NSG 246 Test 2 - Neuro/Eyes&Ears/Seminar
Posterior cord syndrome
preservation of motor function, sense of pain and light touch with loss of proprioception and epicritic sensations below the level of lesion.
Tonic clonic
rigidity and rhythmic jerking lasting 2-5 minutes, loss of immediate consciousness
Myasthenic crisis
(too little cholinesterase inhibitor drug) ***Give Tensilon to ^ muscle strength Priority for nursing management is to maintain adequate respiratory function. Cholinesterase-inhibiting drugs are withheld because they increase respiratory secretions and are usually ineffective for the first few days after the crisis begins.
Manifestations of Migraine
-Auras: may see light or have tunnel vision -Atypical: will happen at random with no apparent triggers Stages of a Migraine: -prodromal: the beginning, may see mood change -aura: may have double vision or visual changes -headache: debilitating part of the cycle -postdromal: after the headache, may have fatigue and be irritable Triggers: stress, alcohol, allergies, fragrances, menstruation, barometric pressure
Dx of MS
-CSF analysis ( ^ protein level & ^ in WCB) -EMG (electoymyography) -Evoked potentials: checks for interruptions in neural patterns of somatosensory, auditory and visual systems -McDonald Criteria: patient will have 2 separate attacks and then an MRI is done and CSF is checked plaque areas in the brain
Nursing Implications of MS
-Gather patient history -Do physical assessment and look for clinical manifestations: may see flexor spasms at night, intentional tremor, dysmetria (cannot limit or direct movement), hypalgesia (decrease in pain sensation), numbness and tingling, bladder and bowel dysfunction -Perform psychosocial assessment -Give meds as ordered -Promote mobility -Symptom management/CAM -Home care management/health teaching/community resources
Guillain Barre
-Muscle weakness from bottom to top -Affects every person differently -Autoimmune dysfunction -Slow progression -May need ventilation assistance
Criteria for fibrinolytic therapy
-Over 18 years old -Ischemic stroke with neurologic deficit -time from beginning is less than 3 hours Must be NOOOOO: evidence of bleeding history of intracranial hemorrhage no know av malformation, aneurysm intracranial surgery, head trauma or stroke in last 3 months No HTN NO PT>15, INR > 1.7, platelet <100,000 NO anticoag or antiplatelet treatment within 24 hours
seizure precautions
-Padding, low beds, side rail padding, keep suction and oxygen on hand, have IV access, nothing in the mouth, keep in view of nursing station if possible, bed rails up (no more than 3 up at any time to keep from being considered a restraint)
Drug therapy for SCI
-methylpredinisolone -dextran (plasma expander for neurogenic shock) -atropine sulfate -dopamine hydrochloride (common side effect is increased heart rate or tachycardia) -tizanidine (Zanaflex, Sirdalud) -intrathecal baclofen implantable infusion pump
s/s of meningitis
-pain -fever -convulsions -stiff neck/ nuchal rigidity -irritability -light sensitivity
Manifestations of Parkinson's Disease
-stuped posture, flexed trunk, fingers abducted and flexed at joints, wrists dorsiflexed -slow and shuffling gait with short, hesitant steps, propulsive gate, difficulty stopping quickly -bradykinesia, muscular rigidity, tremors, pill rolling, mask like facial expression, difficulty chewing and swallowing, uncontrolled drooling, fatigue, reduced arm swinging on one side of the body when walking, change in hand writing -change in speaking, slurred speaking, echolalia -orthostatic hypotension, excessive perspiration, oily skin, eye spasm -emotionally labile, paranoia, easily upset, rapid mood swings, cognitive impairments such as dementia, delayed reactions, sleep disturbances
Special note about SCI patients
. A systolic blood pressure below 90 mm Hg requires treatment because lack of perfusion to the spinal cord could worsen the patient's condition
Interventions for migraines
1. Recognize triggers 2. Give meds as ordered 3. Control the environment 4. Avoidance of triggers Drug Therapy: -Abortive Therapy: treatment when you first feel a migraine coming on; usually NSAIDs -Preventative Therapy: Continual treatment to prevent migraines; may be opioids, barbituates, NSAIDs, tryptan (works on neurotransmitters-no SSRIs with tryptans), beta blockers (watch for lethargy), antiepileptic drugs like Topamax, calcium channel blockers, antidepressants -Complementary and Alt Therapies: yoga, hot/cold compress, dark rooms, silence, biofeedback, accupuncture
Drug Therapy for PD
1. Rivampin 2. Carbidopa-Levidopa
Priority problems for SCI
1.Difficulty breathing related to upper motor neuron injury 2.Potential for neurogenic shock related to loss or interruption of sympathetic innervation in patients with SCIs above T6 3.Potential for further spinal cord injury related to swelling and/or fractures 4.Impaired Physical Mobility and/or Self-Care Deficit (the level depends on the extent and level of the injury) related to decreased or absent muscle control 5.Spastic or flaccid bladder and bowel related to direct neurologic damage or disruption in nerve impulses 6.Impaired adjustment related to disability requiring need for life change
Stroke/ Brain Attack / CVA
2 Types Hemorrhagic (bleeding) or Ischemic (embolism or thrombus)
Diagnosis of Epilepsy
2 or more seizures
From onset of stroke to treatment
3 hours
Recall memory
3 to 4 days ago
What is a good MAP
60-70
From door to drugs
< 60 minutes
epidural hematoma
Neurologic emergencies with potentially catastrophic ICP elevation Arterial bleeding into space between the dura and inner table of skull Temporal bone fractures, middle meningeal artery (often a cause) ****Momentary unconsciousness follows lucid interval within minutes of injury*******
1st priority of SCI patient
ABC
Nonsurgical Management of Head Injury
ABCs ABGs Assessment of vital signs to prevent and detect increased ICP Positioning Pulmonary ventilation and management of oxygen and carbon dioxide levels Suctioning Chest physiotherapy and frequent turning
otitis media
Bacterial or Viral Infections Fluid accumulation Exudate Pain Pressure in the ear Hearing loss Tinninitus Fever, malaise, nausea & vomiting Fluid behind or Bulging tympanic membrane
A client was admitted this morning with an incomplete spinal cord injury and is placed in a halo fixator vest after surgery. Which assessment finding will the nurse report immediately to the health care provider? A. Pulse rate of 78 beats/min B. Blood pressure of 88/42 mm Hg C. Pain level of 4 on a 0-to-10 pain scale D. Loosened halo vest
ANS: B Rationale: A blood pressure of 88/42 mm Hg indicates hypotension, which the nurse should report to the provider immediately because it may be an early sign of neurogenic shock. Neurogenic shock (hypotension, bradycardia, and warm, dry skin) may occur within 24 hours after injury and most commonly in clients with injuries above T6. This potentially life-threatening problem results from disruption in the communication pathways between upper motor neurons and lower motor neurons. A pulse of 78 is normal. The client may commonly experience pain after the traumatic event that led to the spinal cord injury. The nurse should monitor the security of the halo vest.
When providing discharge teaching to a client after a lumbar laminectomy, the nurse teaches him or her to call the surgeon immediately for which potential complication? A. Discomfort at the incision site B. Decreased appetite in the morning C. Slight redness and itching at the incision site D. Clear drainage from the incision site
ANS: D Rationale: Clear drainage may mean cerebrospinal fluid (CSF) leakage.
6th Cranial Nerve
Abducens ***Look side to side
Hormones in Parkinson's
Acetylcholine (ACh) & Dopamine Decrease in the amount of dopamine which means there is an ^ in ACh (excitatory)
8th Cranial Nerve
Acoustic **Hearing
Post Op spinal surgery
After surgical spinal fusion, assess the patient's neurologic status and vital signs at least every hour for the first 4 to 6 hours and then, if the patient is stable, every 4 hours. Assess for complications of surgery, such as hematoma and edema. Look for swelling under the skin.
External otitis
Allergic Reactions Bacterial or fungal Infections Swimming Local Trauma Pain Itching Hearing loss Plugged feeling Redness & edema
Post op ear surgery
Avoid straining at stool (give stool softeners) Avoid drinking from a straw & air travel for 2-3 weeks Avoid excessive coughing X 2-3 weeks Stay away from people with colds Blow the nose gently, one side at a time, with your mouth open Avoid getting the head wet, washing hair & showering x 1 week Keep your ear dry x 6 weeks. Place a cotton ball with petroleum jelly in the ear canal (change daily) Avoid moving the head rapidly, bouncing, & bending x 3 weeks Change dressing daily & report drainage to the physician
Use of a Halo Device
Be aware that the weight of the halo device alters balance. Be careful when leaning forward or backward. • Wear loose clothing, preferably with hook and loop (Velcro) fasteners or large openings for head and arms. • Bathe in the bathtub, or take a sponge bath. (Some physicians allow showers.) • Wash under the lambswool liner of the vest to prevent rashes or sores; use powders or lotions sparingly under the vest. • Have someone change the liner if it becomes odorous. • Support the head with a small pillow when sleeping to prevent unnecessary pressure and discomfort. • Try to resume usual activities to the extent possible; keep as active as possible. (The weight of the device may cause fatigue or weakness.) However, avoid contact sports and swimming. • Do not drive because vision is impaired with the device. • Keep straws available for drinking fluids. • Cut meats and other food into small pieces to facilitate chewing and swallowing. • Before going outside in cold temperatures, wrap the pins with cloth to prevent the metal from getting cold. • Have someone clean the pin sites as recommended by physician or hospital protocol. • Observe the pin sites daily for redness, drainage, or loosening; report changes to the physician. • Increase fluids and fiber in the diet to prevent constipation. • Use a position of comfort during sexual activity.
Post op thymectomy monitor for signs of pneumothorax or hemothorax ...
Chest pain •Sudden shortness of breath •Diminished or delayed chest wall expansion •Diminished or absent breath sounds •Restlessness or a change in vital signs (decreasing blood pressure or a weak, rapid pulse)
rhythmic jerking
Clonic
may cause loss of consciousness (syncope), or "black out," for 1 to 3 minutes. Characteristic automatisms may occur as in absence seizures. The patient is unaware of the environment and may wander at the start of the seizure. In the period after the seizure, he or she may have amnesia (loss of memory). Because the area of the brain most often involved in this type of epilepsy is the temporal lobe, 932 933 complex partial seizures are often called psychomotor seizures or temporal lobe seizures.
Complex Partial seizures
Treatment of Status Epilepticus
Convulsive status epilepticus must be treated promptly and aggressively! Establish an airway and notify the health care provider or Rapid Response Team immediately if this problem occurs! Establishing an airway is the priority for this patient's care. Intubation by an anesthesia provider or respiratory therapist (RT) may be necessary. Administer oxygen as indicated by the patient's condition. If not already in place, establish IV access with a large-bore catheter, and start 0.9% sodium chloride. The patient is usually placed in the intensive care unit for continuous monitoring and management.
FAST acronym for stroke
Facial numbness or weakness Arm numbness or weakness Speech - slurred or difficulty understanding speech Time to call for help
12th Cranial Nerve
Hypoglossal ***ice cream cone - licking tongue movement stick tongue out
What should not be taken with Warfarin?
Dilantin
Safety priority of patient with Halo Fixation
Never move or turn the patient by holding or pulling on the halo device. Do not adjust the screws holding it in place. Check the patient's skin frequently to ensure that the jacket is not causing pressure. Pressure is avoided if one finger can be inserted easily between the jacket and the patient's skin. Monitor the patient's neurologic status for changes in movement or decreased strength. 1. Monitor vitals for any sign of infection 2. Report any changes to the physician immediately
Door to Drug Sequence
Door - recognition Data - CT Decision - hemorrhage or ischemic? Drug - clot buster or treatment for bleeding
3rd Cranial Nerve
Oculomotor **eye movement
Priority Action for migraine
Encourage patients to keep a headache diary, which may help identify the type of headache they are experiencing. Teach them to notify their health care provider if the quality, intensity, or nature of the headache increases or changes. Encourage them to report whether the headache is associated with unusual visual changes and whether the prescribed drug is no longer effective.
Tensilon
Enhance neuromuscular impulse transmission by preventing decrease of ACh by the enzyme ChE. Potential for cholinergic crises pyridostigmine (Mestinon, Regonol) ***Administer with food.*** Observe drug interactions. Improves muscle strength
Expected outcomes for patient with SCI
Exhibits no deterioration in neurologic status •Maintains a patent airway, an alveolar exchange to maintain blood gases, and adequate ventilation •Is free from complications of immobility •Performs basic ADLs as independently as possible with or without the use of assistive/adaptive devices •Achieves control of elimination of stool and urine •Psychologically adapts to a significant life change
7th Cranial Nerve
Facial **smile
******
For the patient with meningitis, assess his or her neurologic status and vital signs at least every 4 hours or more often if clinically indicated. The priority for care is to monitor for early neurologic changes that may indicate increased ICP, such as decreased level of consciousness (LOC). The patient is also at risk for seizure activity. Care should be provided as discussed in Interventions on p. 933 in the Seizures and Epilepsy section.
Future Recommendations for SCI patients
Get flu shots, tetanus shots, & pneumonia vaccine Have pap smears and mammograms regularly Take measures to prevent osteoporosis such as taking calcium and avoiding caffeine and smoking. Practice meticulous skin care, including moisturizing and drinking plenty of water. Take measures to prevent constipation, such as drinking adequate fluids, eating a high-fiber diet, stool softeners, and establishing a regular time for bowel elimination. Modify activities if joint pain occurs; use a powered rather than a manual wheelchair. Ask the health care provider about treatment options.
Brain Death Criteria
Glasgow coma scale <3 Apnea No pupillary response No cough and gag reflex No oculovestibular reflex No corneal reflex No oculocephalic reflex
9th Cranial Nerve
Glossopharyngeal ***speech
Drug Therapy for TBI
Glucocorticoids Mannitol, furosemide (Lasix) Opioids, naloxone Neuromuscular blocking agents (must use sedatives with it) Antiepileptic drugs Acetaminophen and aspirin Barbiturate coma
Traumatic Brain Injury
Head injury occurs as a result of blow or jolt to the head or as a result of penetration of the head by a foreign object such as a bullet.
3rd phase of migraine
Headache phase can last up to 4 days
Interventions for meniere's
Medication: Control vertigo, vomiting, & normal fluid balance Mild diuretics Nicotinic acid (vasodilation) Antihistamines Antiemetics Diazepam: Calms, decreases vertigo, & decreases nausea & vomiting Surgery is last resort: sacrifice hearing in affected ear (labrynthectomy or endolympthatic decompression With drainage & shunt)
Priority for Encephalitis
In severe cases of encephalitis, the patient may have increased ICP resulting from cerebral edema, hemorrhage, and necrosis of brain tissue. Monitor vital signs for indications of a widened pulse pressure, bradycardia, and irregular respirations. The pupils become increasingly dilated and less responsive to light. Left untreated, increased ICP leads to herniation of the brain tissue and possibly death (see Chapter 47).
Meningitis
Inflammation of the meninges around the brain and spinal cord; can affect both the cranial and the spinal nerves and may lead to further deterioration; may cause increased ICP and thrombus formation
incomplete SCI
Injuries that allow some function or movement below the level of the injury are described as an
Anticholinesterase Drug Alert for MG
Instruct the patient to eat meals 45 minutes to 1 hour after taking ChE inhibitors to avoid aspiration. This is especially important if the patient has bulbar involvement. Drugs containing magnesium, morphine or its derivatives, curare, quinine, quinidine, procainamide, or hypnotics or sedatives should be avoided because they may increase the patient's weakness. Antibiotics such as neomycin and certain tetracyclines impair transmitter release and also increase myasthenic symptoms.
Surgical Management
Intraventricular catheter (IVC) Subarachnoid screw or bolt Epidural catheter Subdural catheter Craniotomy may be performed in extreme instances of elevated ICP. Craniotomy more often used Postoperative care—positioning, monitoring the dressing, monitoring laboratory values, ventilating the patient Drug therapy—antiepileptic drugs, proton pump inhibitors, histamine blockers, corticosteroids, analgesics, acetaminophen, prophylactic antibiotics
Drug of choice for treating status epilepticus
Lorazepam or Diazepam or Ativan
Beginning in one area of the body, motor weakness and deterioration spread until the entire body is involved, including the ability to talk, swallow, and breathe.
Lou Gherig's
Testing for Meningitis
Lumbar Puncture -Kernig's sign -back pain and resistance to pulling leg up -Brezinski's sign - lift head up, knees flex
Motor Manifestations • Progressive muscle weakness (proximal) that usually improves with rest • Poor posture • Ocular palsies • Ptosis • Weak or incomplete eye closure • Diplopia • Respiratory compromise • Loss of bowel and bladder control • Fatigue Sensory Manifestations • Muscle achiness • Paresthesias • Decreased sense of smell and ta
MG manifestations
Chronic, episodic headache that can last several hours to several days characterized by excrutiating pain
Migraine Headache
Types of closed head injuries
Mild concussion Diffuse axonal injury Contusion (coup and contrecoup injury) Laceration
Instructions for menieres
Move head slowly Restrict salt & fluid to reduce amount of endolymphatic fluid Cessation of smoking
weakness in muscle innervations of the cranial nerves; an attack on acetylcholine receptors; may need ventilator assistance; considered an autoimmune disorder and is related to the thymus gland; often from a tumor on the gland; progressive paresis and is only partially relieved by resting weakness in muscle innervations of the cranial nerves; an attack on acetylcholine receptors; may need ventilator assistance; considered an autoimmune disorder and is related to the thymus gland; often from a tumor on the gland; progressive paresis and is only partially relieved by resting
Myasthenia Gravis
-droopy eyes -diplopia -occular palsies -weak or incomplete eye closure -feels like electrical shocks through back -pain in muscles and joints -stiff and cracking joints -heavy feeling in limbs -trembling hands -pressure under lower left limb -depression -nightmares -waking up crying -mood swings/suicidal
Myasthenia gravis manifestations
the only drug approved by the Food and Drug Administration for use with ALS patients. It is not a cure, but it does extend survival time. The usual dose is 50 mg twice daily. Teach patients to take the drug without food and when the stomach is empty. Teach the patient how to detect signs and symptoms of liver toxicity, such as vomiting and jaundice, that the drug may cause. Remind them to have frequent liver enzyme tests, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as directed by the health care provider.
Riluzole
Assessment of meniere's
Occurs between 20 & 50 years of age Incidence is higher in caucasian men Severe, debilitating attacks alternate with symptom-free period Pre-attack symptoms are headache, tinnitus, & a feeling of fullness in the ear Vertigo (whirling) may fall & have a sensation of room spinning; may continue while lying down Lasts 3-4 hours, followed by dizziness, nausea & vomiting Rapid eye movements (nystagmus) & severe headaches
1st Cranial Nerve
Olfactory - Smell "The ol factory makes perfume"
2nd Cranial Nerve
Optic Nerve **Vision
Meniere's disease
Overproduction or decreased reabsorpition of endolymphatic fluid Reversible hearing loss Correction prevents permanent damage to cochlea Occurs with infections, allergic reactions, & fluid imbalance; Stress may play a role
Priority for migraine patients
PAIN
Emergency care of Pt experiencing autonomic dysreflexia
Place patient in sitting position (first priority!).******* • Page/notify health care provider. • Loosen tight clothing on the patient. • Assess for and treat the cause. • Check the urinary catheter tubing (if present) for kinks or obstruction. • If a urinary catheter is not present, check for bladder distention and catheterize immediately if indicated. • Place anesthetic ointment on tip of catheter before insertion. • Check the patient for fecal impaction; if present, disimpact immediately using anesthetic ointment. • Check the room temperature to ensure that it is not too cool or drafty. • Monitor blood pressures every 10 to 15 minutes. • Give nitrates or hydralazine (Apresoline, Novo-Hylazin ) as prescribed.
4th phase of migraine
Post dromal irritability
remains conscious throughout the episode. He or she often reports an aura (unusual sensation) before the seizure takes place. This may consist of a "déjà vu" (already seen) phenomenon, perception of an offensive smell, or sudden onset of pain. During the seizure, the patient may have one-sided movement of an extremity, experience unusual sensations, or have autonomic symptoms. Autonomic changes include a change in heart rate, skin flushing, and epigastric discomfort.
Simple partial seizures
1st stage of migraine
Prodromal symptoms you see before it comes on - smell problems, sensitivity to light and noise, taste changes, tunnel vision, nose bleeds
Nursing Care for encephalitis
Provide supportive nursing care for the patient who is immobile, stuporous, or comatose. Delegate and supervise unlicensed assistive personnel (UAP) to turn, cough, and deep breathe the patient at least every 2 hours. Perform deep tracheal suctioning even in the presence of increased ICP if respiratory status is compromised. Assess vital signs and neurologic signs every 2 hours or more frequently if clinically indicated. Elevate the head of the bed 30 to 45 degrees unless contraindicated (e.g., after lumbar puncture or in the patient with severe hypotension). Keep the patient's room darkened and quiet to promote comfort and decrease agitation. Remind UAP to provide safety measures such as keeping the bed in the lowest position.
assessment of patient with seizures
Question the patient or family about how many seizures the patient has had, how long they last, and any pattern of occurrence. Ask the patient or family to describe the seizures that the patient has had. Clinical manifestations vary depending on the type of seizure experienced, as described earlier. Ask about the presence of an aura before seizures begin (preictal phase). Question whether the patient is taking any prescribed drugs or herbs or has had head trauma or high fever. Assess any alcohol and/or illicit drug history. Ask about any other medical condition such as a previous stroke or hypertension.
Nursing Priority of patient with ALS
Refer the patient with amyotrophic lateral sclerosis to a hospice program for palliative care. The hospice team works closely with the family to ensure the patient's comfort and respiratory support. The team collaborates with the health care provider to ensure that the patient has the needed drug therapy and pain control, as well as quality of life for the patient and family
Nursing Priority for MG
Respiratory status Keep a manual resuscitation (breathing) bag (e.g., Ambu), equipment for oxygen administration, and endotracheal intubation equipment at the bedside of the patient with myasthenia gravis in case of respiratory distress Be sure to give these drugs on time to maintain blood levels and thus improve muscle strength. (Anticholinesterases & immunosuppressants )
Presbycusis
Sensorineural hearing loss that occurs as a result of aging
What juice should not be taken with AED medication?
Some citrus juices including grapefruit juice.
11th Cranial Nerve
Spinal Accessory ***shrug shoulders
Precautions for Meningitis
Standard precautions unless bacterial, then droplet precautions
Features of autonomic dysreflexia
Sudden onset of severe, throbbing headache • Severe, rapidly occurring hypertension • Bradycardia • Flushing above level of lesion (face and chest) • Pale extremities below level of lesion • Nasal stuffiness • Sweating • Nausea • Blurred vision • Piloerection • Feeling of apprehension
Treatment for internal otitis media
Systemic antibiotics Analgesics Local Heat Antipyretics Antihistamines Decongestants Myringotomy
Medications implications for MG patients
Take the same dose of med every day Take 1 hour before eating watch for s/s of myasthenic crisis do not take sedatives or sleeping agents while on this drug
Drug Priority for Triptan
Teach patients taking triptan drugs to take them as soon as migraine symptoms develop. Instruct patients to report chest pain or tightness to their health care providers immediately because they may develop angina. Remind them to use contraception (birth control) while taking the drugs because the drugs may not be safe for women who are pregnant. Teach them to expect common side effects that include flushing, tingling, and a hot sensation. These annoying sensations tend to subside after the patient's body gets used to the drug. Triptan drugs should not be taken with selective serotonin reuptake inhibitor (SSRI) antidepressants or St. John's wort, an herb used commonly for depression.
Nursing priority for meningitis
Teach people who live in highly populated areas, group settings, or others at risk about the importance of getting several vaccines to prevent certain types of meningitis. In addition to two vaccines already available for meningococcal meningitis (Menactra and Menomune), the FDA-approved Menveo, a new vaccine which is effective for other infectious strains. The Centers for Disease Control and Prevention (CDC) recommends a single dose of either Meactra or Menveo for all children from ages 11 through 18 years and high-risk adults between 19 and 55 years of age. The most common adverse effects of Menveo are pain at the injection site, headache, and malaise (
Antidote for Tensilon
The Tensilon test can cause ventricular fibrillation and cardiac arrest, but these reactions rarely occur. Be sure that atropine sulfate, the antidote for Tensilon, is available in case these complications occur.
How long can mechanical ventilation stay in ?
Up to 14 days, and then pt will need a tracheostomy
drug therapy for MS
Therapies include: Immunomodulators Β-interferon, Copaxone Corticosteroids Prednisone, methylprednisolone Muscle Relaxants Valium, baclofen Pain Control Acetaminophen, ibuprofen, neurontin Immunosuppressive therapy Cholinergics Anticholinergics Antiparkinsonian Symmetrel Treatment of paresthesia carbamazepine (Tegretol) or tricyclic antidepressants.
Central cord syndrome
These nerves are particularly important for hand and arm function. Symptoms may include paralysis and/or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. Sensory loss below the site of the spinal injury and loss of bladder control may also occur, with the overall amount and type of functional loss dependent on how severely the nerves of the spinal cord are damaged.
Drug therapy for stroke
Thrombolytic therapy (Fibrinolytic) Anticoagulants (Heparin) Lorazepam and other antiepileptic drugs Calcium channel blockers (relax smooth muscles) Stool softeners (no straining) Analgesics for pain (pain increases stress)(not narcotics if we can avoid it) Antianxiety drugs
Tensilon Test
To perform the test, the physician first estimates the strength of cranial muscles. Initially, 2 mg (0.2 mL) is injected IV; if this is tolerated, an additional 8 mg (0.8 mL) is injected after 30 seconds. Within 30 to 60 seconds of the first dose, most myasthenic patients show a marked improvement in muscle tone that lasts 4 to 5 minutes. False-positive test results may be caused by increased muscle effort by the patient. False-negative findings may be seen if the tested muscle is extremely weak or refractory to the drug. ****Prostigmin is also used.
stiffening and rigidity
Tonic
Treatment for external otitis
Topical Antibiotics Corticosteroids Oral analgesics Local heat- warm towel 4 times per day No ASPIRIN!!! **Tinnitus
TIA
Transient Ischemic Attack -warning sign that will lead to a stroke if untreated -doesn't cause any permanent damage -lack of O2 to the brain
5th Cranial Nerve
Trigeminal **Triangle , touch cheek and forehead
4th Cranial Nerve
Trochlear **eye movement down and inward
10th Cranial Nerve
Vagus Nerves **Digestion, Defecation, & slow heart rate
subdural hematoma
Venous bleeding into the space beneath dura and above arachnoid Most commonly from a tearing of the bridging veins within the cerebral hemispheres or from a laceration of brain tissue Bleeding occurs more slowly, and symptoms mirror those of epidural hematoma
Nonsurgical management of SCI
Vessels don't dilate & constrict appropriately ^ their fluids & give vasopressors (watch carefully for HTN) Give Atropine for bradycardia in emergent situation
Receptive aphasia is caused by damage to what area?
Wernicke's area
Hemiphrectomy
a craniotomy under general anesthesia for partial seizures and removes a piece of the brain and can cut the communication between the left and right hemispheres. With this, watch for infection. Patient may have prophylactic antibiotics given. Watch for increased ICP. Patient may have to be on a ventilator, if so watch the PACO2 and keep it at 35 or less to keep acid from building up in the body. Monitor ABG's. Hyperventilate before doing suction if on vent. Patient may be on antihypertensives diuretics, or steroids. May also be on H2 blockers or proton pump inhibitors, pain relievers, and stool softeners.
Status Epilepticus
a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. It is a potential complication of all types of seizures. Seizures lasting longer than 10 minutes can cause death!
Quadreplegia / tetraplegia
all 4 limbs paralyzed
Seizures
an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in level of consciousness (LOC), motor or sensory ability, and/or behavior.
Autonomic dysreflexia
an excessive, uncontrolled sympathetic output. It is characterized by severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing (Chart 45-9). The cause of this syndrome is a noxious stimulus—usually a distended bladder or constipation. This is a neurologic emergency and must be promptly treated to prevent a hypertensive stroke!
2nd stage of migraine
aural phase -visual changes
Neurogenic shock
bradycardia, decreased or absent bowel sounds, warm dry skin, hypothermia, hypotension Notify MD! Treat with fluids
acceleration injury
caused by an external force contacting the head, suddenly placing the head in motion.
Remote Memory
childhood memory
Cholinergic crisis
cholinergic crisis (too much cholinesterase inhibitor drugs) Tensilon will not work Anticholinergic drugs are withheld while the patient is maintained on a ventilator. Atropine may be given and repeated, if necessary. Observe for thickened secretions due to the drugs. Improvement is usually rapid after appropriate drugs have been given. (30-60 seconds, up to 5 minutes)
Open head injury is
compromise of the skull fractures
spinal shock
occurs immediately as the cord's response to the injury. The patient has complete but temporary loss of motor, sensory, reflex, and autonomic function that often lasts less than 48 hours but may continue for several weeks (McCance et al., 2010). Muscle spasticity, reflex activity, and bladder function begin in patients with cervical or high thoracic injuries when spinal shock is resolved.
deceleration injury
occurs when the moving head is suddenly stopped or hits a stationary object.
Usually, the patient has a predisposing condition such as otitis media, pneumonia, acute or chronic sinusitis, or sickle cell anemia that increases the likelihood
of Meningitis
Right Hemisphere damage causes :
difficulty in the performance of visual-perceptual or spatial-perceptual tasks ADLs Ambulation
What treatment is required for spinal cord compression
emergency surgery
Lower motor neuron lesions cause
flaccid paralysis
For paralytic ileus
give G tube to low wall suction
Primary mechanisms of SCI
hyperflexion (neck tucked) hyperextension (neck backwards) axial loading (vertical compression) excessive rotation (twisting head beyond normal)
Risks for PT with SCI
hypotonic bowel & paralytic ileus neurogenic bladder & urinary retention UTI decreased BP, temperature, & breathing skin breakdown, reposition q 2 hours
Brown sequard syndrome
in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side
Difference of Meningitis & Encephalitis
infection of the meninges vs infection in the brain pus vs no pus (lacunae in the brain of necrosis)
Epilepsy
is defined by the National Institute of Neurological Disorders and Stroke as two or more seizures experienced by a person.
complete SCI
is one in which the spinal cord has been severed or damaged in a way that eliminates all innervation below the level of the injury
What should CO2 levels be ?
less than 35
Left Hemisphere damage causes :
memory deficits and changes in the ability to carry out simple tasks
lower motor neuron lesions cause
muscle flaccidity
Implications for EEG
no caffeine, no smoking within 48 hhours, want the patient to be sleepy, wake up early in the morning,
Upper motor neuron lesions cause
spasticity
upper motor neuron lesions cause
spasticity and contractures
ALS ( Amyotrophic Later Sclerosis) Lou Gherig's
spasticity and flaccidity -fatigue while working -tongue movement issues, atrophy -difficulty swallowing -involuntary muscle twitching -can lead to eventual paralysis -weakness in hands and arms -muscle atrophy -twitching in the face (fasciculations) -nasal quality of speech -dysarthria (slurred speech) -dysphagia -fatigue while talking
Implications of Lumbar Puncture
spinal tap, patient in fetal position, contraindicated with ^ ICP, **side effect is spinal headache
Essential elements of bowel training program
stool softeners, increased fluid intake (unless medically contraindicated), high-fiber diet, and a consistent time for elimination
Anterior Cord syndrome
strength below is lost sensory function is limited pain & temperature are lost
Conductive hearing loss
there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). This type of hearing loss may occur in conjunction with sensorineural hearing loss or alone. The Weber test, in which a tuning fork is touched to the midline of the forehead, localizes to the affected ear in people with this condition.
Immediate Memory
what just happened
Sensorineural hearing loss
which the root cause lies in the vestibulocochlear nerve (cranial nerve VIII), the inner ear, or central processing centers of the brain. Sensorineural hearing loss can be mild, moderate, or severe, including total deafness.
Care of PD patient
• Allow the patient extra time to respond to questions. • Administer medications promptly on schedule to maintain continuous therapeutic drug levels. • Provide medication for pain, tingling in limbs, as needed. • Monitor for side effects of medications, especially orthostatic hypotension, hallucinations, and acute confusional state (delirium). • Collaborate with physical and occupational therapists to keep the patient as mobile and as independent as possible in ADLs. • Allow the patient time to perform ADLs and mobility skills. • Implement interventions to prevent complications of immobility, such as constipation, pressure ulcers, and contractures. • Schedule appointments and activities late in the morning to prevent rushing the patient, or schedule them at the time of the patient's optimal level of functioning. • Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board. Refer to speech-language pathologist. • Monitor the patient's ability to eat and swallow. Monitor actual food and fluid intake. Collaborate with the dietitian. • Provide high-protein, high-calorie foods or supplements to maintain weight. • Recognize that Parkinson disease affects the patient's body image. Focus on the patient's strengths. • Assess for depression and anxiety. • Assess for insomnia or sleeplessness.
Improving nutrition with MG patients
• Assess the patient's gag reflex and ability to chew and swallow. • Provide frequent oral hygiene as needed. • Collaborate with the dietitian, speech-language pathologist, and occupational therapist to plan and implement meals that the patient can eat and enjoy. • Offer small, frequent meals. • Cut food into small bites, and encourage the patient to eat slowly. • Observe the patient for choking, nasal regurgitation, and aspiration. • Provide high-calorie snacks or supplements (e.g., puddings). • Keep the head of the bed elevated during meals and for 30 to 60 minutes after the patient eats. • Avoid liquids because they can easily cause choking and aspiration; provide a soft diet. • Monitor food intake carefully. • Weigh the patient daily. • Monitor serum prealbumin levels. • Administer anticholinesterase drugs, as prescribed: 45 to 60 minutes before meals.
Nursing care for PT with meningitis
• Follow ABCs (airway, breathing, circulation). • Take vital signs and perform neurologic checks every 2 to 4 hours, as required. • Perform cranial nerve assessment, with particular attention to cranial nerves III, IV, VI, VII, and VIII, and monitor for changes. • Manage pain with drug and nondrug methods. • Perform vascular assessment, and monitor for changes. • Give drugs and IV fluids as prescribed, and document the patient's response. • Record intake and output carefully to maintain fluid balance and prevent fluid overload. • Monitor body weight to identify fluid retention early. • Monitor laboratory values closely; report abnormal findings to the physician or nurse practitioner promptly. • Position carefully to prevent pressure ulcers. • Perform range-of-motion exercises every 4 hours as needed. • Decrease environmental stimuli: •Provide a quiet environment. •Minimize exposure to bright lights from windows and overhead lights. •Maintain bedrest with head of bed elevated 30 degrees.
Tips for teaching MG patients
• Keep prescribed drugs and a glass of water at your bedside if you are weak in the morning. • Wear a watch with an alarm function (or beeper) to remind you to take your drugs. • Post your drug schedule so others know it. • Plan strenuous activities, when possible, when the drug peaks. • Keep an extra supply of drugs in your car or at work. Be sure they are secured. • Do not take any over-the-counter drugs without checking with your health care provider.
Manifestations of MS
• Muscle weakness and spasticity • Fatigue • Intention tremors • Dysmetria (inability to direct or limit movement) • Numbness or tingling sensations (paresthesia) • Hypalgesia (decreased sensitivity to pain) • Ataxia (decreased motor coordination) • Dysarthria (slurred speech) • Dysphagia (difficulty swallowing) • Diplopia (double vision) • Nystagmus (involuntary eye movements) • Scotomas (changes in peripheral vision) • Decreased visual and hearing acuity • Tinnitus (ringing in the ears), vertigo (dizziness) • Bowel and bladder dysfunction • Alterations in sexual function, such as impotence • Cognitive changes, such as memory loss, impaired judgment, and decreased ability to solve problems or perform calculations
