SNGP3001 LEC4 - Neurological Assessment PDF

SNGP3001 Comprehensive Nursing Assessment LEC 4 – Neurological Assessment TEQSA PRV12057 CRICOS 00026A The University of Sydney Lecture Outline - Neurological system anatomy...

SNGP3001 Comprehensive Nursing Assessment LEC 4 – Neurological Assessment TEQSA PRV12057 CRICOS 00026A The University of Sydney Lecture Outline - Neurological system anatomy - Neurological physiology - Level of consciousness assessment - Cognitive assessment - Physical assessment and history taking The University of Sydney Nervous System Arrangement - The Central Nervous System -The Brain -The Spinal Cord - The Peripheral Nervous System -composed of all the cranial and spinal nerves, the nervous tissues that move out of or into the CNS from the rest of the body. The University of Sydney Brain Anatomy Parietal lobe - Frontal lobe - determines reward, attention, spatial sense and short-term memory navigation, tasks, planning, and language motivation The cerebellum : Temporal lobe – stores muscle processes speech and memory– eg. riding working memory, and also a bike without ‘higher’ emotions such as thinking. empathy, morality and regret. Occipital lobe – Midbrain and brain stem visual processing control bodily functions such as heart rate and digestion Limbic system: processes desires and many and act as an interface emotions. Also contains the hippocampus – between the spinal cord and vital for forming new memories. the rest of the brain. Common Brain Pathology - Increased Intracranial Pressure -Traumatic Injury / Intracranial Bleed -Tumour -Blocked CSF Channels - Infection Subdural haematoma -Meningitis, Encephalitis - Ischaemia -Ischaemic stroke -Microvascular disease, eg in diabetes - Cell death -Alzheimer’s Disease & Other Dementias -Parkinson’s Disease -Hypoxic Brain Injury - Degenerative Disorders -Multiple sclerosis The University of Sydney Cerebral tumour Blood Brain Barrier Complex network of arteries, veins and capillaries Supplies glucose and oxygen to the brain Strictly controlled Segregates brain from the rest of the blood stream by regulating the size of cells able to pass through it to the brain tissue. Protects brain from infection Difficult to treat brain infections Antibiotic molecules often too large to cross barrier Major problem for finding drugs For diseases such as Alzheimer's The University of Sydney Monro-Kellie (Volume-Pressure Status) Consequences for change in intracranial volumes Cerebral oedema Brain Tumour Hydrocephalus CSF Blocked shunt Subdural haemorrhage Blood Subarachnoid haemorrhage The University of Sydney Monro-Kellie (Volume-Pressure Status) - Blood, brain and CSF reside within an enclosed skull. - Any rise in volume in one of these will cause raised ICP if the volume of the other two remain constant - Intracranial pressure (ICP) is stable as long as volume added = volume displaced. Compensatory mechanisms include: - CSF Regulation - feedback mechanisms respond to changes in intracranial pressure and developing hydrocephalus - CSF production is slowed. - Pressure Autoregulation - cerebral blood flow remains reasonably constant due to vasodilation / vasoconstriction - Metabolic regulation - CO2 is a potent vasodilator in the brain & increases cerebral blood flow - High temperatures increase glucose & oxygen use & increases cerebral blood flow - Acidosis increases cerebral blood flow The University of Sydney Level of consciousness Level of Consciousness Levels of consciousness are assessed along a continuum Alert Drowsy Stupor Coma Responds to questions Abnormal posturing in spontaneously Disorientated to name, response to pain time and place Responds to questions Shows irritability, shortened Unable to follow simple spontaneously attention span, unwillingness to commands cooperate The University of Sydney Glasgow Coma Scale: Introduction - Used for bedside assessment of depth and duration of impaired consciousness and coma - Developed by Jennet & Teasdale in 1977 - Objective determination of severity of coma and underlying brain dysfunction 6 hours after head trauma - Avoids overestimation of brain damage from temporary factors such as alcohol, hypoxia or hypotension, and prior to any sedation. - Used in various situations including overdose, infection, and spontaneous intracranial bleeding, seizures and hepatic encephalopathy. - It is also used in settings different from its original cohort situations The University of Sydney Glasgow Coma Scale - To indicate the level of injury and illness, allowing triage and immediate intervention, and enabling monitoring of trends in consciousness - To facilitate understanding, clear description and communication between clinicians Eye-opening - represents information processing by the cerebral cortex and the level of arousal or wakefulness. Verbal response - demonstrates a high degree of integration of cerebral cortex and brainstem. Motor response - overall nervous system function/ integrity of cerebral cortex and spinal cord - represent that part of the central nervous system least affected by trauma The University of Sydney Glasgow Coma Scale Domain Level of response Score Eye opening Spontaneous 4 To speech 3 To pain 2 None 1 Best verbal response Orientated 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 Best Motor Response Obeys commands 6 Localises 5 Normal flexor 4 Abnormal flexor 3 Extensor posturing 2 No Response 1 The University of Sydney  The University of Sydney https://youtu.be/v6qpEQxJQO4 Glasgow Coma Scale Eye opening Verbal Motor Spontaneous; Orientated - 3 orientation Obeys commands (e.g. stick Speech; questions (e.g. time, place, out your tongue); person); Localises to pain (e.g. Painful stimuli (central pain first then peripheral if no Confused; pushes your hand away); response); Inappropriate speech, Withdrawal (e.g. patient tries No response; Incomprehensible sound to move away); (e.g. moaning); Flexion or extension; *May not be able to open eyes after brain surgery due No verbal response No response to periorbital oedema The University of Sydney Glasgow Coma Scale Total GCS of: -