Medsurge test 2 neurologic

intracranial pressure

A hydrostatic force measured through cerebral spinal fluid

70-150 mmhg

what is a normal MAP

5-15 mmHg

what is normal ICP

perfusion to the brain

if ICP is too high, it will not allow 

cerebral perfusion pressure

MAP – ICP =

60-100 mmhg

what is the normal range for cerebral perfusion pressure

hematoma, contusion, abscess, tumor, hydrocephalus, head injury, brain inflammation

what can cause increased ICP

decreased perfusion, impaired autoregulation, increased systolic BP, increased cerebral edema, brain shift, brainstem herniation

what are some clinical manifestations of increased ICP

cushings triad

increased systolic BP with widened pulse pressure. bradycardia with full bounding pulses, irregular respirations (cheyne stokes)

early morning or noctural

when is headache concerning due to ICP

Hemiparesis

weakness on one side

hemiplegia

paralysis on one side

increased BP, bradycardia, elevated temp, irregular respirations

what changes in VS are seen with increased ICP

without nausea

vomiting ______________ is a common ss of ICP

ipsilateral pupil dilation, sluggish, inability to move eye upward, adduct, eyelid ptosis, fixed dilated pupils

what ocular signs of ICP are there

fixed/dilated pupils

what ocular Sign is an emergency

decorticate

an abnormal involuntary posture characterized by flexion inward of the upper extremities and extension of the lower extremities. 

decerebrate

a neurological sign characterized by an abnormal extension posture involving the arms, legs, and head. this is worse and shows more damage

CT/MRI

Used to detect structural abnormalities, hemorrhage, tumors, stroke, or brain swelling.

EEG (Electroencephalogram) 

Monitors electrical activity in the brain, useful for diagnosing seizures and brain dysfunction.

ICP monitoring

Used on patients that have a Glascow <8 and a positive CT. Detects increased pressure inside the skull, often used in traumatic brain injury or hydrocephalus.

cerebral oxygenation monitoring

assesses oxygen levels in the brain to ensure adequate perfusion, useful in critical care settings.

Ventriculostomy

surgical procedure that creates an opening in a ventricle (fluid-filled cavity) in the brain to drain excess cerebrospinal fluid (CSF)

20

if ICP is > _____ call a provider right away

infection

what are we very worried about when doing ICP monitoring

glasgow coma scale

for assessing LOC: Measures eye-opening, verbal response, and motor response to assess neurological function. — Scores range from 3 (severe impairment) to 15 (normal function).

8

intubation is necessary if Glasgow coma scale is <_______

PERRLA

stands for pupils equal, round, reactive to light, and accommodation

herniation

unequal pupils may indicate:

increased ICP, brainstem dysfunction, medications effects

non reactive or dilated pupils may suggest:

ABGs, electrolytes (can worsen neuro function), glucose, coagulation studies (stroke), toxicology screen

what labs should be monitored in neuro patients

Hypertonic

what type of saline should be given to patients with Increased ICP

mannitol, lidocaine per ett, corticosteroids, antiseizure meds

what meds are given to patients with increased ICP

HOB 30 degrees

what is the best positioning for increased ICP patients

enteral

what type of nutrition is preferred for increased ICP patients

scalp lacerations

External injuries to the scalp involving a break in the skin. External with Risk of infection and Profuse bleeding - due to scalps rich blood supply

battle sign, raccoon eyes, rhinorrhea, otorrhea

what are signs of skull fractures

Dextrostix or Tes Tape Strip

what type of testing is done for the presence of glucose.

halo sign

a visual pattern that appears when cerebrospinal fluid (CSF) mixes with blood on an absorbent surface like a nasal drip pad, creating a distinct ring of clear fluid around a central area of blood, indicating a potential leak of CSF from the nose, often due to a skull base fracture

diffuse injury

a head injury which involves the Entire brain. (concussion;, diffuse aconal injury )

Chronic Traumatic Encephalopathy (CTE)

many concussions can lead to _________________: a progressive brain disease characterized by disturbances in brain function, often manifesting as memory problems, mood swings, cognitive decline, and behavioral changes,

diffuse axonal injury

a severe traumatic brain injury that involves the entire brain often caused by motor vehicle accidents. high percentage for immediate death. poor recovery. vegetative state

focal injury

head injury involving just one part of the brain

contusions

bruising to brain

hematomas

brain bleeding

subdural hematoma

An emergency: bleeding between skull and first dura layer (bleeding goes inward). Patient will go unconscious

subdural hematoma

most common type: bleeding between dura matter in that space. bleeding will spread out like banana. slower to develop, slower to show signs, bleeding may stop on its own or they may need surgery

intracerebral hematoma

bleeding inside the brain. not very common and not a good outcome

CT/MRI

what is 1 line diagnostic test for head injury

burr hole

a surgical procedure where small holes are drilled in the skull to relieve pressure on the brain for those exhibiting ICP. usually done in ED trauma situation

craniotomy

a surgical procedure that involves removing a portion of the skull (bone flap) to access the brain: for tumors, fractures, hematomas,

craniectomy

a surgical procedure where a portion of the skull is removed to relieve pressure on the brain. do not roll patient on side with this

cranioplasty

When everything is healed, they’ll go back in and put the bone back. Can be artificial  or use the original bone

meningiomas

common type of primary brain tumor that can be benign or malignant

gliomas

type of primary brain tumor that are almost always malignant.

secondary brain tumor

cancer that has spread from other parts of the body to the brain

HA, seizures, N/V, congitive changes, edema

what are common clinical manifestations of brain tumors

biopsy/debulking

what type of surgery is done for those with brain tumors

ventricular shunt

drains excess of CSF into peritoneal cavity 

bacterial meningitis

a serious infection causing inflammation of the meninges (the protective membranes surrounding the brain and spinal cord). crowded living conditions are at risk. untreated is 100% mortality.

through the respiratory tract (inhalation) or via the bloodstream

how do bacteria typically enter in with bacterial meningitis

skull fractures and ottorrhea

those with bacterial meningitis are at high risk for

high fever, Severe HA w photophobia, N/V, nuchal rigidity***

what are clinical manifestations of bacterial meningitis

Brudzinski's and Kernig's sign

what clinical tests are used to help diagnose meningitis

CT, then lumbar puncture. blood cultures, then antibiotics

what is the plan of care for someone with bacterial meningitis

vaccines, respiratory isolation, seizure precautions, dark quiet environment, pain and fever control

what is the nursing care for bacterial meningitis

Enteroviruses. HIV, Herpes simplex, arboviruses

what are the causes of viral meningitis

antibiotics

what should be done for viral meningitis until confirmed its viral

xpert EV test

what test Helps differentiate viral meningitis from bacterial meningitis

epidemic encephalitis

 acute inflammation of the brain caused by viral infections, though bacteria, fungi, or autoimmune reactions can also be responsible. It can range from mild to life-threatening.

epidemic encephalitis

inflammation of brain due to reaction to prior viral infection: measles, mumps, varicella, herpes simplex 

fever, HA, N/V, CNS changes

what are SS of encephalitis

seizures

Uncontrolled electrical discharge of neurons

focal

seizures that only involve one area of the brain

prodromal

phase weeks before seizure. Notice personality change, behavioral change. Can be hours to days before 

pre-ictal

(aura) phase immediately right before they have the seizure. 

ictal

stage that involves the seizure itself

post -ictal

the recovery period after a seizure

absence seizure

Staring spell. Most common in children. Short spells <10 seconds. (typical is grown out of) (atypical may follow them into adulthood and may include motor movement)

simple focal seizures

person is focally aware. Sudden change (immediate sadness, anger, joy or laughing) brief

complex focal seizure

person is unaware. No communication with you. Appear awake. No idea what they’re doing

status epilepticus

seizure >5 minutes. a medical emergency. Brain ischemia, brain damage, no return to consciousness in between seizures

detailed history, EEG within 24 hr, find underlying cause, medications, surgery, vagal nerve stimulation, diet

what plan of care for seizures

if they’re unresponsive to meds

what seizure patients will get surgery

carbamazepine

which seizure med cannot take with grapefruit juice 

phenytoin (dilantin)

which seizure med can cause gingival hyperplasia 

vitals, O2, neuro assessment,(pt will be tired) identify and avoid triggers, teach limit alc, no tub baths, diary of activity, wear medical alert bracelet,

what should nurse do post seizure

multiple sclerosis

degenerative disease where the body attacks the myelin sheath and break it down. norther latitudes are at risk, 20-50 yo women.

gradual onset, and vague ss, then numbness or weakness in legs, visual problems.

what are the clinical manifestations of Multiple sclerosis

MRI - scar tissues and plaques are seen

what can be used to diagnose MS

no cure, immunomodulators since its autoimmune, corticosteroids to decreased inflammation, muscle relaxants

what medications can be used to help people with MS

minimize triggers, exercise but avoid fatigue, good nutrition, maintain psychosocial

what is nursing care for those with MS

parkinsons disease

Chronic progressive disease with unknown cause but lack of dopamine in the brain. can see Lewy bodies(protein buildup) on cat scans

tremors, rigidity, bradykinesia, gait disturbance, blank expression, drooling, loose involuntary movement

what are the clinical manifestations of parkisnons

manage SS, medications, surgery, nutrition (high fiber, small frequent meals), safety (watch rugs, use nonslip shoes), prevent aspiration

what is the plan of care for parkinsons

no cure or diagnostic test

parkinsons has no:

levodopa/carbidopa, benztropine

what medications are used for parkinsons

protein

levodopa does not work with:

myasthenia gravis

an autoimmune disease that has anti-acetylcholine receptor antibodies. has weakness in certain muscle groups, increased with muscle use, weakness worsens throughout the day.

skeletal muscle weakness, ocular muscle ptosis or diplopia, facial muscles

what are clinical manifestations of myasthenia gravis