neurological system
TRANSCRIPT
![Page 1: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/1.jpg)
Neurological System
![Page 2: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/2.jpg)
Brain Anatomy
Cerebrum Reasoning Judgment Concentration, Motor, sensory, speech
Cerebellum Coordination
Brainstem Cranial nerves Respiratory center Cardiovascular center
![Page 3: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/3.jpg)
Brain Blood Supply 20% of CO Cerebral tissues –
Have no oxygen or glucose reserves
Carotid Arteries to Circle of Willis
![Page 4: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/4.jpg)
Intracranial Pressure (ICP)
Composition 80% brain tissue and water 10% blood 10% cerebrospinal fluid (CSF)
Increased ICP caused by: Severe head injury/ Subdural
hematoma Hydrocephalus Brain tumor Meningitis/Encephalitis Aneurysm Status epilepticus/Stroke
A medical emergency that can lead to:
Brain hypoxia, herniation, death
Clinical Manifestations Vomiting Headache Blurred vision Seizure Changes in behavior Loss of consciousness Lethargy Neurological symptoms
![Page 5: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/5.jpg)
Neurological Assessment
Rapid Neurological Assessment Emergent situations Sudden changes in neurologic status
1. LOC: first indicator of a decline in neurological function and increase in ICP (intracranial pressure)
2. GCS
3. Pupils
![Page 6: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/6.jpg)
2. Glasgow Coma Scale
![Page 7: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/7.jpg)
3. PUPILS
![Page 8: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/8.jpg)
Neuro-Diagnostic Tests Routine labs Radiology Tests
CT scan, MRI Carotid ultrasound Cerebral angiogram/
MRA
CT SCAN
MRA
Carotid US
![Page 9: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/9.jpg)
Neuro-Diagnostic Tests: Lumbar Puncture Spinal needle
inserted into SA L3/L4 or L-4 /L-5
using strict asepsis Obtain specimens Measure pressure Anesthesia
![Page 10: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/10.jpg)
Case Study: Introduction
Nancy came in to the ER with her daughter Gail. Gail states that her mother suddenly was unable to speak clearly and fell to the ground.
![Page 11: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/11.jpg)
Stroke: Brain Attack
Cerebrovascular Accident (CVA) - loss of brain functions that occur when the blood supply to any part of the brain is interrupted.
Sudden onset of neurological deficits
Medical Emergency- reduction in cerebral blood flow & tissue death Brain dependent on constant supply of oxygen and
glucose
![Page 12: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/12.jpg)
Types of Stroke
Ischemic Thrombotic Stroke Embolic Stroke
Hemorrhagic
![Page 13: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/13.jpg)
Ischemic: Thrombotic Stroke
Atherosclerosis is the most common cause of vascular obstruction leading to thrombosis
Thrombosis-clot forms at rough or narrowed artery
Complete blockage Half of all strokes
![Page 14: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/14.jpg)
Ischemic: Embolic StrokeEmbolism-blood clot or fatty plaque released
into circulationOften a fragment from a thrombosis or fatty
plaque
![Page 15: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/15.jpg)
TIA: Transient Ischemic Attack Warning sign: Temporary onset of
neurological symptoms lasting from 1-24 hours
Needs prompt work-up: carotid U/S, brain and heart
Key features:Blurred vision, double vision, blindness one
eyeTransient weakness, ataxiaSpeech deficits
![Page 16: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/16.jpg)
Treatment Cont: Surgical Therapy Carotid
Endarterectomy- for pts who have had TIAs or significant narrowing of carotid arteries
![Page 17: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/17.jpg)
Hemorrhagic Stroke
Rupture of weak vessel wall or cerebral aneurysm
Arteriovenous malformation
Bleeding into brain or meninges
![Page 18: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/18.jpg)
Risk Factors for Stroke
Hypertension Heart disease DM Lifestyle Smoking/Alcohol Obesity Hyperlipidemia Illicit Drug Use;
cocaine Age
![Page 19: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/19.jpg)
Clinical Manifestations Depend on the extent of
injury May be transient, mild or
result in major neuro deficits
Embolic: sudden Hemorrhagic: sudden
Worse HA ever for bleeds
![Page 20: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/20.jpg)
R Hemiplegia/paresis
Impaired speech(Aphasias)
Impaired discrimination(R/L)
Slow performance,Cautious
Aware of deficitsDepression, Anxiety
Impaired comprehension & Memory R/T language and mathLeft -Sided CVA:
LEFT BRAIN DAMAGE Hemianopsia
![Page 21: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/21.jpg)
Right-sided CVA:RIGHT BRAIN DAMAGE Impaired judgment
Impulsive/Safetyproblems
Denies/Minimizesproblems
L hemiplegia/paresis
Left-sided neglect
Spatial-perceptual deficits
Rapid performanceShort attention
span
Hemianopsia
![Page 22: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/22.jpg)
Impaired Swallowing
Cognitive Changes
Motor Deficits
Sensory Changes
Impaired Communication
Altered Elimination
Nancy
Psychosocial
![Page 23: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/23.jpg)
Impaired Swallowing Stroke →dysphagia Risk for airway obstruction/ aspiration Nursing Interventions: Maintain patent airway
NPO until swallow eval (by ST) Assess swallow, cough, gag reflex Safe Feedings: High Fowler’s position with head
flexed forward Thickened liquids if impaired swallowing Instruct to
position food on unaffected side in back of throat Avoid distractions to reduce aspiration risks Soft, semi-soft foods, pureed, baby food, dental diet Suction as needed
![Page 24: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/24.jpg)
Cognitive Changes
Change in LOC Impaired judgment,
memory, problem solving
Denial of illness Inability to
concentrate
Nursing Interventions: Frequent reorientation Frequent safety
instructions Repeat directions on
tasks by steps Give time to process
and respond
![Page 25: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/25.jpg)
Motor Deficits
Loss of voluntary movement on contralateral (opposite) side of stroke
Weakness & paralysis Hemiplegia and/or
Hemiparesis Gait changes
![Page 26: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/26.jpg)
Motor Deficit Cont.
Nursing Interventions: Maintain optimal functioning and assist as
necessary Prevent contractures & atrophy PT and OT eval/tx to promote independence
Positioning- intermittent prone positions; elevate affected extremity
ROM exercises (passive: begin 1st day of hosp; no ambulation with hemorrhagic stroke)
Assist with ADLs (Self Care Deficit) Use assistive devices (wide grip utensils, plate guards) Rehab and use of ambulation devices
![Page 27: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/27.jpg)
Motor Deficit Cont.Splints, hand rolls, trochanter rolls
![Page 28: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/28.jpg)
Assessment and Management Sensory Changes
Contralateral sensory deficits Decreased sensation to
touch Spatial dysfunction
Awareness of position Neglect Syndrome –
Ignore affected side due to altered perception and vision
Visual Deficits
Nursing Interventions: Teach client to touch and
use both sides Remind client to dress and
bathe both sides Place objects within
patients field of vision Approach patient from
unaffected side
![Page 29: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/29.jpg)
Sensory Changes Cont. - Visual Deficits: Hemianopsia
Blindness in half of the visual field Homonymous hemianopsia
Blindness in in the same half of each visual field
![Page 30: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/30.jpg)
Visual Deficits: Hemianopsia Cont. Nursing Interventions:
Place objects in client’s visual fieldRemove clutterTeach patient to attend to the neglected
side Teach scanning technique during ADLs
Assess the neglected side (paralyzed or weak side) for trauma, adequacy of dressing and hygiene
![Page 31: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/31.jpg)
Impaired Communication Aphasia-loss of use
and comprehension
Receptive aphasia- Wernicke’s area (sensory)
Expressive aphasia – Broca’s area (motor)
Global aphasia- mixed
Nursing Interventions:
Assess ability to speak and understand
Provide + reinforcement Picture board Repeat names of
objects routinely
![Page 32: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/32.jpg)
Picture Communication Board
![Page 33: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/33.jpg)
Altered Elimination
Temporary or permanent loss of bladder/bowel function
Constipation common Weakness Dehydration Immobility
Nursing Interventions: Increase fiber and fluids Stool softeners Digital
stimulation/suppositories bladder retraining Straight cath to check
residual
![Page 34: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/34.jpg)
Assessment and Management Problems R/T Immobility
Risk for atelectasis and pneumonia Risk for impaired skin integrity and DVT
Nursing Interventions:
![Page 35: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/35.jpg)
Assessment and Management: Psychosocial Emotional Support
Depression major problem
Discharge planning
Care of the caregiver
![Page 36: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/36.jpg)
Treatment of Stroke:Thrombotic Stroke Thrombolytic Therapy : rtPA (recombinant tissue Plasminogen Activator-
Retavase) A clot-buster delivered intravenously; breaks up the
clot allowing blood flow to return to the deprived area of the brain
Must be administered within 3 hours of the onset of clinical signs of ischemic stroke
Quick CT scan to see if stroke from clot or bleed
![Page 37: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/37.jpg)
Treatment Cont:
Acute phase:
Anticoagulant - Heparin continuous infusion
Osmotic Diuretics – to reduce brain swelling
Anticoagulants contraindicated in Hemorrhagic Strokes
Long Term Drug TherapyTo Prevent Stroke: Antiplatlet Drugs
ASA, Ticlid, Persantine, Plavix
Anticoagulants Coumadin Lovenox
Antiepileptics
![Page 38: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/38.jpg)
Treatment Cont: Surgical Therapy Carotid
Endarterectomy- for pts who have had TIAs or significant narrowing of carotid arteries
![Page 39: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/39.jpg)
Treatment Cont: Surgical Treatment For Bleeds (Interventional Radiology)
Angiograms to see arteries and detect bleeding sites
Aneurysm clips and coils
![Page 40: Neurological System](https://reader035.vdocuments.site/reader035/viewer/2022062313/55a826751a28abf16f8b4816/html5/thumbnails/40.jpg)
Surgical Removal:Hematoma