neuro 355

neuro 355 what are the components of the brain - CSF, blood, brain tissue what are factors that can influence brain development - chronic illness substance use trauma S/S of increased intracranial pressure - lethargy decreased appetite N/V - MORNING TIME headache pupil changes bulging fontanelle high pitch cry seizure coma Cushing triad cushing triad - sign of increased ICP -Widening of pulse pressure (Increased systolic, same diastolic) -Slowing HR -irregular Respiration patern what must be considered before completing a neuro exam - age and level of development what is included in a neuro exam? - description of behavior VS eyes motor function posturing Decorticate posturing - (to the core) severe dysfunction of the cerebral cortex pt may not come out (arms/hands near chest, feet/knees turned in) what do fixed and dilated pupils indicate? - brain death Glasgow Coma Scale (GCS) - a scale used to assess the consciousness of a patient what is the best score a pt can receive on the Glasgow coma scale? Worst? - best: 15 worst: <8 what are the 3 categories involved in the Glasgow coma scale - eye opening motor response verbal response Treatment of increased ICP - VS every hour sedation/intubation/paralyzation Mannitol or Diamox (Diuretic) corticosteroids CLUSTER CARE/MINIMAL STIMULATION what increases ICP? - coughing sneezing sounds positions head injury bleeding infections untreated hydrocephalus how should a pt be positioned when having increased ICP - midline head of bed elevated (No more than 30 degrees) DO NOT TURN PT TBI (traumatic brain injury) - blunt force injury to the head that disrupts normal Brian functioning at risk for long term congenital defects **Shaken baby syndrome** primary TBI injury - instantaneous injury as a result of impact to the head being hit by the airbag in a car accident Secondary TBI Injury - response to the primary injury ex: Brain swelling, Ischemia, Increased ICP when should someone return to activities after suffering a concussion? - when all s/s subside what is the best way to diagnose a concussion? - MRI interventions for children with head injuries - neuro assessments bedrest/limit movement seizure precautions MONITOR FLUID STATUS check ears and nos for CSF drainage don't give pain meds right away (affects neuro checks) Bacterial Meningitis - inflammation of the meninges SERIOUS organisms will spread from CNS to bloodstream can lead to: Increased ICP Hydrocephalus/SIADH who is most at risk for bacterial meningitis? - Babies and newborns what is a risk factor of bacterial meningitis? - head injury s/s bacterial meningitis - increased fever (really high) lethargy vomiting rash opisthotonic: weird positioning to release ICP that child takes on positive kerning and brudzinski signs Kernig's sign - a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down WILL COMPLAIN OF PAIN IN THE NECK Brudzinski's sign - Sign of meningitis; positive when a patient's legs lift involuntarily when lifting a patient's head PT WILL EXPERIENCE PAIN when is it okay to perform a Brudzinski and Kernig - 3+ lumbar puncture (LP) - diagnostic procedure performed by insertion of a needle into the subarachnoid space usually between the third and fourth lumbar vertebrae; performed for many reasons, including the removal of cerebrospinal fluid (also called spinal tap) DEFINITIVE TEST OF MENINGITIS CSF will appear cloudy and thick, WBC >, positive gram stain Management of meningitis - WATCH TEMP (PT AT RISK FOR FEBRILE SEIZURES) - antibiotics - fever control - anticonvulsants - IVF (DONT over hydrate) - increased ICP management Meningococcemia - related to meningitis - swollen skin - purpura DEADLY NEEDS ANTIBIOTIC TREATMENT viral meningitis - meningitis caused by a virus and not as severe as bacterial meningitis - pt does not appear as ill s/s viral meningitis - headache back pin stiff neck altered LOC management for viral meningitis - supportive care: Tylenol decrease stimuli fluids proper positioning what isolation precaution is viral meningitis - contact/droplet spina bifida - neuromuscular condition neural tube defect failure of bony spine to close risk factors of spina bifida - folic acid deficiency epilepsy deficiency in mom substance use, etc diagnosis of spina bifida - - Amniocentesis and alpha-fetoprotein levels (AFP will be increased) myelomeningocele - hernia of the spinal cord and meninges (nerves included) included with spina bifida hydrocephalus is a common result of surgical correction s/s myelomeningocele - sac like protrusion on infants back loss of motor and sensory function scoliosis urinary incontinence or retention bowel incontinence seizures learning problems nursing care for myelomeningocele - surgery within 2 days pre op: IV antibiotics (prevent infection) post op: prone/side lying position monition neuro status measure head circumference daily assess signs of ICP long term management of myelomeningocele - leg brace, walkers, etc calcium/Vd rich diet scoliosis management management of myelomeningocele: neurogenic bladder - pt does not have sensation to urinate straight Cath MITROFANOFF (direct urine outside of abdominal cavity and Chanel through naval) management of myelomeningocele: bowel incontinence - MACE (channel goes to rectum, will allow for an enema) stool softeners, fiber hydrocephalus - body's reaction to an imbalance of CSF production and absorption CONGENITAL OR ACCQUIRED MOST COMMON: Noncommunicating s/s hydrocephalus - enlarged head, headache, change in vision, seizures, sun setting sign or downward deviation of eyes, incontinence infants: frontal bossing bulging fontanels hydrocephalus diagnostics - before born: CONGENITAL CONFIRMATION Head circumference measure CT MRI hydrocephalus surgical intervention - VP shunt (Ventroperitineal) RISK OF INFECTION DUE TO FOREIGN OBJECT ventriculostomy - helps to decrease ICP/ICF while issue is occurring with shunt - make sure to keep level and clamp when changing positions hydrocephalus management post op - keep flat and on unoperated side post op drainage not uncommon watch for signs of infection monitor I&O may restrict fluids skin care complications of increased ICP: SIADH - hyper secretion of ADH CANNOT HANDLE FLUID OVERLOAD-FLUID IS RETAINED NA levels are LOW due to being diluted by fluid complications of increased ICP: DI - decreased production of ADH kidney no longer absorbs water leading to VOLUMINOUS URINATION nothing left to dilute Na, SODIUM WILL BE HIGH seizure - spontaneous electrical discharges initiated by hyper excitable cells some lose consciousness, some do not when is someone classified to have epilepsy - when they have 2 seizures or more how do you diagnose seizures - EEG seizure management - control seizures while avoiding adverse effects start w one drug and add if needed rectal diazepam for breakthrough if no seizure occurs for at least 2 yrs, consider slow weaning off meds nutritional diet consideration for seizure pts - ketogenic diet increase fat intake ketosis is WANTED seen in children 3-school age vagal nerve stimulator - this is a treatment used for seizures that are not controlled with medication. it stimulates the vagus nerve at predetermined intervals to prevent seizure activity. implanted device seen in teenagers status elipticus - continuous seizure activity lasting longer than 30 min with a LOC lack of O2 to the brain will be placed into a medically induced coma