-
tx spinal cord injurie-s
4
- patent airway
- immobilize (traction, special beds)
- administer drugs
- preserve cord function (surgery)
-
autonomic dysreflexia
s/s
9
sudden htn, pounding ha, anxiety, flushed face, diaphoresis, bradycardia, nasal congestion, vasoconstriction below lesion w cold skin and goose flesh, vasodilation above lesion with warm moist skin
-
spinal shock
3
relex activity below level of injury is temporarily stopped. starts 30-60 mins after, paralysis is flaccid (no muscle tone)
-
types of seizures
4
- absence
- tonic-clonic
- myoclonic
- atonic
-
ansence seizures
5
dont include motor signs; may last less than one min; seen in children; thought as daydreaming; no post
-
tonic-clonic
3
- tonic phase- muscles are rigid
- clonic phase - rythmic muscle jerking
- hear "cry" from rigid trunk and diaphragm air coming thru vocal cord
-
myoclonic
3
- muscles to jerk
- person may fall
- no post
-
atonic
- brief loss of tone in muscle
- person may drop things/fall
- no post
-
postictal phase
5
- time immediately after as pt recovers
- clear secretions, open airway, o2, assess for injuries (abrasions, bruises, tongue biten)
-
interictal phase
+6
- time between seizure activity
- siderails up and padded
- suction at beside
- disable locks
- no glass thermometers
- helmets for walkers
-
intracranial surgery baseline assessment
to have something to compare to during surgery
-
management of seizures
8
- remove objects
- turn on side
- note time began and how progresses
- assess/document postictal status
- allow quiet rest
- call emergency for t-c lasting longer than 4 mins or seizes rapidly succession
- dont restrain
- dont put anything in mouth
-
meningitis s/s
8
- ha
- nachal rigidity
- irritability
- decr loc
- photophobia
- hypersensitivity
- seizures
- + kernigs and brudzinskis
-
parkinsons s/s
11
- dont occur until 70% neurons destroyed
- TRAP - tremors, rigidity, akinesia/bradykinesia, and postural instability.
- wkness, fatigue, diff w fine motor movement, loss facial expression, diff chew/swallow, voice changes, memory loss, prob-solving diff, visual spatial deficits
-
myasthenia gravis
6 s/s
muscle wkness, fatigue, ptosis & diplopia, cant keep mouth shut/chew/swallow long periods, emotionless face, wk neck causing head to fall forward
-
myasthenia gravis testing
- tensilon test
- given iv - pt have brief incr in muscle strength
-
primary/closed spinal cord injury
10
- skin and meningeal covering remain in tact:
- compression, flexion, hyperextension, rotation, blunt trauma, hematomas, degeneration, tumor, fx
-
secondary/open spinal cord injury
3
- damage to skin/meninges
- gun shot wound
- stab wound
-
neuro checks
6
- pt hx while gathering:
- speech pattern
- mental status
- intellectual function
- reasoning ability
- movement/lack of
-
agnosia
failure to recognize/identify objects despite intact sensory function
-
assessing pain
- broken wooden applicator as "sharp"
- cotton side as dull
- ask pt whether sharp/dull sensation felt
- recognition of sharp indicates perception of painful stimuli
-
deep pain sensation
may indicate pressure on a sensory nerve
-
rombergs sign
motion and position
- pt stand w feet together eyes close
- if loses balance = presence of pathologic condition
-
kernigs sign
inability to extend legs when knee flexed at hip
-
brudzinskis sign
hip and knee flexed when neck is flexed
-
assessment of pupils
size, shape, response to light, equality
-
12 cranial nerves
OOOTTAFAGVAH
- olfactory
- optic
- oculomotor
- trochlear
- trigeminal
- abducens
- facial
- acoustic
- glossopharyngeal
- vagus
- spinal accessory
- hypoglossal
-
test olfactory
common odors to one nostril at a time
-
test optic
visual acuity, field, optic disk
-
occulomotor
EOMs, dolls eyes, accomodation
-
trochlear
eoms, dolls eyes
-
-
facial
smile, frown, show teeth, puff cheeks, taste (ant 2/3), close eyes
-
acoustic
vestibular not tested
-
glossopharyngeal
- swallow on command
- gage reflex
- taste post 1/3
-
vagus
gag reflex, midline elevation uvula
-
spinal accessory
shrug shoulders, turn head against resistance
-
hypoglossal
protrude tongue (deviates to affected side)
-
eoms
extraocular movements
-
dolls eyes
when head is moved, eyes move opposite direction
-
4 functions nervous system
- receives info from internal and external environments
- communicates info bw bd and cns
- processes info recieved to determine response situations
- transmits info for bd action, control, or modification (touch something hot)
-
speech areas of brain
- cerebrum dominant side
- brocas and wernickes
-
brocas
controls verbal, expressive speech
-
wernickes
reception and understanding language
-
age related changes
6
- loss of cells and wt
- nerve cell loss diffuse and gradual
- decr bld flow
- labile and unpredictable
- decr nerve impulse velocity
- decr sensory and motor conduction
-
nsg role lumbar puncture
monitor insertion site for swelling, redness, or drainage
-
signs of decreased LOC
- minimal agitation/drowsiness
- restless or suddenly quiet - alert dr
- somnolence
- lethargy
- stupor
- semi/coma
-
-
lethargy
excessive drowsiness
-
stupor
decr responsiveness c lack of spontaneous motor activity
-
semicomatose
in stupor but can be aroused
-
-
IICP early signs
4
- decr loc
- ha increased w cough/strain
- pupillary changes (dilation, slowed constict)
- contrlateral motor/sensory losses
-
IICP late signs
12
- change in vitals
- incr systolic
- decr diastolic
- widened pulse pressure
- slow pulse
- resp dysrythmias
- hiccups
- incr pupil size
- fever wo infection
- vomiting
- decerebrate/decorticate posturing
-
IICP meds
osmotic diuretics
- Mannitol
- promotes fluid removal from edematous brn tis
-
IICP meds
corticosteroids
- Decadron
- used to reduce edema associated w tumors/abcesses
-
IICP meds
Anticonvulsants
-
IICP meds
opiods and sedatives
- use cautiously bc of resp depressant effect
- may alter pts ability to cooperate for accurate neuro exam
-
IICP meds
barbituates
- phenobarb
- given to slow cerebral metabolic rate
- and minimize damage caused by IICP induced ischemia
-
significant changes in LOC that need reported
pts who are restless and agitated or suddenly quiet
-
primary ha
- no pathologic cause
- migraine, tension, cluster
-
secondary ha
- pathologic cause
- meningitis, tumor, subarachnoid hemorrhage
-
migraines
cerebral bld ves narrow and bld flow reduced (vasoconstriction) followed by vasodilation and inflammation cause release of serotonin
vary in freq, duration, and intensity
-
cluster ha
- similar to migraines
- but brief (45 mins of less)
-
tension ha
stress-induced muscle tension over neck, scalp, face
-
tx ha
- common meds
- quiet dark room
- relax tech
-
signs of a stroke
5
- sudden numbness/wkness of face, arm, or leg, esp on one side of bd
- sudden confusion, trouble speaking or understanding
- sudden trouble seeing in one/both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden severe ha w no known cause
-
modifiable risk factors stroke
can be controlled reducing risk for cva
-
nonmodifiable risk factors
- cant be changed
- age, race, gender, hereditary
-
causes of stroke in younger ppl
drug abuse, bc pills with smoking, congenital hrt conditions, mitral valve prolapse, a fib, infectious endocardititis, sickle cell anemia, rheumatic fever, leukemia
-
htn
interventions
7
- antihypertensive drugs
- wt control
- stress management
- smoking cessation
- limited etoh
- low fat diet
- reduced na
-
cardia disease
interventions
- drug therapy to improve bld flow and prevent clots
- treatment of a fib
-
dm
interventions
balanced drug therapy, diet, wt control, exercise, bld glucose monitoring
-
hypotension
intervention
- good hydration, esp elderly
- monitor effects of diuretic and antihypertensive drugs
-
migraine ha
intervention
drug therapy to abort impending ha or prophylaxis
-
incr risk for bld clot
intervention
-
excessive etoh
intervention
limit etoh to one oz pure etoh: 2 cans beer, 2 sml glass wine, 2 cocktails
no binge drinking
-
smoking
intervention
- advise of risks
- explain risks falls w cessation
- self help programs
- md for drugs
-
obesity
intervention
- maintain bd normal bd wt
- proper diet instriction
- wt control prgrams
- exercise programs
-
high fat diet
interventions
- instruction in meal planning and prep
- reduce sat-fats
-
drug abuse
interventions
drug abuse tx programs
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