Neurologic disorders

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  1. Review Spinal Taps and nursing dependent and independent interventions.
  2. Which drugs can cross the BBB
    • Narcotics
    • Anesthetics agents. 
    • Antianxiety
    • Anything that affects LOC.
  3. Vascular supply of the brain?
    • Carotid arteries
    • Circle of Willis 
    • Spinal Cord Supply
    • Brain drains via internal Jugular veins, external jugular veins. Have pt align head to improve arterial flow/venous drainage. Keep flat, if elevated use reverse Trendelenburg. 
    • Blood in brain is x2 circulated.
  4. What is the closed box theory?
    • three objects which occupy space in the brain, the tissue, the CSF and vascular supply determine the intra-cranial pressure
    • If one changes, the others change too
    • easiest one to manipulate is blood flow via vasodilators (nitro) or positional. 
    • Tissue: diuretics, drains, craniotomy, anti-enflamatories (salucortec-nicest, decedron-big boy), debulking (take out brains). 
    • CSF: drains, shunts, hyperventilation-->loss of CO2 (PCO2 = 25ish)-->vasoconstriction in response to not needing to collect excess CO2 from cells. Not done anymore because it causes hypo perfusion--> poor pt outcomes.
  5. Which nerves are important to know to assess LOC and safety?
    • II  Optic Sensory
    • III Oculomotor Motor
    • V Trigeminal Sensory and Motor (blink)
    • X Vagus Sensory and Motor (vomit)
    • IX Glossopharngeal Sensory and Motor (swallow)
  6. Effects of aging on neuro fxn?
    • At 30 years of age, number of neurons begin to decrease
    • Little effect on sensory and primary memory
    • Longer retrieval times for short-term memory
    • Receptors decrease in number
    • Sensory reflexes intact, motor slowing
    • *Confusion is NOT part of normal aging process.
  7. Review neuro/physical exams (youtube) on D2L.
  8. Neuro-physical exam
    • Are usually insidious
    • If missed, usually because stimulus was not strong enough. 

    • Simple to complex theory for Neuro!!!
    • VS: Assess first to determine urgency
    • LOC: Most sensitive indicator of change
    • Observe response to stimuli (voice, touch, pain--nail bed)
    • Tracking of eyes
    • Use of painful stimuli to get response (where, amount, repetitions) Sternocliodmastoid pinch for SCI. 
    • Use scale such a Glascow Coma to provide inter-rater reliability
    • Motor
    • Sensory
    • Reflexes
  9. What are flexion and extension responses to pain?
    • Flexion: pulling in toward body with bent elbows
    • Extension: movement of arms away from body.
  10. Glascow Coma Scale
    • Best motor: strength, command, pain (1-6)
    • Best verbal: responds, makes sense (1-5)
    • Best eye: opens spontaneously
  11. Review of LOC assessment
    • Simple to complex theory for Neuro!!!
    • VS: Assess first to determine urgency
    • LOC: Most sensitive indicator of change, but language is subjective. Tune into the language of the the unit/culture where you are. 
    • Observe response to stimuli (voice, touch)
    • Tracking of eyes
    • Use of painful stimuli to get response (where, amount, repetitions)
    • Use scale such a Glascow Coma to provide inter-rater reliability
  12. What are some of the reflexes used in a neuro assessment?
    • Cranial Nerves III: (oculomotor for lid reflexes)
    • IX: (glossopharnygeal for swallow)
    • X: (Vagus for gag)
  13. Review Spinal Tap
    • Pre-procedure teaching, permit, prep
    • Positioning
    • CSF findings:
    • Cells
    • Glucose
    • Blood
    • Protein (albumin)
    • Pressure
  14. What do you need to know about brain tumors?
    • Space occupying lesions
    • Increased ICP
    • Tumors range from grade I (benign) to grade V (malignant)
    • Astrocytomas are most common: spread out like a star making it hard to dissect. 
    • Glioblastomas: large tumors with vague edges (makes it hard to remove), immature cells
    • Meningiomas: are usually benign, but still take up space--> ^ICP
    • Acoustic Neuromas: usually around ears-->deafness.
  15. T/F: Brain tumors like to metatesize.
    • False
    • The BBB does a good job of keeping them in.
  16. Why do pts with neuro issues have n/v?
    • Pressure (^ICP)
    • Tissue damage
  17. How do you discriminate between seizure and pseudo seizures?
    drop pt's arm on his/her face. If it hits, the seizure isn't being faked.
  18. What is a transphenoidal Hypophysectomy?
    • Transphenoidal Hypophysectomy: (pituitary tumors) with incision at the upper lip/gingiva below the nasal cartilage Fat and muscle grafts from the abdomen will seal the surgical site at closing.
    • --Traditional bone flap (frontal, lateral tumors) is accomplished with the skull resected and lifted off the head.
    • --Stereotactic (Frankenstein head with the bolts) is completed with MRI peri-op

    • Nursing care:
    • monitor for drainage (should be clear, maybe serosanguinous at first)
    • Sneeze suppression (good luck)
    • Cx straws

    Goal is to remove/reduce size of lesion.
  19. Pre-Op care of tumor pt.
    • Trend record VS, Neuro Checks including PERRLA, extra ocular motion, limb strength and movement, GCS,
    • Pre-op education for surgery
  20. Post-Op care of tumor pt.
    • Neuro checks
    • Avoid the use of straws
    • Nasal drip pad changes
    • Donor site check
    • Monitor Diabetes Insipidus: Not be be confused with SIADH. Remember, "DI and then you're dry. Going to be peeing A LOT so you'll be really thirsty. 
    • --Decreased ADH secretion--> ^urine output. 
    • --Polyuria & polydipsia
    • --Watch serum electrolytes
    • --Give po/IV fluids
    • --SG of urine  1.005 or less (should be clear)
    • --IV Vasopressin or inhaled DDAVP may be indicated. Both will stop ADH process.

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Neurologic disorders
2013-02-21 13:25:36

Adult MedSurg
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