neuro disorders

what are the two types of neurons in the peripheral NS?

sensory/afferent and motor/efferent neurons

what are the major parts of a comprehensive neuro assessment?

LOC, orientation, eyes, movement, strength, symmetry, sensation

what are the 3 components to the GCS?

eye opening, motor response, verbal response

how to rate eye opening for the GCS?

• 4: spontaneous and not necessarily to command

• 3: opens eyes only to verbal stimuli

• 2: opens eyes only to painful stimuli

• 1: does not open eyes

how to rate motor response for the GCS?

• 6: obeys commands

• 5: purposeful movement to pain

• 4: withdraws from painful stimuli

• 3: flexion in response to pain

• 2: extension in response to pain

• 1: no response to pain

how to rate verbal response for the GCS?

• 5: oriented to person, place, time

• 4: confused conversation

• 3: disorganized or random speech

• 2: moans, mumbles

• 1: no speech

what is the cushing’s triad?

bradycardia, HTN, irregular RR → signs that can indicate increased cranial pressure

what are some interventions for cranial tumors?

avoiding NSAIDs to reduce risk of bleeding, sx or chemo/radiation to remove/reduce tumor (not all tumors are cancerous), elevate HOB to decrease ICP, use anti-seizure meds

what are cryptogenic seizures caused by?

no known cause

what are non-epileptic seizures caused by?

also called secondary seizures → trauma, surgery, tumors, stroke, metabolic syndromes

what are some clinical manifestations of seizures?

daydreaming appearance, subclinical (can’t see symptoms), massive jerking movements, LOC, lip smacking, eye twitch, etc

what is a major complication of seizures?

status epilepticus → seizure that is non-stop; need to potentially intubate to protect airway and give lots of meds to stop it

how to dx seizures?

CT/MRI, lab work up, EEG

how to tx seizures?

anti-epileptic medications like keppra (levetiracetam), depakote, lorazepam → lorazepam only given to stop a seizure

what are some nursing managements for seizures?

protect the airway, check VS, watch seizure, look for presence of an aura/know when seizure is about to happen → want to have oxygen and suction available, turn on the side, don’t restrain, maintain IV access, document seizure

what to teach patients about seizures?

post-ictal phase can last from minutes to few hours, compliance with therapy (med regimen, driving restrictions), medic alert bracelet

what are risk factors for meningitis?

living in close proximity; college dorms, military barracks, prisons

what is meningitis?

infection of the meninges in the brain; can be acute or chronic, can be bacterial, viral, fungal or aseptic (caused by use of abx), can be caused by carcinomatosis

characteristics of acute meningitis?

medical emergency, caused by bacteria with clinical manifestations beginning hours to two days after infection, after infection starts the WBC increases in CSF (“CSF pleocytosis”) → CSF gets opaque and sluggish through brain and spinal cord

characteristics of chronic meningitis?

onset of symptoms weeks to months after infection lasting more than 4 weeks

what are some clinical manifestations of meningitis?

fever, nuchal rigidity, headache, AMS, photophobia, chills, nausea, vomiting, pain; complications of meningitis is increased ICP

how is meningitis dx?

LP and head CT → tx with long-term abx

what are some signs of increased ICP?

headache, blurred vision, altered mental status → late signs: changes in HR, respiratory pattern, and BP

what are some nursing interventions for meningitis?

neuro assessments, checking VS, checking fluid balance (can develop diabetes insipidus → hypokalemia, HTN, tachycardia), renal function, decrease lights/make quiet environment, elevate HOB

what are some important teaching points for meningitis?

importance of follow up apts, compliance of abx, s/s of recurrent infection, droplet precautions

what is the pathophysiology of parkinson’s?

motor system disorder involving the loss of dopamine producing brain cells causing decr dopamine in the brain

what does TRAP mean in regards to parkinson’s?

tremor (shaking, usually starting on one side), rigidity (stiffness of the limbs neck or trunk), akinesia (loss or impairment in power of voluntary movement), posture (and balance) → symptoms are progressive and get worse

how to dx parkinson’s?

need two or more cardinal symptoms with asymmetrical presentation → tx with anticholinergics and dopamine receptor agonists

what are some surgical managements for parkinson’s?

stereotactic pallidotomy (implant an electrode in the brain) and deep brain stimulator

what are some nursing assessments required for parkinson’s?

assess tremors, gag and swallow, mobility, and bowel and bladder function → want to administer meds as prescribed, implement safety precautions, and communication tools also want pt to participate in self-care activities

what is the pathophysiology of alzheimer’s?

no proven cause but there are a decr in neurotransmitters → neurons get tangled and amyloid plaques appear on the brain (block communication in brain)

what are the clinical manifestations of alzheimer’s?

forgetfulness, loss in ability to complete tasks, inability to process sensory information, mood swings, personality changes, loss of cognitive skills → progressive and gets worse

how to dx alzheimer’s?

autopsy

how to tx alzheimers?

physical and emotional support, aricept (increases level of acetylcholine in brain), vitamin E (help decr damage from free radicals)

what are some nursing interventions for alzheimer’s

encourage/assist with feeding, routine, speak calmly, provide diversionary activities, provide emotional support

what are some teaching things for families with alzheimers?

teach families how to provide care, label dangerous substances, monitoring systems, referral assistance, preparation for end of life

what is the pathophysiology of huntington’s disease?

deterioration of cells that lead to neural death within the cortex and basal ganglia → leads to death in 15-20 years after dx

what are the side effects of huntington’s disease?

motor, cognitive, psychiatric symptoms → dx with genetic testing

what is the pathophysiology of amyotrophic lateral sclerosis (ALS)?

rapidly progressive and fatal CNS and spinal cord motor disease that affects voluntary muscle control → upper and lower neurons degenerate and die, muscles gradually weaken atrophy and twitch, loss of ability of brain to initiate muscle movement leading to resp failure

what is the most common adult onset motor neuron disease?

ALS amyotrophic lateral sclerosis

how to dx ALS?

hx and physical, rule out other causes, and get a second opinion → tx with symptom relief and therapy; complications are aspiration, resp failure, and PNA

what are some nursing assessments and interventions for ALS?

check airway, O2 sat, motor strength, ability to swallow; want to administer meds as ordered, elevate HOB, turn cough and deep breathe, provide emotional support

what is the pathophysiology of multiple sclerosis?

chronic autoimmune neurological disorder where there is the buildup of scar tissue causing plaques that demyelinate the myelin sheath; inhibiting transfer of information along the nerves

what are risk factors for MS?

women aged 20-50, positive family hx, immunological factors, and certain viral infections, living in colder regions

what is the difference between progressive relapsing and primary progressive in MS?

PR: gradually gets worse but may or may not have a recovery, PP: gradual progression without remission

what are the clinical manifestations of MS?

numbness/weakness, partial or complete vision loss, double or blurred vision, electric shock sensations with head movement, tremor, fatigue, dizziness

how to dx and tx MS?

hx and exam, neuro examination, labs, MRI → tx by focusing on improving speed of recovery from attacks, reducing number of attacks; complications: muscle stiffness or spasm, paralysis, mental status change, seizures

nursing assessments and interventions for MS?

assessing neuromuscular function, vision/eye movement, ability to perform ADLs, bowel/bladder function → encourage ROM, administer meds, fall precautions

what is the pathophysiology of myasthenia gravis?

autoimmune disorder where body attacks NMJ and decr amount of acetylcholine receptors leading to muscle weakness and fatigue

what are the 3 types of myasthinia gravis?

ocular, bulbar (diff chewing/swallowing/speaking), generalized (weakness)

what are the tensilon test, electromyography, and serological testing used to dx?

myasthenia gravis

what are symptoms of a myasthenic crisis?

often caused by infection: tachycardia, weak muscles, pale cool skin

what are symptoms of a cholinergic crisis?

bradycardia, muscle twitching, sweating, pallor, excessive secretions

what is the most common stroke?

ischemic

what are some non-modifiable risk factors for ischemic stroke?

> 55 yrs old, women > men, african amerian/hispanics/asians, family hx, prior stroke/TIA