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NUR5926 > - NEUROLOGICAL PRESENTATIONS - > Flashcards

- NEUROLOGICAL PRESENTATIONS - Flashcards

1
Q

Discuss the function of the nervous system

A

To co-ordinate and regulate:

  • sensory input
  • integration
  • motor output
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2
Q

Demonstrate the assessment of the nervous system

A

Neurological history includes:

  • clinical manifestations
  • associated complaints
  • precipitating factors
  • progression
  • familial history

Assessment:

  • GCS/AVPU
  • Pupil size, equality and reactivity
  • Limb strength
  • Cranial nerves
  • Seizures
  • Pain
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3
Q

Outline the characteristics of stage 1 of increased ICP/ICHTN

A

Stage 1:

  • vasoconstriction and external compression of venous system (compensatory mechanism)
  • ICP may not change
  • Few clinical manifestations evident
  • If ICP monitered may see an increase in pressure that takes longer to return to baseline
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4
Q

Discuss compensatory mechanisms critical to preserving the integrity of the brain

A
  • shunting of blood

- regulation of CSF

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5
Q

Differentiate between the following brain disorders; viral and bacterial meningitis and encephalitis

A

Encephalitis - inflammation of brain parenchyma, caused but bacteria and viruses, diagnosed by bloods, treated with ampicillin and cephalosporins, photophobia and stiff neck

Meningitis - inflammation of the protective layers covering the brain, caused by viral agents, neuroimaging usually required to diagnose and bloods, treated with acyclovir, seizures and behavioural changes

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6
Q

Discuss the assessment of an ACS

A

PEARL, GCS, Limb strength, neurological S+S and history of PP

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7
Q

Discuss the management of an ACS

A
  • High vis cubicle
  • Regular neuro obs
  • Pathology, including urine
  • Investigations (CTB, MRI)
  • Differential Dx
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8
Q

Discuss the assessment of a TIA or stroke

A

Pupil size and reactivity, GCS, Limb strength, neurological S+S and history of PP, presence/absence of raised ICP

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9
Q

Discuss the management of a TIA

A

Referred to as ‘minor stroke’ or ‘mini stroke’:
- When clinical manifestations are present but resolve
within 24 hours
- TIA’s require emergency treatment
- Needs prompt investigation

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10
Q

Discuss the management of a hemorrhagic stroke

A
  • intubation if low GCS
  • BSL management
  • cessation and reversal of anticoagulants
  • craniotomy
  • spinal tap to relieve ICP
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11
Q

Discuss the management of a non-hemorrhagic stroke

A
  • aspirin or other anticoagulants
  • Tissue plasminogen activator (tPA)
  • surgical intervention
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12
Q

Discuss the management of a traumatic brain injury

A 
Protect the airway & oxygenate. 
Ventilate to normocapnia. 
Correct hypovolaemia and hypotension. 
CT Scan when appropriate. 
Neurosurgery if indicated. 
Intensive Care for further monitoring and management.
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13
Q

Discuss the management of seizures

A
  • protect airway
  • witnessing (time, length)
  • ?bite block
  • safe space
  • medications (benzodiazepines, phenytoin, sodium valporate, keppra, barbitates, propofol)
Investigations:
Neuroimaging
Lumbar puncture
Toxicology
EEG to monitor for seizures (especially NCSE)
Anticonvulsant
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14
Q

Discuss the assessment of a traumatic brain injury

A
  • ABCD
  • avoid hypotension and hypoxia
  • GCS and brief neurological Ax
  • history and MOI
  • vitals
  • full neuro assessment
  • external head and neck examination
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15
Q

Discuss the assessment of seizures

A
  • description of the seizure phenomena
  • time of seizure and treatment
  • previous seizures
  • stroke or other epilepsy risk factors
  • other medical conditions
  • current medications
  • neurological assessment
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16
Q

Discuss the management of meningitis

A
  • Bacterial meningitis is a medical emergency
    Airway:
    – assess LOC
    – nil orally
    – intubate if GCS < 8 or signs of raised ICP

Breathing:
– assess WOB, RR, SaO2
– supplemental O2 if SaO2 < 95%

Circulation:
– vital signs
– FBC
– fluid management

Disability:
– antibiotic (don’t wait for specimens)
– analgesia
– positioning
– dark room and cover for eyes
– minimal stimulation
– seizure management
– antipyretics
– skin care
– nutritional support
17
Q

Discuss the clinical manifestations of Guillian-Barre syndrome

A
  • sudden bilateral weakness (days or weeks)
  • SOB
  • unable to perform previously effortless tasks, such as swallowing
  • cramps and body aches
  • ascending (usually temporary) paralysis
  • areflexia
  • absence of fever
  • Loss of vasomotor control
  • Fluctuating BP
  • Postural hypotension
  • Cardiac dysrhythmia
18
Q

Discuss the management of Guillian-Barre syndrome

A 
Symptomatic management / supportive care:
 - airway maintenance (secretions can cause choking or pneumonia)
 - ventilation if respiratory failure
 - IDC
 - pain relief
Treatment:
 - Plasmaphoresis
 - High dose immunoglobulin therapy
19
Q

Discuss the difference between an epidural, subdural and intracranial bleed

A

EDH - between the skull and the dura, (commonly from meningeal artery)

SDH - between the dura and the arachnoid mater (commonly trauma, elderly, shaken baby syndrome)

Intracranial - bleed in the parenchyma or meninges (usually caused by hypertension, aneurysm, drugs etc)

20
Q

Discuss the use pf thrombolysis in a stroke

A

Inclusion Criteria:

  • BSL 2.7 – 22 mmol/L
  • Ischaemic stroke on CT brain
  • rt-PA administration < 3 hours post onset of symptoms
Exclusion Criteria:
Onset of symptoms > 3 hours
- BSL < 2.7 or >22 mmol/L
- Seizure at onset
- AMI > 7 days or < 3 months
- Stroke or serious head trauma within 3 months
- Major surgery within 14 days
- GIT or urinary haemorrhage in last 21 days
Pregnant
- Check haemorrhage risk (INR > 1.5 on warfarin or other anticoagulant)
- Platelets < 100000/mm3
- Systolic BP >185 despite Rx
- Diastolic BP >110 despite Rx
21
Q

Discuss the nursing management of a pt with a raised ICP

A
  • Treatment depends on underlying cause and focus is removing the cause.

AIRWAY:
- Intubate if GCS<8

BREATHING:

  • monitor breathing pattern
  • Apply O2 if SaO2 < 95%
  • aim for PaCO2 @35mmHg

CIRCULATION:

  • hypotension treated with fluid +/- Inotropes
  • Aim for a systolic BP>90mmHg
  • Osmotic Diuretic eg Mannitol 20%
  • Steroids

DISABILITY:

  • position @30-40 degree angle
  • take measures to prevent (coughing, vomiting, shivering, posturing)
  • control seizure activity
  • adequate sedation
  • reduce noxious stimuli
22
Q

Outline the characteristics of stage 2 of increased ICP/ICHTN

A
  • Inrease in ICP exceeds compensatory mechanisms
  • Oxygenation compromised
  • Systemic arterial vasoconstriction to increase BP
  • Clinical manifestations subtle and transient (episodes of confusion, restlessness, drowsiness, slight pupil changes, slight respiratory changes)
23
Q

Outline the characteristics of stage 3 of increased ICP/ICHTN

A
  • ICP begins to reach arterial pressures
  • Brain experiences hypoxia, hypercapnia and acidosis
  • Rapid deterioration in condition
  • Clinical manifestations: decreased GCS, central neurogenic hypoventilation, widened pulse pressure, bradycardia, small sluggish pupils
24
Q

Outline the characteristics of stage 4 of increased ICP/ICHTN

A
  • Herniation of brain tissue
  • Compromised blood supply leading to further hypoxia and ischaemia
  • Small heamorrhages develop
  • Obstructive hydrocephalus may develop
  • Marked and rapid increase in ICP
  • MAP = ICP
  • Cerebral blood flow ceases
25
Q

What is a normal ICP

A

5-15mmHg

26
Q

What is the calculation for CPP (cerebral perfusion pressure)

A

CPP = MAP minus ICP

27
Q

What is the normal range for CPP

A

60-80mmHg

28
Q

Outline the clinical manifestations of an increased ICP

A
  • Altered conscious state (restless, agitation, confusion drowsiness unresponsive)
  • Headache
  • Nausea and vomiting
  • Pupil changes
  • Cushing’s Reflex (Raised systolic BP (widening pulse pressure), Bradycardia, Irregular respirations (Cheyne-Stokes respirations)
  • Abnormal posturing
29
Q

List the clinical manifestations of meningitis

A
  1. Fever
  2. Neck stiffness / Nuchal rigidity
  3. Severe headache
  4. Nausea and vomiting
  5. Photophobia
  6. Decreased level of consciousness
  7. Positive Kernig’s sign
  8. Positive Brudzinski’s sign
  9. Petechial skin rash (if meningococcal)

NUR5926 (20 decks)

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