neuro 1

Resources

• YouTube Videos: Different from those embedded in the PowerPoint. Recommended for extra help on difficult topics.

• Textbook Reference: Page numbers provided for related topics in your textbook for further reading.

Cranial Nerves Assessment

• Importance: Knowing and being able to assess all 12 cranial nerves is crucial for nurses. Will be on the exam.

Diagnostic Procedures

Overview

• Discussing diagnostic procedures related to neurosensory disorders.

Cerebral Angiography

• Definition: Cerebro (brain) + Angio (vessel) + Graphy (picture) = Picture of brain vessels.

• Procedure: Utilizes X-ray to visualize blood vessels; requires contrast (dye) for visibility.

• How Contrast Works: Injected via percutaneous catheter (femoral or radial artery).

• Nursing Considerations:

  • Monitor for bleeding and hematoma formation post-injection.

  • Pre-procedure assessment of pulses, color, and temperature of the affected extremity.

  • Educate patients about sensations during contrast administration (warmth, metallic taste).

  • Assess kidney function due to contrast elimination (BUN and creatinine levels).

  • Note allergies to iodine and shellfish (related to contrast).

  • Perform neuro assessments for stroke risk.

Collateral Circulation

• Definition: Formation of new blood vessels to reroute blood flow in the presence of blockages.

• Importance: Acts as an alternative pathway for blood, reducing ischemia effects when blockages are present.

Computed Tomography (CT)

• Definition: Updated version of CAT scan using X-ray for layered body scanning. Provides cross-sectional images.

• Uses: Detects brain lesions, tumors, infarction (tissue necrosis), hemorrhage, and other abnormalities.

• Procedure: Patient lies still as scanning equipment rotates around head.

• Nursing Considerations: Check for iodine/shellfish allergies and renal function (BUN and creatinine).

• Key Point: CT scans are typically rapid with minimal radiation exposure.

Glasgow Coma Scale (GCS)

• Purpose: Measures level of consciousness, crucial for assessing neurological function.

• Scoring: Comprises eye-opening, verbal response, and motor response. Total score: 3-15 (15 is normal, 3 is severe brain damage).

• Safety Point: GCS of 8 or less indicates intubation.

Magnetic Resonance Imaging (MRI)

• Definition: Uses a magnetic field to create images; superior in identifying cerebral anomalies.

• Uses: Brain tumors, strokes, multiple sclerosis; assesses chemical changes in cells.

• Considerations: Ensure no metal implants (e.g., pacemakers, clips) before the procedure.

• Duration: Takes longer than CT scans, typically not used in emergencies due to time constraints.

Lumbar Puncture (LP)

• Definition: Insertion of a needle into the lumbar subarachnoid space to extract CSF for examination.

• Uses: Examines CSF for blood, measures pressure, and administers medications (intrathecal).

• Appearance of CSF: Should be clear; any discoloration may indicate problems.

• Risks: Risk of herniation in cases of brain tumor; monitor for infection, headaches, and complications after procedure.

Cerebrovascular Disorders

Overview

• Definition: Disorders affecting blood supply to the brain, leading to decreased perfusion/ischemia.

• Stroke: The primary cerebrovascular disorder in the U.S., leading cause of disability.

Types of Stroke

• Ischemic Stroke: Accounts for 87% of strokes; results from blood flow obstruction.

• Hemorrhagic Stroke: Represents 13% of strokes; results from blood vessel rupture.

Risk Factors and Symptoms

• Symptoms vary based on which hemisphere is affected.

• Left side damage leads to right side symptoms (e.g., aphasia, visual field deficits).

• Right side damage leads to left side symptoms (e.g., neglect, motor impairments).

Stroke Prevention

• Lifestyle: Healthy diet, physical activity, avoiding smoking, and managing stress.

• Medications: Antiplatelets (aspirin, clopidogrel) for prevention and management.

Transient Ischemic Attack (TIA)

• Definition: Temporary loss of blood flow causing neurologic deficits that resolve within 24 hours. A warning sign for potential strokes.

Hemorrhagic Stroke

• Types: Intracerebral (inside the brain) and subarachnoid (between brain and skull).

• Symptoms: Severe headache, vomiting, altered consciousness, seizures.

Increased Intracranial Pressure (ICP)

• Causes: Usually due to head injury or pathologic states (tumors, bleeding).

• Signs: Cushing's triad (high blood pressure, irregular breathing, low heart rate) is a late sign.

• Nursing Role: Monitor neuro signs, GCS, and baseline assessments for changes.

Nursing Interventions Post-Stroke

• Monitor vital signs, administer oxygen, conduct neuro assessments, evaluate blood sugar levels, and evaluate swallowing ability (avoid aspiration).

• Supporting Rehabilitation: Encourage participation in physical, occupational, and speech therapy.

• Emotional Support: Provide resources for patients and families; support communication needs.

Summary of Key Points

• Neurological assessments, safeguarding airway, immediate intervention for strokes, understanding diagnostic tools, and knowing nursing protocols are crucial for providing patient care in the neurosensory unit. Additional resources like videos and practice material can assist in thorough preparation.