Neuro Med Surg
The therapeutic level for Phenytoin sodium
10-20
The PNS consists of how many pairs of cranial nerves?
12
The glasgow coma scale of a patient who is not neurologically impaired
15
After an angiogram pressure is held to the puncture site for
15 minutes
The incubation period for a person with WNV is
2-14 days
Lowest possible glasgow coma scale
3
Glasgow Coma Scale
3 part neuro assessment
The PNS consists of how many pairs of spinal nerves?
31
How many stages of AD are there?
4
The ultimate confirmation of Parkinsons diseasae
A positive response to a low dose trial of antiparkinsonian medication such as carbidopa-levodopa
The first sign that a patient may have MS
A proliferation of gamma delta T cells
Dementia
A set of symptoms caused by a disease
Battles Sign
A small hemorrhagic spot begind the ear
Deep brain stimulation (DBS)
A surgery for PD that consists of blocking impulses that are causing the tremors
Craniotomy
A surgical opening though the skull
Parkinsons Disease
A syndrome that consists of a slowing down in the initiation and execution of a movement, increased muscle tone, tremor, and impaired postural reflexes
Thymoma
A tumor of the thymus
Concussion
A violent jarring of the brain against the skull
MRA (Magnetic Resonance Angiography)
Can be done with or without contrast. Views the flow of blood in the brain
Traction-inflammatory headaches
Caused by infection, intracranial or extracranial causes, and temporal arteritis
Effects of severe head injury include
Cerebral edema, sensory and motor deficits, and increased ICP
Epilepsy
Characterized by reccuren seizures
Decorticate response
Characterized by the flexion of the arms, wrists, and fingers with abduction of the upper extremities, and extension, internal rotation, and plantar flexion of the lower extremities
CSF normal color
Clear
The subsequent jerking of the extremities that lasts for about 30-40 seconds during a Tonic-Clonic seizure
Clonic phase
Nursing interventions for patients with GBS
Closely monitor respiratory function
Comfort measures for headaches
Cold packs and a quiet, dark room
Nursing interventions and patient teaching for neuropathic pain
Comfort measures and promotion of rest and relaxation
A total transection may also be called a
Complete cord injury
Paralysis
Complete loss of function
CLosed head injuries include
Concussions, contusions, and lacerations
Brain stem
Consists of midbrain, pons, and medulla oblongata
Diencephalon
Contains thalamus and hypothalamus
Dysphagia places patients at an increased for
Aspiration
Prior to a myelogram a nurse should
Assess and document baseline lower extremity strength and sensation.
Meningitis can be classified as
Bacterial (septic), or viral (aseptic)
Psychomotor seizure
Behaves as if partially conscious, often appears intoxicated, complex hallucinations or illusions with the presence of an aura
Where is the needle inserted during a lumbar puncture?
Below the level of the spinal cord
Characteristic appearance of a patient with PD
Blank facial expression, forward tilt to posture, slow monotonous slurred speech, tremor, and short shuffling gait
Brain tumors include
Both benign and metastatic lesions
Effects of normal aging on the nervous system
Brain decreases in weight, loss in neurons, decrease in cerebral blood flow
Time lost is
Brain loss
Parts of the nervous system commonly subjected to trauma include
Brain, spinal cord, and peripheral nerves
Spinal cord extends from
Brainstem to L2
Many infections of the nervous system can be diagnosed by examining the
CSF
An angiogram places a patient at a high risk for a
CVA (stroke)
Second stage of AD
Obvious memory lapses, disoriented to time, loss of personal belongings is common as is confabulating, may lose ability to recognize familiar faces, places and objects, may get lost in familiar places, loss of impulses is common, as are behavioral changes
Increased ICP
Occurs suddenly, progresses rapidly, and requires surgical intervention
Cranial nerve III
Oculomotor. Testing of ability of eyes to move together in all directions; testing pupillary response
Crainial nerve I
Olfactory. Identifaction of common odors
CNS myelin is produced by
Oligodendrites
How should a client with PD lie in a bed?
On a firm matress, with no pillow
During a lumbar puncture the patient is positioned
On his/her side with head and knees flexed at an acute angle
Tetraplegic patients are those who sustain injuries to
One of the cervial segments of the spinal cord
Cranial nerve II
Optic. Testing of visual acuity and visual fields
Awareness associated with LOC has 4 components
Orientation, memory, calculation, fund of knowledge
Mental status assessment
Orientation, mood and behavior, general knowledge, short and long term memory, and attention span and ability to concentrate
Three types of medications to treat ICP
Osmotic diuretics, corticosteroids, and anticonvulsants
What is not a common symptom of MS?
Pain
Intractable
Pain that is unbearable and does not respon to treatment
Sensory and perceptional status assessment
Pain, touch, temperature, and proprioception
Hemiplegia
Paralysis of one side of the body
Paresis
Partial loss of function
Lumbar puncture is contraindicated in
Patients with an increased ICP, because it can cause the brain to herniate
Oriented times 4
Person, place, time, and purpose (or event)
Medication for preventing and controlling seizures
Phenytoin sodium
Atherosclerosis
Plaque buildup
Examples of neuropathic pain
Postherpetic neuralgia, diabetic neuropathies, trigeminal neuralgia, and phantom limb pains
Carbidopa
Prevents breakdown of levodopa
Aura
Prodominal signs that occur before a headache
Spastic
Prone to spasms, involuntary sudden movements or muscular contractions
Protection of what is important with Bell's Palsy?
Protection of the eye
Signs and symptoms of occular MG
Ptosis and diplopia
Immediate care after spinal cord injury is directed towards
Realignment of the body column in the presence of fractures or dislocations
Neuropathic Pain
Refers to pain originating from the PNS or CNS caused by direct stimulation of the myelinated fibers
Early stage of AD
Relatively mild memory lapses, may have difficulty using correct words, attention span decreased, disinterest in surroundings, depression may occur
MRI patient education
Remove jewelry, ask patient about any metal objects inside of body (pacemaker, orthopedic devices), educated patient that the machine makes a loud noise, and assess for fear of small spaces
Resection
Removing small area of brain that is experiencing the misfiring and causing the seizure
Why do seizures cause brain damage or death?
Repeated seizures cause the brain to use more energy than supplied and the neurons become tired and cease function
Pons
Respiratory center
What is the main cause of death in patients with MG?
Respiratory failure
Patients with ALS usually die from
Respiratory failure secondary to compromised respiratory function
As ICP increases
Respiratory paralysis occurs
Alert
Responds appropriately to auditory, tactile, and visual stimuli
Stupor
Responds to verbal commands with moaning or groaning, if at all; seems unaware of the surroundings
Parasympathetic
Rest and digest
Patient teaching for headache management
Rest and relaxation
Throughout all stages of hospitalization of the patient with a spinal cord injury, nursing and medical interventions are directed towards
Restoring structural or body integrity
The most common deficits of a stroke
Contralateral weakness
Hypothalamus
Controls body temperature
Cerebellium
Coordination of voluntary body movements
Choose an insect repellent that contains
DEET
What does Levodopa cause in PD?
Decrease in the severity of the symptoms
In parkinsons what is happening to dopamine and AcH?
Decreased dopamine, and increased AcH
Cushings response includes
Deepending, irregular respirations, widening pulse pressure, increased systolic pressure, and bradycardia
Hemianopa
Defective vision or blindness in half of the visual field
Ischemic stroke
Deficient blood flow to the brain from a partial or complete occlusion of an artery. Either thrombotic or embolic
Increased ICP must be
Detected early to be reversible
Thymectomy
Excision of the thymus
Trigeminal neuralgia is characterized by
Excrutiating, knifelike, or lightning-like shock in the lips, upper or lower gums, cheek, forehead, or side of the nose
The 4 categories of the FOUR Score Coma Scale
Eye response, motor response, brainstem reflexes, and respiration pattern
Cranial nerve VII
Facial. Ability of face to move in symmetry; identification of tastes
WNV meningitis is usually associated with a sudden onset of
Febrile illness, headache, chills, and neck pain
WNV encephalitis often have
Fever, headache, altered LOC, behavioral and speech disturbances, and other neurologic signs such as hemiparesis, seizures, and coma
Those who develop west nile fever have flulike manifestations of
Fever, headache, back pain, myalgia, and anorexia
Sympathetic
Fight or flight
Blown pupil
Fixed and dilated
Brudzinkis sign
Flexion of the hip and knee when the neck is flexed
CT with contrast may cause these symptoms, which are common
Flushing sensation and a metallic taste
The presence of Battles sign usually indicates
Fracture of a bone of the lower skull
Motor function assessment
Gait, stance, muscle tone, coordination, involuntary movements and the muscle stretch reflexes
ABG's
Gas levels may be altered with neurologic diseases
Global cognitive dysfunction
Generalized impairment of intellect, awareness, and judgment
Two types of MG
Generalized, and occular
Hunningtons Disease
Genetically transmitted autosomal dominant disorder that involves overactivity of dopamine pathways
Immediately before an angiogram a nurse should
Get baseline vitals, pusles and nuero check
After an angiogram the nurse should
Get vitals, encourage bed rest, do neuro checks, and assess the puncture site for a hematoma
AIDS patients that have ADC may exhibit difficulty concentrating, or a recent memory loss, which may progress to a
Global cognitive dysfunction
Cranial nerve IX
Glossopharyngeal. Identification of tastes
What must the client practice if they are on long term phenytoin?
Good oral hygiene
Myasthenia Gravis is also known as
Grave muscular weakness
If a patient has increased ICP what bed position should they be in?
HOB 30-45 degrees with neck in midline neutral position
EEG nursing roles
Hair and scalp must be cleaned before electrode placement
The second most common cause of neurologic injuries
Head injury
What is a common complaint after a lumbar puncture?
Headache
Clinical manifestations of brain abscesses
Headache and fever
Common symptoms with a suspected neurologic condition
Headache, clumsiness, change in visual acuity, any new or worsened seizures, numbness or tingling in one or more extremities, pain in an extremity of other part of the body, personality changes or mood swings, extreme fatigue or tiredness
Manifestations of encephalitis resemble those of meningitis but they have a more gradual onset and they include
Headache, high fever, seizures, and a change in LOC
Medulla Oblongata
Heartbeat, rhythm of breathing, swallowing, coughing, sneezing, vommiting, and regulation of blood pressure through dilation of blood vessles
Common long term disabilities associated with strokes are
Hemiparesis, inability to walk, complete or partial dependence in ADLs, aphasia, and depression
An aneurysm is often the cause of a
Hemmorrhage
Risk factors for neruological problems
High blood pressure, high cholesterol levels, smoking, obesity, stress, and lack of exercise
A patient with Hunningtons requires a diet
High in calories, typically 4000-500 calories
Once GBS is suspected what is essential?
Hospitalization
Drug holiday
Hospitalization, during which time all drugs are withdrawn
The single most modifiable risk factor associated with strokes
Hypertension
As ICP increases failure of the thermoregulatory center occurs causing
Hyperthermia
Cranial nerve XII
Hypoglossal. Tongue motion
How are medications given to a client having a seizure?
IV
Myelogram
Identifies lesions in spinal cord
Ataxia
Impaired ability to coordinate movements
In AD where does the neuronal damage primarily occur?
In the cerebral cortex
PET Scan
In this procedure the patient recieves an injection of deoxyglucose combined with radioactive fluorine. The area in question is scanned
Sensory or Receptive Aphasia
Inability to comprehend the spoken word or written word
Anomic Aphasia
Inability to name objects
Visual agnosia
Inability to recognize objects by sight
Motor Aphasia
Inability to speak or write, using symbols of speech
Global Aphasia
Inability to understand the spoken word, or to speak
A decreasing LOC is the earliest sign of
Increased ICP
Rigidity
Increased muscle tone
Changes in a patients LOC is one of the earliest signs of
Increasing ICP
The reactivation of HSV associated with Bell's Palsy causes
Inflammation, edema, ischemia, and eventual demyelination of the facial nerve, creating pain and disturbances in motor or sensory function
Patient education for an EMG
Inform patient that it is uncomfortable when the electrode is inserted and when the current is used and that their muscle may ache afterwards
Autonomic Nervous System
Involuntary. Transmits messages from CNS to smooth muscle, cardiac muscles, and certain glands
Stereotactic biopsy
Involves drilling a small hole through the patients skill, after which the tumor biopsy is obtained
Agnosia
Is a total or parial loss, as a result of organic brain damage, of the ability to recognize familiar objects by sight, touch, or hearing or to recognize familiar people through sensory stimuli
Semicomatose
Is in an inpaired state of consciousness, characterized by stupor, from which a patient can be aroused only by energetic stimulation
Levodopa
Is the most commonly prescribed medication for PD, which is converted to dopamine in the brain
Strokes are classified as
Ischemic or hemorrhagic
Why should the first specimen obtained during a lumbar puncture not be sent to the lab?
It may contain blood from the puncture site which would give a false sample
Two abnormal signs that occur with meningitis are
Kernigs sign, and Brudzinkis sign
Cerebrum
Largest part of the brain. Consists of left and right hemispheres.
Cushings response is a
Late sign of brain herniation
After a lumbar puncture the patient should
Lie flat for several hours
Amyotrophic Lateral Sclerosis (ALS)
Loss of both upper and lower motor neurons
Other symptoms of Bell's Palsy may include
Loss of taste, altered chewing ability, reduction of saliva on the affected side, pain behind the ear on the effected side, and ringing in the ear or other hearing loss
ALS is also known as
Lou Gehrigs disease
Primary function of autonomic nervous system
Maintain internal homeostasis
The most important nursing intervention for the client having a seizure
Maintaining an airway and providing safety
Neurotransmitters Norepinephrine
Maintaining arousal, dreaming, and regulation of mood
Sport, car, and swimming safety
Wear protective sports pads, wear seatbelts, no diving
Status epilepticus
When recurrent, generalized seizure activity occurs at such frequency that full consciousness is not regained between seizures
Direct trauma occurs
When the head is directly injured
Sundowning
When the patient becomes more confused and agitated in the late afternoon or evening
Supratentorial shift
When the pressure buildup is greater than the brains ability to compensate, pressure is exerted on the surrounding structures where the pressure is lower
Late signs of increased ICP and signs the brain is about to herniate
Widening pulse pressure, bradycardia, and abnormal respirations.
GBS results in
Widespread inflammation and demyelination of the peripheral nervous system
Micrographia
Words become tiny and different from earlier handwriting
The bacteria in meningitis cause
an inflammatory reaction in the pia mater, with pus accumulation in the arachnoid space high protein and white blood cell levels in the CSF, and possiblre injury to nervous tissue
Patient teaching and nurse interventions for patients with disturbances in muscle tone and motor function
Safety, skin care, activity, medications, good nutrition, ADLs, bladder care, and follow up care
PNS myelin is produced by
Schwann cells
Embolic stroke
Second most common cause of a stroke, they most frequently occur in the midcerebral artery
A tonic-clonic seizure can be treated with first aid, it is not necessary to
Send the patient to the hospital
Aura
Sensation that preceeds an attack, occurs a few seconds to a few minutes before seizure
Plasmapheresis
Seperates plasma from blood
Clinical signs of autonomic dysreflexia
Severe bradycardia, hypertension, diaphoresis, flushing, dilated pupils, blurred vision, restlessness, nausea, severe headache and nasal stiffness
The onset of meningitis is usually sudden and is characterized by
Severe headache, stiffness of the neck, irritability, malaise and restlessness
Terminal stage of AD
Severe mental and physical deterioration
PD rarely causes
Shaking of the head
Open head injuries result from
Skull fractures of penetrating wounds
Neurotransmitters Serotonin
Sleep, sensory perception, controls temperature, and plays role in mood control
The first most subtle clue to trouble in the brain is a
Slow, sluggish pupil reaction
Bradykinesia
Slowing down in the initating or execution of a movement
Ipsilateral pupil
Sluggish reaction on same side as the pressure
Fasciculations
Small, rapid muscle twitches
Cranial nerve XI
Spinal accessory. Shoulder and neck movement
During a myelogram dye is injected into the
Subarachnoid space
The clinical signs of an absence seizure
Sudden acant facial expression with eyes focused straight ahead
Absence seizure
Sudden impairment in or loss of consciousness with little or not tonic-clonic movement. With no presence of an aura
What is the most common cause of a seizure?
Sudden withdrawk from anticonvulsant medication
Aspetic (viral) meningitis is treated with
Supportive therapy, such as maintaining bed rest, ensuring fluid and electrolyte balance, and providing rest and comfort measures
Permanent relief of pain from trigeminal neuralgia is obtained by
Surgery
The general method of treatment for brain tumors includes
Surgival removal when feasible, radiation, and chemotherapy
Nonsurgical medical management for neuropathic pain
TENs unit, and accupuncture
The most important nursing intervention for the patient with sensory dysfunction is to
Teach the patient protective measures
Indirect trauma is caused by
Tension strains and shearing forces transmitted to the head by stretching the neck
The current standard for diagnosing WNV is by
Testing bloof or CSF with the immunoglobulin M, antibody capture enzyme-linked immunosorbent assay, and imminoglobulin G indirect ELISA
In GBS the antibodies attack
The Schwann cells, causing the sheath to break down and the uninsilated portion of the nerve to become inflammed
Carotid endarterectomy (CEA)
The artheromatous lesion is removed from the carotid artery to improve blood flow
The principal route of human infection with WNV is through
The bite of an infected animal mosquito
Seizures are classified according to
The features of the attack
What is happening to the myelin in MS?
The immune system is eating away at it
Kernings sign
The inability to extend the legs completely without extreme pain
Asprin
The most frequently used antiplatelet aggregation agent
A lesion on one side of the brain effects motor function on
The opposite side of the body
The first sign of improvement during recovery from Bell's Palsy
The recovery of taste
Craniectomy
The removal of part of the skull without replacement
Paraplegic patients are those who lesions are confined to
The thoracic, lumbarl, or sacral segments of the spinal cord
A primary brain tumor originates from
The tissues of the brain and forms when changes occur in the genetic structure of normal brain cells
In most spinal cord injuries
There is a period of flaccid paralysis and a complete loss of reflexes below the level of trauma
Bell's Palsy (Peripheral Facial Paralysis)
There is usually an abrupt onset of numbness, stiffness, or drawing sensation of the face
About 25% of patients with MG have been found to have a
Thymoma
Epidemic encephalitis is transmitted by
Ticks and mosquitoes
The goal of treatment for MS
To control symptoms
Goal of nursing management for a patient with Hunningtons
To provide the most comfortable environment possible by maintaining safety
The stiffening of the body that lasts for 10-20 seconds during a Tonic- Clonic seizure
Tonic phase
Third stage of AD
Total disorientation to person, place, and time, and motor problems
Severe traumatic lesions of the spinal cord may result in
Total transection of the spinal cord or tearing of the cord from side to side at a particular level, with a complete loss of spinal cord function
The classic triad consists of
Tremor, rigidity, and bradykinesia
Cranial nerve V
Trigeminal. Jaw strength, and sensation of face; corneal reflex
Cranial nerve IV
Trochlear. Tested with oculomotor; testing eye movement
What is a major problem with MS clients?
UTIs
Comatose
Unable to respond to painful stimuli; corneal and pupillary reflexes are absent, cannot swallow or cough, is incontinent or urine and feces, and electroencephalogram pattern demonstrates deceased or absent neuronal activity
Unilateral neglect
Unaware and unattentive to one side of the body
Proprioceptual problems
Unilateral neglect, and hemianopa
The exact cause of a migraine is
Unknown
FOUR Score Coma Scale
Used to assess patients with neurologic conditions that affect cognitive function. "User friendly"
Echoencephalogram
Uses ultrasound to depict intracranial structures of the brain
Cranial nerve X
Vagus. Gag reflex, movement of uvula and soft palate
Classification of headaches
Vascular, tension, and traction-inflammatory
Headaches occur by
Vasodilation
Areflexia
Vasodilation, increased venous capacity, and hypotension
An aneurysm often causes
Vasospasms
Auras commonly include
Viseal field defects, unusual smells or sounds, disorientation, paresthesias, and in care cases, paralysis
Clinical manifestations for MS
Visual problems, urinary incontinence, fatigue, weakness or incoordination of an extremity, sexual problems and difficulty swallowing
Angiogram
Visualizes the cerebral arterial system by injecting radiopaque material.
Somatic Nervous System
Voluntary. Sends messages from CNS to skeletal muscle
Flaccid
Weak, soft, and flabby. Lacking normal muscle tone
Primary symptioms of ALS
Weakness of the upper extremities, dysarthria, and dysphagia
Increased ICP is most commonly caused by
head injuries
The right side of the brain controls
the left side of the body
The left side of the brain controls
the right side of the body
Medications for neuropathic pain
Anticonvulsants, NSAIDs, and antidepressants
The primary treatment for brain abscess
Antimicrobial therapy
Trigeminal neuralgia is often treated with
Antiseizure medications and antispasmodic, muscle-relaxing agents
Neoplasm
Any abnormal benign or melignant mass
One can reduce the risk of becoming infected with WNV by
Applying insect repellent to exposed skin
Urine cultures
Are done to rule out infection
LOC has two components
Arousal and awareness
Aneurysm
A localized dilation of the wall of a blood vessle, usually caused by atherosclerosis and hypertension
Hyperrefliexia
A neruologic condition characterized by increased reflex actions
Carotid Duplex
A noninvasive study that evaluates carotid occlusive disease; often ordered after a patient has a TIA
People with MS do best in
A peaceful and relaxed environment
Cranial nerve VI
Abducens. Tested with oculomotor; testing eye movement
Seizures are the result of
Abnormal electrical activity within the brain
Clinical manifestations of Hunningtons
Abnormal, excessive, involuntary movements
Indirect trauma results in an
Acceleration-deceleration injury, with rotation of the skull and its contents
Cranial nerve VIII
Acoustic or vestibulochoclear. Testing of hearing through whisper or other means and checking equilibrium and balance
The first step in managing ICP
Adequate oxygenation
Postical period
After a seizure, complaints are usually of a headache, nausea, confusion, or drowsiness. This stage usually lasts about 30-50 minutes
Decerebrate response
All four extremities are in rigid extension, with hyper-pronation of the forearms and plantar extension of the feet
With a complete cord injury
All voluntary movements below the level of the trauma is lost
If a contrast is used in any procedure the nurse should assess for
Allergies
Clonus
Alternating contractions and partial relaxation of a muscle initiated by muscle stretching
Autonomic dysreflexia
An abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nercous system
Stroke
An abnormal condition of the blood vessles of the brain, characterized by hemorrhage into the brian or the formation of an embolus or thrombus that occludes an artery, resulting in ischemia of the brain tissue normally perfused by the damaged vessles
Aphasia
An abnormal neurologic condition in which the language function is defective or absent because of an injury to certain areas of the cerebral cortex
Brain abscess is
An accumulation of pus within the brain tissue that can result from a local or a systemic infection
Meningitis
An acute infection of the meninges
Encephalitis
An acute inflammation of the brain and is usually caused by a virus
Gullain-Barre Syndrome (Polyneuritis)
An acute, rapidly progressing, and potentially fatal form of polyneuritis
What is MG
An autoimmune disease of the neuromuscular junction, characterized by the fluctuating weakness of certain skeletal muscle groups
GBS is thought to be
An autoimmune reaction involving the peripheral nerves, most often following a respiratory or gastrointestinal viral infection
Transient Ichemic Attack (TIA)
An episode of cerebrovascular insufficiency with temporary episodes of neurologic dysfunction lasting less than 24 hours and often less than 15 minutes
Apraxia
An inability to carry out learned sequential movements on command, preform purposeful acts, or use objects properly
Halo Sign
An indication of CSF leakage
Alzheimers disease (AD)
A chronic, progressive, degenerative disorder that affects the cells of the brain and cause impaired intellectual functioning
Multiple Sclerosis
A chronic, progressive, degenerative neurologic disease with an unknown cause
AIDS
A disease that has serious implications for the nervous system, with more than 80% of patients with HIV having neurologic signs and symptoms
Any score of this or less is commonly accepted as a definition of coma
8
The commonly prescribed dose of Asprin
81-325mg/day
Percutaneous transluminal angioplasty (Stenting)
A balloon is inserted to open a stenosed artery to permit increased blood flow
A ventriculoperitoneal shunt
A catheter draining excess fluid from the brain into the abdomen
A stroke is also known as
A cerebrovascular accident or CVA
Patients with AIDS may have
AIDS dementia complex (ADC)
Pseudobulbar affect (PBA)
AKA emotional incontinence, sudden explosive emotional outburts of crying or laughing
With Bell's Palsy the face appears
Asymetric, with dropping mouth and cheek
A firm diagnosis of Parkinsons disease can only be made when the patient has
At least two signs of the classic triad
Common causes of spinal cord trauma
Automobile accidents, falls, violence, and sports
One important complication of spinal cord injury is
Autonomic dysreflexia or hyperreflexia
Aspiration precautions
Avoid choking foods, check affected side for food pocketing, small bites, do not mix solids and liquids, no straws, 90 degree angle, head up and chin slightly tucked
Prevention of neurological problems
Avoid drug and alcohol use, gun safety.
Dietary counseling for headache management
Avoid foods containing tyramines, nitrates, and glutamates
Teaching areas for patients with headaches
Avoidance of factors that trigger headaches Relaxation techniques Maintenance of regular sleep patterns Medications to be used The importance of follow up care
The term head trauma is used primarily to signify
Craniocerebral trauma, which includes alteration in consciousness, no matter how brief
Medical management of headaches
Dietary counseling, psychotherapy, and medications
Dysarthria
Difficult, poorly articulated speech that usually results rom interference in control over the muscles of speech
Dysgraphia
Difficulty communicating via writing
Dysphagia
Difficulty swallowing
Encephalitis is characterized by
Diffuse damage to the nerve cells of the brain, perivascular cellular infiltration of glial cells, and increasing cerebral edema
The primary cause of a brain abscess
Direct extension from ear, tooth, mastoid, or sinus infection
A CVA is the most common
Disease of the nervous system
Changes in a patients LOC that may indicate increasing ICP
Disorientation, restlessness, and lethargy
Disorientation
Disoriented; unable to follow simple commands; thinking slowed; inattentive; flat affect
Drug screens
Done to rule out drug use
When can an AD diagnosis be confirmed?
During an autopsy
Ictal
During the seizure and usually lasts about 60-90 seconds
LOC
Earliest and most sensitive indicator of patients neuro status
Contralateral weakness
Effecting the opposite side
CSF in patients with GBS commonly has
Elevated protien levels
If a femoral approach is used for an angiogram a nurse should
Mark bilateral pedal pulses
Tension headaches
May arise from psychological problems related to tension, stress, or from medical problems such as cervical arthritis
Nonepidemic encephalitis may occur as a complication of
Measles, chickenpox, or mumps
If a carotid approach is used for an angiogram a nurse should
Measure baseline neck circumference
EEG
Measures electrical activity of brain.
Electromyogram (EMG)
Measures the contraction of a muscle in response to electrical stimulation
Seizures are a
Medical emergency
Long term symptoms of encephalitis include
Memory impairment, epilepsy, anosmia, personality changes, behavioral abnormalities, and dysphasia
The first symptom of AD
Memory loss combined with the inability to carry out normal activities
The sequelae of encephalitis include
Mental deterioration, amnesia, personality changes, and hemiparesis
Vascular headache
Migraine, cluster, and hypertensive headaches
Thrombotic stroke
Most common cause of a stroke, symptoms usually occur while sleeping or soon after rising
Generalized Tonic-Clonic seizure
Most common, characterized by loss of conciousness and falling to the floor or ground. With the presence of an aura
Neurotransmitters Dopamine
Motor function, and emotional responses
What does dopamine deal with?
Motor functions and emotional responses
Midbrain
Motor movement, relay of impulses, and auditory and visual reflexes
Treatment of meningitis includes
Multiple antibiotics given intravenously over a 2-week period
Classic signs of GBS
Muscle weakness, tingling, and numbness. These signs usually begin in the legs or feet and work their way upwards
During MG, nerve impulses fail to pass at the neuromuscular junction resulting in...
Muscular weakness
What type of injury should you assume with a head injury?
Neck injury
Neurotransmitters AcH
Nerve impulse transmission
What does AcH aide in?
Nerve impulse transmission
Treatment for Bell's Palsy
No specific therapy, corticosteroids, especially prednisone, are started immediately, preferably before paralysis is complete
After a myelogram a nurse should
Observe for CSF leakage and instruct the patient to lie flat
Lumbar puncture is done to
Obtain CSF for examination, to relieve pressure, or to introduce dye or medication
The 3 parts of the Glasgow coma scale assessment
eye opening, best motor response, and best verbal response