Neurology Nursing Study Guide

8/10/2019 Neurology Nursing Study Guide

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Neuro Study Guide

Disease Brief

pathophysiology

Clinical

manifestation

/Assessment

Diagnostic

tests &

findings

Medical

management

Nursing

diagnoses

Interventions Other notes:

Altered Level

of

Consciousness

(LOC)

Not a disease

process!

3 types

-Neurologic

-Toxic

-Metabolic

Can be caused by

factors such as:

drug overdose

head injury

strokealcohol

hepatic/renal

failure

DKA

LOC is a

continuum from

A&O x3 to coma

Restlessness

Anxiety

Slow pupils

Conscious?

Decreased

verbal response

Decreased

motor response

Decreased eyeresponse

Respiratory

depression

At risk for

alterations in

any body

system!!!

Full

assessment

Neuro exam

Glasgow

coma scale

Potential labs:

Blood glucose,Electrolytes,

Liver function,

BUN, Serum

ammonia,

PT/PTT, Serum

ketone, Blood

alcohol/drug,

ABGs

Diagnostic:CT, MRI, EEG,

PET/SPECT

**Airwayis first

priority,

especially if

unconscious

-Find the cause

to find the

treatment

Ineffective Airway

clearance

Risk of injury

Deficient fluid

volume

Impaired oral

mucous

membranes

Risk for impaired

skin integrity

Impaired tissue

integrity of the

corneaIneffective

thermo-regulation

Impaired urinary

elimination

Bowel

incontinence

Disturbed sensory

perception

Interrupted family

process

Obtain/ maintain

patent airway

Protect the patient

Maintain fluid balance/

IV fluids as ordered

Tube feedings if

indicated

Mouth care

ROM

Turning/ repositioning

Keep eyes moist and

protected

Heat/cold as necessaryto maintain body

temperature

Bladder scan/ Catheter

Promote bowel

function

Provide sensory

stimulation

Care for the family

SCD hose/ DVT

prevention

Coma:

unconscious,

unrousable,

unresponsive

LockedIn

syndrome:

Inability to move

or respond except

for eye movement

(lesion of Pons)

Akinetic Mutism:

Sometimes opens

eyes but makesnot movement or

sound

Persistent

vegetative state:

devoid of

cognitive function

but has sleep-

wake cycles

Increased

Intracranial

Pressure (ICP)

Not a disease

process!

Increased ICP

occurs when one

of the three

factors

(blood,brain,CSF)

increases and the

*Earliest signs arechange in LOC,

slowed speech,

delayed response

More signs:

Restlessness

Increased

drowsiness

Confusion

**NO lumbar

punctures!!

CT, MRI, PET,

SPECT, cerebral

angiography,

transcranial

doppler,

Evoked

EMERGENCY

Intracranial

monitoring

indicated

Craniotomy,

craniectomy,

Osmotic

Ineffective airway

clearance

Ineffective

breathing pattern

Ineffective

cerebral tissue

perfusion

Deficient fluid

volume

Maintain patent

airway

Monitor respiratory

status

HOB up to 60

Avoid stimuli that

increases ICP

Hourly I/O during

acute phase

CPP: 70-100 mm

Hg

ICP in ventricles is

0-10 mm Hg, with

a max of 15 mm

Hg


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Neuro Study Guide

other two cannot

compensate to

maintain normal

ICP

Weakness on one

side or in one

extremity

Headache

Vomiting

Impaired gag

and/or corneal

reflexes

Progression

towards stupor

and coma

Late signs:

Coma

Fixed pupils

Decortication

Decerebration

Impaired/ absent

respirationsCushings

response:

Increased BP

Widened pulse

pressure

Cardiac slowing

Cushings triad:

Bradycardia

Hypertension

Bradypnea

potential

studies,

electrophysio-

logic

monitoring.

diuretics, fluid

restriction, CSF

drainage, fever

control,

maintaining BP

and O2 status,reducing cerebral

demands, avoid

increases r/t

increased

abdominal

pressure,

straining with

BM, high PEEP.

Risk for infection

Impaired skin/

mucous

membrane

integrity

Strict aseptic

technique with ICP

monitoring

Turn/reposition -

hygiene

Seizures Uncontrolledelectrical

discharge in the

brain.

Is either primary

or secondary to

metabolic,

systemic and

other causes.

Depends on

type of seizure

how they

present- see

note.

During a seizure

documentation:

Circumstance

before the seizureAura

Dx:

CBC, CMB, UA,

drug screen,

lumbar

puncture, CT

scan, EEG, skull

xray

Assess:

Patient Hx

Family Hx

Usually treated

with medication

though surgical

options do exist

in some cases.

Risk for injury

Fear

Ineffective

individual coping

Do not restrain

patient, pad siderails,

place on their side

Adherence to

medications is

important to prevent,

identify triggers and

avoid

***See pages 8-11

on the ch 61-62

notes packet.

Details types of

seizures, etc

**recommend re-

reading the status

epilepticus section

as well


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Neuro Study Guide

Head injury, CVA

are biggest causes

of new onset

seizures

What the patient

doesfirst area

affected and how,

type of

movements,

areas of body

involved, size of

pupils and if eyes

are open,

automatisms,

incontinence,

duration,

unconsciousness,

paralysis, inability

to speak,

cognitive status,

and movements

at the end ofseizure as well as

if the patient

sleeps after.

protect from

injury and do not

touch during

seizure-

Nurse then

prevents

complications andallows patient to

restbedrails up

and padded if

needed

Characteristics

of the seizures

Deficient

knowledge

Teaching about

management and

referral to counseling

Ongoing education

and encouragement.Medic alert bracelet.

Family teaching.

Headache (HA) Migraine:abnormal

metabolism of

serotoninexact

mechanism

unknown

4 phases of

migraine:

Prodrome

nondescript

symptoms

(depression,food cravings,

Detailed Hx

Medication Hx

Assessment of

head and neck

Complete

neuro exam

Abortive

medications

Prevention

techniques

(identify triggers,

etc)Analgesics

Acute pain Medication and other

nonpharmacological

measures(dark, quiet

room, cold/heat,

massage, elevate HOB

30)

Migraine in

particular can

occur with

hormonal changes

related to

menstruation


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Neuro Study Guide

Tension

contraction of

scalp/neck

muscles with

physical or

emotional stress

Clusterdilation

of orbital and

nearby

extracranial

arteries (theory)

feeling cold)

hours-days

before

Aura-

Not in most

patients, mayhave neuro

symptoms

Headache- 4-72

hours

Recovery

exhaustion, may

sleep for

extended

periods

Tension:

Band like pain

or like a weight

on the head.

Steady, constant

pressure

Cluster:

unilateral and

come in clusters

of 1-8 in a day.Excruciating

pain 15min-3hrs

usually in

eye/orbit region

but may radiate

Other

diagnostics not

used unless

biologic, toxic,

oncologic

causesuspected

Non-medication

therapies

(massage,

heat/cold, etc)

Deficient

knowledge

Help identify triggers

and provide teaching

on lifestyle

modifications to

prevent or reduce

occurrences. Provideteaching about

medications and to

take triptans and

ergot derivatives at

the first symptoms.

Good health Hx is

a mustas well as

good assessment

of the headache

See

questionson page

1891

Ischemic

stroke

Separated into 5

catagories based

on location/origin

but basically ablood clot or

Numbness/wea

kness of

face/arm/leg on

one side

Hx, complete

neuro and

physical exam,

-initial focus is

Thrombolytic

therapy within

less than 3 hours

unlesscontraindicated

Impaired physical

mobility

ROM, positioning,

turning q 2,

ambulation

assistance, exercises,PT consult


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Neuro Study Guide

plaque causes

blockage in the

brain causing

tissue death

Confusion/LOC

change

Trouble

speaking or

understanding

speechVisual

disturbances

Difficulty

walking and

dizziness

Sudden severe

headache

Hemiplegia

Sensory

loss/agnosia

airway

patency-

CT asap to

determine if

ischemic or

hemorrhagic,MRI/MRA,

ECG, carotid

ultrasound, TE

echo, and

SPECT

by INR >1.7,

anticoagulant

use, and recent

intracranial

pathology.

If not candidatefor TPA-

Heparin not

usually used but

is still an option.

Maintenance of

cerebral

hemodynamics

mannitol, PCO2

between 30-35,

preventing

increase in ICP,

and managing

complications

(UTI,

dysrhythmia, etc)

Acute pain

Self care deficit

Disturbed sensory

perception

Impaired

swallowing

Impaired urinary

elimination

Disturbed thought

processes

Impaired verbal

communication

Risk for impaired

skin integrity

Interrupted family

processes

Sexual

dysfunction

Analgesia,

amitriptyline, lamictal,

lyrica

Assistive devices,

teaching,

encouragementApproach from

unaffected side and

put objects on that

side

Special diet (thick

liquid and pureed

foods), tube feeding if

needed, swallowing

techniques

Bladder (and bowel)

training, cath if

needed

Reality orientation,

cueing,

interdisciplinary

training program

Emotional support

and understanding,

therapeutic and

facilitating

communication,speech therapy, social

contact

Patient and family

teaching and inclusion

in plan of care,

realistic approach that

progress may be slow,

emotional care

Communication,

education, counseling,medication adjust


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Neuro Study Guide

Hemorrhagic

stroke

Depends on

cause:

Arteriovenous

malformations,

aneurysm,

intracranialneoplasms,

subarachnoid

All cause bleeding

into the brain and

increased ICP

which can cause

brain death

The same as

intracranial

most common

complaint is

severe

headache

Key symptoms:

Vomiting

Seizures

Sudden change

in LOC

CT, MRI,

cerebral

angiography,

lumbar

puncture (only

if ICP notincreased)

Toxicology

screening

If bleeding

caused by

warfarin, Vit K or

FFP given.

Surgical

interventionwhen applicable

or endovascular

procedures.

Prevent/treat

rebleeding,

antiseizure meds,

DVT prevention,

Fever,

hyponatremia

and

hyperglycemia

treated, BP

stabilized

Ineffective

cerebral tissue

perfusion

Risk for bleeding

Disturbed sensory

perception

Anxiety

-others depending

on needs of the

patientsee

above

Avoid increase in ICP,

HOB 15-30, SCD, close

monitoring of VS and

status

(Rebleeding) BP

carefully maintainedand increase in ICP

avoided

r/t aneurysm

precautions, pt is on

strict bedrest with

environment keep as

calm and quiet as

possible, visitors

restricted, etc. keep

patient informed and

family when possible.

Provide reassure and

support

Head injury

(HI)

Skull fracture,

Contusion,

laceration and/or

torn blood vessels

due to impact,

acceleration-

decelerationinjuries, and

foreign object

penetration.

Increase in ICP

can cause

ischemia

Symptoms

relate to the

injury and

affected area

May have

nosebleed,

battle sign,bleeding from

pharyx or ears,

csf drainage

May have

seizures, coma,

S/S of increased

ICP

Hx, Neuro

exam, xray,

MRI, CT,

cerebral

angiography

Depends on

injury.

May have

surgical

intervention

Maintaining

cerebral

homeostasis is

key

Also depends on

type of injury and

if there is brain

damage present

and/or

neurological

symptoms anddeficits. Managing

ICP is key here so

review (again) the

second topic of

this study guide

Airway is #1

there rest are also

similar to stroke

Terms:

Concussion

Contusion

Diffuse Axonal

injury?

Epidural and

subduralhematoma


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Neuro Study Guide

Spinal Cord

injury (SCI)

Traumatic damage

to any level of the

spinal cord. May

have partial or

complete lesions

of either sensoryor motor or both

Dependent on

type and level of

injury.

May have

respiratory

failure, impairedsensory and/or

motor function,

dependent on

level of injury,

may be unable

to speak,

swallow

Xray, CT,

possibly MRI

Full

neurological

exam

IV corticosteroids

(methylpredniso

ne) first 24-48

hrs, respiratory

therapy

including vent ifnecessaryO2

given bc

hypoxemia

increased

secondary

damage.

Immobilization

and stability

devices. Surgical

intervention

when indicated

(compression,

fragmented or

unstable

vertebrae,

wound

penetrating cord,

bone frags in

spinal canal,

deterioration of

pt neuro status)

Long term

anticoagulation

Ineffective

breathing pattern

Ineffective airway

clearance

Impaired bed and

physical mobility

Disturbed sensory

perception

Risk for impaired

skin integrity

Impaired urinary

elimination

Constipation

Acute pain

CAUTIOUS suctioning,

close monitoring of

resp status, assisted

coughing, air

humidification

Frequent positioning

and early ambulation,

ROM

Provide prism glasses,

coping strategies,

provide emotional

support, music, touch

Turn q2, frequent

assessment, kinetic

bed, hygiene and

skin/peri care

Intermittent cath,

teach pt and family

and encourage

participation, teach to

record I/O and

monitor void status

Stool softeners, high

fiber diet, bowel

program institutionProvide comfort

measures, analgesia

Most common in

young males

MVAs, falls,

violence, sports

Respiratoryaffected T1-T11

Diaphragm

controlled by C4

Review chart 63-7

on pg 1935 &

table 63-3 on pg

1936

Autonomic

Dysreflexia

know it, know its

signs and

symptoms. Know

that can be

caused by ANY

stimulus below

level of injury

Spinal and

Neurogenic shocknot well

described in book,

google for better

idea

Also- this study

guide doesnt

cover long term

management pgs

1943-46


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Neuro Study Guide

Multiple

Sclerosis (MS)

Immune

mediated,

progressive

demyelinating

disease. Theory

virus triggersautoimmune

response. T cells

allow infiltrates in

that cause

demyelination.

Areas- optic

nerves chiasm and

tracts, the

cerebrum, brain

stem, cerebellum

and spinal cord.

Most patients

have relapse

and remission

deficits may

occur and

accumulate overtime.50% of

RR progress to

secondary

progressive

course with

increase in

deficits and rare

plateaus

Primary

progressive:

Quadriparesis

Cognitive

dysfunction

Visual loss

Brain stem

syndromes

Specific

symptoms

depend on area

of brain affected

MRI,

electrophoresis

of CSF, Evoked

potential

studies,

urodynamicstudies, neuro-

psychological

testing

Sexual Hx

Pt may have:

Diplopia, pain,

fatigue,

numbness,

weakness,

blurry vision,

patchy and

total blindness,

depression,

coordination

difficulties

No Cure

Individualized

treatment based

on symptoms

Nerve blocksPossible meds:

Rebif, Betaseron,

Avonex,

Copaxone- cause

flu like

symptoms-treat

with nsaids

May take 6

months for

improvement

Baclofen, valium

for spasticity

Symmetrel,

Cylert and Prozac

for fatigue

Inderal,

Neurontin, and

Klonopin for

Ataxia

Bowel andbladder meds

Impaired bed and

physical mobility

Risk for injury

Impaired urinary

and bowel

elimination

Impaired verbal

communication

Impaired

swallowing

Disturbed thought

processes

Ineffective

individual coping

Impaired homemaintenance

management

Potential for

sexual dysfunction

Exercises, walking,

minimize spasticity

and contracture,

stretching

Gait training, assistive

devices, monitor forpressure ulcers

Void schedule,

bowel/bladder

training, self-cath

teaching, adequate

fluids and diet

including fiber

Diet modifications if

needed, speech

consult, alternate

communication

methods teaching

Pt and family

teaching, set realistic

goals, structured

environment

Support, home care,

service referrals,

assistive devices, offer

resources

Home modificationsfor independence,

assistive devices,

temperature control

Identification of the

problem, Referral to

sex counselor,

alternative methods

Onset ages 20-40

Terms:

Spasticity

Ataxia

Myasthenia

Gravis (MG)

Auto-immune

disease thattargets

Initial:

Diplopia andptosis,

Acetycholinest

erase inhibitortest.

Aimed at

improvingfunction and

Myasthenic Crisis: Education and

medication

During

Myasthenic crisisABGs,


9/19

Neuro Study Guide

acetycholine and

impairs

transmission of

impulses across

the myoneural

junction.Causes weakness

of the voluntary

muscles.

80% also have

thymic

hyperplasia or

thymic tumor.

weakness of

face and throat

muscles.

Dysphonia and

generalized

weakness.

-tensilon given

IV to diagnose.

-face weakness

and ptosis

resolve for 5

minutes

MRI, EMG

targeting

antibodies

No Cure

Anticholinesteras

e mediation,

pyridostigmine,corticosteroids,

imurian, IVIG

*No Novocaine

Plasmapheresis

Thymectomy

Respiratory

Distress

Dysphagia

Dysarthria

Ptosis

DiplopiaProminent Muscle

Weakness

*Airway is priority

Nursing Diagnoses

depend on

symptoms and

course of disease.

Aimed at

preventing and

managing

complications

management

important.

Conservation of

energy.

Minimize aspiration

by timing meals at

peak effect of

anticholinesterase

medications.

Supplemental

feedings may be

needed for adequate

nutrition.

Eye care important for

prevention of corneal

damage.

Avoidance of

triggering factors and

infections.

electrolytes, i/o

and daily weight

are monitored.

NG tube if

impairedswallowing.

Sedatives and

tranquilizers

avoided.

Guillain-Barre

syndrome

Autoimmune

Attack on the

peripheral nervemyelin. The result

is acute rapid

demyelination of

peripheral nerves

and some cranial

nerves producing

ascending

weakness with

dyskinesia,

hyporeflexia andparesthesias.

Begins with

muscle

weakness anddiminished

reflexes of

lower

extremities and

may progress to

tetraplegia,

Neuromuscular

respiratory

failure, bulbar

weakness,blindness,

Patient

presents with

symmetricweakness,

diminished

reflexes and

ascending

motor

weakness.

Hx of viral

illness.

Lab tests not

useful.CSF evaluation.

** Medical

Emergencies **

Requires ICU

management.

Assessment of

muscle strength

and respiratory

function.

Intubation.

Plasmapheresis

and IVIG

continuous ECGmonitoring

Ineffective

breathing pattern

Impaired bed and

physical mobility

Imbalanced

nutrition, less

than body

requirements.

Close Monitoring and

potential mechanical

ventilation whichshould be discussed

on admission.

ROM, SCD, Position

Changes,

Anticoagulation.

IV fluids and

Parenteral nutrition,

gastrostomy

management


10/19

Neuro Study Guide

Caused by

antecedent event

most often viral

infection. The

myelin damageresults from the

inability to

distinguish

between two

proteins.

inability to

swallow or clear

secretions and

autonomic

dysfunction.

Evoked

potential

studies.

Hypotension

managed with

fluid.

Impaired verbal

communication

Fear and anxiety.

Picture Cards, Eye

blink system, speech

consult.

Encourage family

participation in care,

increase patient senseof control, provide

information about the

condition, teach

relaxation and

distraction,

diversional activities,

encourage visitors,

listening to music,

reading, TV.

Bells PalsyParalysis of the

face caused by

unilateral

inflammation of

cranial nerve VII.

Exact cause

unknown,

theories include

vascular ischemia,

viral disease,

autoimmune

disease or acombination.

May be a type of

pressure paralysis.

Increased

lacrimation,

painful

sensation in the

face behind the

ear and in the

eye, speech

difficulties,

unable to eat on

affected side.

No Diagnostics Treatment aimed

at maintaining

muscle tone and

preventing or

minimizing

denervation.

Corticosteroids,

analgesics,

surgical

exploration if

tumor suspected

or to decompressnerve if doesnt

resolve.

Acute pain

Risk for Corneal

injury

Analgesic and facial

massage when

tolerated.

Eye patch, eye

ointment,

moisturizing drops,

eye shield and use of

wrap around glasses

during the day to

minimize moisture

loss.

Most patients are

younger than 45.

Meningitis Septic=bacterialinfection.

Aseptic=viral

infection.

Can be blood

stream or direct

Nuchal

rigidity=early

sign. +kernigs

sign.

+brudzinskis

sign.

photophobia

CT, MRI, CSF

studies may

demonstrate

low

glucose/high

WBC/high

protein.

Antibiotics for

bacterial (vanco,

cephalosporins).

Decadron,

dexamethasone,

dehydration and

shock are treated

Hypovolemia.

Actual infection.

Risk for injury r/t

seizures.

Impaired gas

exchange.

ABGs and PO2 to

identify need for

support if increasing

ICP compromises

brain stem. Possible

trach. Possible

mechanical

Protect patient

from further

injury and

infection.


11/19

Neuro Study Guide

introduction

through trauma.

with fluids.

Phenytoin for

seizures.

ventilations. Monitor

BP. Rapid fluid

replacement but take

care to prevent

overload. Fever

reduction.Creutzfeldt-

Jakob disease

Caused by a prion.

It causes

spongiform

changes in the

brain

(degeneration of

brain tissue).

Muscle spasms,

rigidity,

dysarthria,

incoordination,

cognitive

impairment.

Mental

deterioration,

memory loss,

paralysis.

MRI, EEG, CSF,

brain biopsy

No effective

treatment. Death

is inevitable.

Palliative care

Ineffective coping

Grief

Offer support to the

patient and family.

Palliative care. Offer

emotional support.

Progression of the

disease occurs

quickly after the

onset of specific

neurologic

symptoms.

Survival is an

average of

22months.

Trigeminal

Neuralgia

As the brain ages

a loop of cerebral

artery or vein may

compress the

nerve root entry

point.

Pain ends as

abruptly as it

starts and is

usually

unilateral and

described as

shooting or

stabbing.

MRI, assessing

trigger points

Pharm:

antizeisure

agents,

gabapentic,

baclofen

Surg:

decompression

of the nerve,

radiofrequency

thermal

coagulation,percutaneous

balloon

microcompressio

ns.

Acute pain.

Risk for injury.

Educating on

preventative

strategies such as

avoiding too hot or

too cold foods, drinks,

water. The nurse

needs to assist with

the care of the

anxiety, depression,

and insomnia that

often accompaniesthe chronic pain.

Occurs most often

before the age of

35 and is more

common in

women and

people with MS

compared to the

general

population.

Peripheral

neuropathy

Most commonly

caused by

diabetes and poor

glycemic control.

Loss of

sensation and

muscle atrophy

and weakness.

Diminished

reflexes.

Physical

assessment

and findings.

Pain and

sensation

Gabapentin,

lyrica,

Chronic pain.

Risk for injury/fall

Diabetes education

and management.

Depression and

anxiety are common

side effects and

It is important

that it is

prevented b/c

there is no cure.

Educating

diabetics on the


12/19

Neuro Study Guide

Parasthesia and

pain.

testing of

extremities.

support for these are

important.

importance of

blood sugar

management is

key.

Huntingtons

Disease

Premature death

of cells in thestriatum of the

basal ganglia. Cells

are also lost in the

cortex (the region

associated with

thinking, memory,

perception,

judgment) and in

the cerebellum

(the region

responsible for

coordinated

voluntary muscle

movement)

Abnormalinvoluntary

movement

(chorea),

intellectual

decline,

emotional

disturbance,

constant

writhing,

motions are

devoid of

rhythm or

purpose.

Positive family

history.Presence of

genetic

markers.

No cure just treat

the symptoms.Dopamine

receptor

blockers.

Antiparkinsons

medications for

rigidity.

Risk for injury.

Focus on thepalliative and

coping

Look beyond the

disease and focus onthe patients needs

and capabilities. End

of life care will be a

priority. Teach

strategies to manage

symptoms. Increased

risk for aspiration

pneumonia.

If there is a family

history, peoplecan be tested for

the genetic

marker before

symptoms occur.

Degenerative

Disc Disease

Herniation of the

intervertebral disc

with subsequent

compression it is

preceded by

degenerative

changes thatoccur with aging.

C/M depends on

the location in

the spine.

Health HX.

Physical exam.

MRI, CT

Neurologic

exam.

Bedrest and pain

medications for

cervical and

lumbar disks.

Surgical excision

of the herniated

disc.,laminectomy,

fusion.

Pain.

Infection risk if

surgery is

undertaken.

Pain management and

support.

Often prescribed

many pain

medications and

can have chronic

narcotic use

resulting in

increased need forpain medications.

Cervical

Herniation

The same at DDD

but with the risk

of lesions forming

on the spinal cord.

Typically occurs

at the C5-C7

interspaces.

Pain and

stiffness of the

neck.

Parasthesia.

MRI of the C-

spine.

Pain medications

and rest of the

surgical spine to

allow the C spine

to heal and

reduce

inflammation.

Surgical excision

Pain. Infection risk

if surgery.

Skin integrity is at

risk d/t bedrest.

May be flat bedrest

after surgery. Watch

for excruciating pain

after surgery. Could

mean a need for

further surgery. Neck

should be kept

Hospital stay is

likely to be short.

Self care must be

promoted and

taught.


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Neuro Study Guide

of the herniated

disk may be

necessary.

midline and in a

neutral position.

Brain Abscess Collection ofinfectious

material withinthe tissue of the

brain.

Can be caused by:

-intracranial

surgery,

penetrating head

injury, of tongue

piercing.

-Headache,

usually worse in

the morning-fever

-vomiting

-focal

neurologic

deficits

-Decrease LOC

-seizure

-MRI or CT scan

-blood cultures

-Chest x-ray-EKG

-Control ICP

-drain abscess

-Antimicrobialtherapy

-high dose

antibiotics

-Corticosteroids

-Antiseizure

meds

-Acute confusion

-fear

-Grieving-Decreased

intracranial

adaptive capacity

-Acute pain

-Vision loss

-Risk for injury

-Vision loss

-Prevention such as

promptly treating

otitis media,mastoiditis,

rhinosinusitis, dental

infections, and

systemic infections.

-monitor neuro status

-admin meds

-assess response to

treatment

-supportive care

-monitoring safety

-educate patient and

family

-Seizures are

common.

Alzheimers A chronic,

progressive, and

degenerative

brain disorder

that is

accompanied by

profound effects

on memory,

cognition, andability for self-care

-loss of memory

and cognition

that disturbs

daily life

-Trouble

understanding

visual images

and spatial

relationships-Problems with

words or

speaking

-Misplacing

things and

losing the ability

to retrace steps

-Poor judgment

-withdrawn

from activities

-Medical

history

including

family history

-Mental status

testing

-physical and

neurological

exam-Blood test to

rule out other

causes

-MRI & CT

usually used to

rule out other

causes

-goal is to

manage

symptoms

-assessing for

underlying

depression

-pharm to treat

symptoms but

does not stop theprogression.

-behavioral and

psychosocial

therapies

-Wandering

-impaired memory

-impaired physical

mobility

-self-neglect

-risk of loneness

-caregiver role

strain

-chronic confusion-hopelessness

-powerlessness

-Promoting patient

function and

independence.

-promoting safety

-reducing anxiety and

agitation

-providing

socialization

-adequate nutrition-supporting and

education patient and

family

-definitive

diagnosis can be

made only at

autopsy


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Neuro Study Guide

-Change in

mood or

personality

Parkinsons -Slowly

progressingneurologic

movement

disorder that

eventually leads

to disability.

-decresed level of

dopamine

resulting from

destruction of

pigmented

neuronal cells in

the substatia nigra

in the basal

ganglia region of

the brain. The loss

of dopamine

results in more

excitatory

neurotrasmitters

than inhibitory

neurotransmitters, leading to an

imbalance that

affects voluntary

movement.

Gradual onset

and symptomsprogress slowly.

-Cardinal

manifestations:

-Tremors

-Rigidity

-Bradykinesia

-Postural

instability

-PET & SPECT

scans-diagnosed

clinically from

the patients

history and the

presence of

two of the four

cardinal

manifestations

Focuses on

controllingsymptoms and

maintaining

functional

independence

-Pharm therapy:

antiparkinsonian

meds (ex.

levodopa)

-stereotactic

procedures

-neural

transplantation

-Deep brain

stimulation

-Impaired physical

mobility-Self-care deficits

-Constipation

related to

medication and

reduced activity

-imbalanced

nutrition

-impaired verbal

communication

ineffective coping

-Improving mobility

-Enhancing self-careactivities

-Improving bowel

elimination

-Improved nutrition

-enhancing swallowing

-encouraging the use

of assistive devices

-Improving

communication

-supporting coping

abilities

-promoting home and

community-based

care

Cerebral

metastases

-cancer that has

metastasized

(spread) to the

brain from

another location

in the body

-neurologic

exam

-Headache

-gait

disturbances

-MRI along

with S/S

-palliative and

involves

eliminating of

reducing serious

symptoms.

-Self-care deficit

-Imbalanced

nutrition

-Anxiety

-Interrupted

family processes

-Pain management

-improve nutrition

-compensation for

self-care deficits

-relieving anxiety

-survival time:

*no treatment for

brain metastases:

1 month


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Neuro Study Guide

-visual

impairment

-personality

changes

-altered

mentation(memory loss

and confusion)

-focal weakness

-paralysis

-aphasia

-seizures

-Radiation

therapy

-surgery

-Chemotherapy

-Corticosteriods

-Osmoticdiuretics

-Antiseizure

agents

-enhancing family

processes

-promoting home and

community-based

care.

*corticosteroid

treatment alone:

2 months

*Radiation

therapy: 3-6

months.

Spinal tumors Tumor within thespine. Classified

by anatomic

relation to the

spinal cord.

-intramedullary

lesions: within the

spinal cord

-extramedullary-

intradural lesions:

within or under

the spinal dura

-extramedullary-

extradural lesions:outside the dural

membrane

-localized or

shooting pains

and weakness

and loss of

reflexes above

the tumor level

-neurologic

examiniation:

assess pain, loss

of refexes, loss

of sensation or

motor function,

and the

presence of

weakness andparalysis

-pain longer

than 1 month

-MRI scans:

most common

used.

-x-ray

-radionuclide

bone scan

-CT scans

-biopsy

-Surgical

interventions:

primary

treatment

-partial removal

of the tumor

-decompression

of the spinal cord

-chemotherapy

-radiation

therapy

-Provide per and post-

operative care

-Managing pain

-monitoring for

complications

-Patient and family

teaching.

-compensation for

self-care deficits

ALS Unknown cause,there is a loss of

motor neurons in

the anterior horns

of the spinal cord

and the lower

-depends on

location of the

affected motor

neuron

-fatigue

Diagnosed on

the basis of the

signs and

symptoms, no

clinical or

laboratory test

NO specific

therapy exists for

ALS. The main

focus of medical

and nursing

management is

on interventions

-ineffective

breathing pattern

-impaired verbal

communication

-decisional conflict

-Chronic sorrow

-Monitor for

aspiration may in

enteral feeds

-maintain or improve

function, well-being,

and quality of life

-The average

survival time is 3-5

years with death

due, most

commonly to

respiratory

insufficiency.


16/19

Neuro Study Guide

nuclei of the

lower brain stem.

-progressive

muscle

weakness,

-cramps,

-facial twitching

-loss ofcoordination

are specific for

this disease.

-Electro-

myography and

muscle biopsy

may be done-MRI

-Neuro-

psychological

testing

to maintain or

improve

function, well-

being, and

quality of life.

-riluzole (Rilutek),a glutamate

antagonist, is the

only med

approved for the

treatment of ALS.

-Impaired

swallowing

-Risk for

aspiration

-anxiety

Muscular

Dystrophies

Incurable muscle

disorders

characterized by

progressive

weakening and

wasting of the

skeletal or

voluntary

muscles.

-Muscle wasting

and weakness

-abnormal

elevation in

serum levels of

muscle

enzymes.

-elevated

muscle

enzymes.

-focuses on

supportive care

and prevention

of complications

-individualized

therapeutic

exercise program

-spinal fusion

-intense therapy to

keep the muscles

active and functioning

normally

-night splints

-teaching patient self-

care

-Most of these

disorders are

inherited.

-spinal deformity

is a severe

problem.

Post-Polio Unknownpriorpolio infection

Post-Polio

symptoms:

-Progressive

muscle and joint

weakness and

pain-General fatigue

and exhaustion

with minimal

activity

-Muscle atrophy

-Breathing or

swallowing

problems

-Sleep-related

breathing

NO diagnostic

test for this**

Hx, physical

exam and

exclusion of

other medicalconditions

No specific

treatment

focus on

symptoms

Activity

intolerance

Chronic pain

Risk for ineffectivebreathing pattern

Imbalanced

nutrition: more

than

requirements

Disturbed sleep

pattern

Risk for injury/falls

Plan activities to

conserve energy,

schedule rest periods,

use assistive devices

Heat/Cold, cautious

use of medications

Pulmonary hygiene,adequate fluid intake,

CPAP if applicable

Provide teaching and

resources for diet and

safe exercise

Limit caffeine, assess

for nocturia

Use of assistive

devices, fall


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Neuro Study Guide

disorders (as

sleep apnea)

-Decreased

tolerance of

cold temps

prevention, and

osteoporosis

(common with post-

polio) management

Primary Braintumors

Note: I

recommend

re-reading this

section: brief

synopsis only

included here

+ the following

sections on

pre/post

surgical care

Glioma:most common

type, with the

most common

type of glioma

being an

astrocytoma

which is also

graded

Meningioma:Common,

benign and slow

growing.

Manifestations

are result of

pressure.

Surgery is

preferred

treatment

Acousticneuroma:

8th cranial

nerve tumor-

tinnitus,

hearing loss,

vertigo,

stagger- most

benign and

managed

conservatively

Pituitaryadenoma:

Either cause

pressure effects

or hormonal-

usually prolactin,

growth hormone

and ATCH- also

rarely TSH, FSH

and LH.

Angioma:Abnormal clusters

of blood vessels

cause

hemorrhagic

stroke in


18/19

Neuro Study Guide

Burr holes: either

to facilitate a

craniotomy OR as

a means of

pressure relief

(also usually forpressure relief,

but can be used

for access of

specific site)

Likely ET tube.

Assess:

Respiration

and

oxygenation

status, VS, LOC,bleeding/CSF

leakage,

seizure, I/O

ICP monitoring

ABGs

CBC/CMB

BUN/

Creatinine,

blood glucose,

phenytoin

levels (10-20

mcg/mL)

Ineffective

cerebral tissue

perfusion

Risk of

imbalanced body

temperature

Potential for

impaired gas

exchange

Disturbed sensory

perception

Body image

disturbance

Impaired

communication

Risk for impairedskin integrity

Risk for infection

Risk for fluid and

electrolyte

imbalance

Q15-60min VS/Neuro

assessment, HOB flat

or 30 degrees, control

cerebral edema and

ICPCover pt

appropriately, treat

hyperthermia

aggressively

Deep breathing/

Incentive spirometer,

Cautiously suction/

help pt cough,

humidify air

Announce presence,

cool compresses and

HOB elevation (30) to

decrease periorbital

edema

Verbalization,

interaction, grooming,

cover head with

turban (later, a wig)

Use of communication

boards, signals

Turning q 2 hours,hygiene care

Aseptic technique

with ICP monitoring

Monitor I/O,

electrolyes, and urine

specific gravity, fluid

restriction, IV

fluids/diuretics as

ordered


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Neuro Study Guide

Trans-

sphenoidal

surgery

Description:

Access to the

brain (usually the

pituitary gland)

through the

mouth andsinuses

Also used for

ablation of the

pituitary with

disseminated

breast or prostate

cancer

Pre-Op:

Depends on

reason for

surgery. May

have increased

ICP and alteredLOC

Post-Op:

Swollen/

bruised face

Nasal packing

cannot remove

blood around

until packing

removed!

Pre-Op:

Endocrine

workup

Rhinologic

evaluation

Nasopharyngeal culture

(surgery

contraindicate

d with sinus

infection)

Visual

evaluation

Neuro-

radiologic

studies

Post-Op:

Urine specific

gravity after

EACH urination

to monitor for

diabetes

insipidus and

SIADH

ICP monitoring

CMBCBC

Pre-Op:

May have

corticosteroids,

phenytoin,

and/or

prophylacticantibiotics

prescribed

before surgery

Post-Op:

Antibiotics

Corticosteroids

Analgesics

-medication for

diabetes

insipidus if

indicated

(Desmopressin)

Pre-Op: Same as

above

Post-Op: Same as

above

Impaired oral and

nasal mucous

membranes

**Disturbed

sensory

perception r/t

proximity to optic

chiasm

Pre-Op: Same as

above

Post-Op: Same as

above

Mouth rinses every 4

hoursno brushing

until incision heals

Petrolatum for lips

Use of air humidifier

Monitor visual fields

and acuity frequently

-decreasing acuity

suggests expanding

hematoma

***Deficient

knowledge of

Post-Op

expectations/care

needs to be

addressed BEFOREsurgery

HOB at 60 for at

least 2 weeks to

promote venous

drainage from site

Teaching:

Post Op

expectations,

potential

complications,

cares, Deep

breathing,

avoidance of

increasing ICP

(coughing,

sneezing etc)

Neurology Nursing Study Guide

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