procedure done to repair a skull defect

composed primarily of water glucose, sodium chloride, and protein

which are possible neurologic changes associated with normal aging

what are some of the possible functional abilities affected by normal aging

select all that apply

give an example of a genetic disorder

what may be the causative agents of meningitis and encephalitis

what are examples of some degenerative disorders

select all that apply

What would you assessment for neurologic disorder

sata

Physical Exam four major components

- neurological exam provides baseline data

sata

Advanced Neurological Exam

a shampoo is done before the test, and medications such as anticonvulsants and stimulants are withheld 24-48 hours before the test

- measures brain activity

tell the patient to expect to lie still on a stretcher while the dye is injected, and radiographs of the head are taken

- to diagnosis brain abscesses, tumors, contusions, hemorrhages, hematomas, or occlusions

a cannula is inserted into subarachnoid space at the fourth or fifth lumbar vertebra, which ends at the second lumber vertebra.

pt must remain on one side in knee to chest position

have patient void before the procedure to reduce discomfort from the position

- after procedure patient should be instructed to lie flat. (serious headache)

needle electrodes are placed on several points over a nerve and muscles supplied by the nerve.

- used to diagnosis neuromuscular disorders such ALS, peripheral neuropathy, MG, carpal tunnel syndrome

Inform the radiologist about any allergies to iodine, shellfish, or contrast media

a contrast is dye is injected, followed by a series of radiographs

complementary, computer-assisted radiographic procedure for visualization of cerebral vessels

enhancement of an area may be achieved by inject contrast medium

this procedure does not expose the patient to radiation. it is noninvasive examination that involves placing the patient in a strong magnetic field and then applying bursts of radio frequency waves. Sophisticated technology converts information about the movement of molecules in the tissue into precise, clear images

many drugs stimulate or depress the CNS

for example caffeine is stimulant whereas morphine is a depressant

true/false

what types of drugs are used for neurologic disorders?

sata

what are some preoperative care & postoperative care

for craniotomy

sata

to minimize headache following a lumbar puncture what should be increased

the family should be advised that a craniotomy can take as long as

what evaluations are included in a neurologic assessment?

sata

what are the possible risks for a patient who has had a craniotomy performed?

sata

as intracranial pressure (ICP) increases and perfusion is reduced, oxygen delivery to cerebral tissue is

a patient with increased ICP has a "blown pupil". which describes this condition

the pupils may become dilated and fixed as ICP rises due to pressure on the

what are the measures used to decrease ICP

sata

which priority measures are indicated for patients with increased ICP?

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which drugs are commonly used in the treatment of patients with increased ICP

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ICP is

ICP S/SX

ICP Intervention

a nurse is caring for a patient who was a victim of a violent crime and has experienced a head injury. she is lying very still and does not respond when spoken to or when shaken by the shoulder. the nurse squeezes her trapezius muscle and the patient responds to the painful stimuli. what is the term that describes her level of consciousness

disturbances in glucose metabolism and electrolyte imbalances can lead to deterioration in what two neurologic functions

sata

a male patient who is being treated for a closed head injury is lying still and appears to be sleeping even in the noisy emergency department. when you shake his shoulder and call his name, he open his eyes and says "Huh"? then he closes his eyes again. which of the following is a term that describes his level of consciousness

diuretics used to treat increase intracranial pressure (ICP) can cause fluid and electrolyte imbalances.

1. how does increased ICP affect respiration?

2. why would the patient lose consciousness when the ICP is elevated?

true/false

which one of the following is a nursing measure used to decrease ICP

causes intense unilateral pain and usually begins in temple or eyes

sensation such as dizziness, eye or hearing disruption, etc. that can occur prior to a seizure

frequently occurs in a series followed by extended period with no symptoms

can last for days or even years and the location of the pain can vary

seizure disorder is

how to diagnose seizure disorder

involves part of the brain

simple

- part of one cerebral hemisphere; consciousness not impaired

complex

- consciousness impaired; may exhibit bizarre behavior

involves entire brain

involves the entire brain from the onset

consciousness lost during the ictal (seizure) period

types: tonic-cionic, absence, myoclonic, and atonic

·   Medical emergency: continuous seizures or repeated seizures in rapid succession for 30 minutes or more

is status epileptics

Aura

·   Dizziness, numbness, visual or hearing disturbance, noting an offensive odor, or pain may precede a seizure

seizures treatment is

Underlying cause/condition (tumor), anticonvulsants, surgery, Dilantin commonly used – read patient teaching, side effects

true/false

fSurgical treatment for seizures

·   Removal of seizure foci in the temporal lobe and pallidotomy or vagal nerve stimulator

 true/false

seizures interventions

– loss of consciousness, falling, crying, and generalized stress

•– jerking of limbs, salivary frothing

•– seizure activity stops, patient is drowsy and has no memory of the seizure

a type of headache in which the pain is usually unilateral and has warning is called

most common causes of head injurys

what type of head injury

·   Lacerations, contusions, abrasions, and hematomas

·   Trauma with no visible injury to the skull or brain

loss of consciousness >5 minutes, headache, amnesia, nausea and vomiting

·   Bruising and bleeding in the brain tissue

·   Subdural hematoma or epidural hematoma

(subdural or epidural) – collection of blood, may cause increased ICP, if suspect assess for drowsiness

·   From lesions within the tissue of the brain itself

Sharp objects penetrate the skull and brain tissue

Head Injury

Surgical treatment

·   Directed at evacuating hematomas and débriding damaged tissue

what are some head injuries interventions

§Malignant or Benign

§May be result of metastasis in cancer patients

§Cause generally unknown, heredity, drugs, or environment

inflammation of the coverings of the brain and spinal cord caused by either viral or bacterial organism

·   Cause and risk factors

·   Inflammation of brain tissue caused by virus

·   Signs and symptoms

·   Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and restlessness commonly seen

·   Comatose or exhibit aphasia, hemiparesis, facial weakness, and other alterations in motor activity

·   Medical treatment

·   Enhance patient comfort and increase strength

·   Because seizure activity is a potential problem, take appropriate safety precautions

•No known specific cause

•Possible autoimmune response to viral infection

•Patients usually report recent virus or vaccination 

•Also called acute inflammatory polyneuropathy

•Progresses rapidly and affects motor and sensory part of the peripheral nervous system  

what phase is this in Gillian barre syndrome

·   Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper extremities

·   Visual and hearing disturbances, difficulty chewing, and lack of facial expression

·   Mild paresthesias or anesthesia in feet and hands in a glove or stocking distribution pattern

·   Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention

·   Remains essentially unchanged

·   No further neurologic deterioration, but no improvement either

·   Remyelinization; muscle strength returns in a proximal-to-distal pattern (head to toes)

Cause and risk factors

·   Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement

Signs and symptoms

·   Tremor, rigidity, and bradykinesia

·   Loss of dexterity and power in affected limbs, aching, monotone voice, handwriting changes, drooling, lack of facial expression, rhythmic head nodding, reduced blinking, and slumped posture

·   Depression common; dementia may develop

·   Cause

·   Chronic, progressive degenerative disease

·   Attacks the protective myelin sheath around axons and disrupts the conduction of impulses through the CNS

·   Chronic, progressive MS: progresses steadily

·   Exacerbating-remitting MS: exacerbations and remissions

·   Relapsing-progressive MS: less stable periods than exacerbating-remitting

·   Stable MS: stable; no active disease for a year

·   Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated

Signs and symptoms

Fatigue, weakness, and tingling in one or more extremities; visual disturbances; problems with coordination; bowel and bladder dysfunction; spasticity; and depression

·   Cause

·   Also known as Lou Gehrig’s disease; a degenerative neurologic disease

·   Virus suspected, but exact cause unknown

·   Pathophysiology

·   Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms

·   Signs and symptoms

·   Weakness of voluntary muscles of the upper extremities, particularly the hands

·   Difficulty swallowing and speaking

·   Eventually, respirations shallow; difficulty clearing airway of pulmonary secretions

Death results from aspiration, respiratory infection, or respiratory failure

Inherited degenerative neurologic disorder

Usually begins in middle adulthood with abnormal movements, emotional disturbance, and intellectual decline

Symptoms progress steadily: increasing disability and death in 15 to 20 years

Medical and nursing care are supportive only; there is no cure

Inherited degenerative neurologic disorder

Usually begins in middle adulthood with abnormal movements, emotional disturbance, and intellectual decline

Symptoms progress steadily: increasing disability and death in 15 to 20 years

Medical and nursing care are supportive only; there is no cure

·   Signs and symptoms

·   Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking

·   Partial improvements of strength with rest

·   Dramatic improvement with the use of anticholinesterase drugs

·   Ptosis and diplopia commonly seen

•Intense Pain involving:

•1.  Ophthalmic nerve

•2. Mandibular nerve

•3.  Maxillary nerve

•Abrupt onset, unilateral, lasts seconds to minutes

•May be triggered by hot or cold liquids, chewing, shaving, or washing face

edrophonium (tension) rapidly reverses a myasthenic crisis but has no effect on cholinergic crisis

sudden discontinuance of anticonvulsant drugs can trigger seizure activity