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Nursing Care for patients with neurosensory problems

Nursing Care for patients with neurosensory problems. Session 9 & 10 Nadeeka Jayasinghe. CONTENT. Diagnostic studies Neurological assessment Stroke – assessment, nursing management Infectious diseases – menengitis Reading: Cranial nerve function. Brain Needs…. Blood flow Glucose Oxygen.

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Nursing Care for patients with neurosensory problems

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  1. Nursing Care for patients with neurosensory problems Session 9 & 10 Nadeeka Jayasinghe

  2. CONTENT • Diagnostic studies • Neurological assessment • Stroke – assessment, nursing management • Infectious diseases – menengitis • Reading: Cranial nerve function

  3. Brain Needs… • Blood flow • Glucose • Oxygen

  4. Diagnostic Studies • Skull and Spinal Radiology • CT (Computerized Tomography) • MRI (Magnetic Resonance Imaging) • PET (Positron Emission Tomography) • EEG (Electroencephalogram) • EMG (Electromyelogram) • Cerebral Blood Flow Studies

  5. Neurological Assessment • Level of Consciousness (LOC) • Pupils • Vital Signs (VS) • Neuromuscular status • Response to stimuli • Posturing • Glasgow Coma Scale (GCS)

  6. STROKE

  7. Types of Stroke • Ischemic: embolic or thrombotic • blocked blood flow to the brain • Hemorrhagic: ICH, SAH, ruptured cerebral aneurysm • TIA: This is a stroke, although symptoms resolve within an hour

  8. Signs and Symptoms of Stroke • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden dizziness, loss of balance or coordination or trouble walking • Sudden severe headache with no known cause

  9. Risk Factors • High blood pressure • Carotid artery disease • Physical inactivity • Excess alcohol intake • Atrial fibrillation • Diabetes • Heart disease • Smoking • Family history • Prior stroke/TIA • High cholesterol • Obesity

  10. Treatment for Ischemic Stroke • tPA=Thrombolytic agent • Document time of symptom onset. (If awoke with symptoms, must go by time when last seen normal) • Immediate head CT (check for blood) • Evaluate for tPA administration (reviewexclusion/inclusion criteria)

  11. If not a tPA candidate, ASA in ED. Rectal ASA if fails swallow eval. or if swallow eval. not complete. Keep NPO, until a formal swallow eval. is done. Admit as Inpatient and perform diagnostic testing: Carotid US, Echo, TEE, ECG monitoring for a-fib, MRI, fasting Lipid, Clotting disorder blood work (Antiphospholipid, Factor V, Antithrombin III) Rehabilitation Treatment Cont…

  12. Hemorrhagic Stroke Treatment • Do not give antithrombotics or anticoagulants • Monitor and treat blood pressure greater than 150/105 (Table 6, 2005 Guidelines update) • NPO, until swallow eval is completed • Anticipate Neurosurgical consult • Possible administration of blood products

  13. If not a tPA candidate, ASA in ED. Rectal ASA if fails swallow eval. or if swallow eval. not complete. Keep NPO, until a formal swallow eval. is done. Admit as Inpatient and perform diagnostic testing: Carotid US, Echo, TEE, ECG monitoring for a-fib, MRI, fasting Lipid, Clotting disorder blood work (Antiphospholipid, Factor V, Antithrombin III) Rehabilitation Treatment Cont…

  14. Meningitis • An inflammation of the meninges of the brain and spinal cord • Bacterial Causes:Meningococcus and pneumococcus ,Haemophilus-influenza Organisms enter brain by: • Blood stream • Respiratory tract • Penetrating wounds of skull It is secondary to another infections such as otitismedia, upper respiratory infection,pneumonia • Viral (aseptic): less severe than bacterial

  15. Clinical Presentations • High fever, tachycardia, chills, petechial rash • headache, photophobia, stiff neck • Nausea, vomiting • papilledema (> ICP),confusion, altered LOC • Restlessness and irritability • Seizures • Brudzinski’s: passive flexion of the neck produces pain & increased rigidity • Kernig’s: Flex hip and knee and then straighten the knee…pain or resistance?

  16. complication of Meningitis Seizures Sepsis Cranial nerve dysfunctions Cerebral infarction Coma Death

  17. Collaborative care • Bacterial menigitis is a medical emergency • Treatment focus on rapid diagnosis and starting IV antibiotic therapy immediately(7-21 days) • Isolation • Antipyretics • Analgesics • Anticonvulsants • Osmotic diuretics • IV fluids

  18. Diagnosis • lumbar puncture :collect samples of CSF • Bacterial: • Cloudy csf • Elevated protein level • Increased WBC • Decreased glucose level • Elevated CSF pressure • C&S OF CSF • CBC • Cultures from Blood, urine, throat, nose

  19. Cranial Nerve function • Reading: Perry, A & Potter, A 2010, “Clinical Nursing Skills & Techniques”, 7th edition, Mosby Elsevier, St Louis, pg 764.

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