Neurological changes

Question 1

what are sudden onset conditions and some examples?

Answer 1

full or partial recovery e.g. tumours, infections, stroke, SC injury

Question 2

what are intermediate and unpredictable conditions and some examples?

Answer 2

relapses and remissions e.g. epilepsy, ME, headaches.

Question 3

what is a progressive condition and some examples?

Answer 3

care needs increase, e.g. MND, parkinsons and MS

Question 4

what is a stable neurological condition? some examples

Answer 4

needs change due to aging or development e.g. post-polio syndrome or cerebral palsy

Question 5

what are the risk factors for neurological deterioration and their outcomes?

Answer 5

hypoxia= neuronal death
hypotension= triggers for ischaemia and haemorrhage strokes
cardiac dysrhythmias= AF risk factor in ischaemic stroke, dysrhythmias can affect CO, BP= affects cerebral perfusion
hyperthermia= affects cerebral blood flow, inflammatory and cellular changes
raised ICP= altered GCS, neurological deterioration and death
coagulopathy= increased risk of a cerebral haemorrhage
stress and fatigue= MS, myasthenia gravis, epilepsy, Parkinson’s.

Question 6

how can sodium levels affect neurological deterioration?

Answer 6

hyponatremia induces increased ICP and ISF= cerebral odema= altered GCS, seizures and pulmonary oedema.

Question 7

describe an A to E assessment for neurological deterioration

Answer 7

A: cranial nerves IX and X, altered consciousness, airway adjuncts
B: pons and medulla, PNS control of resp muscles, SaO2
C: medulla: HR, rhythm and BP, hypothalamus: temp
D: brain and spine: GCS, pupils, motor, sensory and cranial nerves
E: everything else

Question 8

what are red flags for neuro deterioration?

Answer 8

altered GCS
pupil changes
motor and sensory changes
seizures
sudden onset of headache
new speech deficit
CN deficit
resp failure (type 2)
gait and balance disorders
visual changes
N+V
nuchal rigidity- neck stiffness
Photophobia- sensitivity to light
hypertension, bradycardia

Question 9

early signs and symptoms of raised ICP

Answer 9

deterioration in LOC 
confusion
restlessness
lethargy
pupullary dysfunction
motor and sensory deficits
cranial nerve palsy

Question 10

transient signs of raised ICP

Answer 10

decreased LOC 
pupil abnormailities
visual disturbances
motor dysfunction
headaches and vomiting
aphasia
changes in resp pattern
changes in vital signs

Question 11

late signs of raised ICP

Answer 11

continuous deterioration of LOC
hemiplegia, decortication and decerebration
alteration in vital signs

Question 12

what is cushings response?

Answer 12

a compensatory response to provide adequate cerebral perfusion pressure (CPP) in the presence of increasing ICP

Question 13

what is involved in cushings triad?

Answer 13

hypertension
bradycardia
abnormal resp pattern

Question 14

name the causes of altered consciousness- extracranial

Answer 14

metabolic
hypoxia
hypercapnia
hypothermia
sepsis
dehydration
drug toxicity and withdrawal
delirium
pharmacological- opiates, anti-convulsants
alcohol
MI
ventricular arrhythmias
carbon monoxide poisoning
thyrotoxicosis
constipation and urinary retention.

Question 15

name the neuro conditions that affect the respiratory system and how it affects

Answer 15

spinal cord injury, Guillain-Barre syndrome, MND, MG

respiratory muscles compromised

Question 16

name the neuro condition that affects the cardiovascular system and how its impact

Answer 16

Spinal Cord Injury, brain stem, GBS

altered BP, HR, vasotone

Question 17

name the neuro condition that affects the ocular-audio system and its impact

Answer 17

stroke, Traumatic Brain Injury, tumours

affects vision and hearing

Question 18

name the neuro condition that affects the muscular system and its impact

Answer 18

SCI, MND, Spinal muscular atrophy, parkinsons, MD

muscle power, tone and dystrophy

Question 19

name the neuro condition that affects the renal/urinary system and its impact

Answer 19

MS, SCI, TBI, Subarachnoid haemorrhage, pituitary space-occupying lesion
neurogenic bladder, Diabetes insipidus, Syndrome of inappropriate antidiuretic hormone secretion, cerebral salt watering

Question 20

name the neuro condition that affects the gastrointestinal system and its impact

Answer 20

brainstem, SCI, MS, MND

altered swallowing, GI motility, neurogenic bowel

Question 21

name the neuro condition that affects the reproductive system and its impact

Answer 21

pituitary, SCI

altered hormone levels

Question 22

name the neuro condition that affects the integumentary system and its impact

Answer 22

SCI

altered tissue perfusion

Question 23

name the neuro condition that affects the endocrine system and its impacts

Answer 23

pituitary SOL, craniopharyngioma

hypo/hyper hormone release

Question 24

what is delrium?

Answer 24

an acute change in cognition, attention and LOC. can be hyperactive or hypoactive
causes are same as extracranial causes of alterec consciousness.

Question 25

ABCDE management of delirium

Answer 25

``` A/B: avoid hypoxia suction positioning vital capacity ABG if needed- advanced airway review may need- ETT/ tach/ NIV/ IPPV C: full monitoring of HR, rhythm and BP ECG avoid hypotension and severe hypertension may need pharmacological management to treat altered BP hypotension: inotropes/ vasopressors hypertension: betablockers Avoid hyperthermia observe UO high or low IV fluids avoid dextrose (can increase cerebral oedoema) D: neuro obs blood glucose frequent neuro obs S+S of raised ICP with uni/bilateral fixed dilated pupils- may require mannitol (osmotic diuretic - decrease fluid= temporary fix to buy time) if spinal- spinal turns and spinal immobilization c-spine injury- cervical collar treatment of autonomic dysreflexia treatment of seizures. E: full U&Es, FBC, clotting, cultures and specimens may require management of abnormal clotting treatment of abnormal U&Es full assessment of other systems consider assessment of gag and swallow- may require NG tube catheterization? assess for paralytic ileus control N+V pain management pressure area care bowel/bladder care ```

Question 26

what is autonomic dysreflexia?

Answer 26

occurs after spinal shock has been resolved, affects lesions above T6, can occur in acute but also a potential life long risk autonomic response to painful stimuli perceived below spinal cord lesion level due to abnormal reaction of sympathetic nervous outflow the denervated cord, resulting in vasodilation

Question 27

what are the causes of AD?

Answer 27

blocked Indwelling catheter, pressure sore, UTI, anxiety and pain

Question 28

what are the symptoms of AD?

Answer 28

severe hypertension, bradycardia, heachache, blotching/ flushing above, sweating below injury level and pallor

Question 29

what is the treatment for AD?

Answer 29

remove cause, tilt bed head up and a vasodilator may be prescribed.

Question 30

what is a seizure?

Answer 30

a result of uncontrolled, rapid discharge of action potentials within neurones causing prolonged neuronal depolarisation can affect anyone

Question 31

what is the care required pre-seziure?

Answer 31

note date and time where was pt and what were they doing changes in mood/behaviour? warning/aura?

Question 32

what is the care required during a seizure?

Answer 32

``` altered concoiusness heach or eyes deviate? which way? did they respond/groan/mumble? colour change breathing change body movements ```

Question 33

what is the care required post seziure?

Answer 33

``` how long incontinence injuries speech sleep behaviour headache how long before returned to normal ```

Question 34

what to do when someone is having a sezuire?

Answer 34

``` protect person from injury cushion head no not restrain when stopped- check airway and recovery position observe until recovered examine and manage injuries call 999 if: first seizure another one occurs shortly person is injured ```

Question 35

what is the treatment for a seziure?

Answer 35

``` Buccal midazolam or rectal diazepan for community IV lorazepan only in hospitals may require regular anti-epilptic meds ensure airway is secured emergency is: seziure= >5 mins after meds administered history of serial sezuires prolonged or repeated sezuires any difficulty managing ABCD ```

Question 36

what is diabetes insipidus caused by?

Answer 36

result of insufficient ADH causing water to be excreted rather than reabsorbed

Question 37

what are the signs and symptoms of DI?

Answer 37

polyurea and high serum osmorlarity

Question 38

what is the treatment for DI?

Answer 38

fluid replacement, potential use of DDVAP

Question 39

what is symdrome of inappropriate anti-diuretic hormone caused by?

Answer 39

inappropriate eccessive secretion of ADH

Question 40

what are the S+S of SIADH?

Answer 40

decreased serum sodium and decreased UO

Question 41

what is the treatment for SIADH?

Answer 41

sodium replacement (slowly as rapid replacement= pontine demyelination)

Question 42

what are the pharamacological management for neurological disorders?

Answer 42

osmotic diurectics: mannitol or 5% NaCl immunoglobulin e.g. GBS, polyneuropathy antimicrobial treatment- global or focal infections disease modifying treatments e.g. MS, parkinsons steriods- tumours, MG analgesia- neuropathic and acute pain antiepileptic- sezures

Question 43

non-surgical managements of neurological disorders

Answer 43

``` radiotheraphy- tumours plasma exchange- polyneuropathies TPA/ clot retrival- ischaemic stroke symptom management conservative management ```

Question 44

surgical interventions for neurological disorders

Answer 44

``` craniotomy craniectomy excision or drainage of space occupying lesion treamtnet of hydrocephalus endovascualr treatment spinal decompression spinal fixation ```