adult 2 neuro

Change in LOC is a

late sign

central nervous system

brain and spinal cord

glial cells

protects neurons

peripheral nervous system

cranial nerves, spinal nerves, peripheral nerves

where are relay (inter) neurons located

CNS

where are sensory and motor neurons located

PNS

neurons

receive and transmit signals

cranial nerve 1

Olfactory

cranial nerve 2

optic

cranial nerve 3

Oculomotor

cranial nerve 4

Trochlear

cranial nerve 5

Trigeminal

cranial nerve 6

Abducens

cranial nerve 7

Facial

cranial nerve 8

Vestibulocochlear

cranial nerve 9

Glossopharyngeal

cranial nerve 10

Vagus

cranial nerve 11

spinal accessory

cranial nerve 12

Hypoglossal

COCABAES

level of Consciousness
Orientation
Cognition
motor Activity
Body posture
ADL
facial Expression
Speech pattern

motor function is measured by

1-5 scale

brocas area

controls language expression (speech)

+5 motor strength

full strength

+1 motor strength

trace movements

+2 motor strength

limb movement but not against gravity

+3 motor strength

Movement against gravity not resistance

+4 motor strength

movement against some resistance

hypotonia

flaccidity

hypertonia

spasticity

other components of motor function

coordination
symmetry of muscles
pronator drift test
involuntary movements (tremors)
balance
pace/rhythym of gait
speech

sensory function

test pain, touch extremities for feeling

romberg test

used to evaluate cerebellar function and balance

reflexes

biceps, triceps, brachioradialis, patellar, achilles

reflex strength scale

1-5

0 reflex

absent

1 reflex

weak reflex

2 reflex

normal response

3 reflex

brisk response

4 reflex

hyperreflexia with non-sustained clonus

5 reflex

hyperreflexia with sustained clonus

what conditions cause a drop in cardiac output that could negatively affects the brain

factors that influence CBF

CO2
O2
hydrogen ions concentration

cerebral bloof flow is

15-20% of total cardiac output

15-20% of total cardiac output is

750ml of blood

what is the brain extremely sensitive to

hypoxia

why is the brain extremely sensitive to hypoxia

the blood brain barrier

hypoxic damage to the brain is

irreversible after a few minutes

intercranial pressure

measure amount of CSF

normal ICP

0-15mmHg

\>20 ICP for \>5 minutes

is an emergency

components that impact ICP

brain tissue
blood
CSF

factors that influence ICP

cerebral edema
increased cerebral blood volume (hypercapnia, hypoxemia, inc metabolic demands (fever, burns), inc intra-abdominal and intra-thoracic pressure (ascites, pregnancy, obesity, gunshot), venous outflow obstruction)
too much CSF production

transient ischemic attack

can be a small clot, deficits for short period of time, may not know
can be from hypertension, hyperlipidemia, DM, etc
no treatment (may go on low dose aspirin)

ischemic stroke

stroke from clot
thrombotic (most), embolic (mid), lacunar (less)

hemorrhagic stroke

brain is bleeding out

intracerebral hemorrhage ICH

high mortality, brain bleed, can happen at any age

Alteplase (t\=PA)

for non-hemorrhagic stroke
clot buster
given within 4-4 1/2 hours of stroke
no surgery or stroke within last 3 months
no abnormal bleeding, or current/severe uncontrolled htn (bc inc risk of bleeding)

severe uncontrolled htn can be a sign of

stroke

liver failure in stroke means

cannot filter well
risk for bleeding

what non-neurological conditions can cause a change in mental status

UTI
hypoglycemia
alcohol
delirium

outside of hospital delirium can come from

alcohol
side effects of meds
polypharmacy
sleep deprivations
dehydration
electrolyte imbalance
glucose abnormalities
acute or chronic issues

inside of hospital delirium can come from

all outside factors and unfamiliar environment
sensory overload or deprivation
emotional stress
pain
restraint use

what to expect in delirium

hypoactivity or lethargy
hyperactivity and agitation, hallucinations
inability to concentrate, disorganized thinking, irritability

diagnosis for delirium

look for underlying cause

treatment of delirium

NO benzos
change meds if needed
meds if severely agitated (haloperidol, vitamin H), risperidone, quetiapine, olanzapine

nursing interventions for delirium

reorientation
encouraging family
reducing environmental stimuli
treat pain
mobility
moving patient closer to nursing station
avoid restraints
calm music

labs and testing in neuro

lumbar puncture
CSF culture
EEG/EMG
peaks and troughs for meds
blood cultures
MRI/MRA/CT
UA
genetic testing

lumbar puncture

measures ICP
can be for meningitis
can be used for infusions of chemo, injecting contrast

Nurse's role in a lumbar puncture

educate
support
prep patient

bacterial meningitis key facts

increased pressure
WBC \>1,000 mainly neutrophils
protein \>500mg/dl
decreased glucose
Cloudy appearance

viral meningitis key facts

increased pressure
25-500 WBC mainly lymphocytes
50-500mg/dl protein
normal or low glucose
clear or cloudy appearance

encephalitis key facts

normal/slight inc pressure
500 neutrophils (early) and lymphocytes (late)
slight inc in protein
normal glucose
clear appearance

brain abscess key facts

increased pressure
25-300 WBC mainly neutrophils
normal protein
low or absent glucose
clear appearance

brain abscess

accumulation of pus from local or systemic infection

brain abscess etiologies

direct extension from ear, teeth, mastoid, sinus, skull fracture, brain, trauma

brain abscess manifestations

HA
fever of unknown origin
N/V
lethargy
confusion
seizures

brain abscess treatment

antibiotics
+/- surgical evacuations/drain

meningitis

infection of meninges
usually from respiratory tract or through blood that got to brain

types of meningitis

bacterial
viral
fungal

bacterial meningitis

most serious form

common causative agents of meningitis

streptococcus pneumonia (gram +) (older adults)
neisseria meningitis (gram -) (adolescents and young adults)
haemophilus influenzae (gram -)
listeria monocytogenes
group B streptococcus

diagnosis of bacterial meningitis

H & P
head ct/mri
lumbar puncture (fluid with white/yellow with high pressure)

treatment of bacterial meningitis

antibiotics
dexamethasone
pain meds
NO sedatives
antipyretics
hydration

Nursing Management for bacterial meningitis

assess for signs of neurological decompensation/seizure
frequent neuro checks
seizure precautions
low lighting
pain/fever management
antibiotic/steroid management
DROPLET precautions
vaccine awareness

symptoms of bacterial meningitis

HA
altered mental status
phonophobia
photophobia
stiffness in neck
high fever
petechiae

viral meningitis signs/symptoms

less severe but same as bacterial

fungal meningitis signs/symptoms

same signs and symptoms as bacterial

viral meningitis diagnosis

H&P
CT/MRI
LP
fluid may be clear to slightly white and less pressure than bacterial

viral meningitis treatment

initially with antibiotics until confirmed or bacterial ruled out

viral meningitis nursing management

DROPLET precaution
and same as bacterial

fungal meningitis diagnosis

H&P
CT/MRI (may show fungal lesions)
LP

fungal meningitis treatment

antifungals

fungal meningitis nursing management

same as bacterial

encephalitis

acute inflammation of brain parenchyma caused by virus

encephalitis etiologies

west nile virus
equine viruses
HIV
CMV
HSV

encephalitis signs/symptoms

viral prodromes followed by mental status changes
neuro deficits and inc ICP

encephalitis diagnoses

LP
viral blood culture

encephalitis treatment

antivirals

encephalitis nursing management

same as meningitis

acute cranial nerve disorders

aka peripheral neuropathies from tumors, trauma, infection, inflammatory disorders, or idiopathic causes