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Neuro /musculoskeletal. By: Diana Blum Msn NURS 2150 Metropolitan Community College. Selective Anatomy. 12 cranial nerves 31 spinal nerves Neuron transmits impulses to facilitate movement or sensation Meninges serve as protection of the brain and spinal cord - PowerPoint PPT Presentation

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Neuro/musculoskeletal

By: Diana Blum MsnNURS 2150Metropolitan Community CollegeNeuro/musculoskeletal

Selective Anatomy12 cranial nerves 31 spinal nervesNeuron transmits impulses to facilitate movement or sensationMeninges serve as protection of the brain and spinal cordBroncas area in frontal lobe forms speechHypothalamus regulates water, appetite, tempCSF: surrounds and cushions brain and cord

Olfactory optic oculomotor trochlear trigeminal abducens facial accessory vestibulocochlear glossopharyngeal vagus hypoglossalI would know the cranial nerves.2Physical assessmentOrientationLOCMemoryLTM (DOB)STM (mode of transportation to hospital)Immediate memory (repeat 3 words after 5 minutes)AttentionSerial 7 testLanguage/copyingFollows simple commandsCognition Current eventsStudent A try to remember: apple pumpkin lemon barsStudent B: count backwards from 100 by 7s

3 functional Assessment Appearance SpeechMotor functionFamily historyEthnicity Diet ADLsRight handed or left handedBrain injury is more pronounced in dominant hemisphereWhat would be concerning with speech or appearance?SlurredDisheveled Wearing to many layers for a given season4Sensory assessmentPain and tempCotton ball vs paper clipCold vs warmTouchPt closes eyes and you touch hand etc and then have them touch where you touchedABNORMAL FINDINGSPropioception-position sense below injuryContralateral- loss of sensation in opposite side of body affected

The cotton ball is soft and fluffy which looks at light touch or sensationWhereas paperclips are sharp and wherever you poke it it should be felt5Motor assessmentHand graspsFoot strengthArm driftCoordinationGaitBalanceReflexesABNORMAL FINDINGStremors, weakness, paralysis, jerking musclesWhy are these important? What do they tell us?stroke..drunk etcHow do you measure arm drift?What do you do with abnormal findings..call the md. 6Rapid assessmentGlascow coma scale: eye opening, motor response, and verbal responsepainful stimuliSupraorbital pressureSternal rubMandibular pressureTrapezius squeezeLOCDecortication-hands/arms turned in Decerebration- hands/ arms turned outPupil assessResponse to lightMental StatusDoes not decline with ageCaused by drugs or lack of o2 to the brainAs we age LTM is better then STMPg. 491 glascow coma scale is most widely used for measuring loc in Traumatic Brain Injuryeye opening verbal response motor response

Certain conditions may alter the results: ETOH shock drugs metabolic issues7

20-3 in bookThe GCS is scored between 3 and 15, 3 being the worst score, and 15 the best. It is composed of three parts: Best Eye Response, Best Verbal Response, Best Motor ResponseWhen doing a neuro assessment it is important to watch for trends indicating a decreasing LOC. Keep in mind that when patients have ingested alcohol, mind altering drugs, have hypoglycemia or shock with a systolic BP 9 Liters /24 hours. DDAVP is the drug tx90Skull FracturesCategorized according to type and severityFrequently seen in conjunction with brain injuriesLinear skull fractures Comminuted skull fracturesBasal skull fracturesPossible associated cranial nerve deficits

What symptom do you think would be alarming? letharg91Open Skull FracturesLinear- simple clean break

Depressed - bone pressed in towards tissue

Open -lacerated scalp that creates opening to brain tissue

Comminuted - bone fragments and depresses into brain tissue

Basilar- unique fx at base of skull with CSF leaking though the ear or noseRacoon eyes/Battles sign

http://www.pearlau.com.au/jpg/raccoon%2520eyes%

http://www.pearlau.com.au/jpg/raccoon%2520eyesClosed Skull FracturesClosed- blunt trauma Mild concussion-brief LOCDiffuse axonal injury- usually from MVA May go into comaContusion-bruising of brainSite of impact (coupe)Opposite side of impact (contrecoupe)

If you see clear liquid draining from ears or nose what do you think? CSFWhat do you do? Check for dextrose look for halo95

96Intracranial HematomasEpidural- bleed b/w skull and duraLaceration of artery or vienSubdural-bleed below dura and arachoid layers Acute, subacute, chronicIntracerebral-accumulation of blood in brain tissueBlunt traumaPenetrating wounds Acceleration/deceleration injuries97Along with hematomas is hemorrhages that can occur. Which are discussed in chapter 22. seizures can occur from them along with hyponatremia. Salt wasting can occur due to trauma or tumor. Once salt levels get to around 120 or lower seizures can occur. (pg. 575).

98Increased Intracranial Pressure(ICP)Pg 56899Increase is caused by an increase in the volume of any of the intracranial components

Drivers of increased ICPHypoxia triggers the vasodilatory cascadeIschemia in acute brain injury

Increased ICPNormal ICP 10-15mmHgNormal increases occur with coughing, sneezing, defecationLeading cause of death for head trauma

As ICP increases cerebral perfusion decreases causing tissue hypoxia, decrease serum pH, and increase in CO2102ICP continued3 types of edemaVasogenic: increase in brain tissue volume Cytotoxic: result of hypoxiaInterstitial: occurs with brain swelling

103Assessment

s/s of a problem: altered LOC usually first, restless, unequal pupils, coma, death, comitting, increased sbp decreased hr irregular respiration

Goal of management is to prevent secondary injury

Tx:mannitol, hyperosmol fluids and those listed here.

Mannitol is used in acute situations only.. It is caustic to the body causing heart issues, RF etc.104Hydrocephalus abnormal increase in CSF volumeCauses: impaired reabsorption from subarachnoid hemorrhage or menengitis

105Pg. 575Found from ct scan.. Treatment is a shunt

Brain HerniationIncreased ICP will shift and move brain tissue downwardCentral HerniationDownward shift to brainstemS/SCheyne stokes , pinpoint pupils, hemodynamic instabilityThe most life threatening is Uncal because it causes pressure on the 3rd cranial nerveS/S Dilated, nonreactive pupils, ptosis, rapidly decreased LOC

106Pg 568 Herniation syndromes.

Movement/musculoskeletalRheumatoid Arthritis

Pg 1836-47109Most common connective tissue disorders Most destructive to jointsRA factors looked for in lab Assess sedrate Assess immunoglobinsMRIs performedEMGs are performed to measure function

Assessment/ S/S continuedJoint stiffnessSwellingPainFatigueWeight lossReddened jointsDeformity of jointsBakers cysts may occur and cause painDry eyes, dry mouth, dry vaginaAssess ADLs, coping, paininterventionsNsaidsImmunosuppressive drugRest Proper positioningPain managementIceHeart parafin waxPlasmapheresisFish oil tabletsHeat relaxes muscles but cold therapy reduces swellingSwimming is good for jevenile typeGouty arth is from uric crystals depositing usually in big toeTx avoid pruine foods 112GoutType of arthritisUrate crystals deposit in jointsPrimary gout is most commonInflammation is key sign2nd ary is when too much uric acid in bloodCan affect kidneysMeds to treat Pain managementDrugs are allopurinol and cholchinine SE of diarrhea113Fibromyalgia Chronic pain syndromePain is burning or gnawingHeadache and jaw pain are also commonChest pain is commonPain control is the keyMuscle relaxers, nsaids, antidepressantsMuscular distrophies9 typesProgression is slow or fastMost common is severe X linked recessiveDiagnosis is difficultComfort is key Treat symptomsCharacterized by progressive weakness and degeneration of muscles that control movementDuchenne is most common and more in boysMyotonic is most common adult Tx symptoms---steroids anticonvulsants antibx, immunosuppresants, vents

ALS dx of nerves aka lou gerhigs: diff breathing swallowing head drop paralysisno cureTx riluzole helps prolong life pt ot speech vent

MS damaged myelin sheaths most common in young women no cureDiff to dx Tx steroids interferon rehab medical cannibus, hyperbaric oxygen115

AMPUTATION REVIEW

amputationsRemoval of part of the bodyTypesSurgical-example digit Traumatic- example digitLevelsLower extremity: digits, bka, aka, midfootUpper extremity: hands, fingers, armsComplicationsHemorrhageInfection Phantom limb pain: perceive pain in the amputated limbImmobilityNeuroma: sensitive tumor consisting of nerve cells found at several nerve endingsContractures

Review Meds on 599-604Review cranial nerves

TIPS!!