Neurologic Assessment PDF

Neurologic Assessment Health Assessment Goals of Assessment Determine presence of central nervous system dysfunction Determine presence of peripheral nervous system dysfunction Ascertain degree or complexity of dysfunction Linking symptoms with disease states/disease progression Neuro Surgeries Two...

Neurologic Assessment Health Assessment Goals of Assessment Determine presence of central nervous system dysfunction Determine presence of peripheral nervous system dysfunction Ascertain degree or complexity of dysfunction Linking symptoms with disease states/disease progression Neuro Surgeries Two general categories Brain Spine Both are considered “intermediate” risk procedures on the AHA Cardiac Risk score Intracranial Pressure Intracranial Pressure Goal of assessment of patient with neuro symptoms is determining elevated ICP Papilledema Headaches (worse with coughing) N&V Speech problems Confusion Hemiplegia Oculomotor palsy Respiratory changes Intracranial Pressure Hypertension in the neuro patient should be considered elevated ICP until ruled out HTN + Decreased HR = Bad Physiological change to increase cerebral perfusion EKG (hypothalamic ischemia & sympathetic over activity) Q waves Deep, inverted T Long QT interval ST elevation Intracranial Pressure Midline shifts >0.5cm on CT/MRI are diagnostic of increased ICP Sensitive to ‘sedatives’ Causes cerebral vasodilation due to increased CO2 Avoid changes in ventilation Assume everyone is at risk of herniation until proven otherwise Brain Tumors Primary or Metastatic Tumors originate from any neuro cell type Supratentorial tumor (adults > kids) Headache Seizures Neuro deficits Infratentorial (kids > adults) Obstructive hydrocephalus ataxia Pituitary Tumors Review CT to determine location Usually anterior and associated with parathyroid tumors Functional v. nonfunctional tumors Understand relationship between pituitary tumors and impact on hormone regulation Positioning Considerations Brain surgery is not necessarily in the supine position Sitting, prone, lateral, or a combination Preoperative assessment of neuro changes Seizure Disorders Compliance with medications Date of last seizure Type of seizure and physical symptoms Epilepsy v. seizures If not epileptic, then find underlying cause Anticonvulsants (phenytoin) cause agranulocytosis CBC Think about treatment options if patient seizes Alzheimer’s Disease Chronic neurodegenerative disorder Synaptic changes, neurotransmitters (acetylcholine and nicotine) Progression of cognitive impairment No known cure, treat symptoms Preoperative assessment establishes a baseline Set clear, realistic expectations Parkinson’s Disease Neurodegenerative disease, unknown cause Loss of dopaminergic fibers in basal ganglia Depletion of dopamine concentrations Diminished inhibition of neurons and unopposed stimulation by acetylcholine Muscle tremor, rigidity, and akinesia Treatment aimed at increasing dopamine in basal ganglia Deep brain stimulator Parkinson’s Disease Assessment focused on determining extent of symptoms Degree of skeletal muscle tremors Rigidity and positioning Postoperative considerations for recovery Spinal Cord Injury Acute → spinal shock Chronic → autonomic hyperreflexia Acute Cervical spine assessment Injury level T1-T4 injury → bradycardia Loss of sympathetic tone Chronic SCI Assessment focuses on extent of impairment Ventilation CV stability Chronic pulmonary involvement Chronic GI involvement Assessment of baseline status Pressure points and positioning issues Autonomic Hyperreflexia (Dysreflexia) Appears after SCI and in response to return of spinal cord reflexes (as early as 3 weeks post injury) Response is initiated by cutaneous OR visceral stimulation below level of injury Surgery of bladder or rectum are common stimuli Autonomic Hyperreflexia Efferent impulses from brain that produce compensatory vasodilation cannot reach neurologically isolated portion of spinal cord Unmodulated vasoconstriction develops BELOW level of injury Systemic hypertension develops Preoperative assessment to determine level of injury Incidence of AH in past Autonomic Hyperreflexia