Review:

Age-Related Changes The number of nerve cells decreases and brain weight decreases Increased plaques and tangled fibers in nerve tissue Eye pupil often smaller; may respond to light more slowly. Tracking may be jerky. Reflexes intact except for Achilles tendon jerk, which is often absent Lipofuscin and amyloid tangles present Reaction time increases, especially complex reactions Tremors in the head, face, and hands are common Some develop dizziness and problems with balance***** – This is not normal!!

General Neuro Assessment: LOC- Approach the patient Call their name Touch them Shake them Nail bed pressure Perform Romberg Test: Stand with eyes closed Pat knees with palms and back of hands rapidly Touch fingertips Touch nose open eyes Touch nose closed eye

Main Neuro Assessment Tool? Glasgow Coma Scale

Other Neuro Assessment Tools: Babinski:

Neuro Assessment Tools (Diagnostic): CT Scan: enhanced ct? use contrast MRI: complete ck list EEG: great for seizures

Crebral Angiography: NKA? Fluids after? PET Scan:

Lumbar Puncture To obtain specimen Measure CSF pressure Inject anesthetic Inject air for testing

LP Procedure Sterile Position pt on side, knees bent, back arched out Needle between L3-4 subarachnoid space

Potential complications Severe HA N/V Irritation / hematoma Leg / buttock pain CNS irritation Brain herniation

Nursing Care after LP Flat – horizontal Check site Ongoing neuro assess Push fluids

ICP What is it? – Increase pressure inside that reduces perfusion to the brain. – Decrease perfusion…decrease oxygen…decrease oxygen…decrease LOC

ICP S&S – in consciousness – Headache – The 2 postures – Pupillary changes. Oculomotor nerve pressure. Fixed and dilated – Cushings Triad Bradycardia, HTN, Widening pulse pressure

ICP TX – Mannitol – Steroids – HOB at 30 degrees – Remain straight….even head – Limit fluid intake

Seizures What is it? – Miss-firing of neurons in the brain – Storm – Common cause?...Not taking seizure medicine 2 major types: Partial (simple and complex)-No LOC Generalized- Tonic/Clonic Movement-LOC

Generalized Seizure Ictal Phase: Mark time, so you can figure duration May try to cradle head and or loosen clothes if safe to do so If in hospital, pads should already be on bed!! NOTHING ELSE!!

Generalized seizure Post Ictal phase – Aura? – Check mouth – Reassure

Generalized Seizure Tx – Dilantin- Perform mouth care – Other anti-convulsants Over 30min seizure is status epilepticus – Emergency. Needs IV anticonvulsants

Headaches Types: – Migraine – Cluster – Tension

Migraine Cause – Intracranial vasoconstriction followed by dilation S&S – Unilateral pain – N/V – Photosensitivity Tx – Meds (Imitrex, steroids), quietness, low lights

Cluster Cause – Stress, anxiety S&S – Lacrimation, Rhinorreha, pain unilateral head Tx – Meds(Tylenol, Advil), cool compresses

Tension Cause – Something else S&S – Pain Tx – Treat the cause – Non opoid meds, warm compressess

Meningitis Cause – Bacterial or viral infection of the Meningies S&S – Headache – Nuchal rigidity – Positive Kernig’s sign and Brudzinski’s sign – ICP

Figure 27-16A

Figure 27-16B

Meningitis – Tx Antibiotics if…..

Vocab Synapse Somnolent Semicomatose Comatose Lethargic Hemiplegia Hemiparesis Ipsilateral Decorticate Decerebrate

Figure 27-5