brain disorders Flashcards
1
Q
review: what makes up the nervous system
A
1) central nervous system: composed of brain + spinal cord
2) peripheral nervous system: composed of 12 pairs of cranial nerves, 31 pairs of spinal nerves, and autonomic nervous system
- somatic: voluntary movements
- autonomic: involuntary movements (sympathetic/parasympathetic)
2
Q
sympathetic nervous system
A
“fight/flight”
- dilated pupils
- increase HR/BP
- increased rate of breathing
- decreased peristaltic movements of digestive tube
- thick viscid saliva secretion
- increased conversion liver glycogen to glucose
- relaxed urinary bladder muscles
- increased secretion of sweat
- secretion of epinephrine and norepinephrine
3
Q
parasympathetic nervous system
A
“rest/digest”
- constricted pupils
- decreased HR/BP
- decreased rate of breathing
- increased peristaltic movements of digestive tube
- thin, watery saliva secretion
- contracted urinary bladder muscles
- dilated blood vessels
4
Q
review: neurotransmitters acetylcholine
A
- major transmitter of the parasympathetic nervous system
- source: many areas of the brain, autonomic nervous system
- action: EXCITATORY, parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerves)
5
Q
review: neurotransmitters serotonin
A
- source: brain stem, hypothalamus, dorsal horn of spinal cord
- action: INHIBITORY, controls mood and sleep, inhibits PAIN PATHWAYS
6
Q
review: neurotransmitters dopamine
A
- source: substantia nigra and basal ganglia
- action: usually INHIBITORY, affects behavior (attention/emotions) and fine movement
7
Q
review: neurotransmitters norephinephrine
A
- major transmitter of the sympathetic nervous system
- source: brain stem, hypothalamus, postganglionic neurons of the sympathetic nervous system
- action: usually EXCITATORY, affects mood and overall activity
8
Q
review: gamma aminobutyric acid (GABA)
A
- source: spinal cord, cerebellum, basal ganglia, some cortical areas
- action: INHIBITORY
9
Q
review: endorphin
A
- source: nerve terminals in spine, brain stem, thalamus, hypothalamus, pituitary gland
- action: EXCITATORY, pleasurable sensation, inhibits PAIN transmissions
10
Q
excitatory
A
excites (activates) activity of target cell
11
Q
inhibitory
A
inhibits (stops) activity of target cell
12
Q
meninges
A
fibrous connective tissue that cover brain/spinal cord provides protection, support, and nourishment
- 3 layers: dura mater, subarachnoid, arachnoid
13
Q
dura mater
A
tough, inelastic, fibrous, gray
- “top mother”
14
Q
subarachnoid mater
A
“weblike, cushions, delicate”
- arachnoid villi absorbs CSF -> venous system
15
Q
pia mater
A
“inner most layer of the brain, delicate”
- thin, goes into different folds of the brain
- transparent
16
Q
frontal lobe
A
largest lobe, front of brain
function:
- concentration
- abstract thought
- information storage or memory
- motor function
- affect
- judgement
- personality
- inhibitions
17
Q
parietal lobe
A
sensory lobe, posterior to frontal
function:
- analyzes sensory information and relays interpretation of this information to other cortical areas
- essential to person’s awareness of body position and orientation
- taste, touch, pressure, body awareness
18
Q
temporal lobe
A
inferior to parietal and frontal lobe
- auditory receptive areas, memory of sound and understanding language and music
- facial recognition
19
Q
occipital lobe
A
back of head
- visual interpretation, memory
20
Q
cerebellum
A
coordination, positional (postural) sense
21
Q
changes in nervous system related to aging (neuro changes associated with aging) (7)
A
1) slower processing time (provide sufficient time for patient to respond to questions or instructions)
2) recent memory loss (reinforce teaching by repetition, written language, employing memory aids like electronic alarms or applications for devices that provide recurrent alerts)
3) decreased sensory perception of touch (remind patient to look where they are positionally)
4) change in perception of pain (assess pain and monitor for health problems)
5) change in sleep patterns (assess sleep habits and preferences and provide usual routine)
6) altered balance and/or decreased coordination (move slowly when changing positions, assess needs for mobility aids)
7) increased risk for infection (monitor carefully for infection s/sx)
22
Q
brain disorder assessment PE
A
1) compare each assessment with pt. baseline, R vs L, UE vs. LE
2) evaluate mental status, cranial nerves, mobility, motor function, sensation, reflexes and cerebellar function
- brainstem, thalamus, cortex lesions -> loss of sensation on contralateral sides of the body (opp)
- cerebellar lesions -> sensory deficits on same side of the body
3) assess memory
- long term, recall/recent, immediate memory
- loss of memory, especially recent memory, tends to be an early sign neurologic problems (dementia)
23
Q
decorticate
A
damage to hemispheres (higher functioning)
- flexed hands
- adducted arms
- flexed elbows
- internally rotated legs
- plantar flexed
24
Q
decerebrate
A
damage to brain stem
- adducted arms
- extended elbows
- pronated forearm
- flexed hands
- plantar flexed
25
Romberg test
close eyes and balance, can be standing/sitting
- positive: loss of balance (abnormal)
- negative: no loss of balance (normal)
26
babinski test
- stroke lateral aspect of sole, patient toes will contract and draw together
- CNS disorder
- if toes fan out and draw back (adult) -> abnormal
- if toes fan out and draw back (newborn) -> normal
27
diagnostic evaluation labs
1) labs: glucose, cmp, cbc, abg, blood cultures, toxins, lumbar puncture (CSF)
- "spinal tap"
- needle is subarachnoid space to draw CSF -> lab (trauma at site, bit will be come more clear as continue to draw up)
- meds can be given through spinal canal
- tense/nervous: might artificially change pressure reading
- complications: post lumbar puncture headache, infection, nerve damage
28
normal CSF values
29
diagnostic evaluation imaging
- XRAY
- cerebral angiography (arteriography)
- ultrasound
- computed tomography (CT)
- magnetic resonance imaging/angiogram (MRI/MRA)
- positive emission tomography (PET)
- electroencephalography (EEG)
30
altered level of consciousness
- present when patient is not oriented, does not follow commands, or needs persistent stimuli to achieve a state of alertness
- most important indicator of the patient's condition
- LOC is gauged on a continuum, with normal state of alertness and full cognition (consciousness) on one end and coma on other end
- initial alterations in LOC may be reflected by subtle behavioral changes, such as restlessness or increased anxiety
31
stages of altered LOC
1) coma
2) akinetic mutism: no voluntary movements
3) persistent vegetative state
4) minimally conscious state
5) locked in syndrome: lesions affects pons -> paralysis, doesn't speak, have vertical eye movement and lid elevation
32
nursing assessment for altered LOC (12)
1) level of responsiveness or consciousness (eye opening, verbal and motor responses, pupils)
2) pattern of respiration (RR, cheyne-stroke respiration, hyperventilation, ataxic respiration with irregularity in depth/rate)
3) eyes/pupils (size, equality, reaction to light) (PERLA)
4) eye movements (side to side)
5) corneal reflex (brisk response when touched with clean cotton)
6) facial symmetry (asymmetry - sagging, decrease in wrinkles)
7) swallowing reflex (drooling vs. spontaneous swallowing)
8) neck (stiff neck)
9) respond of extremity to noxious stimuli (firm pressure on a joint of UE/LE)
10) deep tendon reflexes (tap patellar and biceps tendon)
11) pathologic reflexes (firm pressure w/ blunt object on sole of foot, moving along lateral margin and crossing ball of foot)
12) abnormal posture (observation for posturing, flaccidity with absence of motor response, decorticate or decerebrate posturing)
33
altered LOC nursing interventions
- maintain airway
- aspiration precautions
- protect the patient
- maintain fluid balance and nutritional needs
- provide oral hygiene
- maintaining skin and joint integrity
- preserve corneal integrity
- maintain body temperature
- promoting urinary elimination and bowel function
34
increased intracranial pressure (what, cause, example)
- rise in pressure inside the skull that can result from or cause brain injury
- causes: decreases cerebral perfusion, stimulates further swelling (edema), and may shift brain tissue, resulting in herniation
- monro Kellie hypothesis
35
what is monro Kellie hypothesis
pressure volume relationship that aims to keep. dynamic equilibrium among the essential non-compressible components inside rigid compartment of the skull
- blood
- CSF
- brain matter
36
changes in ICP are closely linked with
cerebral perfusion pressure (CPP)
37
cerebral perfusion pressure
- pressure gradient over which the brain is perfused
- through auto regulation, normal cerebral vasculature maintains an adequate cerebral blood flow with a wide range (50-150 mmHg) of mean arterial blood pressure (MAP) -> perfusion
- maintenance of CPP above 70 mmHg is generally accepted as an expected outcome of therapy
- rise in MAP -> elevated ICP
- decrease in MAP -> hypoperfusion
- equation: MAP - ICP = CPP
38
s/sx increased intracranial pressure (9)
- decreased LOC
- behavior changes (restlessness, irritability, confusion)
- headache
- N/V
- changes in speech (aphasia, slurred speech)
- seizures
- changes in sensorimotor status (pupillary changes, cranial nerve dysfunction, ataxia)
- Cushing's triad (increased SBP w/ widened pulse pressure, bradypnea, bradycardia)
- abnormal posturing
39
complications of increased intracranial pressure
1) brainstem herniation
2) diabetes insipidus (DI)
3) syndrome of inappropriate antidiuretic hormone (SIADH)
40
brainstorm herniation
shifting of brain tissue from an area of high pressure to an area of lower pressure
- herniated tissue exerts pressure on the brain area into which it has shifted, which interferes with the blood supply in that area -> cessation of cerebral blood flow results in cerebral ischemia, infarction, and brain death
41
diabetes insipidus (DI)
result of decreased secretion of antidiuretic hormone (ADH). excessive urine output, decreased urine osmolality, and serum hyperosmolarity
- tx: fluid replacement, electrolyte replacement, VASOPRESSINsyn
42
syndrome of inappropriate antidiuretic hormone (SIADH)
result of increased secretion of ADH. volume overload, urine output diminishes serum sodium concentration becomes diluted
- tx: fluid restriction (<800cc/day with no free H2O), careful hypertonic solution administration (3% hypertonic solution)
43
increased intracranial pressure nursing interventions
- ABC's
- frequent neurological checks
- decreasing cerebral edema
- monitor intracranial pressure and cerebral oxygenation
- maintaining cerebral perfusion
- controlling fever
- maintaining oxygenation and reducing metabolic demands
44
how to control ICP in patients with severe brain injury
- elevate HOB 30-45 degrees
- maintain pt. head and neck in neutral alignment (no twisting or flexing the neck)
- initiate measures to prevent valsalva maneuver (eg. stool softeners)
- maintain body temp normal
- administer O2 to maintain partial pressure of arterial oxygen (PaO2) >90mmHg
- maintain fluid balance with normal saline solution
- avoid noxious stimuli (eg. excessive suctioning, painful procedures)
- administer sedation to reduce agitation
- maintain cerebral perfusion pressure of 50-70 mmHg >70mmHg
45
intracranial surgery
- craniotomy
- transsphenoidal
- burr holes
- craniectomy
- cranioplasty
46
complications of intracranial surgery(8)
- increased ICP
- bleeding/hypovolemic shock
- seizures
- DI or SIADH (pituitary gland)
- CSF leakage
- visual disturbances
- postoperative meningitis
- pneumocephalus (air in intracranial cavity)
47
dementia
permanent cognitive impairment, an irreversible and degenerative condition
- chronic and progressive loss of brain function, affects the ability to learn new information and impairs language, judgement, and behavior
- at least 2 must be significantly impaired: memory, communication and language, attention span or ability to focus and pay attention, reasoning and judgement, visual perception
48
delirium
acute, confusional state characterized by new and sudden cognitive impairment; symptoms tend to fluctuate over the course of a day and include disturbances in consciousness, attention, memory deficits, and perceptual disturbances
- can be manifested by delusional (paranoid) thoughts and behavior
- MEDICAL EMERGENCY and specifically places geriatric patients at risk for harm and prolonged cognitive impairments
49
potential causes of cognitive impairment in older adults (8)
1) neurological: vascular insufficiency, infections, trauma, tumors, normal pressure hydrocephalus
2) cardiovascular: MI, dysrhythmias, HF, cardiogenic shock, endocarditis, stroke
3) pulmonary: infection pneumonia, hypoventilation
4) metabolic: electrolyte imbalance, acid/base imbalance, hypo/hyperglycemia, CKD, fluid volume deficit, UTI, hepatic failure
5) drug intoxication: misuse of prescribed medications, side effects of medications, incorrect use of medications, ingestion of heavy metals
6) nutritional deficiencies: B vitamins, vitamin C, hypoproteinemia
7) environmental: hypo/hyperthermia, unfamiliar environments, sensory deprivation/overload
8) psychological: depression, anxiety, pain, fatigue, grief, paranoia
50
alzheimers disease
neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults
- most common demetia
- microscopic changes include neurofibrillary tangles, amyloid rich neuritic plaques, and granulovascular degeneration
- 6th leading cause of death in US
51
s/sx Alzheimer's disease: early (mild) or stage 1 (first symptoms up to 4 years)
- independent ADLs
- no social/employment problems initially
- denies symptoms
- forgets names
- misplaces household items
- short term memory loss
- subtle changes in personality and behavior
- loss of initiative (less engaged in social relationships)
- mild impaired cognition
- problems with judgment
- decreased performance
- unable to travel alone to new destinations
- decreased sense of smell
52
s/sx Alzheimer's disease: middle (moderate) or stage 2 (2-3 years)
- impairment of all cognitive function
- problems with handling or unable to handle money and finances
- disorientation to time/place/event
- possible depression
- agitation
- increasingly dependent ADLs
- visuospatial deficits (difficulty driving, gets lost)
- speech and language deficits (less talkative, decrease vocab, increasingly nonfluent)
- incontinent
- wandering
- trouble sleeping
53
s/sx Alzheimer's disease: late (severe) or stage 3
- completely incapacitated/bedridden
- totally dependent in ADLs
- motor and verbal skills lost
- general and focal neurological deficits
- agnosia (loss of facial recognition)
54
Alzheimer's disease nursing interventions
- health promotion
- maintaining a safe, structured and consistent environment
- cognitive stimulation, memory training, orientation and validation therapy (frequent reorientation, promote self care, reality reorientation)
- promoting self care and ADLs
- reality orientation vs. validation therapy
55
Alzheimer's disease nursing interventions pharmacological
1) cholinesterase inhibitors: treats AD symptoms by delaying the destruction of Acetylcholine to slow onset of cognitive decline in some patients
- meds: donepezil (aricept), galantamine (reminyl), rivastigmine (exelon)
2) N-methyl-d-aspartate receptor antagonists (NMDA): blocks excess amounts of glutamate that can damage nerve cells (advanced AD)
- meds: mematine (Namenda)
3) Atypical antipsychotics: reserved for patients with emotional and behavioral health problems that can accompany dementia
- meds: risperidone (risperdal), quetiapine (Seroquel), olanzapine (zyprexa)
4) antidepressants: for patients that develop depression
- meds: SSRIs (paroxetine - Paxil, sertraline - zoloft)
56
Alzheimer's disease nursing interventions r/t promoting communication with patients with AD
- simple, direct questions that require yes or no answers if patient can communicate
- provide instructions with pics that patient will see if he/she reads them
- simple, short sentences and one step instructions
- gestures to help patients understand what is being said
- validate patients feelings as needed
- limit choices, too many choices cause frustration and increased confusion
- never assume patient is totally confused and cannot understand what is being communicated
- try to anticipate patient's needs and interpret nonverbal communication
57
seizures
abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within brain that may result in change in LOC, motor, or sensory ability and/or behavior
- 3 broad categories: partial/focal, generalized, unclassified
REVIEW slide 47
58
epilepsy
two or more seizures experienced by a person
- chronic disorder which repeated unprovoked seizure activity occurs
59
partial seizures
- AKA focal/local seizures that begin in part of one cerebral hemisphere
60
absence seizures
- characteristic automatisms
- where patient is unaware of the environment and may wander at the start of the seizure and afterwards they may have amnesia
61
generalized seizures
involves both cerebral hemispheres
- tonic clonic
- tonic
- clonic
- myoclonic
- atonic
extra: bilateral, intense rigidity of body followed by alternating muscle relaxation and contraction (tonic clonic), epileptic cry, tongue chewed, incontinent feces/urine, lasts 1-2 minutes
62
postictal seizures
fatigue, acute confusion and lethargy that can last up to an hour after the seizure
- depression, headaches
63
seizures assessment and diagnostics
- CBC
- CMP
- MRI
- EEG: brain electrical activity for seizures
- SPECT: new diagnostics that identify and locate epileptic zone to determine where seizure occurs and to remove surgically
64
seizures care during
- protect patient from injury
- DO NOT force anything into patient's mouth
- turn the patient to the side to keep airway clear (MAIN)
- loosen any restrictive clothing patient is wearing
- maintain patient's airway and suction oral secretions as needed
- do not restrain or try to stop the patient's movement; guide movements if necessary
- record time of seizure beginning and end
65
seizure care after
- take VS
- perform neuro checks
- keep patient on their side
- allow the patient to REST
- document
TIP: pad side rails, low positioning of bed, SUCTION EQUIPMENT
66
seizure nursing interventions
- removing or treating the underlying cause if possible
- antiepileptic drugs (AED) or anticonvulsants: seizure control sometimes is controlled only with combo of drugs, take them on time to maintain therapeutic blood levels and maximize effectiveness
- balanced diet
- proper rest
- vagal nerve stimulation (VNS): refractory epilepsy, for patients who are drug resistant, outpatient, electrode attached to vagus nerve programmed to deliver pulses at regular intervals on L chest placement
67
status epilepticus
MEDICAL EMERGENCY, prolonged seizure lasting longer than 5 minutes or related seizures over the course of 30 minutes
treatment:
- lorazepam (Ativan) IVP: 4mg over 2 minutes
- diazepam (Valium) IVP/rectal: 5-10 mg Q10-15 min PRN
- phenytoin (dilantin) IVPB: 15-20 mg/kg, additional 10mg/kg after 20 minutes PRN, maintenance: 100mg PO/IV Q6-8H
68
headaches
AKA cephalalgia
- one of the most common of all human physical complaints
- symptom rather than a disease entity
- may indicate organic disease (neurological or other)
- stress response
- vasodilation (migraine)
- skeletal muscle tension (tension)
- combination of factors
69
primary headache
- NO organic cause can be identified
- types: migraine, tension type, cluster headache
70
migraine headache (what, cause, s/sx)
characterized by recurrent episodic attacks of head pain that serve no protective purpose, usually described as throbbing and unilateral in the front-temporal area
- cause: vascular disturbances, strong familial tendency
- s/sx: N/V, sensitivity to light (photophobia), sensitivity to sound (pognophobia), sensitive to head movement
71
what are the 4 phases of migraine headaches
1) premonitory phase
- light, sound, smell sensitivity (can last hours to days)
- sx: depression, irritability, feeling cold, cravings, anorexia, decreased activity, increase urine/diarrhea/constipation
2) aura phase
- focal neurological sx: numbness/tingling, mild confusion, extremity weakness, drowsiness/dizziness, visual disturbances
3) migraine headache
- photophobia (light), phonophobia (sound), allodynia (abnormal perception innocuous stimuli),
4) post headache
- subsided sx., mood changes, muscle contractions, sleep longer, weak/fatigue, muscle contraction
72
migraine headache nursing interventions
1) priority is PAIN MANAGEMENT
- abortive therapy: aims at alleviating pain during beginning of an episode
- preventative therapy: aims at preventing headache from occurring
2) educate patient on avoidance of possible triggers
3) environmental manipulation
73
abortive pharmacological interventions
- NSAIDS/acetaminophen
- ergotamine preparations (aborts headache if taken early)
- beta blockers
- calcium channel blockers
- triptan preparations: 1st line for moderate/severe pain
- isometheptene combinations - vasoconstriction to relieve headache
- antiepileptic drugs (AEDs)
TIP: timing is KEY, know ONSET and DURATION of meds
74
preventative interventions
- yoga
- meditation
- massage
- exercise
- biofeedback
- pharmacological (vitamin B12, coQ10, magnesium, botox, calcitonin gene related peptide (CGRP) antagonists)
75
cluster headaches
manifested by brief (15 minutes to 4 hours), intense unilateral pain that generally occurs in the spring and fall without warning
- "weight on top of my head"
s/sx:
- ipsilateral tearing of the eye
- rhinorrhea
- ptosis (drooping eyelid)
- eyelid edema
- facial sweating
- mitosis (excessive contstriction of pupils)
76
cluster headache nursing interventions
- consistent sleep wake cycle
- pharmacological: lithium and corticosteroids
- CAM therapy: capsaicin nasal spray, melatonin, glucosamine
- oxygen therapy
- be mindful of onset and duration of meds)
77
cranial nerve 1
olfactory (sensory)
- sense of smell
- test each nostril for smell reception with various agents and interpretation
78
cranial nerve 2
optic (sensory)
- sense of vision (acuity and field of vision)
- test vision for acuity and visual fields
79
cranial nerve 3
oculomotor (motor)
- pupil constriction + raise eyelids
- PERRLA, ability to open and close eye
80
cranial nerve 4
trochlear (motor/proprioceptor)
- downward, inward eye movement
- test for downward and inward movement of eyes
81
cranial nerve 5
trigeminal (motor)
- jaw movements - chewing and mastication
- ask patient to open and clench jaws while palate jaw muscles
(sensory)
- sensation of the face and neck
- test face and neck for pain sensations, light touch, and temp.
82
cranial nerve 6
abducens (motor)
- lateral movements of the eyes
- test ocular movements in all directions
83
cranial nerve 7
facial (motor)
- muscles of the face
- ask the patient to raise eyebrows, smile, show teeth, puff out cheeks
(sensory)
- sense of taste on the anterior two thirds of tongue
- test of the taste sensation with various agents
84
cranial nerve 8
acoustic (sensory)
- sense of hearing
- test hearing ability
85
cranial 9
glossopharyngeal (motor)
- pharyngeal movement and swallowing
- ask patient to say "ah" and have patient yawn to observe upward movement of soft palate, elicit gag response and note ability to swallow
(sensory)
- sense of taste on posterior one third of tongue
- test for taste with various agents
86
cranial nerve 10
vagus (motor/sensory)
- swallowing and speaking
- ask patient swallowing and speak, note hoarseness
87
cranial nerve 11
accessory (motor)
- movement of shoulder and muscles
- ask the patient to shrug shoulders against your resistance
88
cranial nerve 12
hypoglossal (motor)
- movements of the tongue, strength of tongue
- ask the patient to protrude tongue, ask patient to push tongue against cheek
89
CT scan
- uses narrow XR beams to scan body parts in successive layers
- provides cross sectional views of the brain, distinguishes differences in tissue densities of skill, cortex, subcortical structures and ventricles
- IV contrast agent may be used to highlight different further
- quick, painless
- small amounts of radiation to produce images
- high degree of sensitivity for detecting lesions
- can detect: tumor/masses, infarction, hemorrhage, displacement of ventricles, and cortical atrophy
90
CT angiography
allows visualization of blood vessels
- eliminates need for formal angiography
- injection of water soluble iodinated contrast agent into subarachnoid space through lumbar puncture
91
CT nursing interventions
- sedation for agitation, restlessness, confusion
- education about lying quietly throughout procedure
- relaxation for claustrophobia
- assess: iodine/shellfish allergy, kidney function (contrast), IV patient
- encourage fluid intake to facilitate contrast clearance through kidney
92
MRI
powerful magnetic field to obtain images of different areas of the Boyd
- causes hydrogen nuclei (protons) within body to align like small magnets on magnetic field
- radio frequency pulses and protons emits signal that are converted to images
- provides info about chemical changes within cell, allowing monitoring of tumor response to treatment, brain blood flow and metabolism
diagnosis: brain tumor, stroke, multiple sclerosis
- NO IODINE USE
- 30-90 minutes
- costly
93
MR angiography
separate visualization of cerebral vasculature without arterial contrast agent
94
MRI nursing interventions
- assess any cardiac implantable electronic device, metal (aneurysm clips, orthopedic hardware, artificial heart valves, intrauterine devices), cochlear implants, credit cards
- no metal anything can be on patient (oxygen tanks, IV poles, ventilators, stethoscopes)
- loud thumping sound so educate patient to expect that, claustrophobia can occur so sedation may be required
95
PET
- positron emission tomography is composted based nuclear imaging technique that produces images of actual organ functioning
- patient inhales radioactive gas or is injected with radioactive substance that emits positively charged particles, which combine with negative charged electrons (found in body).
- provides composite picture of the brain at work
- permits measure of blood flow, tissue composition, brain metabolism and brain function
- detects alzheimers, locating lesions (brain tumor), identifying blood flow and oxygen metabolism in patients with strokes, distinguishing tumors from areas of necrosis, and revealing biochemical abnormalities associated with mental illness
96
PET nursing interventions
- patient prep, explaining test and educating the patient about inhalation techniques and sensations (dizziness, lightheadedness, headache) that may occur. IV injection of radioactive substance produces similar side effects
- relaxation exercises may reduce anxiety during the test
97
SPECT
single photon emission computed tomography
- three dimensional imaging technique that uses radionuclides and instruments to detect single photons
- perfusion study that captures moment of cerebral blood flow at the time of injection of a radionuclides
- allows areas behind overlying structures or background to be viewed, greatly increasing the contrast between normal and abnormal tissue
- inexpensive, duration similar to CT scan
- detects extent and location of abnormally perfused areas of the brain, thus allowing detection, localization, and sizing of stroke, location of seizure foci in epilepsy, detection of tumor progression
98
SPECT nursing interventions
- patient prep and monitoring
- providing education about what to expect before test can allay anxiety and ensure patient cooperation during the test
- pregnancy and breast feed are CONTRAINDICATION to SPECT
99
cerebral angiography
XR study of cerebral circulation with contrast agent injected into selected artery
- detects for vascular disease or anomalies, determine vessel latency, identify presence of collateral circulation
- less frequently performed
100
cerebral angiography nursing interventions
- assess blood urea nitrogen (BUN) and creatine (kidney function basically) to ensure contrast can be excreted
- well hydrated with clear liquids
- remain immobile during angiogram process and expect brief feeling of warmth in the face, behind the eyes, or in the jaw, teeth, tongue, and lips, and metallic taste when contrast agent injected
- neuro assessments conducted during (LOC, weakness, motor/sensory deficits, speech disturbances)
POST: assess injection site for bleeding or hematoma, frequent peripheral pulse assessment, fluids encouraged, monitors for allergic reaction to the contrast agent, hypotension assessment (d/t vasodilatory meds)
