neurology 2 part 1. history family member present vaccination major injuries childhood illnesses...
TRANSCRIPT
![Page 1: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/1.jpg)
Neurology 2
Part 1
![Page 2: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/2.jpg)
History
• Family member present• Vaccination• Major injuries• Childhood illnesses• Family• Present illness
![Page 3: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/3.jpg)
Complaints specific to neurology
• Pain– Location– Quality– Severity– Duration– Precipitating factors– Associated symptoms– Exasperation / diminished
pain– Onset
![Page 4: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/4.jpg)
Pain assessment
![Page 5: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/5.jpg)
Headaches
• Multiple causes• Not a good indicator of
neuro trouble
![Page 6: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/6.jpg)
Vertigo
• Sensation of moving around in space or objects moving around them
• Assoc symptoms
![Page 7: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/7.jpg)
Paresthesia
• Definition– Unusual sensation
• Examples– Numbness– Tingling– Burning
• Assessment– ? Weak– ? Intermittent or
constant
![Page 8: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/8.jpg)
Vision
• Diplopia• Clarity• Nystagmus
![Page 9: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/9.jpg)
Disturbances in…
• Thinking• Memory• Personality
![Page 10: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/10.jpg)
Nausea and vomiting
• Projectile
![Page 11: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/11.jpg)
Assessing Cerebral Function - PE
• Mental status• Intellectual function• Thought content• Emotional status• Perception• Motor ability• Language ability
![Page 12: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/12.jpg)
Mental Status
• Level of consciousness– Rostral-claudal
Progression• Dullness • Confusion • Lethargy • Stupor • Coma
![Page 13: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/13.jpg)
Alert
– Alert• Open eyes
spontaneously• Responds
appropriately, briskly• Oriented
![Page 14: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/14.jpg)
Lethargic
• Lethargic– Opens eyes to verbal
stimuli– Slow to respond, but
appropriate– Short attention span– Obtunded
• Sleepy
![Page 15: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/15.jpg)
Stupor
• Stupor– Responds to stimuli
(usually physical) with moans and groans
– Never fully awake– Confused– Conversation unclear
![Page 16: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/16.jpg)
Semi-comatose
• Semi Comatose– Responds to painful
stimuli– Conversation:
• none
– Protective reflexes• present
![Page 17: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/17.jpg)
Comatose
• Coma– Unresponsive except
to severe pain– Protective reflexes
absent– Pupils fixed– No voluntary
movement
![Page 18: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/18.jpg)
Unconscious
• Non-medical word• Ranges from stupor to
coma
![Page 19: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/19.jpg)
Persistent Vegetative State
• No cognitive brain function
• Wake sleep cycles• Very poor prognosis (if
> 3-6 months)
![Page 20: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/20.jpg)
Brain Dead
• No brain function• Only reflexive
movements
![Page 21: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/21.jpg)
Types of Stimuli response
• Voice• Touch• Shaking• Voice + Shaking• Noxious/painful stimuli
![Page 22: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/22.jpg)
Nature of response
• Eye opens• Remove stimuli• Abnormal posturing• No response
![Page 23: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/23.jpg)
Glasgow Coma Scale
• Eye Opening– Spontaneous – 4– To speech – 3– To pain – 2– Nil – 1
![Page 24: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/24.jpg)
Glasgow Coma Scale
• Best Motor Response– Obeys -6– Localizes – 5– Withdraws – 4– Abnormal flexion – 3– Extension response – 2– Nil - 1
![Page 25: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/25.jpg)
Glasgow Coma Scale
• Verbal response– Oriented – 5– Confused conversation –
4– Inappropriate words – 3– Incomprehensible
sounds – 2– Nil - 1
![Page 26: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/26.jpg)
Glasgow Coma Scale
A strong predictor of outcome13: mild brain injury9-12: Moderate brain injury< 8: Severe brain injury (coma)
![Page 27: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/27.jpg)
Sample Question
• The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT• Eye opening • Motor response • Pupillary reaction • Verbal performance
![Page 28: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/28.jpg)
Sample Question
• The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT• Eye opening• Motor response• Pupillary reaction• Verbal performance
![Page 29: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/29.jpg)
Small Group QuestionsA. Give 5 questions you might ask a neuro patient who is
complaining about a headache during an intake assessment B. Identify the rostral-caudal progression of consciousnessC. Identify the differences in patients in each of the stages of
consciousnessD. What is the lowest score a patient can get on a Glasgow
coma scale?E. What is the highest score a patient can get on a Glasgow
Come Scale?F. What is the most sensitive indicator on the Glasgow Coma
Scale?
![Page 30: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/30.jpg)
General Appearance
• How do they look?– Grooming– Dress– Aids– Eye deviation– Skin
![Page 31: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/31.jpg)
• Signs of trauma, wounds, scrapes, ecchymosis etc.
![Page 32: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/32.jpg)
Battle’s sign
• Bruising over the Mastoid– Where’s the mastoid?
![Page 33: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/33.jpg)
Battle’s sign
• Bruising over the Mastoid
![Page 34: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/34.jpg)
Battle’s sign
• Bruising over the Mastoid
![Page 35: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/35.jpg)
Battle’s sign
• Bruising over the Mastoid
![Page 36: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/36.jpg)
Battle’s sign
• Bruising over the Mastoid
![Page 37: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/37.jpg)
Battle’s Sign
• Bruising over the Mastoid area
• Suggests – Basal skull fracture
![Page 38: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/38.jpg)
Raccoon’s eyes
• Periorbital edema and bruising
![Page 39: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/39.jpg)
Raccoon’s eyes
• Periorbital edema and bruising
• Suggests:– Frontal-basal fracture
![Page 40: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/40.jpg)
Rhinorrhea
• Drainage of CSF from the nose
• Suggests– Fracture of the
cribiform with torn meninges
![Page 41: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/41.jpg)
Otorrhea
• Drainage of CSF from the ear
• Suggests:– Fracture of the
temporal bone with torn meninges
![Page 42: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/42.jpg)
Decorticate Posturing
• Flexed Posturing– Flexed arm/elbow– Flexed wrists/fingers– Adducted arms– Legs with internal
rotation– Foot: Plantar flexed
![Page 43: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/43.jpg)
Decorticate Posturing
• Suggests– Damage to the
cortico-spinal tract• More favorable than
decerebrate posture
![Page 44: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/44.jpg)
Decerebrate Posturing -
• Extension posturing– Extended arm/elbow– Flexed wrist/fingers– Adducted arm– Pronation of arm– Foot: Plantar flexed
![Page 45: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/45.jpg)
Decerebrate Posture
• Suggests– severe injury to the brain at the level of the
brainstem
• Opisthotonos – severe muscle spasm of the neck and back
• More ominous posture
![Page 46: Neurology 2 Part 1. History Family member present Vaccination Major injuries Childhood illnesses Family Present illness](https://reader030.vdocuments.site/reader030/viewer/2022032703/56649d1f5503460f949f398c/html5/thumbnails/46.jpg)
Orientation
• x 3– Person – Place– Time