Traumatic Brain Injury Signs and Symptoms

• Decreased Level of Consciousness: Major indicator of brain injury.
• Basilar Skull Fracture: Bruising behind the ear; indicative of severe head trauma.
• Raccoon Eyes: Periorbital bruising associated with severe head injury.

Cushing's Triad

• Definition: Triad of symptoms indicating increased intracranial pressure.
• Vital Signs:
  • Increased Systolic Blood Pressure: Elevated blood pressure.
  • Decreased Heart Rate: Bradycardia, indicating potential neurological distress.
  • Irregular Respiratory Patterns: Changes in breathing rate and depth.

Meningitis Assessment

• Nuchal Rigidity Check:
  • Perform Brudzinski's Sign: Flexion of neck causes involuntary leg flexion.
  • Perform Kernig's Sign: Inability to fully extend the leg when the hip is flexed.
• Potential Fatality: If untreated, meningitis can lead to severe complications and death.

Types of Stroke

• Ischemic Stroke:

  • Caused by a clot obstructing blood flow in the brain.
  • Risk Factors: Hypertension, smoking, high cholesterol, over age 55.
  • Signs: Hemiplegia, dysphasia, sensory loss, vision changes, left-right body deficit.
  • Management: Use the acronym FAST (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services).
  • Time-sensitive treatment with tPA (Tissue Plasminogen Activator) may be given within a specific window post-symptom onset.

• Hemorrhagic Stroke:

  • Resulting from a ruptured blood vessel.
  • Causes include hypertension, trauma, or aneurysm rupture.
  • Management: No anticoagulants, monitor vital signs, adjust positioning to avoid increased ICP.

Seizures

• Types: Partial (simple/complex), Generalized (tonic-clonic, myoclonic, absence).
• Seizure Phases:
  • Prodromal Phase: Warning signs such as feeling of impending doom.
  • Ictal Phase: Active seizure phase; protect the patient from injury.
  • Postictal Phase: Recovery period; confusion and lethargy are common.
• Emergency Medications: Benzodiazepines (e.g., Lorazepam) to cease seizures.

Parkinson's Disease

• Pathophysiology: Loss of dopamine-producing cells leading to motor deficits.
• Symptoms: Resting tremors, shuffling gait, muscular rigidity, bradykinesia, postural instability.
• Diagnosis: At least two cardinal symptoms and asymmetrical presentation.
• Treatment: Medications (Levodopa and Dopamine agonists), implement safety precautions due to increased fall risk.

Multiple Sclerosis (MS)

• Pathophysiology: Demyelination of axons within the CNS.
• Symptoms during Exacerbation: Numbness, fatigue, weakness, visual disturbances, sphincter dysfunction.
• Diagnosis: MRI shows plaques in CNS; lumbar puncture reveals oligoclonal bands in CSF.
• Management: Corticosteroids for flare-ups, disease-modifying therapies (e.g., beta-interferons).

Myasthenia Gravis

• Description: Autoimmune disorder affecting neuromuscular transmission.
• Symptoms: Fluctuating muscle strength, ocular symptoms like ptosis, and weakness in interfacing.
• Diagnosis: Tensilon Test can be administered to assess muscle strength post-administration of Edrophonium.

Guillain-Barré Syndrome

• Pathophysiology: Characterized by acute, ascending paralysis.
• Symptoms: Recent viral infection history leading to progressive weakness; can cause respiratory failure.
• Management: Plasmapheresis or immunoglobulin therapy.

General Nursing Management for Stroke

• Immediate Actions: Assess airway and breathing.
• Monitoring: Use Glasgow Coma Scale (GCS) for neurological assessment; frequent reassessment is critical.
• Intervention Goals: Ensure patent airway, provide nutrition, monitor for aspiration precautions.
• Medications: Post-stroke, patients may require anticoagulants (if ischemic) or antiplatelet agents (Aspirin, Plavix).