Nursing Care of Neurologic Alterations (Nursing 3270)

Head injuries

Most common cause of death from trauma in US TBI most serious form Broad classifications (Scalp, Skull, and Brain)

Invasive ICP monitoring (Ventriculostomy)

Allows for continuous monitoring Drains CSF

Concussion

Alteration in mental status from trauma (+/- LOC) Typically < 24hrs

Current Criteria for Brain Death

Condition irreversible with known cause Apnea No brainstem reflexes Core body temp >90 Neuroimaging evidence of catastrophic CNS damage

Skull Fracture diagnostic

Assessment (Focus on Neuro and HEENT) X ray CT scan MRI

Myasthenia Gravis

Autoimmune disorder that impacts neuromuscular junction Fewer receptors for Ach which impairs transmission

Basilar skull fracture

Base of Skull

Which brain injury tends to produce bleeding from the nose, pharynx, or ears?

Basilar Fractures

Skull Fracture Med management

Bone or artificial graft Control hemorrhage IV ATB

Depressed skull fracture

Bone pieces dig into brain

Simple skull fracture

Break

Skull Fractures

Break in the continuity of skull by forceful trauma May or may not include damage to the brain Dura may remain intact or become open

Battles Sign

Bruising behind the ears (Mastoid bone indicative of a basilar skull fracture

Diffuse Axonal Injury: Decerebrate posturing

Extreme Extension of upper and lower extension

Types of brain injury

Closed (Blunt) Open (Penetrating)

Head injuries: Primary Injury

Damage caused by initial impact

Increased ICP causes

Decreased cerebral perfusion Further swelling Shift brain tissue through openings

Late detection of increasing ICP

Decreased/erratic RR Cheyne-stokes resp Projectile vomiting Comatose Posturing Loss of brain stem reflexes

Spinal Cord Injury CM

Depends level and type of injury

What type of fractures require surgery?

Depressed (non depressed generally dont require surgery)

Multiple Sclerosis clinical manifestations

Different patterns S/S vary related location of lesions Fatigue Pain Sensory issues

Early detection of increasing ICP

Disorientation Restlessness Increased respiratory effort Pupillary and EOM changes Weakness in Extremity Constant H/A (Increases with straining and moving)

Invasive ICP monitoring (Subarachnoid bolt or screw)

Does not require ventricular puncture Does not drain CSF

MG clinical manifestations (initial)

Double vision and drooping of eyelids

MG clinical manifestations

Dysphonia (laryngeal involvement) Generalized weakness (impacts all extremities and intercostal muscles) Only motor function impaired Look at thymus (enlargement or tumors)

Head injuries: Secondary Injury

Effects seen later as a result from primary injury

Management of Brain Injuries

Exam and diagnostic tests Cervical spine injury possible Glasgow coma scale (<8 indicates severe injury)

Diffuse Axonal Injury: Decorticate posturing

Flexion of upper extremities Extension of lower extremities

What should you test for when you see clear fluid?

Glucose

In ____ cord injury, acute respiratory failure is the leading cause of death

High Cervical cord injury

Multiple Sclerosis

Immune mediated progressive demyelinating disease of CNS (interrupts flow of nerve impulses) Leading cause of non traumatic disability in young adults

MG Medical and Nursing Management

Improving function and reducing/removing circulating antibodies Anticholinesterase meds and immunosuppresive therapy Plasmapharesis and IVIG Thymectomy

Causes of spinal cord injury

MVA Violence Fall Sports (May be transient; complete transection)

Contusion

More severe (Bruising of brain) Patient is unconscious (Few seconds/minutes) BP and temp subnormal Recovery could take months

Symptom management for MS

Muscle spasticity Promoting physical mobility Preventing injury Enhancing bladder and bowel control Enhancing communication and swallowing Improving sensory and cognitive function Improving home management Promoting sexual functioning

Altered LOC causes

Neurologic (injury and stroke) Toxicologic (OD, alcohol poisoning) Metabolic (Renal and hepatic issues)

Does absence of pain rule out Spinal cord injury?

No

Is there a single test to diagnose MS?

No

Skull fracture Nurse management

Not to blow nose (Increases ICP) HOB >30 Neuro checks Report CSF leaks ASAP DO NOT insert NG tube with suspected basal fracture

Decreasing Cerebral Edema in increasing ICP

Osmotic Diuretics (mannitol) Hypertonic saline Fluid restriction Hypothermia

Spinal Cord Injury Medical and Nursing management

Prevent further injury High dose Solu-Medrol Stabilization, decompression and realignment

Halos sign

Red circle surrounded by yellowish fluid (Yellow fluid is CSF)

Controlling Fever in increasing ICP

Removing heavy bedding Giving Tylenol as ordered Cool sponge bath with fan Hypothermia blanket

Altered LOC CM

Restlessness Anxiety Fixed pupils Unresponsiveness (Be familliar with baseline!)

MG complications: Cholinergic Crisis

Severe generalized weakness (results in resp failure due to meds) Mechanical ventilation required CN VII, IX, and X

Spinal Cord injury complications

Spinal and neurogenic shock DVT Ortho HPN Autonomic dysreflexia

Comminuted skull fracture

Splitting of fraction line

MG complication: Myasthenic crisis:

Sudden temporary exacerbation (triggered by infx) Assess for respiratory failure and need for mechanical ventilation

MS medical and nursing management

Treatment aimed at managing exacerbation and chronic symptoms

Who is most likely to get MG?

Women before 40 Men after 70

Paraplegia

paralysis from the waist down T6 and L1 injury (T6 causes paralysis to be a little above waist)

Tetraplegia

paralysis of all four limbs C4 and C6 injury (C4 injury also causes neck paralysis)