Exam 5: Neuro & Perception

what is the frontal lobe responsible for?

personally, concentration, speech, motor

What cranial nerve test for menieres disease or tinnitus ?

• Vestibulocochlear

• Nerve Vlll (8)

• balance and hearing

Cranial Nerve for vision

• optic

• nerve ll

what is the parietal lobe responsible for?

senses

what is the temporal lobe responsible for?

auditory & hearing

what is the occipital lobe responsible for?

vision

what is the cerebellum responsible for?

coordination & balance

what is the brain stem responsible for?

memory

What is the major cause of headaches?

stress

What is a tension headache

mild-moderate pain bilaterally, dull/band- line pressure → both sides

What is a cluster headache?

 Severe, unilateral (behind eye) → one side

migraine vs headache

migraine: severe, comes in stages, can influence function

headache: more of a symptom, mild

stages of a migraine (Prodromal, Aura, Headache, Postdromal)

Prodromal

• Hours–days before headache

• Sensitivity to light/sound/odor

• Fatigue

Aura

• Precedes headache

• Visual, sensory, or motor disturbances

• Visual field loss, tingling sensation

• no pain at start, but there are visible changes

Headache

• Hours to days

• pain itself

• Photophobia → sensitive to light

• Phonophobia → sensitive to sound

Postdromal

• Hours to days after the headache is gone

• Exhaustion, dizziness

• “Migraine hangover”

Triggers for headaches/migraines

• stress

• injury

• posture

• chocolate, caffeine

• light

• noise

Glasgow Coma Scale and headaches

score impairment for traumatic brain injury

• lower the number, the worse it is (15 is max)

Red flags of headache

• sudden onestones

• severe HTN → hypertension

• altered mental status

Preventive treatment for headache?

beta blockers

• end in OLOL

• prevents not treat current pain

Primary headaches vs secondary

Primary

• migraine

• cluster

• tension

Secondary

• trauma

• infection

• interracial disorders

• psychiatric conditions

Define Seizure

Abnormal, unregulated electrical impulses in brain gray matter ® interrupts the normal function of the brain.

Status epilepticus

• emergency

• seizure lasting more than 5 minutes

• give benzo

Seizure Diagnosis

• CT/MRI

• Electroencephalogram (EEG)

Immediate treatment for seizure

• maintain airways (ABCs, supplemental oxygen, and suction can be useful to prevent aspiration)

• Preventing injury by laying the patient on the left side, placing something under their head, and padding can help

• ALWAYS NOTE THE TIME IT STARTS/ENDS → Give bezo

What is a transient Ischemic Attack (TIA)

• mini stroke → can be reversed

• cause: stenosis (narrowing of artery) or occlusion (clot)

• effects are reversible but MAJOR warning sing for a stroke

• blood flow is stopped for a small amount of time

Risk factors for TIA

• hypertension

• cardiovascular disease

• diabetes

• hyperlipidemia

• physical inactivity

• smoking

• obesity

• excessive alcohol intake

• low socioeconomic status

• think anything that influences perfusion

FAST (TIA) & manifestations

• Facial dropping

• Arm weakness

• Speech disturbances

• Time → time is important call 911 → get CT/clot buster

Can also cause blurred/double vision, weakness, dizziness, and headache

Assessing TIA

• Fast

• Neuro assessment

  • cranial nerves

• NIH Stroke Scale

•  Evaluate LOC, language, vision, motor, sensation,

  cerebellar function

What to do if you suspect a stroke?

• keep patient NPO → aspiration perceptions

• fall and safety precautions → patient can be weak

• get CT

• Perform assessments like NIH scale

Medications for stroke?

Clot busters

• antiplatelets → Asprin

• anticoaglunats → warfrin

• antihypertensives to control BP

• statins to control cholesterol

What is a carotid endarterectomy

removes plaque from arteries that cause clots

How often to we reassess stroke with the NIHSS?

every 4 hours

NIH stroke scale scoring

• 0-42 → higher = worse

• 0 → no stroke symptoms

• 1-4 → minor

• 5-15 → moderate

• 16-20 → moderate to severe

• 21-42 → SEVERE

Definition of Stroke

Disruption of brain blood supply

Ischemic vs Hemorrhage Stroke

• Ischemic: clot or blockage resulting from sudden changes in blood supply

  • most common

  • easier to treat → get rid of clot

  • weakness/numbness → common symptom

  • aphasia

  • vision loss

• Hemorrhagic stroke: bleeding in brain causing increased pressure

  • harder to treat, patients often have much larger deficits

  • “worst headache of my life”

  • seizure

  • decreased LOC

If suspected get imagining!

stroke manifestation

• Weakness/numbness

• Facial asymmetry

• Vision changes

• Cognitive changes

• Loss of balance

• Ataxia → involuntary muscle movement

• Speech difficulty, severe headache

Ischemic Stroke Management

• FIRST GET CT AS FAST AS POSSIBLE, Complete Stroke scale

• T-PA once confirmed!! → Alteplase end in PLASE

• T-PA → Thrombolytic Therapy

  • once confirmed with CT

  • Give IV Clot Buster

  • client will be at risk for bleeding check labs, blood in stool, change in neuro status, bleeding from holes

• elevate HOB

• maintain airway

Thrombolytic Therapy Monitoring

• Check BP every 15 min for 2 hr

• Neuro checks every 30 min for 4 hr

If bleeding suspected:

• STOP tPA infusion

• Notify provider

• STAT CT

• draw labs

• Prepare Cryoprecipitate → antidote for active bleeding

Hemorrhagic Stroke Treatment

• CT/MRI to confirm type, location, size of hematoma

• Often surgical to evacuate the bleeding

• not much treatment outside of cutting hole to relieve pressure

 Peripheral Neuropathy

• Damage to peripheral nerves

• leads to changes in blood flow and can cause uncomfortable numb sensation in feet

Peripheral Neuropathy causes/ comorbidities

• Stress, inflammation

• Genetic, acquired, idiopathic

comorbidities

• diabetes, autoimmune, and liver disease (think alchol use)!alcohol

Peripheral Neuropathy considerations

• Assess environment & risk factors

• Implement safety measures → protect feet

• Early wound detection

• Patient education on foot wounds & how to prevent

These patients are at risk for foot injuries due to their decreased feeling

Treatment for Peripheral Neuropathy

• medication for neuropathic pain → end in PINE

• lidocaine patches

• opioids if pain is bed

• surgery for pinched nerve

• TENS unit

Bleeding Labs

Hema

• F: 37-47

• M: 42-52

Hemo

• F: 12-16

• M: 14-18

Platelete: 150,000-400,000

Age related Macular Degeneration (AMD)

• blurred vision

• irreversible blindness and vision loss

• Dry: gradual loss Vs Wet: rapid loss with blind spots

Cataracts definition

• cloudy lens altering the passage of light

• can still see, but there is blurred vision

• diabetes and hypertension are common comorbidities, but happen with age

Cataracts treatments/ post op

• surgical → removed and lens is replaced

• Lots of eye drops will be given

• Report any sudden changes in eye pain, purulent drainage/bleeding, floaters, or swelling around the external eye

• Avoid ­ in intraocular pressure → no bending, lifting heavy objects, straining at tv

• vision should increase not decrease

Glaucoma definition and symptom

• increased ocular pressure on the optic nerve

• may not notice at first as it starts with blurry vision or halos around lights, then peripheral vision will worsen (stuff on the side)

• myopia → risk factor

Common comorbidities with eye issues

• diabetes and hypertension, hyperlipidemia but happen with age

Glaucoma treatments

• monitor intraocular pressure → eye drops can be used to lower pressure

  • Tonometry: frequent monitoring of pressure

Retinal Detachment

• retina separated from blood vessels

• patient will report dark floaters, flashing lights, a curtain drawn over the eye, and halos around lights

  • photopsia → flashing lights

• EMERGENCY TREATMENT NEEDED as there is a loss of oxygen to the eye → will need surgery

• DOES NOT CAUSE EYE PAIN

Headaches can cause what?

• smells to be strong or reporting strange smells

• N/V

• bothered by lights and sounds

• THEY DO NOT CAUSE CONFUSION OR CLOUDY THINKING

Ophthalmoscope

used to see if retina is detached in eye

Post OP care for retinal reattachment surgery

• Lie face-down → prone

• Medications

• Avoid exercise, heavy lifting

• Eye shield

• Avoid water in the eye

• Avoid eye strain (screens, driving)

• Sunglasses when outdoors

General considerations for eye surgery

• no driving

• no tv, or screens

• avoid water in eye

• wear sunglasses

• nothing that will increase pressure like bending over, heavy lifting

Tinnitus

rining in the ear

Types of hearing loss: Sensorineural, Conductive, Mixed

• Sensorineural → damage to inner ear due to damage

  • aging, noise damage, drug side effect, explosion blast

• Conductive → damage to middle/ outer ear due to blockage

  • fluid, object in ear, rupture eardrum, impacted cerumen (ear wax)

• Mixed → mix of both

What do you always want to ask cleints with hearing loss?

• do you use a hearing aid

• is it in if yes

Hearing test

• whisper

• finger rub

• audiometry test

Meniere’s Disease

• excessive fluid in inner ear that causing ringing, hearing loss, and vertigo

• risk for falls! due to balance

• diuretics (reduce fluid) and corticosteroids (decrease pressure) can be used

trigger for seizures

• seizure disorder

• head injury

• substance withdrawal

• infection

• cerebral edema

• metabolic disruptions

what to avoid with Meniere’s Disease

• Dietary modifications: ↓ sodium & ↓ sugar

• Decrease nicotine, caffeine, & alcohol

eating with stroke

• if cleared

• do not give first feed to AP

• have suction

• no distraction

• neck flexed forward