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Neurology 2

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.

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Neurology 2

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  1. Neurology 2 Part 1

  2. History • Family member present • Vaccination • Major injuries • Childhood illnesses • Family • Present illness

  3. Complaints specific to neurology • Pain • Location • Quality • Severity • Duration • Precipitating factors • Associated symptoms • Exasperation / diminished pain • Onset

  4. Pain assessment

  5. Headaches • Multiple causes • Not a good indicator of neuro trouble

  6. Vertigo • Sensation of moving around in space or objects moving around them • Assoc symptoms

  7. Paresthesia • Definition • Unusual sensation • Examples • Numbness • Tingling • Burning • Assessment • ? Weak • ? Intermittent or constant

  8. Vision • Diplopia • Clarity • Nystagmus

  9. Disturbances in… • Thinking • Memory • Personality

  10. Nausea and vomiting • Projectile

  11. Assessing Cerebral Function - PE • Mental status • Intellectual function • Thought content • Emotional status • Perception • Motor ability • Language ability

  12. Mental Status • Level of consciousness • Rostral-claudal Progression • Dullness  • Confusion  • Lethargy  • Stupor  • Coma

  13. Alert • Alert • Open eyes spontaneously • Responds appropriately, briskly • Oriented

  14. Lethargic • Lethargic • Opens eyes to verbal stimuli • Slow to respond, but appropriate • Short attention span • Obtunded • Sleepy

  15. Stupor • Stupor • Responds to stimuli (usually physical) with moans and groans • Never fully awake • Confused • Conversation unclear

  16. Semi-comatose • Semi Comatose • Responds to painful stimuli • Conversation: • none • Protective reflexes • present

  17. Comatose • Coma • Unresponsive except to severe pain • Protective reflexes absent • Pupils fixed • No voluntary movement

  18. Unconscious • Non-medical word • Ranges from stupor to coma

  19. Persistent Vegetative State • No cognitive brain function • Wake sleep cycles • Very poor prognosis (if > 3-6 months)

  20. Brain Dead • No brain function • Only reflexive movements

  21. Types of Stimuli  response • Voice • Touch • Shaking • Voice + Shaking • Noxious/painful stimuli

  22. Nature of response • Eye opens • Remove stimuli • Abnormal posturing • No response

  23. Glasgow Coma Scale • Eye Opening • Spontaneous – 4 • To speech – 3 • To pain – 2 • Nil – 1

  24. Glasgow Coma Scale • Best Motor Response • Obeys -6 • Localizes – 5 • Withdraws – 4 • Abnormal flexion – 3 • Extension response – 2 • Nil - 1

  25. Glasgow Coma Scale • Verbal response • Oriented – 5 • Confused conversation – 4 • Inappropriate words – 3 • Incomprehensible sounds – 2 • Nil - 1

  26. Glasgow Coma Scale A strong predictor of outcome • 13: mild brain injury • 9-12: Moderate brain injury • < 8: Severe brain injury (coma)

  27. 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

  28. 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

  29. 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?

  30. General Appearance • How do they look? • Grooming • Dress • Aids • Eye deviation • Skin

  31. Signs of trauma, wounds, scrapes, ecchymosis etc.

  32. Battle’s sign • Bruising over the Mastoid • Where’s the mastoid?

  33. Battle’s sign • Bruising over the Mastoid

  34. Battle’s sign • Bruising over the Mastoid

  35. Battle’s sign • Bruising over the Mastoid

  36. Battle’s sign • Bruising over the Mastoid

  37. Battle’s Sign • Bruising over the Mastoid area • Suggests • Basal skull fracture

  38. Raccoon’s eyes • Periorbital edema and bruising

  39. Raccoon’s eyes • Periorbital edema and bruising • Suggests: • Frontal-basal fracture

  40. Rhinorrhea • Drainage of CSF from the nose • Suggests • Fracture of the cribiform with torn meninges

  41. Otorrhea • Drainage of CSF from the ear • Suggests: • Fracture of the temporal bone with torn meninges

  42. Decorticate Posturing • Flexed Posturing • Flexed arm/elbow • Flexed wrists/fingers • Adducted arms • Legs with internal rotation • Foot: Plantar flexed

  43. Decorticate Posturing • Suggests • Damage to the cortico-spinal tract • More favorable than decerebrate posture

  44. Decerebrate Posturing - • Extension posturing • Extended arm/elbow • Flexed wrist/fingers • Adducted arm • Pronation of arm • Foot: Plantar flexed

  45. 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

  46. Orientation • x 3 • Person • Place • Time

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