470 likes | 601 Views
Neurology 2. Part 1. History. Family member present Vaccination Major injuries Childhood illnesses Family Present illness. Complaints specific to neurology. Pain Location Quality Severity Duration Precipitating factors Associated symptoms Exasperation / diminished pain Onset.
E N D
Neurology 2 Part 1
History • Family member present • Vaccination • Major injuries • Childhood illnesses • Family • Present illness
Complaints specific to neurology • Pain • Location • Quality • Severity • Duration • Precipitating factors • Associated symptoms • Exasperation / diminished pain • Onset
Headaches • Multiple causes • Not a good indicator of neuro trouble
Vertigo • Sensation of moving around in space or objects moving around them • Assoc symptoms
Paresthesia • Definition • Unusual sensation • Examples • Numbness • Tingling • Burning • Assessment • ? Weak • ? Intermittent or constant
Vision • Diplopia • Clarity • Nystagmus
Disturbances in… • Thinking • Memory • Personality
Nausea and vomiting • Projectile
Assessing Cerebral Function - PE • Mental status • Intellectual function • Thought content • Emotional status • Perception • Motor ability • Language ability
Mental Status • Level of consciousness • Rostral-claudal Progression • Dullness • Confusion • Lethargy • Stupor • Coma
Alert • Alert • Open eyes spontaneously • Responds appropriately, briskly • Oriented
Lethargic • Lethargic • Opens eyes to verbal stimuli • Slow to respond, but appropriate • Short attention span • Obtunded • Sleepy
Stupor • Stupor • Responds to stimuli (usually physical) with moans and groans • Never fully awake • Confused • Conversation unclear
Semi-comatose • Semi Comatose • Responds to painful stimuli • Conversation: • none • Protective reflexes • present
Comatose • Coma • Unresponsive except to severe pain • Protective reflexes absent • Pupils fixed • No voluntary movement
Unconscious • Non-medical word • Ranges from stupor to coma
Persistent Vegetative State • No cognitive brain function • Wake sleep cycles • Very poor prognosis (if > 3-6 months)
Brain Dead • No brain function • Only reflexive movements
Types of Stimuli response • Voice • Touch • Shaking • Voice + Shaking • Noxious/painful stimuli
Nature of response • Eye opens • Remove stimuli • Abnormal posturing • No response
Glasgow Coma Scale • Eye Opening • Spontaneous – 4 • To speech – 3 • To pain – 2 • Nil – 1
Glasgow Coma Scale • Best Motor Response • Obeys -6 • Localizes – 5 • Withdraws – 4 • Abnormal flexion – 3 • Extension response – 2 • Nil - 1
Glasgow Coma Scale • Verbal response • Oriented – 5 • Confused conversation – 4 • Inappropriate words – 3 • Incomprehensible sounds – 2 • Nil - 1
Glasgow Coma Scale A strong predictor of outcome • 13: mild brain injury • 9-12: Moderate brain injury • < 8: Severe brain injury (coma)
Sample Question • The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT • Eye opening • Motor response • Pupillary reaction • Verbal performance
Sample Question • The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT • Eye opening • Motor response • Pupillary reaction • Verbal performance
Small Group Questions • Give 5 questions you might ask a neuro patient who is complaining about a headache during an intake assessment • Identify the rostral-caudal progression of consciousness • Identify the differences in patients in each of the stages of consciousness • What is the lowest score a patient can get on a Glasgow coma scale? • What is the highest score a patient can get on a Glasgow Come Scale? • What is the most sensitive indicator on the Glasgow Coma Scale?
General Appearance • How do they look? • Grooming • Dress • Aids • Eye deviation • Skin
Battle’s sign • Bruising over the Mastoid • Where’s the mastoid?
Battle’s sign • Bruising over the Mastoid
Battle’s sign • Bruising over the Mastoid
Battle’s sign • Bruising over the Mastoid
Battle’s sign • Bruising over the Mastoid
Battle’s Sign • Bruising over the Mastoid area • Suggests • Basal skull fracture
Raccoon’s eyes • Periorbital edema and bruising
Raccoon’s eyes • Periorbital edema and bruising • Suggests: • Frontal-basal fracture
Rhinorrhea • Drainage of CSF from the nose • Suggests • Fracture of the cribiform with torn meninges
Otorrhea • Drainage of CSF from the ear • Suggests: • Fracture of the temporal bone with torn meninges
Decorticate Posturing • Flexed Posturing • Flexed arm/elbow • Flexed wrists/fingers • Adducted arms • Legs with internal rotation • Foot: Plantar flexed
Decorticate Posturing • Suggests • Damage to the cortico-spinal tract • More favorable than decerebrate posture
Decerebrate Posturing - • Extension posturing • Extended arm/elbow • Flexed wrist/fingers • Adducted arm • Pronation of arm • Foot: Plantar flexed
Decerebrate Posture • Suggests • severe injury to the brain at the level of the brainstem • Opisthotonos • severe muscle spasm of the neck and back • More ominous posture
Orientation • x 3 • Person • Place • Time