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what are the 5 main componets to a neuro assessment?
- 1) mental status
- 2) cranial nerves
- 3) motor system
- 4) sensory system
- 5) reflexes
- -seen w/ lesions that interupt corticospinal (motor) pathways between upper neurons in brain and spinal cord
- -arms flexed, fists clenched, legs extended
- -disruption of motor neurons of the brainstem and midbrain
- -arms stiff and extended, forearms pronated, DTRs exaggerated
-may be seen w/ tetany, seizures (grand-mal), meningitis
What are the focus assessment areas of the Glascow Coma Scale, GCS? The scoring?
- GSC= used to assess LOC, usually the first sign that is altered w/ incr. ICP
- 1) motor response (e.g. obeys commands, loczlized to noxious stimuli, withdraws from noxious stimuli...)
- 2) verbal response
- 3) eye opening (e.g. spontaneous, open to speech...)
Normal= 15, 7 or less = comatose, "less than 8, intubate!"
What are some main assessments we gain from mental status?
- -general appearance
- -thought content (e.g. delusions, hallucinations)
- -intellectual capacity
- -ADL assessment = good baseline to evaulate progressive neuro disease
What is the function of the cranial nerves and what are some things that can impair them?
- -sensory and motor function
- -may be impaired by incr. ICP, surgery of head/neck tumor, trauma
What are the main CN affected by changes in ICP d/t their location?
2, 3, 4, 6
CN II (optic)
-incr. ICP causes direct pressure, assess w/ simple vision test (e.g. ask pt. to read something or put 2 fingers up and say how many?)
CN III (Oculomotor), IV (Trochanter), VI (Abducens)
- -incr. ICP causes indirect pressure bc they exit at the brainstem at the level of the tetorial notch, so they are affected when the brain shifts
- -these CN (3,4,6) are responsible for extraocular movements, and CN 3 is responsible for pupil constriction
- -assess using
- Accomodation (pupils shouls slightly constrict as you move finger toward pt's face)
-evaulates the lower motor neurons (anterior horn cell and the motor fibers that leave it) and the sensory fibers within the particular levels of the spine
- 4+ hyperactive (may be assoc. w/ upper motor neuron disease of the cerebral cortex)
- 3+ brisker than normal (not necessarily pathologic)
- 1+ diminished (may be normal)
- 0 absent (assoc. w/ lower neuron disease, like Guillan-Barre)
Define abdominals, cremasteric, and plantar reflexes
- -Abdominals- equal movement of umbilicus (absent movement = damage in pyramidal tract (pyramidal tract deals w/ regulation of fine muscle movements))
- -Cremasteric- rising of the testicle and scrotum
- -Plantar- (Babinski) fanning of toes (normal in baby, not adult), or dorsiflexion of great toe
Abbreviated neuro assessment
- 1) VS (checking for HTN, bradycardia, widened pulse pressure, change in resps)
- 2) pupil size, shape, reaction
- 3) eye opening
- 4) verbal response
- 5) motor response
- 6) extremity strength
- the most accurate indicator of changing neurological status is LOC!!!
What is a Lumbar Puncture (spinal tap) and why is it used?
- -insertion of spinal needle into subarachnoid space between 3rd and 4th or 4th and 5th lumbar vertabrae (=no danger bc spinal cord ends at L1-L2) but temporary leg pain or muscle twitching may result from spinal root irritation
- -used to obtain CSF pressure readings or to relieve pressre in certain conditions, may be used to obtain CSF for analysis, inject contrast medium, inject anesthesia
What are the risks w/ a lumbar puncture?
-rusk of uncal herniation and infection, contraindicated w/ incr ICP or infection at the puncture site
What are some considerations w/ Lumbar puncture?
- -local anesthetic
- -fetal position
- -bedrest in FLAT position for 4-8 hrs post procedure to prevent spinal cord HA
- -icr. fluids to 3000 mL for 24-48 hrs
- -post procedure: monitor for CSF leak, hematoma, infection, bleeding, numbness, decr. ability to move extremities, inability to void, signs of meningeal irritation (nuchal rigidity, photosensitiviey, Kernigs and Brudzinskis sign)
- -lavel and number specimen tubes, transport to lab immediately
What is a electroencephelography (EEG)? Main uses?
- -records activity of the cerebral hemisphere to: (main uses)
- 1)determine orgin of seizure activity
- 2)monitor cerebral activity during surgical anesthesia
- 3)determine brain death
What is the nursing care for an EEG?
- -if the test is to be performed under sleep deprived conditions, tell pt to awaken at about 2 or 3 am and stay awake for rest of night
- -instruct pt to aviod CNS depressants or stimulants, and withhold anticonvulsants only if prescribed by physicain
- -tell pt not to drink caffeine on day of test (stimulant)
- -have pt wash hair and not put sprays/oils in the day of test
What is a Positron Emission Tomography (PET scan)? Why is it used?
-provides info about the FUNCTION of the brain, specifically glucose and O2 metabolism and cerebral bloodflow (CT provides info about structure only)
-used to detect areas of metabolic alteration (dementia, epilepsy, psych and degenerative disorders, neoplasms, Alzheimers)
-Deoxyglucose is injected which is tagged to an isotope, the isotope emits activity (positrons) which are scanned and converted to a color image by the computer, the more aciteve a given part of the brain the more glucose uptake
What is the client care w/ a PET scan?
- -no caffeine, ETOH, tobacco 24 hrs before test
- -NPO for 4-12 hrs prior, if pt. is diabetic do not give insulin before test
- -do not give glucose sln or other drugs that alter glucose metabolism
- -IV line established
- -client may be asked to perform functions such as counting, test takes 2-3 hrs
- -icr. fluid intake after exam, no special urine precautions
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