Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Neurology Module: Clinical Neurology Module: Clinical Manifestations and Diagnosis of Manifestations and Diagnosis of

Neurological DisorderNeurological Disorder

Clinical Manifestations related to a Clinical Manifestations related to a Neurological Disorder Neurological Disorder

Loss of consciousness, coma, lethargy, Loss of consciousness, coma, lethargy, drowsinessdrowsiness

Disorientation, confusion, depressionDisorientation, confusion, depression

Convulsions, excitability, tremor, restlessConvulsions, excitability, tremor, restless

Headache (frontal or occipital) Headache (frontal or occipital)

Vomiting (projectile, without nausea)Vomiting (projectile, without nausea)

↓ ↓ co-ordination, balance, proprioception, co-ordination, balance, proprioception, ataxic gait ataxic gait

Clinical Manifestations related to a Clinical Manifestations related to a Neurological Disorder (cont)Neurological Disorder (cont)

Visual: diploplia, blurred vision, ↓ visual Visual: diploplia, blurred vision, ↓ visual field, photophobia, unequal pupils, field, photophobia, unequal pupils, ↓ reactivity to light↓ reactivity to lightAltered motor function: paralysis (spastic Altered motor function: paralysis (spastic or flaccid), paresis, aphasia, dysphagiaor flaccid), paresis, aphasia, dysphagiaReduced fine motor controlReduced fine motor controlAltered sensory function: paraesthesia, Altered sensory function: paraesthesia, numbness, ↓ sensory organ function numbness, ↓ sensory organ function (taste, smell, sight , hearing)(taste, smell, sight , hearing)

Other Signs of Neurological Other Signs of Neurological Disorder on Clinical AssessmentDisorder on Clinical AssessmentHyperpyrexia (loss of hypothalamic Hyperpyrexia (loss of hypothalamic temperature control)temperature control)BradycardiaBradycardia↑ ↑ pulse pressure (↑ systolic; ↓ diastolic)pulse pressure (↑ systolic; ↓ diastolic)Slow respirations (depressed resp centre)Slow respirations (depressed resp centre)Signs of neurogenic bladder (retention/ Signs of neurogenic bladder (retention/ incontinence)incontinence)Decorticate/ decerebrate posturing (in Decorticate/ decerebrate posturing (in unconscious patient)unconscious patient)

Neurological Disorder:Neurological Disorder:Physical Examination Physical Examination

History and physical examination including History and physical examination including tendon reflexes/ Babinski responsetendon reflexes/ Babinski response

Conscious level/ orientationConscious level/ orientation

Glasgow Coma ScaleGlasgow Coma Scale

Cranial nerve assessment including sight, Cranial nerve assessment including sight, hearing, smell, tastehearing, smell, taste

Sensory and motor functionSensory and motor function

Vital signs, bladder controlVital signs, bladder control

Neurological Disorder: Neurological Disorder: Diagnostic Tests*Diagnostic Tests*

CT scan with or without contrast mediumCT scan with or without contrast mediumMRIMRIEcho encephalogramEcho encephalogramCerebral angiographyCerebral angiographyCarotid dopplerCarotid dopplerBrain scan (radioactive substance IV)Brain scan (radioactive substance IV)Electro-encephalogramElectro-encephalogramLumbar puncture/ myelogram Lumbar puncture/ myelogram

Neurological Disorder: Neurological Disorder: Diagnostic Blood TestsDiagnostic Blood Tests

Blood glucose/ ketonesBlood glucose/ ketonesSerum ammoniaSerum ammoniaSerum urea/ electrolytesSerum urea/ electrolytesOsmolalityOsmolalityABGABGSerum calciumSerum calciumDrug/ alcohol levels if suspected overdoseDrug/ alcohol levels if suspected overdoseCoagulation studies/ prothrombin time Coagulation studies/ prothrombin time