MOD 3 Neurology Flashcards by Michael Price

follows a sudden neuro event
the client is critically ill
focus on stabilizing the patient
prevent further damage
respiratory support

Acute Phase of neurological deficit

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Pharmacological management
–Agitation - Lorazepam; Haldol
–Dementia - Aricept
Nutrition
–Finger foods; frequent feedings; encourage fluids
Safety

Alzheimer’s Disease - Nursing / Medical Management

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Early Stage
–Mild Memory lapse
–Decreased attention span
Second Stage
–obvious memory lapse
Third Stage
–Total disorientation to person, place, time
–Apraxia, wandering
Terminal Stage
–Severe mental and physical deterioration

Alzheimer’s Disease - S/S

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No Cure, palliative treatment
Pharmacological management
–Antipsychotics
–Antidepressants
–Anti-choreas
Safe environment
Emotional support
High-calorie diet

Huntington’s Disease - Nursing / Medical Management

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Inflammation process involving the facial nerve
Herpes Simplex Virus

Bell’s Palsy - Etiology / Pathophysiology

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Pharmacological Management
–Corticosteroids
–antiviral medication
Electrical stimulation
Moist heat
Massage of the affected area
Facial exercise

Bell’s Palsy - Nursing / Medical Management

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Facial numbness or stiffness
Drawing sensation of the face
Unilateral weakness of the facial muscle
Reduction of saliva
Pain behind the ear
Ringing in the ear or other hearing loss

Bell’s Palsy - S/S

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Accumulation of pus within the brain tissue

Brain Abscess - Etiology / Pathophysiology

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Antimicrobial therapy
Supportive care

Brain Abscess - Nursing / Medical Management

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Headache
Fever
Drowsiness
Changes in LOC
Seizures

Brain Abscess - S/S

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some neuro events are chronic and progressive
prevent complications
environmental changes
home care
facility placement
coping
socialization

Chronic Phase of neurological deficit

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No specific treatment
–Meds to enhance function as long as possible
Symptoms management
–Baclofen (Lioresal)
–Steroids
Nutrition
Skincare
Activity
Environmental controls
Patient teaching

Multiple Sclerosis - Nursing / Medical Management

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Aura
Status Eplilepticus
Postictal period

Epilepsy / Seizures - S/S

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Viral or Autoimmune Reaction
Schwann cells are attacked

Guillain-Barre Syndrome - Etiology / Pathophysiology

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Plasmapheresis
Supportive therapy
–Neurontin
–Mechanical Ventilation
–Gastrostomy Tube
–Meticulous skincare
–ROM exercises
–Monitor respiratory distress

Guillain-Barre Syndrome - Nursing / Medical Management

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Progressive paralysis
Starts in the lower extremities
Moves upward
May stop at any point
Respiratory failure
Difficulty swallowing, breathing, and speaking

Guillain-Barre Syndrome - S/S

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Overactivity of dopamine
Genetically transmitted - 50%

Huntington’s Disease - Etiology / Pathophysiology

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Chorea (involuntary, irregular, and brief muscle contractions)
Ataxia to immobility
Hallucinations, delusions present

Huntington’s Disease - S/S

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Drowsiness
Confusion
Restless
Personality changes
Dull headache
Vomiting

Increased Intracranial Pressure - ICP
Early S/S

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Increase in any content of the cranium
–Tumor or Hemorrhage
Space-Occupying lesions
Cerebrospinal problems
Cerebral edema
NEEDS TO BE DETECTED EARLY

Increased Intracranial Pressure - ICP
Etiology/Pathophysiology

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Unresponsive
Dilated pupils
Seizures
No response to painful stimuli
Cushing Triad

Increased Intracranial Pressure - ICP
Late S/S

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Elevate HOB 30-45
Neck in neutral position
Restrict fluid intake
Administer stool softener
Place Foley
Suction only as necessary
O2 as necessary
Monitor body temp
Limit coughing
Communicate with family

Increased Intracranial Pressure - ICP
Nursing Management

Treat cause (if possible)
Pharmacological Management
–Osmotic Diuretic
–Corticosteroids
–Anticonvulsants
–Benzodiazepines
Mechanical decompression
–Craniotomy/Craniectomy
Internal monitoring device

Increased Intracranial Pressure - ICP
Medical Management

Pharmacological management
–Manage ICP
–Antibiotic
—-Massive Doseses
—-Multiple Types
—-IV or intrathecal
–Antipyretics
Dark, quiet room
Meningococcal Vaccine

Meningitis - Nursing / Medical Management

Motor neurons in the brain stem and spinal cord gradually degenerate. Electrical and chemical messages originate in the brain do not reach the muscles to activate them

Lou Gehrig's Disease - ALS Etiology / Pathophysiology

NO CURE Rilutek (Riluzole) Emotional support

Lou Gehrig's Disease - ALS Nursing / Medical Management

Weakness of the upper extremities Dysarthria Dysphagia Muscle wasting Compromised respiratory function

Lou Gehrig's Disease - ALS S/S

Acute infection of the meninges Bacterial or aseptic Increased incidence in winter and fall months

Meningitis - Etiology/Pathophysiology

Headache Stiff neck irritability restlessness Malaise Nausea / Vomiting Delirium Elevated --Temp --Pulse --Respirations Kernig's and Brudzinski's signs

Meningitis - S/S

Autoimmune Disease Triggered by a defective gene Degenerative with permanent demyelination of the myelin sheath

Multiple Sclerosis - Etiology / Pathophysiology

Blurred vision Muscle weakness Incontinence Incoordination - Dysmetria Dysphasia

Multiple Sclerosis - S/S

Autoimmune Weakness during activity Strength restored with rest antibodies attack acetylcholine receptor sites

Myasthenia Gravis - Etiology / Pathophysiology

Pharmacology Management --Plasmapheresis --Anticholinesterase drugs ----Prostigmin ----Mestinon --Corticosteroids --Immunosuppressants May require mechanical ventilation

Myasthenia Gravis - Nursing / Medical Management

Ptosis(eyelid drooping) Diplopia Mask-like facial expressions Bowel and bladder incontinence Weakness with repetitive movements

Myasthenia Gravis - S/S

Muscle relaxants Protect from falls Assess skin integrity Positioning Sit up and tuck chin when eating Encourage patient to assist with ADLs Emotional Support

Neurological Deficit - Nurse/Medical Management

Flaccid Hyperreflexic clumsiness/incoordination abnormal gait

Neurological Deficit - S/S

Pharmacological management --Sinemet (levodopa-carbidopa) Surgery --Deep brain stimulation Activity Nutrition

Parkinson's Disease - Nursing / Medical Management

Muscular tremors Bradykinesia Rigidity Propulsive gait Emotional instability Heat intolerance Decreased blinking "Pill-rolling" motions of fingers

Parkinson's Disease - S/S

keep client stable environmental changes prevent complications rehabilitation

Recovery Phase of neurological deficit

Spinal shock Autonomic dysreflexia Pressure ulcers Respiratory infections Urinary and fecal Impactions Spasticity and contractures Calcium depletion Urinary calculi Pain

Spinal Cord Injury - Complications

Automobile / Motorcycle accidents Athletic Accidents Violence Falls Fracture of vertebra Cord Compression Hematoma Complete vs. Incomplete cord injury

Spinal Cord Injury - Etiology / Pathophysiology

Long term Management --Functional Electrical stimulation --Treadmill training --Tendon transfer surgery --Cell transplantation

Spinal Cord Injury - Medical / Surgical management

Initial Treatment --Immobilization; cervical; collar; traction, halo --Realignment for fractures or dislocations --Surgery for spinal decompression --Corticosteroids

Spinal Cord Injury - Medical / Surgical management

Anticonvulsant medication Surgery --Removal of brain tissue where seizure occurs

Epilepsy / Seizures - Medical Management

Protect pt Adequate rest Good nutrition Avoid alcohol Avoid operating machinery Avoid swimming Good oral hygiene Medic alert tag

Epilepsy / Seizures - Nursing Management

Thrombosis Embolism Cerebral Aneurysm ISCHEMIA OF THE BRAIN TISSUE

Stroke - Etiology / Pathophysiology

Thrombosis or embolism --Thrombolytics - TPA --Heparin and Coumadin Decadron

Stroke - Medical Management

Neurological checks Nutritional alterations Physical therapy Occupational therapy Speech therapy Communicating with patients

Stroke - Nursing Management

Headache Sensory deficit Hemiparesis Hemiplegia Aphasia --Expressive --Receptive

Stroke - S/S

Involuntary contractions of a group of muscle Partial Seizures --Dont usually lose consciousness Generalized Seizures --Involve the entire brain

Epilepsy / Seizures - Etiology / Pathophysiology

Tegretol Surgical resection of the trigeminal nerve Avoid stimulation of the face on the affected side

Trigeminal Neuralgia - Nursing / Medical Management

Acute Phase Recovery Phase Chronic Phase

What are the phases of neurological deficit?

Pressure on the trigeminal nerve

Trigeminal neuralgia - etiology / pathophysiology

Excruciating burning facial pain

Trigeminal neuralgia - S/S