The Acute Neurological/Neurosurgical patient Flashcards Preview

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Flashcards in The Acute Neurological/Neurosurgical patient Deck (12):
1

Why might a PD patient be admitted to the acute ward?

1. Implantation of DBS (deep brain stimulator) - electrodes in subthalamic nucleus, wires run down side of the neck and attached to a device that sits under the clavicle; PHYSIO can be assessing the patient before/after this procedure

2. PD patients also can have a lot of #s - hips, wrists - due to falls

3. PD pts apt to have lot of infections

2

Why might an MS patient be admitted to hospital?

1. Initial diagnosis
2. Acute exacerbations (steroid injections given)

3

Why might an MND patient be admitted to hospital?

1. If they have chest infection (usually they are in palliative care depending on stage of disease so you won't see them much)

4

What factors should be considered in physio management of Guillain Barre?

- MONITOR VITAL CAPACITY!
- may be required 2x/day or 1x every 2 hours depending on pt
- these results determine whether BiPAP or intubation/ventilation is needed
- no point giving exercises since they won't work
- standardize vital capacity testing

5

CI's + Precautions to treatment for GBS

1. plasmapheresis (blood taken from body - plasma is seperated - ABs removed; plasma returned) - pt feels exhausted after this process

2. neuropathic pain - 50% of GBS pts get terrible neuropathic pain so even mild touch causes excruciating pain - pain meds needed before

3. Low BP - lack of mm pump (precaution for mobilising+tilt table)

6

What are the different types of spinal surgery?

DECOMPRESSION:
Laminoplasty
Laminectomy (relieves pressure on SC but also creates more instability; might also need fusion)
Foraminotomy
Discectomy

Spinal Fusion
Disc replacement

7

What are the differences between an anterior and posterior cervical spine surgery approach?

Anterior approach:
- better access
- less destructive to mm's
- but nerves controlling speech+swallowing are here so can have problems with these

Posterior approach:
- more pain bc cutting through more mm

8

What are the considerations for managing after anterior spinal surgery (cervical)?

Monitor for signs of DYSPHAGIA (since these mm's can be affected by damage to nerve in anterior cx)
- DURING EATING: multiple swallows, cough/sneeze/'pcoketing food'
- AFTER EATING: wet/hoarse voice
- drooling, poor oral hygeine

Monitor for signs of DYSARTHRIA
- hoarse
- garbled
- slurred

9

CIs + Precautions

- Log roll (to prevent spinal cord injury)
- Follow medical protocols!
- Follow restrictions post surgery (<1.5kg for 4 weeks)

10

What is the management for spinal fracture

- bed rest
- collar
- log roll
- do NOT treat unless specifically asked to do so (since risk of SC injury)

11

What are the 3 diff types of collars and what is their effect on mobility?

Soft collar - more for pain relief that immobilization
Hard collar - partial immobility
Halo - complete immobility

12

When are halos used?

- when external immob needed (post op immob to allow for healing; cx or upper tx #s)
- can be on 6 weeks to 3 mons
- put on in OR - 4 screws drilled into skull to attach it; infection risk so must be cleaned regularly