoregualtion 3) cushings triad (HTN, bradycardia, bradypnea) and herniation Catch IICP s/s early to prevent permant damage Early S/S: changes in LOC (earliest sign!!!)) ANY change in condition (restlessness, drowsiness, confusion, purposeless movements) PERRLA changes, weakness in one side or one extremity, persistent headache that increases w movement or straining Late S/S: Cushings Triad (HTN, bradypnea, bradycardia), severe projecticle vomting, further LOC worsening (like stupor/coma), loss of brainstem reflex (pupils,corneas, swallowing, gagging) respiratory arrest risk! NSG assessment of the patient with IICP: What led to this/underlying cause?, mental status, LOC, cranial nerves, glasgow coma scale, PERRLA, vitals, assessment of ICP. cerebral, sensory, and motor function NSG Interventions: CT, MRI, no contrast, dopplers, evoked potential monitors, NO LUMBAR PUNCTURE!!!! Maintain the patients airway. Remember your ABCs!! Fix what caused the IICP (keep head neutral w cervical collar and bed 0-60 degrees. Maintain a calm and quiet area, do not let pt strain for bathroom purposes specifically the valsalva maneuver (pooping) , flex hips, raise up in the bed, etc. basically any movement can cause IICP. Maintain sterility with procedures Potential complications: Brainstem herniation- from excessive increase in ICP, the brain swells and pushes down into brain stem. This leads to irreversible brain anoxia and death Diabetes inspidius (DI)- decreased ADH. excessive UO, decreased urine osmolality, and serum hyperosmolarity. Replace electrolytes!! SIADH - increased ADH. volume overload, oliguria, dilute urine, Restrict fluids!! Treatment options: Prompt treatment is from continuous montiroing of ICP w the probes that go into the pts brain. Check the probes for drainage. If cerebral edema caused the IICP: Osmotic diuretics(mannitol or hypertonic 3% saline are given) or fluid restriction Dextamethasone can be given to decrease brain swelling. To maintain cerebral perfusion during IICP: Manipualtion of cardiac output is needed by giving dobutamine and norepinephrine. A lower CPP (70) indicated the cardiac output is INSUFFICIENT to maintain the CPP. so we want a normal CPP to indicate adequate cardiac output. High CSF or blood volume caused the IICP: Drain CSF with the already placed ventriculostomy (what montiors the ICP) but do not excessivly drain bc the ventrilcles could collpase and cause a decrease in PaCO2 (hypoxia, ischemia, high lacate) keep the PaCO2 above 30. Control the patient temperature: Intense shivering or sweating can result in an increase in ICP Use hypothermia blankets and antipyretics Surgical interventions: Craniotomy ( opening of the skull to releive IICP) craniectoy(removal of aprt of skull to releve IICP) Burr holes (holes drille to relieve IICP) Cerebral response to ICP (CPP and CCP) Cerebral perfusion pressure (CPP also called CCP) is how well the blood is flowing. Should be 70-100 CCP/CPP is MAP-ICP = 70-100 (normal) CCP 18, ISCHEMIC STROKE, ptt 65. a TBI is ANY injury to the head. - Types: Primary (opened and closed) open- scalp and skull are open. Closed- accel or decel inside brain that damages brain tissue Contusions(bruising, more severe), lacerations(opening in the skin) , external hematomas, skull fractures, subdural hematoma, concussion(temporary loss of neuro function without structural damage) diffuse axonal (widespread amazon damage. Pt immediately goes into coma. ) Intracranial hem, epid hema, and subd hema: Intracranial/ intracerebral hematoma: hemorrhage in the substance of the brain. Treatment includes control of ICP, admin fluids, electrolytes, ace inhibitors(-PRIL), and anti-hypertensives(-OLOL), craniectomy or craniotomy Epidural hematoma: blood in the outer layer (between skull and dura), EMERGENCY!! s/s are brief LOC then lucid state, increased ICP with reduced LOC TX: quickly reduce ICP (mannitol and hypertonic solution), burr holes, or cranitomy Subdural Hematoma: collection of blood between dura and brain. A late sign of increased ICP Control ICP, crantiomy, remove clot. Can be chronic or acute Secondary:damage evolves over days. (cerebral edema, ischemia, or chemical changes) Complications: cushing's triad and brain stem herniations For open head lacerations! Check for tetanus shot. Booster every 5 years! Glasgow coma scale- apply it to scenarios The most sensitive indicator of a lapse in neuro function in pts with TBI. it is used to access LOC. scores are between 3-15. A score of 3-8 is indicative of severe TBI. LESS THAN 8= INTUBATE!!! Basilar skull fractures -battles sign Fractures at the base of the skull. Usually has localized persistent pain. s/s: bleeding from nose or pharynx,rhinorrhea(leaking from nose) , otorrhea (leaking from ear) battles sign ( ecchymosis(bruise) behind ear), or CSF leak CSF: if it is CSF, there will be a HALOS sign ( a ring of fluid around the blood stain in the drainage) and the CSF will contain glucose Types of spinal injuries; look over syndromes on pg 2071, read pgs 2070-2085. Nsg interventions | neurogenic /spinal shock differences SCI: Males around age 43, alcohol and drug use, gunshot injuries, MVAs, sports Major causes of death from SCI: pneumonia, PE, and sepsis Caused by concussion, contusion, laceration, or compression of spinal cord Primary- results from a different initial trauma. Usually permanent Secondary- results from SCI. includes edema and hemorrhage *keep pt neck and back braced!!! Neurogenic and spinal shock: Spinal: a sudden depression of reflex activity BELOW THE LEVEL OF SCI!!! s/s: muscle flaccidity, lack of sensation and reflexes Neurogenic: loss of function of the autonomic nervous system below level of SBI. ( blood pressure, HR, RR, CO decrease, no perspiration below level of injury ) Autonomic dysreflexia- what is it, what to check for, how to manage it and who usually gets it? ACUTE EMERGENCY!!! Biggest concern in patients with SCI! *occurs in pts with spinal lesions above T6. *occurs AFTER spinal shock has resolved. Even years later s/s: pounding headache, sudden increase of BP, severe diaphoresis, nausea, nasal decongestion, bradycardia Things that may trigger this: DISTENDED BLADDER!!, distention or contraction of visceral organs (CONSTIPATION/DIARRHEA), skin stimulation (even a wrinkle in the bed sheets) Interventions: high fowlers immediately !! reduce that BP and alleviate T6 pressure Rapidly identify cause and treat it !! Admin apresoline IV ! Chapter 64: Kernig/Brudzinski: signs of meningitis infection Kernig: nurse bends knee. Pain is felt in the opposite leg and foot is flexed Brudzinski: nurse lifts neck and pain is felt, at the same time the legs move in a pain reflex Meningitis- distinguish between bacterial vs/ viral. There is a vaccine! What is it? Know the s/s HA, stiff neck, kernig and brudzinski, photophobia, seizure risk, IICP risk Meningitis: inflammation of the meninges, which protect the spinal cord. There are two types (bacterial and viral) Bacteria: caused by bacteria (streptococcus pneumoniae) Temp >103 Viral: secondary to cancer or a weak immune system. Temp