neuro

• Components of the nervous system

  • Spinal cord
  • Brain
  • Cranial nerves
• Divisions of the autonomic nervous system

  • Sympathetic (S) - Stress response, flight or fight
  • Parasympathetic (P) - Peaceful, balance and rest
• Expressive aphasia

  Difficulty or inability to speak to others with incorrect words
• Receptive aphasia


  Patient cannot understand when spoken to
• Decorticate


  Inward posturing
• Decerebrate


  Extended posturing
• Age-related changes


  • Decrease in sensation
  • Changes in level of consciousness
  • Decrease in neurotransmitter (dopamine)
• LOC


  Level of consciousness
• GCS


  Glasgow Coma Scale
• PERRLA


  Pupils are Equal, Round, Reactive to Light and Accommodation
• Basic Neuro Assessment


  1. Determine history of neurologic problems

  2. Assess level of consciousness and orientation

  3. Obtain vital signs

  4. Check pupillary response to light

  5. Assess strength and equality of hand grip and movement of extremities

  6. Determine ability to sense touch or pain in extremities
• Glasgow Coma Scale

  The highest GCS score is 15, indicating full consciousness. A score less than 8 is associated with severe head injury and coma.
• Lumbar punctures can be associated with rare but serious complications, such as brain herniation, especially when performed in the presence of increased intracranial pressure (ICP).
• Lumbar punctures for clients who have bleeding disorders or who are taking anticoagulants can result in bleeding that compresses the spinal cord.
• Postprocedure for lumbar puncture

  1. CSF is sent to the pathology department for analysis

  2. Monitor the puncture site

  3. Client should remain lying for several hours to ensure that the site clots and to decrease the risk of a post-lumbar puncture headache, caused by CSF leakage

  4. Obtain vital signs, perform neuro check of the client's legs

  5. Collect pain data

  6. Encourage fluid intake
• Client Education for lumbar puncture

  Normal activities may be resumed after prescribed bed rest is complete as long as in stable condition
• Meningitis


  Inflammation of the meninges, which are the membranes that protect the brain and spinal cord. Nerve damage can leave patient blind or deaf.
• Viral (aseptic) meningitis


  Most common form of meningitis, commonly resolves without treatment in 1-2 weeks
• Bacterial (septic) meningitis


  Contagious infection with a high mortality rate. The prognosis depends on how quickly care is initiated.
• There are three vaccines for different pathogens that cause bacterial meningitis. One is available for high-risk populations, such as residential college students, which is required for college entrance.
• Risk Factors for Viral Meningitis

  • Viral illnesses (mumps, measles, herpes, arboviruses [West Nile])
  • There is no vaccine against viral meningitis
• Risk Factors for Bacterial Meningitis

  • Bacterial-based infections (otitis media, pneumonia, sinusitis) in which the infectious micro-organism is Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae
  • Immunosuppression
  • Direct contamination of spinal fluid
  • Invasive procedures, skull fracture, or penetrating wound
  • Overcrowded or concentrated living conditions
• Expected Findings in Meningitis


  • Subjective Data: Excruciating, constant headache; Nuchal rigidity (stiff neck); Photophobia (sensitivity to light)
  • Objective Data: Fever and chills; Nausea and vomiting; Altered level of consciousness (confusion, disorientation, lethargy, difficulty arousing, coma); Positive Kernig's sign; Positive Brudzinski's sign; Hyperactive deep tendon reflexes; Tachycardia; Seizures; Red macular rash (meningococcal meningitis); Restlessness, irritability
• Increased Intracranial Pressure (ICP)

  Normal ICP is 0-15. Increased ICP can be caused by trauma or illness.
• Signs and Symptoms of Increased ICP

  Restlessness, irritability, hyperventilation, fixed pupils, weakness, paralysis, posturing (decorticate - inward, decerebrate - outward)
• Types of Headaches


  • Migraine (with aura, without aura)
  • Cluster
  • Tension
• Migraine with Aura


  Aura develops over minutes to an hour and includes neurologic findings like numbness, tingling, acute confusion, visual disturbances. Severe, incapacitating, throbbing headache accompanied by nausea, vomiting, and drowsiness.
• Migraine without Aura (Common Migraine)


  Pain is aggravated by physical activity. Unilateral, pulsating pain. May include photophobia, phonophobia, nausea, and/or vomiting. Persists for 4 to 72 hours.
• Cluster Headache


  Brief episode of intense, unilateral, non-throbbing pain lasting 15 min to 3 hr that can radiate. No aura or preliminary manifestations. Tearing of the eye, runny nose, nasal congestion, facial sweating, pupil constriction, facial pallor or flushing.
• Tension Headache


  Persistent contraction of scalp, facial, cervical, and upper thoracic muscles can cause pressure, aching, steady, tight pain.
• Seizure Disorders


  Abrupt, abnormal, excessive, and uncontrolled electrical discharges of neurons within the brain that can cause alterations in the level of consciousness and/or changes in motor and sensory ability and/or behavior.
• Seizure Triggers


  • Increased physical activity
  • Excessive stress
  • Hyperventilation
  • Overwhelming fatigue
  • Acute alcohol ingestion
  • Excessive caffeine intake
  • Exposure to flashing lights
  • Substances such as cocaine, aerosols, and inhaled glue products
• Generalized Seizure


  Involves both cerebral hemispheres. Can begin with an aura.
• Partial Seizure


  Patient does not lose consciousness and less than a minute, one hemisphere affected.
• Tonic-Clonic (Grand Mal) Seizure


  Begins with a tonic episode (stiffening of muscles) and loss of consciousness, followed by a clonic episode (rhythmic jerking of the extremities) for 1-2 minutes. Breathing can stop during the tonic phase and become irregular during the clonic phase. Cyanosis, biting of the cheek or tongue, and incontinence can occur. A postictal phase of confusion and sleepiness follows.
• Absence (Petit Mal) Seizure


  Loss of consciousness for 10 to 30 seconds with no motor activity or mild symmetrical activity such as blinking. Rare in adults, typically stop occurring during adolescence.
• Status Epilepticus


  Repeated seizure activity within a 30-min time frame or a single prolonged seizure lasting
• Anticonvulsant


  Small dose working up test levels
• Correct cause
• During aura


  1. Sit or lie down

  2. Move furniture

  3. Time seizure

  4. Protect head

  5. Put on side

  6. Don't put anything in mouth