neuro

• patent airway
• immobilize (traction, special beds)
• administer drugs
• preserve cord function (surgery)

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

relex activity below level of injury is temporarily stopped. starts 30-60 mins after, paralysis is flaccid (no muscle tone)

• absence
• tonic-clonic
• myoclonic
• atonic

dont include motor signs; may last less than one min; seen in children; thought as daydreaming; no post

• tonic phase- muscles are rigid
• clonic phase - rythmic muscle jerking
• hear "cry" from rigid trunk and diaphragm air coming thru vocal cord

• muscles to jerk
• person may fall
• no post

• brief loss of tone in muscle
• person may drop things/fall
• no post

• time immediately after as pt recovers
• clear secretions, open airway, o2, assess for injuries (abrasions, bruises, tongue biten)

• time between seizure activity
• siderails up and padded
• suction at beside
• disable locks
• no glass thermometers
• helmets for walkers

to have something to compare to during surgery

• 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

• ha
• nachal rigidity
• irritability
• decr loc
• photophobia
• hypersensitivity
• seizures
• + kernigs and brudzinskis

• 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

muscle wkness, fatigue, ptosis & diplopia, cant keep mouth shut/chew/swallow long periods, emotionless face, wk neck causing head to fall forward

• tensilon test
• given iv - pt have brief incr in muscle strength

• skin and meningeal covering remain in tact:
• compression, flexion, hyperextension, rotation, blunt trauma, hematomas, degeneration, tumor, fx

• damage to skin/meninges
• gun shot wound
• stab wound

• pt hx while gathering:
• speech pattern
• mental status
• intellectual function
• reasoning ability
• movement/lack of

failure to recognize/identify objects despite intact sensory function

• broken wooden applicator as "sharp"
• cotton side as dull
• ask pt whether sharp/dull sensation felt
• recognition of sharp indicates perception of painful stimuli

may indicate pressure on a sensory nerve

• pt stand w feet together eyes close
• if loses balance = presence of pathologic condition

inability to extend legs when knee flexed at hip

hip and knee flexed when neck is flexed

size, shape, response to light, equality

• olfactory
• optic
• oculomotor
• trochlear
• trigeminal
• abducens
• facial
• acoustic
• glossopharyngeal
• vagus
• spinal accessory
• hypoglossal

common odors to one nostril at a time

visual acuity, field, optic disk

EOMs, dolls eyes, accomodation

eoms, dolls eyes

• eoms
• dolls eyes

smile, frown, show teeth, puff cheeks, taste (ant 2/3), close eyes

vestibular not tested

• swallow on command
• gage reflex
• taste post 1/3

gag reflex, midline elevation uvula

shrug shoulders, turn head against resistance

protrude tongue (deviates to affected side)

extraocular movements

when head is moved, eyes move opposite direction

• 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)

• cerebrum dominant side
• brocas and wernickes

controls verbal, expressive speech

reception and understanding language

• 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

monitor insertion site for swelling, redness, or drainage

• minimal agitation/drowsiness
• restless or suddenly quiet - alert dr
• somnolence
• lethargy
• stupor
• semi/coma

drowsy/sleepy

excessive drowsiness

decr responsiveness c lack of spontaneous motor activity

in stupor but can be aroused

cannot be aroused

• decr loc
• ha increased w cough/strain
• pupillary changes (dilation, slowed constict)
• contrlateral motor/sensory losses

• 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

• Mannitol
• promotes fluid removal from edematous brn tis

• Decadron
• used to reduce edema associated w tumors/abcesses

• Dilantin
• prevent seizures

• use cautiously bc of resp depressant effect
• may alter pts ability to cooperate for accurate neuro exam

• phenobarb
• given to slow cerebral metabolic rate
• and minimize damage caused by IICP induced ischemia

pts who are restless and agitated or suddenly quiet

• report to dr
• monitor

• no pathologic cause
• migraine, tension, cluster

• pathologic cause
• meningitis, tumor, subarachnoid hemorrhage

cerebral bld ves narrow and bld flow reduced (vasoconstriction) followed by vasodilation and inflammation cause release of serotonin

vary in freq, duration, and intensity

• similar to migraines
• but brief (45 mins of less)

stress-induced muscle tension over neck, scalp, face

• common meds
• quiet dark room
• relax tech

• 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

can be controlled reducing risk for cva

• cant be changed
• age, race, gender, hereditary

drug abuse, bc pills with smoking, congenital hrt conditions, mitral valve prolapse, a fib, infectious endocardititis, sickle cell anemia, rheumatic fever, leukemia

• antihypertensive drugs
• wt control
• stress management
• smoking cessation
• limited etoh
• low fat diet
• reduced na

• drug therapy to improve bld flow and prevent clots
• treatment of a fib

balanced drug therapy, diet, wt control, exercise, bld glucose monitoring

• good hydration, esp elderly
• monitor effects of diuretic and antihypertensive drugs

drug therapy to abort impending ha or prophylaxis

• good hydration
• drug tx

limit etoh to one oz pure etoh: 2 cans beer, 2 sml glass wine, 2 cocktails

no binge drinking

• advise of risks
• explain risks falls w cessation
• self help programs
• md for drugs

• maintain bd normal bd wt
• proper diet instriction
• wt control prgrams
• exercise programs

• instruction in meal planning and prep
• reduce sat-fats

drug abuse tx programs