Lesson 2 -

• DEMOGRAPHIC HISTORY should include Age, sex, Education, religion, race, occupation, source of finances.
• PAST MEDICAL HISTORY

  1. Family medical history : disease (hypertension, CVD, and stroke), family condition, and age at death
  2. Previous injuries and/or congenital problems
  3. Chronic disease - NCDs
  4. Previous neurologic problems - seizure, vertigo, stroke
• NEUROLOGIC HISTORY

  1. Right/left handedness - rehab goals & func. abilities
  2. Headaches - frequency & characteristics (PQRST)
  3. Blackout spells/dizziness - frequency, duration, aura (seizure warning signs)
  4. Vomiting or nausea - frequency, projectile vomiting
  5. Loss of balance
  6. Tingling / numbness of legs after prolonged sitting
  7. Unknowingly cuts/burns self
  8. Seizure - frequency & characteristics
• CURRENT HISTORY

  1. Current symptoms

  • blurring of vision
  • Headaches
  • Dysphagia or difficulty speaking
  • Numbness, tingling, sensation, weakness
  • Bladder/bowel dysfunction
  • seizures
  • Personality and/or LOC changes

  2. Allergies - contraindications

  3. Medications - drugs & resources

  4. Pain tolerance

  5. Activity of daily living - how performed previously & current
• SOCIAL HISTORY

  1. Physical activity
  2. Vices - use of alcohol, cig, drugs
  3. Sleep habits
  4. Handedness
  5. Educ. bg/attainment - tailor intervention
• Known risk factors to the development of CVA

  • Modifiable 
  • Lifestyle, nutrition, substance abuse, exercise 
  • Non-modifiable 
  • Age 
  • Family History 
  • Gender (better CVA behavior for female)
  • Race
• Assessment

  • NHH
  • History of risk factors
  • Diet
  • Physical inactivity
  • Physical Examination
  • GCS
  • Weakness, blurry vision
  • Cranial Nerve assessment
  • Diagnostic Evaluation
  • MRI
  • CT scan, MRI, neuro imaging (faster)
• Widened Pulse Pressure

  PP = SBP - DBP
• MAP= 2 (DBP) + SDP/3
• RAPID Stroke Assessment: FAST

  
• Special States of Altered Levels of Consciousness

  ○ Brain Death

  ■ An irreversible loss of cortical and brain stem activity (no brain waves)

  ○ Persistent Vegetative State

  ■ A condition that awake but lacks awareness due severe cerebral injury

  ○ Locked-in Syndrome

  ■ A state of muscle paralysis (cant move/communicate) w/ full consciousness and awake
• DeCORticate - papunta sa CORE

  DeCEREBRATE - nagse-celebrate, extend

  
• Cranial Nerves

  
• During EEG, Document w/ specific time:

  • BP, LOC, movements/posture, noxious stimuli/ EEG blinking lights
• Level of responsiveness and consciousness is the most important indicator of the patient’s condition
• Specific interventions for alteration in LOC include maintaining the airway through monitoring of respiratory status and auscultation of lung sounds.
• The position for a patient with an alteration in LOC is typically HOB elevated at 30• lateral or semi prone position.
• Specific interventions for maintaining tissue integrity include turning the patient every 2-4 hours, performing passive range of motion, and maintaining good body alignment.
• Cleaning eyes with cotton balls and sterile water is a part of maintaining tissue integrity.
• Specific interventions for maintaining fluid status include maintaining normal body temperature, using a mini blanket, and providing acetaminophen or a cooling sponge bath.
• Promoting bowel and bladder function includes initiating a bladder training program, clamping the catheter for 4 hours and then releasing it for 15 minutes for 24-48 hours, and promoting elimination through the use of stool softeners, enemas, and glycerin suppositories.
• Promoting bowel and bladder function includes initiating a bladder training program, clamping the catheter for 4 hours and then releasing it for 15 minutes for 24-48 hours, and promoting elimination through the use of stool softeners, enemas, and glycerin suppositories.
• Sensory stimulation and communication with a patient with an alteration in LOC can involve talking and touching the patient, and referring support and services to the family.
• normal ICP is 10 to 20 mm Hg
• decrease CO2= vasoconstriction = decrease ICP
• Increased CO2=vasodilation= increase ICP
• increase ICP decreased CP
• normal values:

  ICP: 10 - 20 mmHg

  CCP: 50-60 (70-100) mmHg

  MAP: 80-120 mmHg
• CPP: MAP - ICP

  MAP: 2(DBP) + SBP/3
• Cushing triad = hypertension, bradypnea, bradycardia

  
• Ventriculostomy is a neurosurgical procedure that involves creating a hole (stoma) within a foramen of monro for drainage, calibration of ICP. 
• The position for a patient with increased ICP HOB elevated at 0°-60° w/ head in neutral position.
• Cranial Surgical Approaches

  
• • Craniotomy: opening of the skull
  • Craniectomy: excision of a portion of the skull
  • Cranioplasty: repair of a cranial defect using a plastic or metal plate
  • Burr holes: circular openings for exploration or diagnosis
• Seizure - (one episode) Abnormal episodes of motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons
• Epilepsy – A chronic disorder characterized by recurrent seizures.
• Status Epilepticus – Prolonged seizure lasting more than five minutes or repeated seizures over course of 30 mins
• Partial seizures 

  Simple Partial/Focal onset aware -  awake & alert

  Complex Partial/ Focal impaired awareness - alteration in consciousness
• Types of General Seizures 

  Tonic - muscle stiffening 

  Atonic - no muscle strength /drop seizure

  Clonic - muscle jerking/ twitching

  Tonic-clonic - grand mal; stiffening & jerking

  Absence - petit mal; blank stares
• SEIZURE PRECAUTIONS

  • Available oxygen and suctioning equipment at bedside
  • IV access - diazepam
  • Side rails up at all times
  • Turn to side during seizure to prevent aspiration
  • Do not restrain patient to prevent injury
  • Remove objects that may injure the patient