Alterations In Neuro, Summaries of Neurological Basis of Behavior

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ALTERATIONS IN THE

NEUROLOGICAL SYSTEM

Condensed ADN-Level Interactive

Version

OVERVIEW OF THE NERVOUS SYSTEM

• (^) Central Nervous System (CNS): Brain and Spinal Cord
• (^) Peripheral Nervous System (PNS): Cranial and Spinal Nerves
• (^) Autonomic Nervous System (ANS): Sympathetic and Parasympathetic
• (^) Neurons: Excitability, Conductivity, and Influence

IN CRE ASE D IN TRAC RANI AL PRE SSURE (IC P) Normal ICP: 5– mmHg; sustained >20 mmHg = elevated Causes: Trauma, Tumors, Infection, Hemorrhag e Early Signs: LOC changes, headache, vomiting, visual changes Late Signs: Cushing’s triad, posturing

ICP NURSING MANAGEMEN T Maintain patent airway, optimize oxygenation Elevate HOB 30°, avoid neck flexion Monitor GCS, neuro checks, ICP monitoring if ordered Medications: Mannitol, hypertonic saline, corticosteroids

CASE STUDY

• A.T. is a 68-year-old male brought to the ED with confusion, lethargy, and headache. He was in a car accident 2 days ago where he hit his head on the windshield. He felt fine at the time and did not seek medical care.
• The health care provider suspects A.T.’s symptoms may be caused by increased intracranial pressure (ICP).
• What causes increased ICP?
• A.T.’s BP is 144/54 mm Hg, HR 76 bpm, RR 12 breaths/minute, and Temp 98.9° F. His CT scan reveals a subacute subdural hematoma.
• What stage of increased ICP is A.T. displaying?

HEAD INJURY OVERVIEW Trauma to scalp, skull, or brain Types: Concussion, Contusion, Hematoma (Epidural, Subdural, Intracerebral) Common causes: Falls, MVAs, Sports

CASE STUDY

• (^) K.D., a 33-year-old woman, is brought by paramedics to ED following a motor vehicle accident. She has a laceration to her forehead and bruises from her seat belt. She is stuporous and does not answer questions.
• (^) What is the most likely cause of her change in LOC? An emergent CT scan on K.D. reveals an epidural hematoma.
• (^) What is an epidural hematoma?
• (^) What type of emergency treatment would you expect the health care provider to order?
• (^) What would be the initial priority care for K.D. upon admission to the ED?

STROKE OVERVIEW

• (^) Ischemic (Thrombotic/Embolic) vs. Hemorrhagic
• (^) Modifiable risks: HTN, diabetes, smoking, obesity
• (^) FAST: Facial droop, Arm weakness, Speech difficulty, Time to call 911

MATCH THE TYPE OF STROKE

• (^) 1. Bleeding into brain tissue →
• (^) 2. Blood clot blocking artery →
• (^) 3. Sudden neurologic symptoms <1 hour → ____
• (^) Choices: A) Ischemic B) Hemorrhagic C) TIA

SEIZURE DISORDERS

• (^) Uncontrolled electrical discharge in brain
• (^) Types: Generalized (Tonic-Clonic, Absence) and Focal
• (^) Safety first: Airway, protect from injury, record duration

CRITICAL THINKING QUESTION

• (^) What should you do if your patient who has uncontrolled seizures tells you he insists on driving when it is against the law in your state under these health circumstances?

QUICK QUIZ

• (^) Which of the following is TRUE during a seizure?
• (^) A) Insert oral airway B) Apply restraints C) Turn patient to side D) Check glucose after

REFLECTION QUESTIONS

• Should nurses have the right to refuse preventive vaccinations, such as the flu shot, which could potentially affect the health of their patients through transmission of communicable diseases?
• Why or why not?
• Do you obtain vaccinations that are available or recommended such as HPV, flu, meningococcal meningitis, etc.?
• Has that changed since you became a nursing student?
• How/why have your self-care practices changed in this regard?

CASE STUDY 19-year-old L.P. presents to your clinic with severe headache and vomiting. She is a college student who lives in the dorm. She states she began feeling badly a few days ago. L.P.’s temperature is 102.3° F. She is wearing a cap to shield her eyes from light and is slightly confused. Blood and CSF cultures are obtained. She is diagnosed with bacterial meningitis. What should you tell her about her condition? What can you do if she is too confused to understand