NE 211 Test 2 Neuro

preventing latex allergy

* use non-latex gloves * use latex-free cart supplied with latex-free items * wash hand with mild soap and dry hand completely after. at risk due for allergy due to multiple surgeries and bladder caths. a latex free environment should be created for all procedures child should wear an ID bracelet

cerebral vascular vasodilators

**carbon dioxide **Hydrogen Ions lactic acid pyruvic acid carbonic acid

types of neurotransmitters

- acetylcholine - dopamine - serotonin - norepinephrine -GABA

therapeutic management of hydrocephalus

-Relief of hydrocephalus -Treatment of complications -Assessment of problems related to the effects of motor/growth development -Treatment: most often surgical *Ventriculoperitoneal shunt must be identified early, need to prevent brain tissue damage from IICP the shunt needs replaced as the child grows parents need to knwo the signs when a shunt needs replacing or when complications are occuring

apraxia

-The inability to carry out specific motor tasks in the absence of sensory or motor impairment (drawing a figure, getting dressed)

Reflex measurments

0 = absent are no response 1= hypoactive; weaker than normal 2= normal 3= stronger than nomal 4= hyperactive, sustained clonus 2 is considered normal

CSF WBC's

0-8

abbreviated Neurologic assessment

1. assess LOC (response to auditory and or tactile stimulus) 2. obtain V/S (measure of ANS function) 3. check pupillary response to light 4. assess strength of hand grip and movement of extremities bilaterally 5. Determine ability to sense touch/pain in extremities.

CSF Specific gravity

1.007

CSF chloride

118-132 mEq/L

head circumference

2 and under plot on growth cart and look at percentiles all the bones are not ossified yet. Allows for brain growth If the head is growing too fast and before ossification, can mean the brain is expanding and is indicative of problems with CSF and it flowing through ventricles in the brain, so backs up in the brain and the brain expands anterior fontanel- closes 12-18 months posterior fontanel- closes 4-8 weeks look at the fontanels- should be flat and soft -bulging can indicate Increased ICP -depressed could indicate dehydration

each minute during a stroke

2 million brain cells die

Peripheral nervous system

31 spinal nerves 12 cranial nerves reflexes- a rapid, involuntary, predictable motor response to a stimulus-indicate the nerves are intact and are responsive and healthy can be a contraction reflex or a secretion response

ventricles int he brain

4 ventricles CSF is made in the Chorid Plexus flows through the ventricles -need good communication through the ventricles (meaning openings). CSF is absorbed through the arachnoid vili

CSF protein

40

CSF glucose

40-70 mg/dL Brain gets it's energy solely from glucose

Pediatric Glasgow Coma Scale: verbal response

5- smiles, listens, follows the person 4-consolable 3-inappropriate, persistent cry 2-agitated, restless 1-no verbal response

Normal Intercrainial pressure (ICP)

5-10mmHg or 60-180 cm H2O

spinal cord

7-cervical 12-thoracic 5-lumbar 5-sacral (some are fused together) messages go to brain via the spinal cord and return to the body by the spinal cord

CSF specific gravity

7.35

CSF pressure

70-180 mm H2O

Temporal lobe

A region of the cerebral cortex responsible for hearing and language. memory, language, auditory Weirneke's- area that helps us interpret specch

occipital lobe

A region of the cerebral cortex that processes visual information

parietal lobe

A region of the cerebral cortex whose functions include processing information about touch. sensory imput and body sensory

risk for ineffective tissue perfusion: cerebral

ABC's are monitored and neurological status is monitored and interventions to maintain cerebral perfusion. Goal: patient demonstrates appropriate orientation X4 and have adequate motor/sensory functions, pupillary size and reaction, and behaviors monitor resp status, ox sat, and airway patency. Auscultate pulmonary sounds and monitor resp rate and results of ABG's. suction as necessary, no longer than 10 seconds at one time, use sterile technique. administer O2 as prescribed position patient on side to prevent aspriation monitor mental status and LOC: restlessness, drowsiness, lethargy, inability to follow commands, unresponsiveness: often initial manifestations of IICP. Assess for pain, HA, decreased muscle strength, sluggish pupils, absent gag or swallow reflex, hemiplegia, babiniski's sign and decerebrate or decorticate posturing. All indicate IICP, the major cause of death in stroke acute phase continuously monitor cardiac status, observe for dysrhythmia monitor body temp and maintain temp at <98.6 fever is associated with worse outcomes maintain i and O: watching for damage to pituitary and Diabetes insipidus moniotr for DI and dehydration seizure precautions: pad side rails and give prescribed AED meds

And=

Abducens #6 (Motor control of some eye muscles)

Forces resulting in SCI

Acceleration injury- when external force is applied in a rear end collision; the upper torso and head are forced backward and then forward deceleration injury- head on collision, external force is applied from the front. The head and and body move forward until they meet a stationary object and then are forced back --Hyperflexion: or forcible forward bending --hyperextension- forcible backward bending (whiplash) --axial loading injury-compression , vertical force to the spinal column (falling or landing on the feet or buttocks, diving into shallow water) --excessive rotation: head is excessively turned can also see penetrating injuries.

And=

Accessory #11 (Motor impulses to pharynx and shoulder)

thrombotic stroke

Arterial occlusions caused by thrombi formed in arteries supplying the brain or in the intracranial vessels **most often occur in older people who are sleeping or resting. The bp is lower during sleep, so there is less pressure to push the blood through and already narrowed arterial lumen, and ischemia may result. Evolves over a couple of days seen in arteries that bifurcate and have narrowed lumens as a result of deposits of artherosclerotic plaque usually in 3 days the stroke is completed, the damaged area is edamatous and necrotic. If not too large, the person can recover most common CVA

Sensory function assessment

Assess ability to feel touch touch both sides of various parts of the body with: cotton sharp dull vibrating tuning fork on bony prominence Move the patient's finger or big toe up or down. Ask the patient to describe the movment assess ability to discriminate fine touch: 1. what's the object in the hand (coin or key) 2. Number written on the palm of hand (test graphesthesia 3. Two points of simultaneous pinpricks on the hand 4. where he or she is being touched 5. How many sensations are felt when touched simultaneously on both sides of the body

A=

Auditory #8 (Hearing, equilibrium)

spinal cord tumors

Benign or malignant, primary or metastatic tumor of the spinal cord.

impaired gas exchange

C3-c5 affects the diaphragm and phrenic nerve.. C3 and above need ventilator. all injuries can impair gas exchange. monitor vital capacity and resp effectiveness, assess for tachycardia, restlessness, pao2 less than 60, co2 greater than 50 and vital capacity less than 1 L changes in ABG's and vital capacity signal respiratory insufficiency monitor for signs of ascending edema of the sc, including difficulty swallowing or coughing, respiratory stridor, use of accessory muscles for resp, bradycardia, increase motor and sensory loss.

TUMOR NEAR THE HYPOTHALAMUS

CAN HAVE SIAD- CAN INCREASE ICP, DUE TO TOO MUCH ADH

Diagnostic test for IICP

CT MRI LP is NEVER done when IICP is suspected because the sudden release of the pressure int he skull may cause cerebral herniation. serum osmolality for hydrations status (normal is 280-300) ABG's of O2 and CO2 and H ions

CSF appearance

Clear, colorless

Increased Intracranial Pressure (ICP) signs

Decreased level of consciousness (early we see confusion, restlessness, lethargy, disorientation) Pupillary dysfunction, sluggish response to light progresses to dilated and fixed. (vision becomes blurred and diplopia is common. There may be an inability to move the eyes upward and drooping of eyelid Papilledema (edema of optic disc) Abnormal motor responses (weakness of the opposite side early, followed by hemiplegia, decorticate or decerebrate posturing) Increased MAP (significant increase in systolic bp and pulse pressure) decreased pulse rate dramatic increase in body temp altered respirations Headache, worse on rising to upright and changing positions Nausea with projectile vomiting.

motor deficits

Depend on area of damage. Contralateral hemiparesis (weakness) or hemiplegia (paralysis). May be arm or leg predominate depending on affected artery. Initial flaccidity and hypoactive reflexes. Eventually spacticity and hyperactive reflexes (usually within 6-8 weeks)

Detect stroke symptoms FAST

F= face: ask the person to smile, is it symmetrical A= arm: ask the person to raise both arms, are they symmetrical S= Speech: ask the person to repeat a simple sentence. Do they sound strange T= Time: if you see these symptoms call 911 and get to the nearest stroke center or hospital. Time is brain

Feel=

Facial #7 ( Motor control of facial muscles, salivation, tastes and cutaneous sensations)

Girls=

Glossopharyngeal #9 (Salivation, sensations of skin, taste)

manifestations of subdural hematoma

HA develops drowsiness confusion agitation slowed thinking enlargement of the pupil within minutes to hours of injury unilateral headache hemiparesis and resp pattern changes

manifestations of epidural hematoma

HA vomiting fixed, dilated pupil on affected side contralateral hemiparesis/hemiplegia possible seizure momentary loss of consciousness followed by a lucid period for a few hours to 1-2 days rapid deterioration of LOC rise in bp decrease in pulse resp decrease concern: ICP herniation

increased inter cranial pressure for kids

Headache vomiting, projectile blurred vision, diplopia dizziness decreased pulse and respirations increased bp or pulse pressure pupil reaction sluggish and unequal sunset eyes changes in LOC, irritability seizure activity INFANTS, also: bulging, tense fontanel wide sutures and increased head circumf dilated scalp veins high pitched cry

Hooters=

Hypoglossal #12 (Motor control of the tongue, some skeletal muscles, some viscera, sensation from skin and viscera)

nursing management

INITAL: prevent trauma to sac and prevent infection before surigcal repair prevent infection promote urinary elimiantion promote bowel elimination promote adequate nurtition prevent latex allergy maintain skin integrity education and support child and family

emergency care for SCI

INJURY AT C1-C4 respiratory paralysis is common, and the patient who survives requires ventilator assistance to breathe. below c4 may increase the risk of respiratory failure if edema asends the cord can not allow fractured vertebrae to damage the cord any further during transport. treat all injuries to head or spine, or who or unconscious as if they have a spinal cord injury make sure the scene is safe rapid assessment of ABC's immobilize and stabilize the head and neck remove the individual from the site of injury if needed stabilize other life threatening injuries rapidly transport to hospital do not flex, extend or rotate the neck immobilize the neck, use rolled towels or blankets, apply a cervical collar before moving onto a back board secure the head by placing a belt or tape across the forehead and securing it to the stretcher log roll onto backboard give O2 maintain in supine transfer directly from stretcher with backboard in place on to hospital bed cover with a blanket to keep warm

Locked-in syndrome

Individual is aware and capable of thinking but is paralyzed and cannot communicate through speech or movement because of blocked efferent pathways. Cranial nerves 1-4 are intact, allowing the patient to communicate through eye movement and blinking caused by infarction or hemorrhage on pons, can also be caused by disorders of the lower motor neurons or muscles such as poliomyelitis, Myasthenia gravis, or amyotrophic lateral sclerosis.

2 types of strokes

Ischemic stroke (when blood supply to a part of the brain is suddenly interrupted by a thrombus, embolus, or blood vessel stenosis) Hemorrhagic stroke (when a blood vessel ruptures, spilling blood into the surround space and neurons)

lumbar nerves

L1-L5

focal

Localized to one specific area. Opposite of diffuse include contusions hemorrhage hematomas

dx

MRI CT ultrasound myelography

complications of CP

Mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and hydrocephalus most children can become adults, but function and quality of life can vary from near normal to substantial impairments

ineffective breathing pattern

Monitor; respiratory rate, depth, effort, presence of cyanosis, restlessness, use of accessory muscles ABG's, Spo2. an increase in ICP causes respirations to slow initially, but then as it increase respirations become rapid monitor ICP reading, continousou measurement is used to diagnose and monitor iicp if not intubated, prepare of oxygen admin and or trach intubation if resp distress occurs prepare for cranial surgery if deteriorating resp pattern and neurological changes are noted

diagnosis

NIH stroke scale is a clinical evaluation tool widely used to assess neurologic outcome and degree of recovery. CT w/o contrast- will tell if hemorrhagic or ischemic can also do doppler- check carotids cerebral arteriogram MRI PET SPECT (hot and cold spots) PLAC blood test

meds for ruptured intervertebral disk

NSAIDS muscle relaxants

Oh=

Oculomotor #3 (Motor control of some eye muscles and eyelid)

cranial nerves

Oh, Oh, Oh, To, Touch, And, Feel, A, Girls, Vagina, And Hooters

Oh=

Olfactory #1 (Smell)

Oh=

Optic #2 (Vision)

HEALTH PROMOTION

PUBLIC EDUCATION about safe driving, dangers of DUI or alcohol or drugs, wearing seat belts and helmets, child safety seats, airbags, use of headsets with cell phones and no texting when driving. safety rules of guns, farm safety and preventing falls in home

Medications

Prevention: antiplatelets for patients with TIA's: aspirin plavix dipyridamole ticlopidine

Good Samaritan Law

Provides limited protection to someone who voluntarily chooses to provide first aid, but with provide care within your scope and it covers you.

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched birth to 1 year

moro reflex

Reflex in which a newborn strectches out the arms and legs and cries in response to a loud noise or an abrupt change in the environment birth to 4 months

suck reflex

Reflexive sucking when nipple or finger is placed in infant's mouth. Appears at birth till 2-5 months.

sacral nerves

S1-S5

Nemonic for if sensory, motor or both

Some Say Marry Money But my Brother Says Big Business Makes Money

Make sure to find what the APGAR score was for the child

Tells about oxygenation of the baby when it was born poor scores could indicate poor oxygenation and poor neurologic function seen in Cerebral palsy with anoxia

Duty of Care

The duty of all persons, as established by tort law, to exercise a reasonable amount of care in their dealings with others. Failure to exercise due care, which is normally determined by the reasonable person standard, constitutes the tort of negligence.

left hemisphere of the brain

The left hemisphere of the brain is responsible for control of the right side of the body more academic and logical side of the brain. details thinking investigation analytical LEFT=LANGUAGE most people have a highly developed left side of the brain

hemianopia

The loss of half of the visual field in one or both eyes

right hemisphere of the brain

The right hemisphere of the brain is responsible for control of the left side of the body more artistic and creative side of the brain. imagination emotion

step reflex

This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface. birth to 4-8 weeks

Touch=

Trigeminal #5 (Chewing & facial sensation)

To=

Trochlear #4 (motor control of some eye muscles)

Vagina=

Vagus #10 (Motor control of the heart, sensation from the thorax)

Best indicator for infection in a person with a neurological disorder

WBC elevation. Fever is usually considered a key assessment. However, fever in a patient with a neurologic disorder may be due to damage to the hypothalamus. might see headache, generalized muscle aches, shivering, and chills in the patient with an infection

Medications

WILL PROBABLY be on steroids, for the rest of their life will be on antiseizure meds

Diffuse Axonal Injury (DAI) Shaken Baby Syndrome

Widespread disruption of axons due to acceleration or deceleration injury. Small, petechial hemorrhages at gray-white junction of cerebral hemispheres and or corpus callosum. immediate loc of consciousness Mild: coma last 6-24 hours cognitive, psychologic, sensorimotor deficits moderate: more than 24 hours incomplete recovery likely severe: axonal tearing in both hemispheres IICP profound deficits (movement, written/verbal, learning, modulate behavior

pathophysiology

a benign tumor may be surgically inaccessible an may continue to grow and expand increasing intracranial pressure and causing neurological deficits, herniation and finally death. cancerous tumors grow faster primary brain tumors rarely metastasize secondary tumors metastatsize from lungs, breast and prostate. lung most common

brain abcess

a mass of pus cells in a localized area, neurodeficit in that area, might see s/s in intracranail pressure increasing.

therapeutic managment

a medical emergency and needs hospitalization IV abx LP and blood cultures for diagnosis corticosteroids to help reduce inflammation will tx a infant the comes in with changes in eating and behavior as if they have bacterial meningitis. it can progress in an hour to two hours, very serious. Will do cultures but start on broad spectum abx right aways

neurons

a nerve cell; the basic building block of the nervous system composed of a dendrite, cell body (most located in the CNS), and an axon. The axon is a long process that conducts the impulse away from the cell body. the axon is covered by a mylien sheath that speeds the impulse and is essential for large nerve cell survival. There are nodes inbetween the sheaths "nodes of ranvier" which allow the ions to get back into the ECF.

migraine

a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision. has a triggering event and usually accompanied by neurological dysfunction have a familial association last 4-72 hours they are with and without an aura aura is a sensory manifestation that occurs prior to the manifestations the blood vessels constrict then dilate and the dilation causes the migrain relationship between serotonin and migraines. comes on after awake and gets better with sleep pain is unilateral, throbbing but can progress to bilateral. physical activity and moving can intensify pain

reflex assessment technique

a reflex hammer is used to strike the tendon of various reflex sites: Patellar, Biceps Brachioradialis (Supernator) Triceps Achillies To test deep tendon reflexes, ask the patient to lock the fingers of both hands together and then pull; this encourages relaxation and promotes reflexes of lower extremities

elimination disorders

a stroke may cause partial loss of the sensations that trigger bladder elimination, resulting in frequency, urgency, or incontinence.

crainotomy

a surgical opening into the cranial cavity. A series of burholes are made and the bone between the holes is cut with a saw called a craniotome. The hematoma is excised, and the bone flap is returned to the opening. in some instances the patient is awake during surgery put in quite room after hob elevated 30 degrees watch for increased IICP: change in LOC neurochecks (vitals, strength in feet and hands, pupils, oriented, ability to sense touch/pain in extremites) if the patient hasn't been NPO on an emergency procedure we can crash sedate him. put him out and put an ET tube and inflate it to prevent anything from coming back up

hydrocephalus

a syndrome in which abnormal overproduction, circulation, or reabsorption of CSF occurs classified as either communicating or non communicating noncommunicating occurs when CSF drainage from the ventricular system is obstructed, such as by a mass or tumor, inflammation or hemorrhage or congenital malformation communicating is when CSF is not effectively reabsorbed through the arachnoid villi. Can occur due to a subarachnoid hemorrhage or scarring from infection

assess the superficial abdominal and cremasteric reflexes

abdominal reflex: lightly stroke the abdomen with a tongue depressor from the side to midline --Normally the side of the abdomen being stroked will contract toward the umbillicus Cremasteric reflex: lightly stroke the inner thigh of the male patient with a tongue depressor --normally, the testicle on the side being stroked will rise

assessment

ability to move ROM delayed development size for age sensory alterations (strabismus, vision issues, speech disorders) posturing (arch back, stiff neck, scissor crossing of legs with plantar flexion when supine) when prone may raise their head higher than normal due to arching of the back, or opisthotonic position. may abnormally flex the arms and legs under the trunk primitive reflexes may persist protective reflexes may be delayed abnormal use of motor groups (scooting on back instead of crawling or walking) flexibility (can be stiff, look at muscle tone) movements (involuntary wrtihing) symmetry muscle weakness or rigidity respiratory movements (issues due to thoracic motor problems) passive/active ROM muscle tone can see hypertonicity **increased resistance to dorsiflexion and passive hip abduction are the most common early signs sustained clonus may be present after forced dorsiflexion prolonged standing on toes look for shortening of a unused extremeity look for hand dominance

tx

abx non opioid pain management (in all iicp) antipyretics anit seizures monitor neuro status v/s temp loc orientation seizure precautions cranial nerve damage monitor IICP meds/fluids

ischemic stroke

account for 87% of strokes the blockage may result from a blood clot (thrombus or emboli) or from stenosis of a vessel resulting from a build up of plaque. cardiogenic embolic strokes are caused by a blood clot (usually afib) moving through cerebral blood vessels until the vessel is too small to allow further movement.

basic needs

activity/mobility nutrition (jaw and mouth control problems, moving the tongue) learning problems later on, but not mental status issue (cognitive/intellectual function is not affected) oxygenation self esteem issues

maintaining skin integrity

address the risk related tot he child's prone postion and impaired mobility. constant pressure on knees and elbows and can be difficult to keep clean of urine and feces. may not be able to diaper preop. keep infant clean and dry as much as possible. place pad underneath as frequently as possible. meticulous skin care. place infant on special mattress or synthetic sheepskin under the infant to reduce friction using a folded diaper between the legs can help reduce pressure and friction from the legs rubbing together

education and supporting the family

affects multiple body systems and produces varying degrees of deficits with life long effects parents need a bit to accept the child's condition, but as soon as possible they need to be involved in the care teach positioning, prevention infection, feeding, promoting urinary elimination through cathing, prevent latex allergy, and iding the signs and symptoms of complications: IICP. they will need ROM because extremities can be flaccid

diffuse cerebral injury

affects the entire brain caused by shaking motion, with twisting movement brain tissue is damaged by shearing, tearing, or stretching of nerve fibers. frontal and temporal lobes are the most vulnerable to injury. can cause: physical deficits spastic paralysis peripheral nerve injury swallowing disorders visual and hering impairments taste and smell disorders attention is affected and processing speed serious cognitive and affective impairments confusion poor judgment, impulsivity, depression and social withdrawal

temperature control

after birth can go in isolette, head down to clear secretions and control temperature skin to skin can help, if the sac can be held safely.

The neuro A and P makes us think

all needs can be affected. LOC motor issues, even walking pain can indicate a CNS problem also affects CV, Respiratory, gastrointestinal system

radiation therapy

alone or as adjunctive therapy is the tx of choice for surgically inaccessible tumors. it may decrease the size of a tumor prior to surgery tx for tumors not completely excised by surgery.

increased intracranial pressure IICP

also called intracranial hypertension is sustained elevated pressure (greater than 10 mmHg) withing the cranial cavity can cuase significant tissue ischemia and damage to delicate neural tissue cerebral edema is the most frequent cause of sustained increases in ICP, other causes are trauma, tumor, abscesses, stroke, inflammation, and hemmorhage

often, early manifestations of a change in intracranial pressure are

alterations in the LOC and respirations

genetic considerations

always ask if anybody in the family to something similar to what the patient is experiencing Parkinsons Multiple Sclerosis Narcolepsy Huntington's Disease Friedreich's ataxai Essential tremor epilepsy Charcot Marie Tooth Alzheimer's disease Amyotrophic Lateral Sclerosis Tay-Sachs Disease might be able to identify early and start early tx to delay the disease

arteriovenous malformation

an abnormal communication between an artery and a vein. a congenital intracranial lesion, formed by a tangled collection of dilated arteries and veins that allows blood t flow directly from the arterial into the venous system, bypassing the normal capillary network. rupture of vessels in AV malformations account for 2% of all strokes. The manifestations are the result of spontaneous bleeding from the lesion into the subarachnoid space or brain tissue. will have constant headaches, when burst will get a severe headache with projectile vomiting. blood shunts from the high pressure artery right into the weaker venous system, and this can cause spontaneous bleeding or progressive expansion and rupture of a blood vessel.

always, always, always

an awareness of abuse Kids are vulnerable to injury. Especially infants and their large, unsteady head.

stroke (CVA, Brain attack)

an emergency condition in which neurologic deficits result from a sudden decrease in blood flow to a localized area of the brain

cerebral edema

an increase in the volume of brain tissue due to abnormal accumulation of fluid. Associated with IICP.

if doing a self cath

and get large amount of residual urine means that more frequent catheterizations are necessary 4-6 hours

neglect syndrome

another from of sensory perceptual deficit. Also called unilateral neglect, in which the patient has a disorder of attention. In this syndrome, the person cannot intergrate and use preceptionsf rom the affected side of the body or from the environment on the affect side, and ignores that part. more common when patient has stroke on the right hemisphere where damage tot he parietal lobe.

nursing management

antiviral therapy for disease caused by herpes simplex virus keep child up to date on immunizations avoid mosquito and tick bites are the best prevention of vector borne -use insect repellent (watch using DEET in kids under 12 and not at all in younger than 1) wear clothes to protect arms and legs -get rid of standing water where mosquitos breed -use insect tramps and public measures such as sprayed insecticides to reduce the mosquito population get good baselines of neuro and vitals, because any change will be indicative of the patient worsening or getting better watch urine output prevent and tx IICP: quite environment, cluster care, hob elevated, keep safe, seizures, keep neck neutral, no straining will be on steroids possible anitseizure meds

protective reflexes

appear later

impaired verbal communication

approach and tx pt as an adult do not assume that the patient who does not respond verbally cannot hear. do not raise your voice allow adequate time for patient to respond facet he patient, speak slow when you don't understand the patient, be hones and say so use short, simple statements and questions accept frustration and anger as a normal reaction tot he loss of function alternate means of communication: writing tablets, flash card, computer boards

primary tumors

are rare and have a unknown cause. can arise at any level of the spinal cord majority being thoracic most spinal spinal cord tumors are metatatic

changes with an altered LOC

arousal and cognition patterns of respirations pupillary and oculomotor responses motor responses

on infant

assess pupils should dilate and react to light auditory: after a few months can turn to a familiar voice should be able to make eye contact and turn to look at you at a few weeks root and sucking tell us about CN 5 facial symmetry tells us about CN7 watch when crying and sucking Morro reflex tells us about CN8

Mental status Assessment

assess appearance, including dress, hygiene, grooming, gait and posture assess behavior, including actions and affect, content and quality of speech, and level of consciousness. Use the Glasgow Coma Scale. 15=alert and oriented. assess cognitive function orientation to time, place, person, situation note attention span and recent and remote memory ask patient to do the following 1. repeat 5-7 numbers 2. recall 3 items after 5 mins 3. recall their address, breakfast, or birthday assess thought process by noting responses to questions not ability to understand what is said and express thoughts not ability to make logical and save judgements.

motor function assessement

assess bilateral symmetry and size of muscles assess for tremors (rhythmic movements) and fasciciulations (irregular movements) observe movements as patient is at rest and with activity assess muscle tone assess bilateral muscle strength and movement: 1. squeeze my hands 2. push feet against the resistance of my hand 3. raise both legs off the bed

assess clonus

assess clonus by dorsiflexing a patients foot. no rhythmic oscillations are observed between dorsiflexion and plantar flexion

impaired urinary elimination and constipation

assess for urinary frequency, urgency, incontinece, nocturia and voiding in small amounts, asses pt's ability to respond to the need to void, the ability to use the call light, and the ability to use toileting equipment assess for distended bladder encourage bladder training by having patient void on schedule q 2 hours, rather than in response to the urge to void teach kegel exercises. use positive reinforcement (verbal praise) for successful management of urinary elimination discuss prestroke bowel habits, as well as pattern of bowel elimination if ability to swallow is present, encourage 2 L fluid and high fiber diet increase physical activity as tolerated assist in using the toilet facilities the same time each day, ensure privacy and have pt sit in an upright postion if possible administer prescribed stool softners

acute pain

assess pain use a firm mattress or place a board under the mattress to support the spinal column and muscles teach patient to avoid turning or twisting the spinal column and to assume positions that decrease stress ont he vertebral column: when supine, flex the hips slightly. Place a small pillow under the knees for lumbar disk. Place a small pillow under the neck for cervical disk provide analgesic meds around the clock

ineffective breathing pattern

assess resp rathe, rhythm, and depth q 4 hours or more freq if needed. auscultate breath sounds. monitor ABGs administer supplemental oxygen as prescribed assist patient to turn, cough, and deep breath at least q 2 hours increase fluids given by mouth to 3 L per day according to patient preference for types of drinks and ability to swallow

cerebellar function assessment

assess the gait ask patient to walk normally, then in a heel-to-toe fashion, then on toes, and finally on heels perform Romberg's test: ask patient to stand with the feet together and eyes closed *stand close to patient to prevent falling* should see minimal swaying for 20 seconds assess coordination observe ability to pat knees, alternating front and back of hands and increasing speed observe ability to touch each finger of one hand to the thumb. observe ability to touch the nose, your finger, the nose, your finger moved, the nose, your finger moved again. observe ability to run each heel down each shin, while in supine position.

acute pain

assess the pain raise hob slightly reduce noise and bright lights loosen head dressing administer narcotics analgesics with caution

anti seizure meds

ativan- benzo great to prevent seizures, valium also--stop seizures phentoin (dilatin) prevents seizures, therapeutic range 10-20, causes hypergingaplasia-over grown gums and should use soft tooth bristle toothbrush. Can only mix with saline or will precipitate. can also give atropine eyedrops in the mouth to dry secretions morphine for pain

male self-catheterization

attempt to void, if you get less than 100 mLs or can't void, do self cath sit either on the commode or wheelchair. Hold penis with slight upward tension and extend it to its full lenght (straightens out the urethra) lubricate the cath from tim to about 6 inches down ward take a deep breath and insert the cath 15 to 18 cm or until urine flows hold cath securely ad allow urine to drain until flow has stopped withdraw catheter and wash with soap and water. store in clean airtight container

infant

babies give off reflexes involuntary to show neurological health when the reflex behavior is supposed to disappear, and it doesn't, that is reflective of neurological health if the milestone was not achieved, we need to make sure the parents gave the child the opportunity to hit that milestone developmental milestones are reflective of neurologic health watch irritability of the infant. When you meet their need, are they still crying? The irritable child is inconsolable. Look at the sleep of the infant. Can they sleep uninterrupted. If not, can be indicative of neurological problem look at cry. A higher pitch cry can mean pain and neurologic issues

medication

baclofen-spastic muscles (can be pump if the intrathecal test proves postive. has to be refilled q 3 months and replaced 5-7 years) botulism- spastic muscles dantrolene sodium diazepam anticholinergics (scopolamine or glycopyrrolate decrease saliva and help drooling) pathological drooling is a problem for many with cp. can lead to dehydration, enamel erosion, maceration of the skin, odor and social stigma.

diagnostic test

blood flow studies- weakness or issues with unilateral problems. Can study carotid artery and usually caused by Coronary Artery Disease. cerebral angiogram- blood flow to the brain electroencephlogram- electrical activity in the brain evoked potential- nerve conduction study. how it goes from one nerve to the next lumbar puncture- tells a lot about infection

glossopharyneal

both Cranial nerves 9 and 10 are done together If gag reflex is intact (make sure), observe the patient swallowing a small drink of water. observe for a symmetrical rise of the soft palate and uvula as the patient says "AH" Assess gag reflex by touching the back of the patient's throat with the tongue depressor. Assess ability to taste salty, sweet, and sour substances on the posterior 3rd of the tongue dysphagia is common with impaired blood flow to the brain unilateral loss of gag reflex occurs with lesions.

vagus

both Cranial nerves 9 and 10 are done together If gag reflex is intact (make sure), observe the patient swallowing a small drink of water. observe for a symmetrical rise of the soft palate and uvula as the patient says "AH" Assess gag reflex by touching the back of the patient's throat with the tongue depressor. Assess ability to taste salty, sweet, and sour substances on the posterior 3rd of the tongue dysphagia is common with impaired blood flow to the brain unilateral loss of gag reflex occurs with lesions.

trigeminal

both assess ability to feel light, dull, and sharp sensations of face. With patient's eyes closed, check whether the sensation is the same on both sides of the face. Stroke the cheek with a wisp of cotton for light touch a safety pin for dull touch tongue depressor for sharp touch. rooting and sucking is cranial nerve 5! Assess corneal reflex by touching the corneal surface with a wisp of cotton Contact lenses can make the reflex absent or decreased carotid artery occlusion can change facial sensations, strokes can also cause issues.

facial

both assess the ability to discriminate taste of: Sweet, sour, salty on the anterior 2/3 of the tongue. assess the ability frown, smile, blow out cheeks, show teeth, close eyes, and raise eyebrows muscle movement should be equal billaterally brain tumors, nerve impairment, lesions of lower motor neurons, bells palsy, pain, paralysis can all affect ability

promote bowel elimination

bowel incontinece depends on the level of the lesion. constipation is usually the issue. watch for first meconium stool, Sterile drape over the area to prevent stool from reaching the sac bowel training with the use of timed enemas or suppositories along with diet mod can allow for defecation at predetermined times once or twice a day.

CNS

brain and spinal cord

diagnosis

brain scan mri xray EEG lumbar puncture to rule out structural disease

contusion

bruise of surface of the brain, typically accompanied by small diffuse hemorrhages usually when brain strikes skull in coupe/countercoupe LOC behavior changes/combativeness loss of reflexes hemiparesis abnormal posturing complications cerebral edema IICP

most common sites of injury to spinal cord

c1, c2, c4, c6, T11, l2 cervical spine has a wider range of movement so more prone to injury, and the cord takes up most the canal in the cervical vertebrae usually young males and older women are more prone to spinal injuries

cerivcal nerves

c1-c8

intracerebral hematoma

can be single or multiple are associated with contusions usually in frontal or temporal lobes older adults are particularly vulnerable because their blood vessels are more fragile and easily torn

level of consciousness

can be the first sign there is problem can be the first sign is deteriorating can be the first sign of improvement need to be assessed very frequently, need good baseline to detect changes (head injuries, concussions, or any serious injury)

basilar skull fracture

can result from severe blunt head trauma with significant force fracture at the base of the skull due to the proximity to the brain stem, serious head injury. csf rhinorrhea otorrhea bleeding from the ear orbital or post-auricular ecchymosis (battle sign) raccoon eyes blood behind the tympanic membrane increased risk for infection because portal of entry into the cns through hole in dura

the brain is supplied with blood through the

carotid and vertebral arteries

secondary tumors

caused from metastatic tumors and are most commonly the result of malignancies of the lung, breast, prostate, colon, kidney, or uterus

The brain has 4 major regions

cerebral hemispheres, cerebellum, diencephalon, brain stem

assessment finding in acute SCI

cervical injury: paralysis or weakness of extermities respiratory distress with changes in ABG studies, cyanosis, flaring of nostrils, accessory muscles of respiration and restlessness decreased peristalsis thoracic and lumbar paralysis or weakness of extermities

cognitive and behavioral changes

change in LOC, ranging from mild confusion to coma is common with stroke. can result from ischemia, cerebral edema or IICP can see: emotional lability, loss of self control, swearing/refusing to wear clothing, decreased tolerance for stress. Intellectual changes, memory loss, decreased attention span, poor judgement, and an inability to think abstractly.

manifestations

changes in cognition or consciousness headache (usually worse in the morning) seizures vomiting Increased ICP cerebral blood flow can diminish as pressure compresses the blood vessels[

Decorticate posturing

characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.

ineffective tissue perfusion: cerebral

check for and report manifestations of IICP q 15-1 hour as necessary. Assess LOC, behavior, motor/sensory function, pupillary size and reaction to light, and vital signs, including temp. Look for trends pre oxygenate pts with a ventilator before suctioning hyper-oxygenate with 100 O2, and only 10 second suctioning monitor ABG's Elevate head of bed to 30 or keep flat as prescribed, maintain the alignment of the head, neck to avoid hyperextension of exaggerated neck flexion, avoid prone position. (don't want to impeded venous drainage) avoid coughing, blowing nose, straining for bowel movement, pushing against the bed rails or performing isometric exercise---all increase ICP monitor for bladder distention and constipation. use credes to empty bladder do not push against footboard,. avoid foot board on restraints, this increases ICP do not cluster activities together, avoid turning the patient, getting the patient on the bedpan, or suctioning within the same period. Provide rest periods between interventions provide quiet environment. limit noious stimuli, avoid jarring the bed, avoid emotional upset, be calm and reassuring maintain fluid limitations

bacolfen pump

check the incision for infection notify doc of temp greater than 101.5 or if perisitent incision pain to tub baths for 2 weeks no sleeping on stomach for 4 weeks discourage twisting at the waist, reaching high over head, stretching, or bending forward or back for 4 weeks when incision healed, normal activity wear loose clothing to prevent irritation at incision site carry implanted device id and emergency card

neurotransmitters

chemical messengers of the nervous system when an action potential reaches the end of the axon at the presynaptic terminal, a neurotransmitter is released and travels across the synaptic cleft to bind to receptors in the post synaptic neuron dendrites or cell bodies can be excitatory or inhibitory

promote urinary elimination

children with myelomeningocele often have bladder incontinence, though some may achieve normal urinary continence the infant should have the first void in 24 hours and should be prepared to cath the infant then level of lesion will influence the amount of dysfunction they have loss of control over voiding spastic is hyper-reflexive and yields frequent release of urine, but with incomplete emptying hypotonic is flaccid and weak and becomes stretched out, but can hold very large amounts of urine, resulting in continuous dribbling of urine urinary statsis and retention occur in both the child is at risk for urinary infection and reflux goal is to promote optimal urinary continence and prevent renal complications clean intermittent cath to promote bladder emptying. children with normal intellect usually learn to do this themselves around 6 to 7. meds such as oxybutynin to improve bladder capacity for spastic bladder recognition of infections promptly surgery such as a continent reservoir or vesicostomy

other manifestations

chills n/v fatigue photophobia blurred vision anorexia hunger abdominal cramping diarrhea facial pallor sweating stiff neck, tender unilateral, throbbing pain after the scalp is tender, deep aching is present pt is exhausted.

teaching female self catheterization

clean, not sterile technique. Wash hands before the procedure and gently clean urinary meatus with soap and water attempt to void. if urine is not sufficient quantity, at least 100 mL, or cannot void at all, do self cath while sitting on the wheelchair/commode, locate urethra. Visualize urethra by mirror or palpate with fingertip lubricate the meatus with a soluble lubricant take a deep breath and insert the catheter tip 5-7.5 cm or until urine flows. (2-3 inches) hold cath securely and allow urine to drain until flow stops. withdraw cath and wash with soap and water. Store in clean, air tight container

nursing management

comfort measures to reduce pain and fever. can be managed at home if neuro is stable and they are tolerating oral intake

assessment

common signs and symptoms: irritability lethargy poor feeding vomiting headache c/o in older child altered or diminished LOC

syringomyelia

complication of spinal cord tumors involving formation of a fluid filled cystic cavity int he central intramedullary gray matter causing pain, motor weakness and spasticity

spinal cord tumors can cause

compression, invasion, or ischemia and can destroy the cord

diencephalon

conducts sensory and motor impulses regulates autonomic nervous system **regulates and produce hormones mediates emotional responses

neural tube defects

congenital deformities of the brain and spinal cord caused by incomplete development of the neural tube, the embryonic structure that forms the nervous system second most common birthd efect contributing to infant death and disability serious birth defects of the spine and the brain and include spina bifida occulta, myelogminingocele, meningocele neural tube closes between the 3 and 4th week in utero caused by drugs, malnutrition, chemicals and genetics. believed that maternal preconception supplementation of folic acid can decrease the incidence. all women of childbearing age should take 0.4mg. maternal screening of afprotein and ultrasound can help identify fetuses at risk

parasympathetic nervous system

constriction of pupils stimulation of glandular secretions decreased heart rate vasoconstriction of coronary arteries constriction of the bronchioles increased peristalsis and secretion of GI fluid

continuity of care

control pain so that the patient can maintain ADLs, rather than reach a pain free state refer to PT for proper body mechanics and back strengthening exercises

primary signs

could be a slight limp all the way to severe motor and neurologic impairments. primary signs: motor impairments such as spasticity of muscle weakness and ataxia (lack of coordination of muscle movements during voluntary movements such as walking or picking up objects), can lead to contractures due to stiffness, abnormal posturing. Can see more weakness on one side of the body=hemiparesis/plegia, abnormal muscle tone

diagnosis of spinal cord tumor

ct xray MRI myelogram LP will demonstrate CSF with a xanthochromic appearance (having a yellow color, elevated protein, few to no cells, and immediate clotting=Froin's syndrome

nursing assessment

current mobility status and changes in motor abilities Genitourinary function and regimen bowel function and regimen s/s of urinary tract infections hx of hyrocephalus with presence of shunt s/s of shunt infection and malfunction latex sensitivity nutritonal status, weight changes any changes in physical or cognitive resources available and used by family visible external sac protruding from spinal colum is the sac intact ass neru status and associated anomalies ass for movement of extremities and anal reflex to assess level of neurologic involvment. flaccid paralysis, absence of deep tendon reflecs, lack of response to pain, skeletal abnormalities like club feet, constant driblling of urine, and a relaxed anal sphincter may be found

CSF

cushion structures of CNS aids in exchange of nutrients removes waste the amount that is circulating is static, it is always a constant amount with normal functioning csf amount ranges from 80-200mL

quadriplegia

damage to neural structures int he crevical area of the cord, resulting in loss or impairment of motor and sensory function in arms, trunk, legs, and pelvic organs

abonormal posturing for patients who are unconscious

decorticate posturing decerebrate posturing both are bad signs

lower motor neuron damage

decreased muscle tone muscle atrophy fasciculations loss of reflexes

because the motor pathways cross at the junction of the medulla and spinal

decussation: strokes lead to loss or impairment of sensorimotor functions on the opposite side of the brain that is damaged. This effect is known as contralateral deficit means a stroke in the right hemisphere of the brain is manifested by deficits in the left side of the body

brain atrophies less functioning brain cells (neurons) decreased cerebral blood flow slower nerve conduction slower retrieval of info from long term memory slower response to changes in balance may exhibit less readiness to learn and depend on prior experiences to problem solve more easily distracted and loses ability to maintain attention metabolism slows down

delayed response to stimuli and slower reflexes, don't responds as quickly may require additional time to process and respond to verbal stimuli age related forgetfullness can be improved with memory aids and list risk for falls learning new skill is improved when they are r/t previously learned info when time limits set for learning are NO MORE than 30 minutes at a time

preop laminectomy

demonstrate logrolling, and explain will use this method for 1 to 2 days post op and then allowed to do so without assitance explain its important to take pain meds on regualr schedule and its important to ask for them before pain is too severe to control. Pain can last for several days or weeks after surgery demonstrate use of fractured bed pan and ask patient to practice explain the need to lay flat when eating demonstrate and teach deep breathing, IS, and leg exercises

chronic subdural hematomas

develop over weeks to months. seen often in older adults and people who have some brain atrophy with enlarged epidural space associated with minor trauma, fall or spontaneously in pt with bleeding disorder

epidural hematoma

develops int he potential space between the dura and the skill, which normally adhere to one another. As the blood collects, the expanding hematoma pulls the dura away from the skull. usually affects younger, because the dura in older adults is more tightly attached results from a skull fracture that tears and artery, often the middle meningeal artery. tend to develop rapidly LOC, then regain briefly, before LOC rapidly declines from drowsiness to coma as the hematoma expands, compressing brain tissue.

nutrition

difficulty eating and swallowing due to poor motor control of the mouth, tongue, and throat can see poor nutrition and problems with growth may need longer to eat may need to learn to maneuver the jaw when introducing solid foods special dies: soft or pureed, may make swallowing easier speech or OT can assist in working on strengthening swallowing muscles as well as assisting ind developing accommodations to facilitate nutritional intake. consult a dietician feeding tube or g tube may be placed

continuity of care

discuss home environment: -does pt have wheel chair? is there steps, doors, or carpeted floors that present physical barriers if a special bed is necessary, have arrangements been made to provide it psychologic support independent activities emergency alert system through local hospital or agency support group, career centers for job retraining coping skills for pt and caregiver

pathophysiology

disorder caused by abnormal development of, or damage to, the motor areas of the brain, resulting in a neurological lesion that causes a disruption in the brain's ability to control movement and posture some children may improve with growth, but may either plateau in their attainment of motor skills or demonstrate worsening of motor abilities because it is difficult to maintain the ability to move over time. caused by an anoxic event prenatally, natally, or postnatally. There was interference with oxygenation to the brain and affects movements.

basilar

drainage from ear and nose -put gauze under the ear/nose test drainage for glucose blood tinged drainage- will dry in halo/concentric circles if CSF -sterile gauze -no blowing nose -avoid coughing -sneeze all the way, don't hold it back meds: abx and steroids.

constipation

due to reduced mobility may become dependent on laxatives and enemas asses usual routine, diet, fluid, and use of laxative and enemas encourage 2.5-3 l a day increase fiber and bulk in diet, or consult about stool softeners or fiber meds

acute care focus

dxing the type and cause of the stroke supporting cerebral circulation controlling or prevention further deficits

nursing management of spina bifida occulta

educating the family inform presence and what the diagnosis means its not spina bifida cystica, more serious defect may have some pt to strengthen the weakness may eventually need surgical intervention due to degenerative changes or involvement of the spin and nerve roots resulting in teethered cord, syrinogmyelia, or diatematomyelia

dxing brain abcess

elevated pressure markedly, elevated protein, elevated WBC, normal glucose cat scan or MRI

Autonomic Dysreflexia

emergency elevate HOB (1st move, then call doctor) and remove compression stockings to induce orthostatic hypotension assess bp q 2-3 minutes while trying to find the stimuli that caused the response (full bladder, impacted stool, skin pressure) can cause a stroke, mi, dysrhythmia or seizure If bp stays dangerously high, doctor can prescribe hyperstat, diazoxide. can also use nifedipine (procardia), hydralazine (both vasodilate) or labetalol (slows heart) -watch for hypotension will have a line of demarcation

Autonomic Dysreflexia/Hyperreflexia

exaggerated sympathetic response that occurs in patients with SCI's at or above T6 only see after recovery from spinal shock mass reflex stimulation of the sympathetic nerves below the level of the injured cord area occur: massive vasoconstriction. Brady cardia and vasodilation above the level of the injury. this can be fatal triggered by stimuli that would normally cause abdominal discomfort, by stimulation of pain receptors and by visceral contractions: full bladder (most common) fecal impaction bladder infection/stones sex intrauterine contractions surgery pressure ulcers ingrown toenails dressing changes can occur months after the injury so families need to know what to look out for and how to prevent

acetylcholine

excitatory (ACh) broken down by acheylchlineineatrase cholinergic nerves -visceral -skeletal muscle -adrenal medulla

norephinerine

excitatory or inhibitory adrenergic nerves -alpha and beta receptors -heart -lungs -kidney -blood vessels -SNS target organs

efferent nerves

exit to the body motor nerves

anxiety

explain routine medical procedures including blood work and radiological reinforce, clarify, and repeat info encourage patient and family to verbalize feeling, questions and fears. Provide realistic info appropriate to their level of understanding review pt and family strengths and effective coping skills arrange for clergy to visit if desired provide preop teaching: -type of anesthesia and surgery time surgery will be and length of procedure and time in recovery where patient will be taken after surgery, possible tour the ccu and introduce them to who will be incharge where family can wait during surgery appearance of the patient after surgery, swollen, bruised eyelids and other facial features, large dressing over the head, partially of fully shaved head, trachestomy or ettube behavior of the patient after surgery, which will differ depending on the site of surgery, although cognitive and behavioral changes are common allow time for patient and family be together

parachute backward

extension with the arms when titled backward 9-10 months - persist

cluster headache

extremely severe, unilateral, burning pain located behind or around the eyes men 20-40, mostly occur in groups or "clusters" of 1-8 each day for several weeks or months followed by remission lasting months to years patho involves a vascular disorder, a disturbance of serotonergic mechanisms, a sympathetic defect or dysregulation of the hypothalamus. occurs in spring and fall, then disappear for awhile triggers are indvidualized and include alcohol, certain foods, smoking, high altitude and sleep cycle disturbances typically begins 2-3 hours after falling asleep, awakens the person, last 15-3 hours,

Glasgow Coma Scale

eyes, verbal, motor Max- 15 pts, below 8= coma eyes open: 4-spontaneous 3-to speech 2-to pain 1-no response best motor response (record best arm response) 6-obeys commands 5-localizes pain 4-flexion/withdrawl 3-abnormal extension (decortecate) 2-decerebate 1-no response best verbal response 5- oriented 4-confused 3-inappropriate words 2-incomprehensible sounds 1-no response if eyes are swollen closed, record that instead of a number, but document what you can

nursing assessment

fever flu like altered loc headache lethargy drowsiness weakness seizure check for recent travel, recreation activities that put them near vectors. animal contacts neruo exam to distinguish between encephalits and viral meningitis

nursing assessment

fever, ha, mailse, photophobia, poor feeding, nausea, vomiting, irritability, lethargy, neck pain, positive kernig and brudzinski

medication for acute stroke

fibrinolytic therapy (tPA) given concurrently with an anticoagulant is used for ISCHEMIC stroke. tPA bust the clot up and dissolves it. It must be given within 3-6 hours of the onset of manifestations after verifying with a CT scan that it was not a hemorrhagic stroke anitcoag drug therapy may be ordered for ischemic stroke: warfarin, heparin, enoxaprin. They do not dissolve an existing clot but prevent further extension of the clot and formation of new clots. Keeps it stable and allows the body to absorb it if the patient is being approved for tpa, blood pressure control is essential to decrease the risk of bleeding. If the bp is sustained at >185/>110 the patient cannot be treated with tPA patient with afib may go home on a beta blocker also. if its too late for tPA we will put them on heparin. They will start Coumadin a few days before going home to get to a therapeutic level before stopping heparin calcium channel blockers to reduce cerebral spasms mannitol to decrease ICP anticonvulsants and barbituates- seizures (dilatin, pheonbarbital) acute seizure- ativan to stop the procedure

Seizures

find out about body temperature, infection...check for febrile seizures can mean anything from a stare to a full blown tonic/clonic full body seizure. There are many different types of seizures. DONT NEED TO MEMORIZE! Know: if a patient has a history of seizure: what happen before, during and after the seizure. As the nurse, you need to know what to be on the look out for ask appropriate questions: the family/patient may not know what a seizure is or if they have experienced one. Ask "Have you ever or someone else ever observed any unusual sensations, behavior or movement?: If they say, "yes" get more information. If you witness the seizure: move the patient to the ground protect the head make sure the pt has an airway position on the side, helps airway stay open loosen tight clothes around neck call 911: if seizure last more than 5 minutes, recovery is slow, or there is an injury

Information to include when obtaining a health history

find out about vaccines (timelines) find out about infections any falls -what were you doing before you fell, where did you fall, did you hit anything Who witnessed it? All their information substance abuse/alcohol other meds taking present problems/illness communication might be difficult and other family might help, but we still need to hear from the patient and find a way to communicate with them so they can express things to us and understand us in return worry about the older adult hitting head, because the older adults brain atrophies and bleeding can go on for a while before we see symptoms.

brain injury

focal injury diffuse injury

sexual dysfunction

for men the higher the level of injury the greater the potential to have reflexogenic erections, although ejaculation or orgasm may not occur. Fertility can diminish due to lack of temp control. Men who have sacral level injuries do not have reflexogenic erections but may have psychogenic erections and more likely to remain fertile women with SCI usually do not have sensation during intercourse, but pregnancy is possible (can have autonomic dysreflexia during labor or birth) ask about sexuality while getting a history provide accurate info about the effect of the SCI on sexual function initiate a discussion with patient and partner of alternative means of sexual satisfaction refer to sexual counseling of local support group.

4 different lobes

frontal, parietal, occipital, temporal

arousal and cognition

full consciousness: alert; Orient to time. place, person; comprehends spoken word confusion: unable to think rapidly and clearly; easily bewildered, with poor memory and short attention span, misinterprets stimuli, judgment is impaired disoriented: not aware of or not oriented to person, time, or place obtundation: lethargic, somnolent; responsive to verbal or tactile stimuli but quickly drifts back to sleep Stupor: generally unresponsive, may be briefly aroused by vigorous repeated , or painful stimuli may shrink away from or grab at the sourse the stimuli semicomatose: does not move spontaneously' unresponsive to stimuli, although vigorous or painful stimuli may result in stirring, moaning, or withdrawal from the stimuli, without actual arousal coma: unarousable; will not stir or moan in response to stimuli, may exhibit non purposeful response to light, but makes no attempt to withdrawal deep coma: completely unarousable to any kind of stimulus, including pain

manifestations of spinal cord tumor depend on the anatomic location, level of occurrence, type of tumor, and spinal nerves involved.

general manifestations: pain (first) caused by compression of spinal cord motor/sensory deficits change in bowel and bladder elimination changes in sexual function

patients with head issue or trauma

get a good hx talk to the person with injury talk to anyone who witnessed what happen what happen right after the injury

nursing managment

give abx asap after cultures steroids to reduce inflammation supportive measures to ensure proper ventilation, reduce the inflammatory response, and help revent injury to the brain. reduce ICP, maintain perfusion, treat fluid volume deficit, controll seizures and prevent injury. isolation precautions (droplet), for 24 hours after abx

only certain things can get from the blood vessel to the brain due to the blood brain barrier

glucose lipids some amino acids water carbon dioxide oxygen

afferent nerves

go to the brain sensory nerves

Brain tumor

growths of abnormal cells in brain tissue, meninges, the pit gland or blood vessels. can be primary or secondary (metatstatic) potentially lethal because the growth within a closed cranial vault and displace or impinge on CNS structures

manifestations of intracerebral hematoma

ha decreasing LOC hemiplegia dilation of the ipsilateral pupil IICP herniation can occur

optisthotonic postion

head and neck are hyperextended to relieve discomfort

Assess the maternal

health prenatal care

complications of endarterectomy

hemorrhage-assess dressing and the area under neck and shoulders for drainage. Assess for increased pulse and decreased bp (the most common cause of respiratory problems is pressure on trachea from a hematoma). observe for tight dressing can cause a stroke respiratory distress- assess resp rate, rhythm, depth, effort. Observe for restlessness. Keep a trach tray at the bed side cranial nerve impairment-observe and record any facial dropping, tongue deviation, hoarseness, dysphagia, or loss of facial sensation. hypertension/hypotension- take and record blood pressure at least hourly. Report any changes immediately and implement orders for medication to tx hypertension or hypotension. messing with the carotid receptor baroceptors

reduce fever

hyperthermia increases metabolic rate and dehydration. reducing fever is important to help maintain optimal perfusion by reducing metabolic needs of the brain administer antipyretics like acetaminophen or NSAIDs, reduce environmental temp and use cooling blankets, fans, cold compresses, avoid shivering it increases heat production

nursing managment

if the skin covering the sac is intact and the child has normal neurologic functioning, surgical correction may be delayed immediately report any evidence of leaking cerebrospinal fluid to ensure prompt intervention to prevent infection prevent rupture of the sac, prevent infection, provide adequate nutrition and hydration. monitor for s/s of constipation or bladder dysfunction that may result due to increasing size of lesion. resulting hydrocephalus has been associated with some cases of meningocele. monitor head circumference

motor responses

in altered LOC, motor responses to stimuli range from an appropriate response to a command to flaccidity. being able to squeeze a hand to brushing examiners hand away from the face to withdrawal and grimacing, to less purpsoseful

palmar grasp reflex

in response to stroking a baby's palm, the baby's hand will grasp. This reflex lasts a few months 4-6 months

Treating stroke goal

increase or improve blood flow

upper motor neuron damage

increased muscle tone hyperactive reflexes decreased muscle strength decreased coordination defined muscles, that are quick, but not strong or coordinated

plantar graps reflex

infant reflexively grasp with bottom of foot when pressure is applied to plantar surface birth to 9 monhts

shunt complications

infection obstruction need for revision as kid grows

Bacterial memingitis

infectious disorder of the neurologic system infection of the meninges, the lining that surrounds the brain and spinal cord. see edema and IICP can lead to brain damage, deafness, stroke, even death in developed countries, disease resulting from Haemophilius influenzae type B, once the most common cause of meningitis in children, has decreased dramatically since the introduction of the Hib vaccine. it's still a concern in less developed countries. prevnar can help protect from pneumococus close contact living is a risk (college and military recruits), otitis media, mastoiditis, immunosuppresion, day care attendance causes inflammation, swelling, purulent exudates, and tissue damage to the brain can occur secondary to URI, sinus infections, ear infections, or through a LP, skull fracture, or head injury, neurosurgery, congential abnomalities, or presence of foreign bodies (shunt or cochlear implants), basal skull fracture (due to leaking of CSF) rapidly progressing disease. adults to not have much room to accommodate swelling. for IICP: position with head of bed up, use glascow scale to check loc, not straining (bowel movements, blowing nose), keep head in neutral postion, quite subdue environment, cluster care, gentle handling, v/s, neuro checks frequently. could be on fluid restrictions (monitor I and O), seizure precautions.

encephalitis

inflammation of the brain and can cause inflammation of the meningis a rare complication and can be caused by protozoan, bacterial, fungal, or viral invasion common causes enteroviruses, poliovirus and coxsackievirus, herpes simplex virus 1 and 2, vector borne virus recovery may be in a few days or may involve severe neurologic damage with residual effects

Imparied physical mobility

injuries above t12 experience involunatry spastic movements of skeletal muscles. These reach peak about 2 years after the injury and then subside perform passive ROM for all exteremites at least 2 times a day. identify stimuli that cause spastic movements and remove the stimuli or teach patient to expect the movement turn q 2 hours, assess pressure points once a shift, use special bed asses the lower extermities for manifestations of DVTs: redness, swelling, heat and increased circumference. remove sequential for at least 30-60 minutes a shift and assess for skin integrity

manifestations of SCI

injuries to the spinal cord have the potential to affect movement, perception, sensation, sexual function, and elimination

spinal fusion

insertion of wedge-shaped piece of bone or bone chips between vertebrae to stabilize them. bone is usually harvested from the ileac crest). can also use a BAK (a hallow titanium cylinder with holes) which is packed with grafted bone where a disk is removed.

physical assessment

inspection palpation percussion (reflex hammer)

ineffective protection

internal shunts: avoid pressure on the shunt, reservoid, or tubing, pump the shunt if prescribed for external: avoid kinks in tubing, and maintain the drainage collecting device and patient's head at the prescribed levels

cerebrum

interprets input from the senses **controls voluntary movement process intellect and emotions contains memory skills

risk for infection

intracranial surgery is at risk for infection from multiple invasive lines, the scalp wound, and risk of introduction of bacteria into the operative area monitor for leakage of CSF: presence of glucose in clear drainage from ears, nose, or wound, constant swallowing, something dripping down my throat. provide intervention to prevent contamination of the area leaking CSF: -from nose: keep hob elevated 20 degrees, don not suction, don not clean nose, tell patient not to put finger in the nose, no packing. -if ear: position patient on side of leakage. do not clean ear, tell patient not to put finger in the ear, do not insert packing place sterile dressing over the area of drainage and change as soon as it becomes damp. INDICATES A BREAK IN THE DURA AND INCREASE THE RISK OF AN ASCENDING INFECTION. SURGERY MAY BE NECCESSARY TO REAPIR THE BREAK, HOWEVER, THE LEAK USUALLY HEALS SPONTANEOUSLY IN 1 WEEK. monitor and report infection v/s assess iv site for redness, swelling, drainage, pain assess scalp for wound redness, swelling, bulging, drainage and pain assess for meningitis: fever and chills, increaseing headache, neck stiffness, kernigs and brudzinskin, photophobia watch WBC implement interventions to prevent infection -strict aseptic technique when changing dressing and caring for wound drains and ICP monitor lines keep patient's hand away from drains and dressings, use mitten restraints if necessary administer prescribed abx

classic cerebral concussion

involves diffuse cerebral disconnection from brainstem RAS. an immediate loss of consciousness occurs (less than 6 hours) retrograde and antegrade amnesia occur contusions may be present brief seizure and respiratory arrest may occur transient pallor bradycardia hypotension can develop most concussion syndrome

the patient in the ED with a suspected or identified SCI

is also tx for respiratory problems paralytic ileus atonic bladder cardiovascular alterations patinet with a cervical injury in respiratory distress is put on a ventilator oxygen is giving to the thoracic injury nasogastric tube hooked to wall suction will help paralytic ilieus indwelling catheter is inserted to prevent over distention of atonic bladder cardiovascular status is maintained using telemetry and invasive monitoring devices: art lines, pulmonary artery cath.

spinal shock (neurogenic shock)

is the response of the cord to the injury. Begins immediately after the transection/injury of the spinal cord. temporary loss of reflex function below the level of the cord injury at the cervical and upper thoracic spinal cord parasympathetic function is unopposed flaccid paralysis loss of skin and deep tendon reflexes loss of sensation below the injury loss of urinary bladder tone (dilation) intestinal peristalsis decreased persiperation decreased vascular motor tone decreased see **hypotension (muscle not using blood) **bradycardia (50-70) warm, flushed skin and body temp that responds to the environment vasodilation bardaycardia hypotension flaccid paraylsis bowel and bladder dysfnction inablity to regulate body temp lack of perspiration loss of sensation

If a person has a spinal cord injury we open airway

jaw thrust then do rescue breaths 1 to 5. watch the chest to make sure it is rising. Make sure you don't breath to hard to crazy into the mouth--can cause patient to throw up

impaired swallowing

keep patient free from aspiration with clear lung sounds and temp in normal range monitor results of swallowing study prior to giving oral food or fluids the nurse should feed the patient the first time after a swallow study clears the patient to make sure the patient will not aspirate when eating, do the following to avoid aspiration and ensure safety: -upright sitting postion with neck slightly flexed -order pureed or soft food. liquids should be consistency of honey -feed or teach patient to put food behind the front of the teeth on unaffected side of mouth tilting the head slight back -assess for coughing with eating or drinking -have suction equipment at bedside -check for pocketing of food in affected cheek -monitor lungs -minimize distractions, and give step by step instructions

surgery

laminectomy cyber knife- painless, noninvasive tx that delivers high doses of precisely targeted radiation to destroy tumors while minimizing damage to healthy tissues radiation therapy- emergency basis to tx the patient with neurologic deficits, reduce pain, to take as much of the tumor as possible. can cause radiation induced myelopathy to develop. occurs over time to exposure to radiation Brown-Sequared syndrome manifestations: weakness or paralysis on one side of the body and loss of sensation on the opposite side. Develops 12-15 months after therapy. Can progress to paraplegia, sensory loss, and loss of bowel and bladder

surgery

laminectomy spinal fusion foraminotomy intrdiscal electrothermal therapy microdiskectomy

Meninges

layers of protective tissue that line the cranial cavity and vertebral canal -dura matter (a double layer) -arachnoid matter (subaranchnoid space) -pia matter These are potential spaces. Normally, something should not between the layers, but injury or trauma can cause things to get in the layers: blood, infection

meningocele

less serious from of spina bifida cystical occurs when meninges herniate through a defect in the vertebrae spinal cord is usually normal and there are typically minor or no associated neruological deficits. tx involves surgical correction of the lesion

promote adequate nutrition

less than body requirements is the concern related to the restriction on positioning of the infant before and after surgery in another nursing concern assist family to help assume as normal feeding postion as possible risk of rupture pre op may be too high to warrant holding. The infant's head can be turned to the side or they can be placed int he side-lying position for feeding If the infant is held special precaution is taken with the sac or post op incision encourage parent interaction as much as possible by talking and touching. if mom wants to breast feed assist as much as possible. If the infant can be held, encourage her, or assist in pumping and saving breast milk and giving in bottle. provide education and support, and modeling for the parents

providing support and education for cp

lifelong disorder frequent hospitalization and surgeries, which can strain family and finances. encourage respite care and provide support and encouragement. meaningful education programs that emphasize independence in the least restrictive education environment education services, support groups, easter seals, children younger than 3 to early intervention. safety issues respiratory infection awareness, their susceptibility is greater the child needs opportunities to reach their milestones. may need aides for their mobility so they can explore pay attention to other kids and give them attention too. discpline is important and will help the child reach developmental milestones

risk factors for storkes

lifestyle ethnicity diseases HYPERTENSION (taking meds on and off can cause rebound HTN) sickel cell a fib DM (increased BS is irritable to vessels and cause platelets to come to the irritated vessel) hyperlipemia sleep apnea smoking substance and alcohol(get afib early) TIA/previous stroke family history obesity sedentary lifestyle recent viral/bacterial infections Oral birth control pregnancy childbirth menopause migranes with aura autoimmune hormone replacment clotting disorders

chemotherapy

limited due to blood brain barrier can use intraventricular method of med admin uses an Ommaya reservoir that is surgically implanted into a lateral ventricle of the brain biodegradable anhydrous wafer, which are impregnated with a chem drug, may be implanted into the tumor at the time of surgery as another option. oral meds (Temodar) is used for palliative therapy for glioblastoma

skull fractures

linear, depressed, basilar

post concussion syndrome

lingering symptoms from a concussion that last for an extended period of time persistant HA dizziness irritability and insomnia impaired memory and concentration, learning problems

subdural hematoma

localized mass of blood collects between the dura mater and the arachnoid mater....more common. usually at top of head develop within 48 hours of head injury

dxing

lp fluid pressue will be measured. CSF will reveal increased WBC and protein and low glucose CBC will be elevated blood, urine, and nasopharyngeal culture to look for source of infection and to rule out sepesis

dxing

lp for csf will show an elevated leukocyte count and elevated protein and glucose levels. mri ct eeg diagnosed brain biopsy

Post op laminectomy

maintain a position that minimizes stress on the surgical wound cervical laminectomy: elevate the hob slightly position small pillow under neck maintain the postion of the cervical collar lumbar laminectomy: keep the bed flat or elevated the hob slightly place a small pillow under the head place a small pillow under the knees, or use a pillow to support the upper leg when the patient lies on one side turn q 2 hours, using logroll technique. Teach the patient not to use the side rails to change position. Maintain proper body alignment in all positions monitor for signs of nerve root compression: -a. cervical laminectomy: assess hand grips, arm strength, ability to move the fingers, and ability to detect touch -b. lumbar laminectomy: assess leg strength, ability to wiggle the toes, and ability to detect touch compare bilateral findings. Report muscle weakness or sensory impairment to the doctor assess for hematoma formation as manifested by severe incisional pain unrelieved by analgesics and a decrease in motor function. report these findings. assess for leakage of CSF. assess dressing for increased moisture. Check the sheets for wetness when the patient is lying supine' check for clear liquid running down the back when the patient is sitting or standing. Gently palpate edges of wound to detect a bulge. use dextrostix strip to assess leakage for the presence of glucose assess nerve root injury. assess the ability to dorsiflex the foot (lumbar laminectomy) and grip strength (cervical laminectomy). Assess the patient with a cervical laminectormy for hoarseness and ability to swallow assess for urinary retention. Should void within 4-6 hours. If allowed, let man stand to urinate. Compare I and O for each 8 hour period. use a bladder scanner for residual urine assess pain. use analgesics or regular basis or teach use of PCa assess for infection with V/S q 4 hours, report increased body tiemp. Assess the wound and dressing for signs of infection including erythema, purulent drainage, and pain. sterile technique when changing dressing. encourage deep breathing and the use of incentive spirometry q 2 hours, **coughing may be discouraged increase mobility as prescribed. Patients will advance to sitting on side of bed dangling their legs evening of or first day after. Most patients ambulate the first postop day. The help patient out of bed, first elevate the head of the bed. Then bring the patient's legs over the side of the bed at the same time that the upper body moves into the upright postion. Patients should only ambulate without assistance if there is no dizziness or weakness.

impaired physical mobility

maintain and improve function abilities by maintaining normal function and alignment, preventing edema of extremities, reducing spasticity and to prevent complications Encourage active ROM exercises for unaffected extremities and passive for affected q 4 hours during day and evening shift and one during night. Support the joint during passive. Turn q 2 hours around the clock, following a posted schedulefor side to side, and supine-to-prone changes (verify prone with the physician). maintain body alignment and support extremities in proper position with pillows (both active and passive exercises increase venous return and decrease the risk of thrombophlebitis) monitor the lower extremities each shift ofr thrombophlebitis. Assess for increased warmth and red in calves, measure circumference of calves and thights. provide care for sequentials

nursing management of hydrocephalus

maintain cerebral perfusion minimize neurologic complications maintaing adequate nutriton promote growth and development support and educate the child and family for surgery: clear instructions from doctor on how to postion after surgery -not on affected side -lay flat for specific period to prevent too much drainage incision behind ear and near the belly button into the peritoneum, will pass through the peritoneal membrane into the circulation

halo fixation device

maintain integrity of the halo device: -inspect pins and traction bars for tightness, report loose pins to doctor -tape the appropriate wrench to the head of the bed for emergency -never use the halo ring to lift or reposition the patient assess muscle function and skin sensation every 1 hour in the acute phase and q 4 hours after -0-5 scale for muscle contractions. 5 being normal muscle strength and full ROM -assess sensation by comparing touch and pain, moving from impaired to normal areas, and testing both sides of body monitor pin sites each shift and follow policy for pin care daily for the first 48-72 hours and then weekly -assess for edema, redness, odor, drainage -clean each pin site with a sterile applicator dipped in sterile solution, using one applicator per stroke in circular motion, moving away form the pin, remove crust -apply topical abx and cover with sterile 2 inch splint gauze squares maintain skin integrity -turn immobile pt q 2 hours -inspect skin around edges of vest q 4 hours -change the sheepskin liner when it is soiled and at least once a week

most spinal cord injuries are

males between 16-30 most due to MVA's scar tissue won't let impulses go up or down the spinal cord there is likely pain, even though the sensory nerves are disturbed.

narcotics

mask changes in eye signs and depress respirations

sensory-perceptual deficits

may alter the ability to integrate, interpret, and attend to sensory data. may experience deficits in vision, hearing, equilibrium, taste, and sense of smell. The ability to perceive vibration, pain, warmth, cold and pressure may be impaired, as well as proprioception. These all increase the RISK OF INJURY Hemianopia agnosia apraxia neglect syndrom

concussion

means violent shaking temporary axonal disturbances, momentary interruption of brain function. associated with immediate, brief loss of consciousness on impact....can last seconds to several hours can see ante grade and retrograde amnesia loc is no longer than 5 minutes HA drowsiness, confusion, diziness visual disturbances (diplopia, blur) seizure activity with transient apnea, bradycardia, pallor and hypotension

lumbar puncture

measure CSF Pressure and to obtain a sample of CSF for diagnosis. A needle is inserted in L3-l4 l4-l4 and fluid is aspirated have patient void assess and document v/s collect sterile tray, and antiseptic solution, local anesthetic, sterile gloves, and tape label test tubes 1, 2, and 3 place pt on side in fetal postion with back bowed, head flexed on the chest, and knees drawn up to the abdomen assist doctor with procedure following the LP: asses document v/s monitor for neurologic changes (fever, htn, irritability, lower extremity numbness/tingling, nonreactive pupils) administer analgesic for HA Instruct patient to lie flat in bed for 4-8hours monitor puncture site for leakage or cerebrospinal fluid or hematoma formation encourage fluids 3 L

tx for AV malformation

meds to control bp and prevent seizures avoid activites that can increase BP or cause injury surgery if bleed: surgical excision, vascular occlusion and radiosurgery

microdiskectomy

microsurgical procedure performed on the spine to remove bony fragments or disk material that may be causing neural impingement

situation low self esteem

might see depression, anger, or sexually overt statements by the patient after the injury encourage talking about all aspects of physical function and care encourage self-care and independent decision making help identify strategies to increase independence in desired roles, both short and long term goals and discuss assistive devices include family members and important others in discussions refer the patient and family to support groups for psychologic counseling

headaches

migraine, cluster, tension

on discharge

monitor for IICP change in LOC lethargic hard to arouse nausea/vomiting call the doctor

decreased intracranial adaptive capacity

monitor for IICP (eye opening response, motor response, and verbal response) watch v/s: bradycardia/tachycardia, varying breathing patterns, jtn, widening pulse pressure monitor for vomiting, ha, lethargy, restlessness changes in mentation monitor temp and initiate hypothermia tx prescribed (hyperthermia increases ICP) monitor fluid status and compare intake and output, review serum osmolality, use an infusion pump

ineffective airway clearance

monitor neurologic manifestations or a regular schedule (shows IICP) maintain head and neck in neutral alignment, immobilized until injury is determined clear the nose and mouth of mucus and blood suction the airway as needed, limited to 10 seconds at a time. do not suction until dural tear has been ruled out

depressed

more concern risk of brain tissue damage, risk of infection. Can press on the brain. bone is broken and pushed inward causing pressure on the brain surgery is often required to elevate the bony pieces and inspect the brain for injury

women with stroke

more likely to report nontraditional manifestations (disorientation, confusion, loc)

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges defect of the vertebral bodies in most cases has not adverse affects may complain of some weakness. need no immediate intervention, complications are rare, but can see thethered cord, syringomyelia, or diastematomyelia

viral meningitis

most common type usually affects younger than 5 cause by virus: enteroviruseslike echovirus and coxsackievirus. Can also be caused by mumps, herpesvirus, HIV, measels, varicella, flu, vector borne viruses not as serious as bacterial will see changes in glucose (down) and protein (go up) in LP

laniectomy

most often surgery. removal of a part of the vertebral lamina (bony arch on dorsal surface). relieves pressure on the nerves and is combined with removal of the protruding nucleus pulposus. diskectomy is removal of the nucleus pulposus of an intervertebral disk

care for brain injury

most people with mild will go home after observation for 1-2 hours in ED, sent home to watch for maifestations of seondary injury if LOC was longer than 2 minutes, will be staying overnight Acute TBI injuries require care at a trauma center require fluids to tx hypotension, keep mean above 90 hypertonic saline best because it reduces IICP ABC's are assessed and managed ICP montior with probe to reduce cerebral edema and maintain perfusion to brain mannitol may be administered Oxygenation is vital to prevent carbon dioxide from vasodilating the vessels.

myelomeningocele

most severe form of spina bifida in which the spinal cord and meninges protrude through the spine spina bifida cystica can be diagnosed in utero through ultrasound increased risk of meningits, hypoxia and hemorrhage spinal cord often ends at the point of defect, resulting in absent motor function beyond that point

spinal cord injury

most spinal cord injuries involve damage tot he vertebrae and supporting ligaments as well as the spinal cord itself. neuronal injury leads to loss of reflexes below the level of injury. microcirculation to the cord in impaired by edema and hemorrhage, causing the release of norepinephrine, serotonin, dopamine, and histamine. vasospasms occur. when ischemia is prolonged, necrosis of both gray and white matter begins within a few hours, and within 24 hours the function of nerves passing through the injured area is lost Edema extends the level of the injury for two cord segments above and below the affected level, the extent cannot be determined for up to 1 week. Tissue repair occurs over 3-4 weeks

abducens

motor 3, 4, and 6 Assessed together (oculomotor, trochlear, and abducens) Assess extra ocular movements by asking the patient to follow your finger as you write an "H" in the air Assess PERRL (pupils equally round and reactive to light) by covering one eye at a time and shining a pin light into the uncovered eye. Assess for ptosis Extraocular movements should be present bilaterally, and pupils should be equally round and reactive to light (constrict). Eyelids should not droop nystagmus can indicate strokes constricted pupils are associated with stroke or med/drug use ptosis indicates strokes, bells palsy, myasthenia gravis.

oculormotor

motor 3, 4, and 6 Assessed together (oculomotor, trochlear, and abducens) Assess extra ocular movements by asking the patient to follow your finger as you write an "H" in the air Assess PERRL (pupils equally round and reactive to light) by covering one eye at a time and shining a pin light into the uncovered eye. Assess for ptosis Extraocular movements should be present bilaterally, and pupils should be equally round and reactive to light (constrict). Eyelids should not droop nystagmus can indicate strokes constricted pupils are associated with stroke or med/drug use ptosis indicates strokes, bells palsy, myasthenia gravis.

trochlear

motor 3, 4, and 6 Assessed together (oculomotor, trochlear, and abducens) Assess extra ocular movements by asking the patient to follow your finger as you write an "H" in the air Assess PERRL (pupils equally round and reactive to light) by covering one eye at a time and shining a pin light into the uncovered eye. Assess for ptosis Extraocular movements should be present bilaterally, and pupils should be equally round and reactive to light (constrict). Eyelids should not droop nystagmus can indicate strokes constricted pupils are associated with stroke or med/drug use ptosis indicates strokes, bells palsy, myasthenia gravis.

accessory, spinal

motor assess the patient's ability to shrug the shoulders and turn head to each side against resistance of your hand observe symmetry and strength of muscles can't assess if the patient had radical laryngectomy

hypoglossal

motor assess the patient's ability to stick out the tongue and move the tongue from side to side against resistance of a tongue depressor

spinal cord disorders affect

movement sensation perception sexual function elimination

dx miningocele

mri ultrasound

activity mobility

need to get around in their environment to achieve developmental milestones. Movement is the primary problem. might have physiotherapy pharmacologic management surgery PT/OT meds and therapy help facilitate rom, to delay or prevent deformities like contracures, to provide joint stability, to maximize activity, and to encourage the use of adaptive devices The nurse should provide ongoing follow through with the prescribed exercises, positioning or bracing. assess skin integrity for cast or braces pain management may also be necessary help with botulism procedure and provide education and support helping with the test dose of baclofen and providing preop and postop teaching if a pump is placed.

for all pathways to function

nerve cells must be intact for function

neuroglia

neuroglia, are non-neuronal cells in the central nervous system (brain and spinal cord) and the peripheral nervous system.They maintain homeostasis, form myelin, and provide support and protection for neurons.

sympathetic division

norepinephrine is the primary neurotransmitter handles situations perceived as stressful or harmful and to participate in strenuous activity dilated pupils inhibited secretions copious diaphoresis increased rate and force of heartbeat vasodilator coronary arteries dilate brochioles decrease digestion increase release of glucose by liver decrease urine output vasoconstriction of arteries vasoconstriction of abdominal and skin blood vessels increased blood clotting increased metabolic rate increased mental alertness

PTT (partial thromboplastin time) aPTT

normal = 60-70 seconds; on heparin therapy goal is 1.5 - 2.5 times this heparin therapy: 120-140 Normal aPTT: 30-40 seconds therapy is 1.5-2 times the amount heparin therapy: 60-80 heparin: protamine sulfate is the antidote

INR is for WARFARIN and should be

normal INR is around 0.8- 1.1 2-3 for a therapeutic level is needed for coumadin normal INR for someone on Coumadin is 2-3 vitamin k is the antidote

hydrocephalus

obstruction of drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure and enlargement of the head the ventricles enlarge and increase ICP can be congenital or acquried congential is present at birth and due to genetics or environmental influence prognosis depends on the cause and weather brain damage is present. these kids are at increased risk of developmental disabilites, visual problems, memory issue, and reduced intelligence

hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed, or intracranial hemorrhage two types: intracerebral hemorrhage and subarachnoid hemorrhage. intracerebral: usually seen in older adults with sustained increase in bp. Occurs suddenly usually when person is engaged is some activity. subarachnoid hemorrhage is common in younger people. usually this stroke is caused by HYPERTENSION, but can also do to brittle plaque encrusted artery wall, ruptured aneurysms, trauma, erosion of blood vessels by tumors, av malformations, anticoag therapy. Most fatal type of stroke blood enters the brain tissue, causing cerebral edema and irritates the meninges and brain tissue causing an inflammatory reaction and impairing absorption of cerebral spinal fluid. manifestations: rapid vomiting HA seizures hemiplegia LOC increased ICP

paraplegia

occurs with damage to nerual structures in thoracic, lumbar or sacral area of the cord, resulting in loss or impairment of motor and or sensory function in the trunk, legs and pelvic organs

meds for SC tumor

opioids for pain and edema steroids to control edema

Medications of IICP

osmotic diuretics: -mannitol -urea -glucose Loop diuretics- lasix ethacrynic acid

lumbar disk manifestations

pain in lower back, recurrent episodes usually radiates across the buttock and down the posterior leg, this is called sciatica. can be increased by sneezing or coughing results from pressure on L4, L5, S1, S2 (where the sciatic nerve arises) feels pain when lifting one leg while dorsiflexing the foot of that leg. it ranges from mild to excruciating is aggravated by variety of positions, activities, including sitting,s training, coughing, sneezing, climbing stairs, walking, riding in a car. Prolonged sitting and climbing of stairs are especially painful will see postural deformity, motor, sensory deficits, reflex changes when standing pt has slight forward tilt to the trunk, scoliosis of the lumbar spine, slight flexion of the hip and knee on affected side and muscle spasms see weakness and maybe some sexual function and urinary elimination problems Knee and ankle reflexes are decreased or absent

long term complications of mylemeningocele

paralysis, orthopedic deformities, bladder and bowel incontinece. neurogenic bladder (increases the risk or UTI, pyelonephritis and hyronephrosis) accompanying hydrocephalus, also a big risk for meningitis. Birth can cause trauma to the sac usually require multiple surgeries, risk for developing a latex allergy. learning problems and seizures are comon most have average intelligence ambulation may be possible depending on the level of the lesion

complications of SCI

paraplegia quadraplegia autonomic dysreflexia ineffective respirations (dependent on where cord injured) altered skin integrity increased risk of thrombosis alterations in bowel and urinary elimination and sexual patterns

Assess for brudzinski sign

patient lies supine, flex the head to the chest. Patient should experience no pain or resistance, or flexion of the knees and hips. this could be an indicator or meninegeal irritation

assess for Kernig's sign

patient lies supine, flex the knees and hips, then straighten the knee there should be no pain or resistance can see pain and resistance with Multiple sclerosis

rehabilitation

patients are frequently transferred to these settings for post stroke care for several weeks before being discharged to home. Physical therapy: can help prevent contractures and improve muscle strength and coordination. Exercise to help the patient learn to walk, sit, lie down, and change from one type of movement to another. OT: assistive devices and a plan for regaining lost motor skills that greatly improve quality of life after a stroke. Skills include: eating, drinking, bathing, cooking, reading, writing, and toileting Speech: improve swallowing skills as well as how to relearn language and communication.

children assessment

pay attention to child and parent interaction observe them at play watch hand preference- should not see one before 3 or 4 years of age. If you see one it could indicate a motor problem of CP. Speech- should be taking a lot. 3 year old, you should be able to understand 90% of what they say. (make sure they have opportunities to talk) can use a picture chart to assess sight. before kindergarten: will do a denver developmental tool, this test developmental milestones.

s/s of impending death

physical: decreased urine output and more concentrated, pulse increases and becomes weak or thready, decreased BP,mottling of skin, refuse to eat. slower respirations, Cheyne-stokes respirations and secretions begins to pool in lungs. lower body temp, gurgling, cold extremities. Psychosocial: closure with people in saying goodbye. Help pt to find comfort and support.

continutiy of care

postconcussion syndrome can occur notify the doctor if ha persist, dizziness, emotional, seems overly tired, difficulty paying attn or remembering some patients with acute injury will require lifelong care if they regain consciousness, others remain in coma or vegetative state. family should encourage self care and independance get lots of rest. dont' rush back avoid anything that can cause another blow or jolt to the head talk with doc about when it is safte to drive, ride a bike, or use heavy equipment take only prescribed drugs, and no alcohol write down things you have trouble remembering might need therapy to learn speaking, walking, reading. safety issues equipment needed: wheelchair bed vocational counseling and services

Decerebrate posturing

posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out, feet are plantar flexed; more ominous sign of brain stem damage. Most Severe.

manifestations of autonomic dysreflexia

pounding HA bradycardia flushing blurred vision diaphoresis above the lesion hypertension 240/120

surgery

preferred tx of primary tumors goal is to remove the tumor or provide symptom relief burr hole: hole made in skull with special drill. may facilitate the evacuation of an extracerebral clot, or a series of holes to do a craniotomy craniotomy: a surgical opening into the cranial cavity. a series of burr holes is made and the bone between the holes is cut with a caraniotome. Tumor is excised, and the bone flap is returned. In some cases the patient is awake during the craniotomy craniectomy: excision of a potion of the skull and complete removal of the bone flap. may be done to provide decompression after cerebral edema. Pressure on the brain structures is reduced by providing space for expansion carnioplasty: plastic repair to the skull in which synthetic material is inserted to replace the cranial bone the was removed. may be performed after a large cranectomy. the plastic restores the contour and integrity of the cranium MAKE SURE TO GET VERY CLEAR POSITIONING INSTRUCTIONS FROM THE DOCTOR FOR THE PATIENT FREQUENT NEURO CHECKS make sure drains work to decrease ICP (the vacuum is compressed) protect bone flap if open

health promotion

prevent injuries -wear seat belts -use approved booster and infant seats -workplace safety and farm safety for fall prevention and how to use heavy equipment safely

prevent infection for

prevent rupture or leakage of CSF keep sac from drying out and prevent trauma or pressure on sac use STERILE saline soaked nonadhesive gauze or abx soaked gauze to KEEP MOIST report seepage of clear fluid from lesion position prone or supported on side place in isolette to keep warm and avoid blankets which can put too much pressure on sac watch the radiant heat from isolette on the sac and drying it out keep the lesion free of feces and urine put a towel under the abdomen to prevent feces or urine place a piece of plastic wrap below the meningoele to prevent feces touching after surgery, place prone or side lying to allow the incision to heal.

health promotion for strokes

preventing strokes saves more lives than treating them stop smoking and drug use maintain a normal weight through diet and exercise can help reduce obesity, which increases the risk of HTN and type 2 DM have cholesterol checked regularly to monitor hyperlipidemia regular healthcare to monitor and treat cardiovascular disorders and treat infections such as endocartitis know the signs for TIA/stroke: weakness: sudden loss of strength or sudden numbness in the face, arm, or leg, even if temporary trouble speaking: sudden difficulty speaking or understand or sudden confusion, even if temporary vision problems: sudden trouble with vision, even temporary headache: sudden severe and unusual headache dizziness: sudden loss of balance, especially with any of the above signs

Stroke treatment is 3 stages

prevention acute care after the stroke rehab

linear fracture

probably will be no intervention bed rest and close observation, monitor for IICP

a brain injury can cause

problems with cognition, movement, sensation, and emotions

cerebellum

processes sensory input and coordinates movement output and balance

health promotion

proper body mechanics. teach for lifting and moving heavy objects should begin when children enter school. begin by spreading feet apart to broaden base of sport use large muscles of arms to lift and use legs to push if lifting postion body as close to object as possible before lifting or moving when lifting, bend knees and lift up and over center of gravity when lifting, use back support belt slide, roll, push, or pull and object rather than lift.

medications

prophylactic: beta blockers tricyclic antidepressants ergot alkaloids SSRI's calcium channel blockers treatment of acute headache sumatriptan (Imitrex) oral nasal subq if not getting relief can redose in 2 hours for oral and 1 hour for nasal and subq codine for acute attack anti emetics for acute clusters. suppository ergotamin tartrate at bedtime to prevent attack, 100% oxygen at 7L/min for 15 minutes to relieve cluster headache can also use lithium carbonate topirmate baclofen

Parachute (forward) reflex

protective extension with the arms when held up in the air and moved forward. The infant reflexively reaches forward to catch themselves. 6-7 months- persist

Parachute (sideways) reflex

protective extension with the arms when tilted to the side in a supported sitting position 6 months - persist

classifications of SCI

quadriplegia paraplegia

tension headache

r/t stress tight neck muscles head in a vice band around head on both sides brought on by fatigue and stress

triggers for migraines

rapid bg changes stress emotional excitement fatigue alcohol bright lights foods high in tyramine (red wine, cheeses, smoked meats, chocolate) menstrual cycle

myelogram

record of the spinal cord contrast is put in through LP and into the subarachnoid space. drink additional fluids day before test, and then stop 4 hours before the test No antipsychotics, antidepressants, or anticoags a few days before. No smoking day of the test. Assess iodine allergy. void before the test. after, supine with head slightly elevated for several hours, push fluids, watch for fever, excessive nausea/vomiting, severe headache or stiff neck monitor for CSF leakage or hematoma monitor neuro status and ensure voiding in 8 hours. analgesics for HA

carotid endarterectomy postop care

removes the artheroma (fatty plaque), but it can loosen the plaque and cause a stroke. will be in ICU for 24 hours position patient on the unoperated side and either maintain a flat postion or elevate the HOB 30 degrees as prescribed. Maintain head and neck alignment and avoid rotating, flexing, or hyperextending head. support the head when changing positions. Teach to support the head with the hands when able to move about. Assess respirations and oxygen sat.

continuity of care

report manifestations of: stiff neck, increasing HA, elevated temperature, new motor or sensory deficits, vision changes, or seizures safety measures for motor deficits, sensory deficits and lack of coordination, seizures and cognitive deficits. comfort measures for n/v and pain measures for communication if aphasia is present measures to improve vision if visual deficit how to buy wigs support groups

supporting and educating the family

requires lifelong follow up and regular evals will require future surgeries and hospitalizations activities and sports with head injury should be involved: No foot ball or wrestling. will need head shaved and might not want to admit having shunt issues, so help that patient with that give them opportunities to participate and learn just like any other child.

c1 though c4 injuries will have

respiratory complications

self care deficit

result of impaired mobility or mental confusion. Patient needs to provide as much care on own as possible to promote function and increase independence decrease feeling of powerlessness, and improve self-esteem. encourage use of the unaffected arm to bathe, brush teeth, comb hair, dress, and eat teach to put on clothing by first dressing the affected extremites and then the unaffected collaborate with OT for assistive devices

nursing assessment of meningocele

reveals a visible external sac protruding from the spinal area often see int he lumbar region, but can be anywhere on the spinal cord most are covered with skin and pose no threat to the child need assessment to ensure the sac covering is intact remains important assess neurologic function carefully before surgery will be assessed whether there is neural involvement associated anomalies.

diagnosis

rule out everything else EEG radiographs ultrasound MRI/CT screening for metabolic defects and genetic testing. might see abnormal areas but usually everything is ruled out.

assess the babinski reflex

run a tongue depressor up the lateral side of the foot and across to midline underneath the toes. Make an upside down "J". positive is abdnormal. This is if the big toe fans out and up (dorsiflex) negative is good. This is when the toes curl in and down (plantar flexion) UNDER 1: a dorsiflexion is a normal response

herniated intervertebral disk

ruptured disk, herniated nucleus pulposus, or slipped disk rupture of cartilage surround the intervertebral disk with protrusion of the nucleus pulposus. most common cause of low back pain and, affects 2/3 of people at some point

impaired urinary elimination

s2-s4 will have neurogenic bladder monitor for manifestations of a full bladder monitor for bowel sounds, bowel patterns, and stool consistency palpate the bladder about the symphysis pubis in the lower abdomen. voiding in small amounts can indicate a neruogenic bladder teach how to use trigger voiding technqieus prior to straight acth. stroke the inner thigh, pull on pubes, tap over the abdomen over the bladder, pour warm water on uvula. teach self cath to patients who will be able to carry out the procedure with minimal assistance monitor for residual urine through the bladder retraining program <80 mL after a triggered voiding is considered satisfactory monitor for elimination of frequent, small, liquid, foul smelling stools. institute bowel retraining: assess patterns of bowel elimination to establish best times. -maintain high fiber, high fluid use stool softeners as prescribed, suppositories ad enemas used 30 mins after meals to stimulate stronger peristalsis and facilitate evacuation maintain upright postion if possible and ensure privacy if unable to evacuate, digital stimulation or manual removal on a regular basis may be the most effective long term management.

optic

sensory Assess vision in each eye with Snellen chart. Then with both blindness can be seen with TIA's or strokes, and brain tumors. Double vision could indicate MS

acoustic

sensory assess ability to hear the ticking of a watch and whispered and spoken words in both ears use a tuning fork to assess ability of Rhinnes test. Put a tuning fork to the back of the mastoid after striking and see how long bone conduction last in compared to air conduction. kids should turn towards the voice to test hearing. air conduction should be longer than bone conduction. decreased hearing with deafness or strokes or tumors.

Olfactory

sensory Patient's ability to smell scents with each nostril. Should be equal in both anosmia (inability to smell) can mean lesions of frontal lobe

complications of stroke

sensory-perceptual deficits cognitive and behavioral changes communication disorders motor deficits elimination disorders these may be permanent, depending of the degree of ischemia and necrosis as well as time of tx. they also make it harder to get them home and causes many to go to rehab

brainstem

serves as conduction pathway serves as site of decussation (crossing) of tracts contains respiratory nuclei helps regulates skeletal muscles heart rate, respiratory, temperture

linear fracture

simple, don't worry about bone fragments or risk of infection or leakage of CSF. Can see hematoma. follows relatively straight line takes a great deal of force to break the skull for kids under 2 due to flexibility of immature skull. will deform a great deal before fracturing

physical assessment

size of the skull, any asymmetry, head circumference under 2. Any 2% deviation upward. brisk reflexes and spasticity of the lower extremites the infants skull can easily accomodate the extra fluid and expand because sutures have not closed. look for head circumference changes older child will have development loss and changes in personality infants fontanels may be wide open, bulging. They will be nonpulsatile and feel tense and very full positive macewen sign may be noted. cracked pot head sound when percussed.

dx

skull xray ct **mri

manifestations of chronic subdural hematoma

slowed thinking confusion drowsiness lethargy ha dilation and sluggish ipsilateral pupil poss. seizures

emergency tx of spinal cord injury

steroid protocols are often instituted using methylprednisolone (solu-medrol) if it can be give within 8 hours to reduce cord compression from edema and avoid secondary injury.

assessment

stiff neck photophobia headache fever, chills previous respiratory illness, sore throat rash irritability lethargy muscle rigidity seizures infants: weak cry, lethargy, vomiting, poor sucking and feeding, bulging fontanel, apnec spells, hypo or hyperthermic, may be consolable when lying still as opposed to being held positive brudzinskin and kernig signs abrupt eruption of a petechial or purplish rash older adults: confusion is the first sign, nucual rigidity, skin hemorrhages due to infection becoming systemic and causing inflammation in the veins.

tx

subdural hematomas can usually be reabsorbed. epidural hematomas choice tx is surgical evacuation through burr holes

treatments for stroke

surgery rehabilitation

therapeutic management

surgical closure as soon as possible after birth, expecially if a CSF leak is present or there is danger of the sac rupturing goal of surgery intervention is tor prevent infection and minimize further loss of function, which can result from stretching of nerve roots as the meningeal sac expands after birth until surgery the child is placed prone postion with legs flexed underneath the child to release tension on the sac

Foraminotomy

surgical enlargement of the intervertebral foramen through which the spinal nerves pass from the spinal cord to the body. Performed to relieve pressure and impingement of the spinal nerves

MAP pressure formula

systolic + 2(diastolic)/ 3

throacic nerves

t1-t12

cerebral palsy

term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by NONPROGRESSIVE abnormal brain function majority of causes occur before deliver, can also occur in the natal and postnatal period. most common movement disorder of childhood, lifelong and one of the most common cuases of physical disability in children

pupillary and oculomotor responses

the areas of the brainstem that control arousal are adjacent to areas that control the pupils. if a lesion is localized, you will see ipsilateral pupil effects (pupil on the same side of the lesion is affected) with generalized or systemic process, pupils are affected equally as the level of functional impairement progresses, the pupils become fixed and dilated. This is called blown pupils. in decreased LOC and coma, spontaneous eye movements is lost and reflexive ocular movements are altered. Doll's eye movements are reflexive movements of the eyes in the opposite direction of the head movement, they are an indicator of brainstem function. oculocephalic reflex, the eyes move upward with flexion of the neck and downward with extension of the necks. As brain function deteriorates this reflex is lost. They eyes fail to turn together and, eventually, remain fixed in the midposition as the head is turned

agnosia

the inability to recognize one or more subjects that were previously familiar can be visual, tactile or auditory

pathophysiology of ruptured disk

the intervertebral disks, between the vertebrae have a inner nucleus pulposus and a outer collar (annulus fibrosus). This are absorbers of shock. For a herniation, the nucleus pulposus protrudes through he weakened, or torn, collar. Herniation of the thoracic disk is uncommon can result from trauma (lifting heavy objects, lifting inappropriately, degenerative disorders, or aging. rupture of the disk most often allows herniation of the nucleus in the a posterolateral direction, with compression of the nerve root. if the herniation is central, we see compression on spinal cord lifting incorrectly, twisting of the spine can rupture with immediate intense pain and muscle spasm can have radiculopathy: on mor emore nerves, especially nerve routes, do not function normally and paresthesia (abnormal sensation of the skin: numbness, tingling, pricking.

cushing's triad

the loss of compensatory mechanisms and brainstem function is a late sign indicated by: hypertension bradycardia respiration abnormalities caused by IICP and is the opposite of hypovolemic shock

rehab process

the nurse role is to motivate the patient and encourage self care. physical function may improve over 3 months and speech can improve for even longer assist family and patient with home environment and equipment discuss safety and need turn their heads to scan the environment if vision is affected. Make sure glasses are clean, hard to clean glasses with one good arm

autonomic nervous system

the part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Keeps the internal environment of the body stable. Its sympathetic division arouses; its parasympathetic division calms. controlled by the reticular formation of the brain

Pain and discomfort accompany strokes

the patient may experience acute pain, numbness, strange sensations. Damage to the thalamus may cause CPS Central Pain Syndrome: hot/cold, burning/tingling, sharp stabbing pain, most often in extremities It is worse with temperature and movement The pain is not relieved by pain meds, nor are there any specific treatments.

idet

thermal energy to treat pain from a bulging spinal disk. a special needle is inserted into the disk and heated to a high temperature. The heat thickens and seals the disk wall and decreases the bulge

health assessment and interveiw

they need to tell us their story they need to tell us in their words what is happening to them

frontal

thinking cognition memory concentration personality judgment emotions voluntary movements motor speech (Broca's area)-promotes vocalization of words

diagnosis

thororugh hx and physical exam abnormal findings from an examination of the fundus of the eye, visual fields, neurologic assessment eeg biopsy MRI with gadolinium enhancement (test of choice) will show the where, size, shape and extent the normal anatomy is distorted, and cerebral edema arteriograms to show compression of blood vessels endocrine studies for pit tumors

Cushing's response

three classic signs— bradycardia rising systolic bp widening pulse pressure

surgical managment

to correct deformities t/t spasticity usually orthopedic or neruosurgical to correct contractures that cause limitations. tendon lengthening procedures, correction of hip and adductor muscle spasticity, fusion of unstable joints to help improve locomotion, correct bony deformities, decrease painful spasticity, and maintain, restore, or stabilize a spinal deformity shunt placement for hydrocephalus dorsal root rhizotomy to decrease spasticity in the lower extremities by reducing the about of stimulation that reaches the muscles via the nerve

surgery

to prevent reoccurrence of a stroke to restore blood flow when stroke has occurred to repair vascular damage or malformations carotid endarterectomy can do an artery bypass carotid angioplasty with stenting can suction the clot out of the artery or threading a wire through the clot and pulling it out. need permit (the nurse's job is to witness the signature. not our job to explain, but can reinforce or answer some questions. If they are confused, ask what the Doctor had told them) coag times CT and MRI

diffuse

to spread or scatter freely or widely

stabilization devices

to stabilize the vertebral column and prevent further damage to the cord. gardner wells tongs: pins are put in the skill, about 1 inch above the ear, and weights are attached to the device halo: when there is no significant involvement of the ligaments. most often used for stability of the cervical and high thoracic vertebrae without cord damage. Two pins are put in the occipital and 2 in the frontal bones. Halo ring is then attached to a rigid plastic vest lined with sheep skin

TIA/ stroke in evolution

transient ischemic attack (mini stroke) brief period of localized cerebral ischemia that causes neurologic deficits lasting a few minutes to a few hours, less than 24 hours. TIA's are often warning signals of an ischemic thrombotic stroke One or many may precede a stroke, the time can range from hours to months. usually see contralateral numbness or weakness of the leg, hand, forearm and corner of the mouth; aphasia and visual disturbances. May also experience amaurosis fagax: a fleeting blindness of one eye, like a shade coming down over vision in the affected eye

preventing bacterial meningitis

transmitted by direct close contact with respiratory droplets from nose or throat. post exposure prophylaxsis and post-exposure immunization may be effective disinfect toys and shared object reduce group B strep by screening pregnant women, if positive give intrapartal abx vaccines like Hib at 2 months pneumococcal vaccine at 2 months meningococcal vaccine for all kids 11-12 due to the spread through sharing drinking glasses and lip balm. they get a booster at 16

chronic pain

treat pt's reported pain with respect do not refer to the patient as addicted to meds. tolerance doesn't mean addiction. use the pain scale and watch for tolerance and increase need of meds monitor patient carefully for any changes in condtion maintain written care plan for pain management teach alternative methods develop effective methods of improving rest and sleep....these issues make pain management more difficult refer to pt or exercise program assess need for referals

therapeutic management

treated as though has bacterial meningitis until dx is confirmed abx are administered and continued until the causative organism is recognized. antivirals can be started tx is mainly supportive and the illness is usually self limiting( 3-10 days)

Meds for spinal cord injuries

treating symptomatically corticosteroids to decrease inflammation and edema of cord vasopressors in acute care to treat bradycardia or hypotension due to spinal shock and dobutamine to support heart function. makes sure organs get perfused (Kidneys-first affected) atropine can help bardycardia antispasmodics: baclofen, diazepam, and dantrolene for muscle spasticity antiemetics for vomiting analgesics such as NSAIDS and narcotics PPI (prazole and tidines) h2's for stress ulcers anticoagulants can be used to prevent thrombophelbitis, and blood speed is slow and prone to get clots due to low blood pressure stool softeners for bowel retraining.

Neck righting reflex

turning of shoulders, trunk, and pelvis in the same direction when the infant turns the head to the side 4-6 months and persist

tonic neck reflex

turning the head to one side, extending the arm and leg on that side, and flexing the limbs on the opposite side birth to 4 months

alterations in mental status assessement

unilateral neglect could indicate a stroke abnormal gait seen with TIA's and stroke face appears masklike in parkinson's apathy is dementing disorders aphasia strokes and TIA's, problems with left side of the brain dyphonia common is strokes (bad tone of voice) dysarthria (difficulty speakin) seen in lesions damage to brainstem alters LOC, and stroke

manifestations

unilateral, intense pain around or behind one eye rhinorrhea lacrimation flushing sweating facial edema possible ptosis or miosis of affected side same side is involved in the cluster of attacks

communication disorders

usually a result of a stroke affecting the dominant hemisphere (The left is dominant in most people) aphasia: the inability to use or understand language: can be expressive receptive or mixed expressive: you understand what is being said, but you can respond verbally only in short phrases; also called Broca's aphasia receptive aphasia: cannot understand the spoken (and often written) word. Speech may be fluent but with inappropriate content; wernicke's aphasia mixed: issues in both understanding and expression dysarthria: any disturbance in muscular control of speech can pantapime and act out what you want to say

nursing care for spina bifida occulta

usually benign and asymptomatic and produces no neurologic signs defect is usually present in the lumbosacral area, and often goes undetected. dimpling of skin abnormal tufts of hair discoloration of the skin if so, MRI may be warranted

cervical disk manifestations

usually from degeneration, or whiplash see radicular pain in shoulder, neck and arm muscle spasms and stiff neck decreased or absent arm reflexes dull, intermittent pain, but can have lower extremity weakness, unsteady gait, urinary elimination issues, altered sex function, hyperactive lower reflexes.

conservative treatment

usually managed conservatively unless the patient is experiencing severe neurologic deficits. conservative tx is usually prescribed for 2-6 weeks, if pain is still present surgery may be considered. no longer recommended to decrease activity level and be on bed rest. should continue with normal activity while take pain med, inflammation meds, and muscle spasm meds

Embolic Stroke (Ischemic)

usually results when a clot from afib, travels to the cranial vessels and becomes lodged in a cerebral vessel too narrow to permit further movement. **seen in younger patients and occurs when awake and active can originate in left side of the heart due to afib can also see plaque or fat emoli risk of cerebral hemorrhage, due to it traveling so fast it breaks the vessel

suggestion to decrease incidence of migraines

wake up at the same time q morning eat your meals and exercise or reg schedule no smoking or caffeine after 3 no artificial sweetners or MSG reduce/eliminate red wine, cheese, alcohol, chocolate, caffeine relax techniques like yoga, meditation, biofeedback.

prevent and recognize shunt infection and malfunction

watch for infection around day 3 elevated v/s poor feeding vomiting decreased responsiveness seizure signs of local inflammation along the shunt tract nucal rigidity pain changes in usual behavior shunt malfunction: (can occur due to kinking, clogging, or separation of the tubing. blockage) shuts placed within the past year is at high risk for malfunction! **vomiting/Nausea drowsiness **HA increased ICP (headache, vomiting, possible projectile, blurred vision, double vision, dizziness, decreased pulse and respirations, increased blood pressure or pulse pressue, pupil reaction time decreased and unequal, sunset eyes, **changes in LOC, irritability, seizures, bulging fontanel, wide suture and big head, dilated scalp veins, high pitched cry. a new shunt is placed after the infection is cleared

brain injury

watch urine output for DI and SIADH worry about urine output, can be decreased in

when children are sick or have neurologic issues or are ill

we see a change in their daily routine: Change in: daily routines eating level of consciousness, sleepiness we need to know their usuals. When do they normally eat? What do they eat? How much do they Eat? The nurse needs to ask specific questions: Tell me what you feed your child? how are you preparing the formula?

care for the patient who might not make it back from the stroke

what is their code status and wishes his wife will be his POA if it's not assigned meanwhile: O2 suctioning side turn comfort (morphine, atropine eye drops sublingual, Ativan for seizures) seizure monitoring (blood is irritating to the brain and the IICP can cause a seizure) hearing is the last sense to go, so maintain the calm environment pastoral care: they can help you do a living will, it's not legal until you get a DNR

going home on coumadin teaching

what is your normal intake of leafy greens? don't alter that. use an electric razor avoid IM injections soft bristle tooth brush wear shoes to protect feet and non slip/firm have labs drawn no flossing report s/s unusual bleeding and bruising avoid aspirin

root reflex

when infant's cheek is stroked, the infant turns to that side, searching with the mouth birth - 3 months

patterns of respirations

when neural control center of respirations is lost, and lower brainstem centers regulate breathing patterns by responding only to carbon dioxide changes, resulting in irregular patterns yawning and sighing--inidcated inital manifestations of deteriorating brain function cheyne stokes respirations--alternating periods of deep, rapid breathing followed by periods of apnea.

depressed

will have surgery to fix bones and inspect the dura mater and brain

These patients with thrombotic stroke

will need teaching about low fat, low cholesterol diet will go home on statins increase omega 3 fatty acids

cerebral angiogram

x-ray of blood vessels in the brain after intracarotid injection of contrast medium no eating drinking 8 hours prior allergy to iodine? monitor v/s force fluid to clear dye bed rest for 12-24 hours Watch for TIA (weakness/numbness, confusion, slurred speech) and watch for delayed reaction to dye

diagnosis

xray ct scan emg myleogram with contrast muscle strength and reflexes straight leg test important diagnostic tool patient is supine and passively raising the leg, or by having the patient sit on a table and slowly extending the knee with both hip and knee flexed at a 90 degree angle.

dx

xray, ct