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172 Cards in this Set
- Front
- Back
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What are the structural divisions of the Central Nervous system?
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Brain and Spinal Card
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What are the structural divisions of the Peripheral Nervous System?
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Somatic and Autonomic Nervous Systems
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What is the function of the Somatic Nervous System?
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Sends messages from the CNS to the skeletal muscles; voluntary
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What is the function of the Autonomic Nervous System?
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Sends messages from the CNS to the smooth muscle, cardiac muscle and certain glands; involuntary
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What are examples of Neurotransmitters?
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Acetylcholine; norepinephrine; dopamine; serotonin
(open page 1928 for best-known neurotransmitters) |
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What is Myelin?
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Fat layer that covers nerve endings
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What are cells of the nervous system?
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Neurons-
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What are Neurons?
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transmitter cells
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What are Glial cells?
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support cells
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neuromuscular junction
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Area of contact between the ends of a large myelinated nerver fiber and a finer of skeletal muscle
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What are Neurotransmitters?
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chemicals that modify of result in the transmission of impulses btwn the synapses
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What is Neurilemma?
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Cells found only in the peripheral system and helps in regeneration
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Brain weighs?
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abt. 3lbs (one of the largest organs
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What is the function Cerebrum?
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controls initiation of movement on the opposite side of the body Differieantiates what the frontal parietal temporal and occipital lobes do. Divided into the L&R hemispheres
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Cerebral cortex*
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outer portion composed of gray matter "gyri-convolutions-
Sulci-grooves" |
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Diencephalon*
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interbrain lies beneath cerebrum contains thalamus (relay station for some sensory impules and hypothalamus control of body temp fluid balance appetite and certain emotion such as fear pleasure and pain
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Cerebellum*
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lies posterior and inferior to the cerebrum second largest portion ot the brain mainly resp. for coordination of voluntary movement and maintenance of balance, equilibrium and muscle tone.
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Midbreain function*
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Responsible for motor movement auditory and visual reflexes
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Pons are part of...
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Part of respiratory center
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Medulla oblongata
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Center for regulatory function. (such as heart beat, breathing, sneezing vomiting and hiccups)
vasomotor center regulates diameter of blood vessels which aid in control of BP |
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Meninges are...
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Coverings of the brain and spinal cord.
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Outer layer of meninges
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dura mater
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Second layer of Meninges...
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arachnoid membranes
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Iinner most layer of Meninges...
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pia mater
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Meninges provide...
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oxygen and nourishment to the nervous tissue. Bathe the spinal cord and brian with CSF
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Pons are part of...
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Part of respiratory center
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Peripheral nervous system has how many Spinal Nerves? Cranial Nerves?
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31 pairs of spinal nerves (all mixed nerves)
Cranial -12 pairs |
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Cranial nerve function.
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all 12 pairs conduts implulses btwn the head neck and brain excluding the vagus nerve (X)p1932)
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Autonomic nervous system includes...
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Sympathetic nervous system
Parasympathetic nervous system |
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Second layer of Meninges...
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arachnoid membranes
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Iinner most layer of Meninges...
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pia mater
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Meninges provide...
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oxygen and nourishment to the nervous tissue. Bathe the spinal cord and brian with CSF
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Cranial Nerve:Vagus
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Gag reflex movement of Uvula and soft palate
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Cranial Nerve:Spinbal Accessory
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Shoulder and neck movement
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Cranial Nerve: hypoglossal
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Tongue motion
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What are effects of Normal Aging on the Nervous System?
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Loss of brain weight
Loss of neurons Reduction in cerebral blood flow Decrease in brain metabolism and oxygen utilization Decreased blood supply to spinal cord causes decreased reflexes (page 1933…older adult considerations…neurological disorder) |
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Prevention of neurological problems include...
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Avoid drug and alcohol use
Safe use of motor vehicles Safe swimming practices Safe handling and storage of firearms Use of hardhats in dangerous construction areas Use of protective padding as needed for sports (page 1933…safety considerations…preventing neurological injuries) |
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Assessment of the Neurological System include
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History
Mental status Level of consciousness Glasgow coma scale (see page 1934…Table 54-2 for Levels of Consciousness w/ descriptions) Language and speech Cranial nerve function Motor function Sensory and perceptual status |
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What is a Lumbar Puncture?
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The introduction of a hollow needle with a stylet into the lumbar subarachnoid space using strict aseptic technique.
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Why is a lumbar puncture done?
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It is done to measure CSF pressure; examine the CSF for blood; collect CSF for laboratory testing; visualize parts of the nervous system by injection of air, oxygen, or radiopaque material; and evaluate spinal dynamics for signs of blockage of CSF flow.
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In an adult patient, where is the needle placed during a lumbar puncture?
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the needle is placed between L3 and L4 or between L4 and L5 vertebrae
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In regards to the effects of normal aging on the nervous system explain the effect of the decrease in the brain metabolism and oxygen
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altered sleep/wakedfulness ratio, a decrease in the ability to regulate body temp and the decrease in the velocity of nerve impulses
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Assessment of the neurological system: Level of consciousness (Glaslow coma scale)
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quick, practical and standardized system for assessing the degree of consciousness impairment in the critically ill and for predicting the duration and ultimate outcome of coma particularly with head injuries see p 1935 table 54-2 for LOC
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Assessment of the neurological system: Language and Speech
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Speech is a function of the dominant hemisphere which is the left side of the brain for all right handed people and most left handed people
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Assessment of the neurological system: Cranial Nerve Function
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Cranial nerves and testing (p1935)
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Assessment of the neurological system: Motor Function
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Will detect abnormalities in the normal functioning of nerves and muscles, include gait and stance, muscle tone, coordination, involuntary movements and the muscle stretch reflex....words, paralysis, paresis, flaccid, spastic, fasciculations
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Assessment of the neurological system:Sensory and Perceptual Status
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Pain, touch temp and proprioception
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Glasglow coma Scale is
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Time test measures the motor response, verbal response, and eye opening response with set values
3 being worse 15 being highest |
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Glasglow coma Scale motor Response (1-6)
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6 - Obeys commands fully
5 - Localizes to noxious stimuli 4 - Withdraws from noxious stimuli 3 - Abnormal flexion, i.e. decorticate posturing 2 - Extensor response, i.e. decerebrate posturing 1 - No response |
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Glasglow coma Scale:Verbal response (1-5)
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5 - Alert and Oriented
4 - Confused, yet coherent, speech 3 - Inappropriate words and jumbled phrases consisting of words 2 - Incomprehensible sounds 1 - No sounds |
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Glasglow coma Scale: Eye opening (1-4)
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4 - Spontaneous eye opening
3 - Eyes open to speech 2 - Eyes open to pain 1 - No eye opening |
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Assessment of the Neurological System:Mental status
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gen. includes orientation (person…), mood & behavior, gen. knowledge (such as names of U.S. presidents), short & long-term memory; attention span & ability to concentrate
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Laboratory and Diagnostic Examinations: Blood and urine involve
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Culture
Drug screens Arterial blood gases (has intracranial pressure can be due to CO2 increases O2 and PH decrease) |
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Laboratory and Diagnostic Examinations:Cerebrospinal fluid
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(p 1936 T- 54-3) elevated lymphocytes indicate infection of protein is elevated in degenerative diseases or brain tumor is present blood in spinal fluid indicates hemorrhage in the ventricular system
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Laboratory and Diagnostic Examinations:Computed tomography (CT)
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Used to detect pathologic conditions of the cerebrum and spinal cord using a technique of scanning without radiootopes. The only discomfort when IV for contrast dye and lying still and possible feelings of claustrophobia as result of head positioned in head holder
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Laboratory and Diagnostic Examinations: Brain scan
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Used to detect pathologic conditions. Radioactive isotopes and a scanner (not used as frequently with excellent resules of CT and MRI
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Laboratory and Diagnostic Examinations: MRI Scan
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uses magnetic forces to image body structures as it yields greater contrast of soft tissue so it is the choice for many neulogical diseases including stroke, MS, tumors, trauma herniation and seisure
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Laboratory and Diagnostic Examinations: PET Scan
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similar to CT scan and MRI...inj deoxyglucose with radioactive flourine increased clinical use to monitor pts following stroke alsheimers disease tumors and epilepsy and parkinsons disease
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Laboratory and Diagnostic Examinations: Lumbar puncture is contraindicated when...
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there is increases intracranial pressure until you do a CT scan
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Laboratory and Diagnostic exams:
lumbar puncture is used to |
frequently diagnose neurological diseases must lay still for 4-6 hrs
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Electroencephalogram
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–measures electrical activity of the brain. Cerebral diseases assessed by eeg, epilepsy, measles, lesions, (tumors,abscess, hematoma)cerebrovascular lesions, brain injury
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Myelogram
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commonly used to identify lesions in the intradural or extradural compartments of the spinal canal by observing the flow of radiopaque dye thru the subarachnoid space. Most commonly tested for herniated or protruding intervertebral disk. but other lesions include spinal tumors, adhesions, bony deformities and AV malformations. Water soluble dye is used, place on side (bc lumbar puncture is part of this) CT scan often done 4-6hrs after myelogram. HA fairly common post procedure accompanied by V&V-pt should be flat
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Angiogram
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Cerebral anteriography to visualize the cerebral arterial system by injecting radiopaque material which allows the detection of arterial aneurysms vessel anomalies, ruptred vessels) If carotid (neck circumference) or femoral (pedal pulses) artery may be used-careful assessment must be done with baseline VS and neuro checks. Bedrest 4-6-pt is at risk for CVA and ICP
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Laboratory and Diagnostic Examinations: Carotid duplex
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uses combined ultrasound & pulsed Doppler technology – noninvasive study that evaluates carotid occlusive disease – used for pts with TIA to determine pathology of carotids
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Laboratory and Diagnostic Test: Electromyogram (EMG)
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used to measure the contraction of the muscle in response to electrical stimulation (lower motoneuron disease such as myasthenia gravis); during test electric current is passed through the electrode with machine graphing the variations of muscle potentials
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Laboratory and Diagnostic Tests: Echoencephalogram
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uses ultrasound to depict the intracranial structures of the brain; helpful in detecting ventricular dilation & shift in midline structures of brain
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In regards to Common Disorders of the Neurological System, what are headaches?
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exact mechanism is not known; Skull and brain tissues are not able to feel sensory pain (pain arises from the scalp, its blood vessels & muscles, & from the dura mater & its venous sinuses…pain also arises from the blood vessels at the base of the brain & from cervical cranial nerves)
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What are Vascular Headaches?
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Migraine, Hypertensive, Cluster
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What are tension headaches?
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psychological problems of tension or stress or from medical problems such as cervical arthritis
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What are Traction-inflammatory headaches?
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caused by infection, intracranial or extracranial causes, occlusive vascular structures & temporal arteritis
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In regards to Migraines, what are early signs and symptoms?
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(Prodromal) Visual field defects, unusual smells or sounds, disorientation, paresthesias, and rarely paralysis of a part of the body
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In regards to Migraines, what are signs and symptoms patiensts suffer during headaches?
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Nausea, vomiting, light sensitivity, chilliness, fatigue, irritability, diaphoresis, edema, & other signs of autonomic dysfunction
Abnormal metabolism of serotonin, a vasoactive neurotransmitter found in platelets and cells of the brain plays a major role |
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In regards to headaches, what are subjective signs?
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pt’s understanding, possible causes, precipitating causes, what helps; location, frequency, pattern & character of the pain; site of return of HA, time of day, intervals between, symptoms A/W HA, presence of allergies, family history of similar problems
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In regards to headaches, what are objective signs
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behaviors indicating stress, anxiety or pain; changes in ability to carry out ADLs, abnormally raised body temp, presence of sinus drainage, abnormalities in PE
Dx Tests: neuro exam, CT scan (MRI or PET), brain scan, skull X-ray, LP but not if question of IICP |
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In regards to headaches, what are nursing interventions?
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Diet
psychotherapy Medication comfort measures |
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In regards to nursing interventions for headaches, explain Diets.
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: limit MSG, vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured
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In regards to nursing interventions for headaches, explain Medications for Migraine headaches.
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Migraine headaches
Aspirin, acetaminophen, ibuprofen Ergotamine tartrate: alpha-adrenergic blocker (vascular headache suppress.) Codeine; Propanolol - beta-adrenergic blocker (almo-, frova-, nara-triptans: serotonergic blocker (vascular headache suppressant) ~ act on receptors in the extracerebral, intracranial vessels that become dilated during a migraine attack. Stimulating these receptors constricts cranial vessels, inhibits neuropeptide release, & reduces nerve impulse transmission along trigeminal pain pathways |
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In regards to nursing interventions for headaches, explain Medications for Tension headaches.
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- Non-narcotic analgesics
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In regards to nursing interventions for headaches, explain Medications for Traction-inflammatory headaches.
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-Treat causes
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In regards to nursing interventions for headaches, explain comfort measures.
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Cold packs to forehead or base of skull
Pressure to temporal arteries Dark room; limit auditory stimulation |
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In regards to Common Disorders of the Neurological System, explain increased intracranial pressure.
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is a complex grouping of events that occurs because of multiple neurological conditions. Can occur suddenly, can progress rapidly, & often requires surgical intervention; causes: increase in any content of the cranium, space occupying lesions, CSF problems, cerebral edema. As pressure increases, compensated by venous compression & CS displacement, cerebral blood flow decreases & inadequate brain perfusion occurs causing a cycle of PCO2 increase & O2 & pH decrease leading to vasodilation & cerebral edema. No further compensation – pressure exerted to lowest pressure leading to herniation
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In regards to ICP, what are subjective signs?
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diplopia which is early sign of paralysis or weakness of eye muscles, change in personality or thinking, HA
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In regards to ICP, what are objective signs?
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change in LOC – disorientation, restlessness, or lethargy, pupillary changes (CN III) which occurs on same side as “lesion” * 1st indicator: sluggish response * as brain herniates - ipsilateral pupil remains dilated
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Assessment of late sign herniation involves...
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Widening pulse pressure
Bradycardia Respiratory problems High, uncontrolled temperatures Positive Babinski’s reflex- Seizures Posturing Vomiting Hiccup Papilledema |
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In regards to assessment of late sign herniation, explain:
widening pulse pressure |
is the difference of the systolic blood pressure minus the diastolic blood pressure; keep the pulse pressure under 60. A high pulse pressure is a measure of stiffness of the arteries. A high pulse pressure is a risk factor for heart disease and premature death
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In regards to assessment of late sign herniation, explain:Respiratory problems
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(Cheyne-Stokes or ataxic breathing medulla oblongata damage)
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In regards to assessment of late sign herniation, explain: Positive Babinski’s reflex
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large toe goes upward
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In regards to assessment of late sign herniation, explain: Hiccup
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caused from vagus nerve (CN X) compression: reflex spasms of the diaphragm accompanied by a rapid closure of the glottis producing an audible sound
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What are nursing interventions for ICP?
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Treat cause if possible
Mechanical decompression Craniotomy Craniectomy Internal monitoring devices Medically induced coma with benzodiazepines midazolam, diazepam |
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Explain Intracranial Pressure Monitoring
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ICP monitoring is performed by inserting a catheter into the head with a sensing device to monitor the pressure around the brain. IICP can cause a decrease in blood flow to the brain causing brain damage.
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What does Patient teaching for ICP involve?
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Elevate HOB 30-45 degrees
Place neck in neutral position Avoid flexion of hips, waist, and neck Instruct pt to avoid isometric or resistive exercises Restrict fluid intake Implement measures to help pt. avoid Valsalva maneuver Have a Foley catheter in place if pt is not alert Perform suctioning only as necessary & no longer than 10 sec w/ hyperoxygenation before & after Avoid coughing Administer oxygen to improve cerbral perfusion Use hypothermia blanket to control temperature |
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In regards to Common Disorders of the Neurological System, Explain Disturbances in muscle tone and motor function (cerebral palsy)
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Damage to the nervous system causes serious problems in mobility (alterations in strength, tone & reflex activity
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In regards to disturbances in muscle tone and motor function, what are the clinical manifestations?
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Flaccid or hyperreflexic muscle tone
Clumsiness or incoordination Abnormal gait |
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In regards to disturbances in muscle tone and motor function, what are nursing interventions?
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Muscle relaxants
Protect from falls Assess skin integrity Positioning Sit up and tuck chin when eating Encourage patient to assist with ADLs Emotional support |
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What is the incidence rate for seizures?
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1 in 200-300 people
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What are seizures?
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Transitory disturbance in consciousness or in motor, sensory, or autonomic function due to sudden, excessive, and disorderly discharges in the neurons of the brain; results in sudden, violent, involuntary contraction of a group of muscles
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What are Types Of Seizures?
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Characteristics of Seizures – (Table 54-4:) grand mal (generalized tonic-clonic)
petit mal (absence) Psychomotor (automatism) Jacksonian-focal (local or partial) Myoclonic akinetic |
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What is status epilepticus?
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: full consciousness not obtained between seizures; medical emergency
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In regards to seizures, what are clinical manifestations?
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Depends on type of seizure
Aura Postictal period |
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What are nursing interventions for seizures?
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During seizure: protect from aspiration and injury
Anticonvulsant medications (Table 54-5) |
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What are anticonvulsant medications?
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Barbiturates: phenobarbital
Benzodiazepines: diazepam Hydantoins: phenytoins Valproates: divalproex sodium Miscellaneous |
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What is involved in surgery for seizures?
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Removal of brain tissue where seizure occurs
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What is involved in patient teaching for seizures?
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Explain need for taking medications even when seizure activity has stopped
Teach about medications prescribed including expected results, time & dosage, and side effects Adequate rest Good nutrition Avoid alcohol Avoid driving, operating machinery, and swimming until seizures are controlled Good oral hygiene Medical alert tag Explain importance of follow-up care |
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In regards to degenerative diseases, what is: Multiple sclerosis
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Degenerative neurological disorder with multiple foci of demyelination in the white matter of the brain stem, spinal cord, optic nerves, & cerebrum
During demyelination process the myelin sheath and sheath cells are destroyed causing nerve impulse is slowed or blocked (fig 54-13) Unknown cause but genetics implicated |
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What are clinical manifestations of Multiple Sclerosis?
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Visual problems – diplopia, scotomata, blindness, nystagmus
Urinary incontinence Fatigue, weakness or numbness of a part of the body Emotional instability (depression, euphoria, labile) Bowel & bladder problems Changes in coordination – spastic or ataxic gait Ataxia (impaired ability to coordinate movement) Sexual problems – impotence in men Swallowing difficulties |
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What are nursing interventions for Multiple Sclerosis?
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No specific treatment
Adrenocorticotropic hormone (ACTH) Steroids (prednisone or desamethasone) Diazepam – preventing or decreasing spasms Immunomodulating drugs – modify disease (decrease Betaseron (interferon beta-1b) Avonex (interferon beta-1a) Probantheline & bethanechol – used to treat urinary frequency and urgency Prophylactic antibiotics for prevention of UTI |
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In regards to parkinsons disease, what 3 manifestations must be evident in order to be diagnoses?
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slowing down in initiation & execution of movement (bradykinesia)
Increased muscle tone (rigidity) Tremor |
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What is Parkinsons Disease?
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– Damage or loss of dopamine-producing cells of the substantia nigra in the midbrain
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What are the clinical manifestations of Parkinsons Disease?
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Muscular tremors; bradykinesia
Rigidity; propulsive gait Emotional instability Heat intolerance Decreased blinking “Pill-rolling” motions of fingers Dementia (40% of cases |
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What are medications used for Parkinsons Disease?
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Dopamine agonists
Levodopa *carbidopa-levodopa (Sinemet) Anticholinergic Trihexyphenidyl hydrochloride (Artane) Benztropine mesylate (Cogentin) Antiviral Amantadine hydrochloride (Symmetrol |
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In regards to Parkinsons Disease, what surgery is available?
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Ablation surgery (deep brain simulation) in pallidus -Pallidotomy
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In regards to degenerative diseases, what is alzheimers disease?
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Chronic, progressive, degenerative disorder affecting the cells of the brain & causes impaired intellectual functioning
Cause unknown but genetic factor |
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In regards to alzheimers disease, explain brain changes.
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plaques in cortex & neurofibrillary tangles decrease in brain size
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In regards to alzheimers, Explain manifestations in the early stage.
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Mild memory lapses; decreased attention span; depression
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In regards to alzheimers, Explain manifestations in the second stage.
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Obvious memory lapses (STM); loss of impulse control; behavioral manifestations (agitation) changes in the brain
Some develop psychotic manifestations |
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In regards to alzheimers, Explain manifestations in the third stage.
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Total disorientation to person, place, and time
Apraxia; wandering |
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In regards to alzheimers, Explain manifestations in the terminal stage.
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Severe mental and physical deterioration (total incontinence)
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What medications are used for Alzheimers Patients?
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Agitation: lorazepam; haloperidol
Dementia: tacrine hydrochloride (Cognex); donepezil (Aricept); memantine (Namenda) |
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In regards to Nursing Interventions for Alzheimers, what are nutritional interventions ?
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Finger foods; frequent feedings; encourage fluids
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What are safety interventions in regards to Alzheimers?
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Remove burner controls at night
Double-lock all doors and windows Constant supervision |
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What is Myasthenia gravis?
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Chronic autoimmune disease of neuromuscular (NM) junction fluctuating weakness of certain skeletal muscle groups; MG is unpredictable NM disease w/ lower motoneuron characteristics; nerve impulses fail to pass at the myoneural (MN) junction muscular weakness but NO observable structural change at nerve or muscle
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Myasthenia gravis is triggered by what?
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by antibodies that attack acetylcholine (ACh) receptor sites at NM junction in decreased # of ACh receptor sites & interfering with impulse transmission in the muscles
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In regards to Myasthenia gravis, what results when the antibodies attack ACh receptor sites?
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Attack damages & reduces # receptor sites preventing conduction along the normal pathway at normal conduction speed (MG pts have only 1/3 ACh receptor sites)
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Most MG patients have changes in...
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thymus gland cellular structure
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What are clinical manifestations of MG?
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Ptosis; diplopia (~15% remain confined to eye muscles)
Generalized variety vary from mild to severe Skeletal weakness muscles of extremities, neck, shoulders, hands, diaphragm Dysarthria (vocal cords voice sounds nasal) & dysphagia Trunk & legs affected difficulty walking & sitting Bowel and bladder incontinence |
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What are Lab tests performed for MG?
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Simplest pt looks up 2-3 minutes; MG ptosis
EMG IV anticholinesterase test: edrophonium (Tensilon) is given & those w/ the disease have dramatic improved muscle function Serum testing for antibodies to acetylcholine receptors |
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In regards to MG, what are Anticholinesterase drugs?
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(promote nerve impulse transmission)
neostigmine (Prostigmin) pyridostignmine (Mestinon |
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In regards to MG, what are corticosteroids used for?
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adjunct therapy
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In regards to MG, what drugs are used for Immunosuppressive therapy?
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azathioprine (Imuran)
cyclosporine (Sandimmune) |
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What drugs used cautiously with MG?
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Plasmapheresis
Thymectomy May require mechanical ventilation |
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What are nursing interventions for MG?
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At risk for URI due to insufficient energy to cough
Aspiration is common Teach airway protective techniques during swallowing During acute exacerbation – admitted to hospital Suctioning & feeding tube may be needed Teach planning for minimal energy usage Teach how to adjust ADLs to allow for leisure & rest Teach adjusting medication depending on symptoms Medic-alert bracelet |
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In regards to degenerative diseases, what is Amyotrophic lateral sclerosis (ALS) - Lou Gehrig’s disease?
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progressive disease which leads to death in 2-6 years
Motor neurons in the brain stem and spinal cord gradually degenerate Electrical and chemical messages originating in the brain do not reach the muscles to activate them |
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What are clinical manifestations of ALS?
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Weakness of the upper extremities
Dysarthria; dysphagia Muscle wasting Compromised respiratory function |
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What are nursing interventions for ALS?
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No cure
Rilutec (Riluzole) protects motoneurons Multidisciplinary ALS teams; emotional support |
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In regards to degenerative diseaes, what is Huntington's Disease?
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Involves the basal ganglia & extrapyramidal motor system
Overactivity of the dopamine pathways Genetically transmitted (10-20 years after onset of symptoms |
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What are clinical manifestations of Huntington's disease?
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Abnormal and excessive involuntary movements (chorea)
Deteriorating gait Deterioration in mental status Difficulty swallowing & holding head still |
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What are nursing interventions for Huntingtons disease?
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No cure; palliative treatment
Antipsychotics Antidepressants Antichoreas Safe environment Emotional support High-calorie diet (4000-5000) |
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In regards to vascular problems, explain a Stroke.
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(cerebrovascular accident) - brain attack: common
Abnormal condition of the blood vessels of the brain: Ischemia: thrombosis or embolism (85%) Hemorrhagic: hemorrhage (15%) |
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What are risk factors of a stroke?
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atherosclerosis, heart disease, HTN, kidney disease, peripheral vascular disease, diabetes
Family history, obesity, high serum cholesterol, cigarette smoking, stress, cocaine use, sedentary lifestyle, oral contraceptives |
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What are clinical manifestations of a stroke?
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functions affected are directly related to the artery involved & area of the brain it supplies; both unconsciousness & seizures result from generalized ischemia & brain’s response to abrupt hypoxia
Headache Sensory deficit Hemiparesis; hemiplegia Dysphasia or aphasia |
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In regards to a stroke, what are nursing interventions for thrombosis or embolism?
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Thrombolytics – t-PA, streptokinase
Platelet inhibitors – ASA, clopidrogrel (Plavix) Anticoagulants - Heparin and Warfarin |
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In regards to a stroke, what are drugs to reduce ICP?
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dexamethasone (Decadron)
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What are neurological checks?
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Orientation; LOC; bilateral muscle strength; speech ability; involuntary movements; ability to follow commands; & any abnormal posturing
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In regards to a stroke, what is agnosia?
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total or partial loss of the ability to recognize familiar objects or people
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In regards to a stroke, what is unilateral neglect?
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- perceptually unaware of and inattentive to one side of the body
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In regards to a stroke, what is Hemianopia?
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characterized by defective vision or blindness in half of the vision field
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In regards to a stroke, what is Hemiparesis?
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muscular weakness or partial paralysis restricted to one side of the body
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In regards to a stroke, explain communication.
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Dysarthria - muscle weakness affecting speech production
Aphasia – loss of ability to speak Apraxia - trouble saying what he or she wants to say |
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In regards to Cranial and Peripheral Nerve Disorders, what is Bell’s palsy (peripheral facial paralysis)?
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Inflammatory process involving the facial nerve (CN VII)
Unknown but reactive herpes simplex virus is involved inflammation, edema, ischemia & eventual demyelination of FN creating pain & disturbances to motor & sensory fx |
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What are clinical manifestations of Bell's Palsy?
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Facial numbness or stiffness
Drawing sensation of the face Unilateral (or bilateral) weakness of facial muscles inability to wrinkle forehead, close eyelid, pucker lips or retract mouth on that side (face appears asymmetric) Reduction of saliva Pain behind the ear Ringing in ear or other hearing loss |
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What are nursing interventions for Bell's Palsy?
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No specific therapy
Electrical stimulation Moist heat acyclovir alone or in conjunction with prednisone Massage of the affected area Facial exercises Protection of the eye when the eyelid does not close |
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What is the prognosis for Bell's Palsy?
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85% fully recover in wks, months to year – taste is 1st to return; rest have asymmetric movement of facial muscles
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What is Guillain-Barré syndrome?
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Inflammation and demyelination of the peripheral nervous system
Possibly viral or autoimmune reaction |
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What are clinical manifestations of Guillain-Barre syndrome?
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Symptoms are progressive
Paralysis usually starts in the lower extremities and moves upward; may stop at any point Respiratory failure if intercostal muscles are affected May have difficulty swallowing, breathing, and speaking |
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What are nursing interventions for Guillain-Barre syndrome?
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Adrenocortical steroids
Apheresis Mechanical ventilation Gastrostomy tube Meticulous skin care Range-of-motion exercises |
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In regards to Cranial and Peripheral Nerve Disorders, what is menigitis?
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Acute infection of the meninges
Bacterial or aseptic |
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What are clinical manifestations of meningitis?
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Headache; stiff neck
Irritability; restlessness Malaise Nausea and vomiting Delirium Elevated temperature, pulse, and respirations Kernig’s and Brudzinski’s signs |
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What are antibiotics used for meningitis?
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Massive doses
Multiple types IV or intrathecal |
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What meds are used for meningitis?
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Antibiotics
Steroids Anticonvulsants |
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What nursing intervention should be implemented for a pt. with meningitis?
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Patient needs to be in a dark, quiet room
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In regards to Cranial and Peripheral Nerve Disorders, what are Intracranial tumors?
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Benign or malignant
Primary or metastatic May affect any area of the brain |
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What are clinical manifestations of Intracranial tumors?
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Headache
Hearing loss Motor weakness Ataxia Decreased alertness and consciousness Abnormal pupil response and/or unequal size Seizures Speech abnormalities |
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What are Nursing interventions for Intracranial tumors?
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Surgical removal of tumor
Craniotomy Intracranial endoscopy Radiation Chemotherapy Combination of above |
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What is Craniocerebral trauma?
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Motor vehicle and motorcycle accidents, falls, industrial accidents, assaults, and sports trauma
Direct trauma: head is directly injured Indirect trauma: tension strains and shearing forces Open head injuries Closed head injuries Hematomas |
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What are clinical manifestations of craniocerebral trauma?
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Headache
Nausea Vomiting Abnormal sensations Loss of consciousness Bleeding from ears or nose Abnormal pupil size and\or reaction Battle’s sign |
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What are nursing interventions for craniocerebral trauma?
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Maintain airway
Oxygen Mannitol and dexamethasone Analgesics Anticonvulsants |
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What is spinal cord trauma?
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Automobile, motorcycle, diving, surfing, other athletic accidents, and gunshot wounds
Fracture of vertebra Complete cord injury Incomplete cord injury |
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What are clinical manifestations of spinal cord trauma?
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Loss of muscle function depends on level of injury
Spinal shock Autonomic dysreflexia Sexual dysfunction |
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What are nursing interventions for spinal cord trauma?
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Realignment of bony column for fractures or dislocations: immobilization; skeletal traction
Surgery for spinal decompression Methylprednisolone Mobility: slowly increase sitting up Urinary function: Foley catheter; bladder training Intermittent catheterization Bowel program |
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What is spinal shock?
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period of flaccid paralysis and a complete loss of reflexes below the trauma
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What is autonomic dysreflexia?
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occurs as a result of abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nervous system as a result of stimulation of the bladder, large intestine or other visceral organs
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KNOW PICTURE ON PG 1987
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