Study Sheet: Neurological Disorders - Tumors, Meningitis, Encephalitis, and Brain Injuries, Exams of Nursing

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NSG430 Care of the Critically Ill Adult

NEUROLOGICAL DISORDER STUDY SHEET

Disorder Cause S/S DX TX Interventions Oncologic Brain Tumors Primary

• Originarte within the brain matter itself (glioma) Secondary
• Outside of the brain – metastasize from other sources (more common – mengioma)
• Can be both benign and cancerous
• Headache
• Altered LOC
• Seizures
• Visual Changes
• N/V
• Signs of increasing ICP (early and late signs)
• Biopsy
• Primary: MRI
• gives more detailed info (bleeding, structures involved
• CT can show there is a mass
• PET scan for cancer throughout the body
• Lumbar Puncture (CT to rule out space occupying lesions), know procedure and care for a lumbar puncture (informed consent, proper positioning, explaining the procedure), Post op complications (infection, hemorrhage, leaking of CSF,
• Surgical Removal – primary intervention for lesions
• Chemotherapy

chemotherapy must be able to cross the blood brain barrier

• Radiation
• Corticosteroids

dexamethasone (decadron)

• Anticoagulants
• Antiseizure medications (Dilantin)
• Frequent Neuro Checks (q min – q 2- hours)
• Seizure precautions – padding
• Prevent increased ICP
• positioning, stimulus, avoid coughing
• Administer Medication
• Prevent further injury – secondary injury related to tumor or injury related to safety
• Monitor labs – glucose, sodium, BP, Temp, O sat.

PLP headache

• lay flat and fluids at least an hour), monitor site for bleeding and leakage (halo’s sign) contraindicatio ns
• EEG for seizure activity Spinal Cord Tumors May be primary or secondary Classified according to location
• Primary – PAIN
• Weakness
• Loss of Motor Function, reflexes, and sensation
• Uncontrolled bladder and bowel function
• Erectile disfunction

• MRI

• Biopsy
  • Surgical Removal
  • • Neuro Checks
    • Pain Control
    • Assess Respiratory function (difficulty breathing – ineffective)
    • Medications – steroids
    • Monitor for constipation (decreased peristalsis) that can lead to autonomic dyreflexia – bowel training, stool softners
    • Skin precautions
      • turning and repo Infective Meningitis (^) Inflammation of the menininges ( layers) Bacterial or Viral in origin
• Severe headache
• Nuchal rigidity (neck stiffness)
• Lumbar Puncture: color and clarity, elevated
• Early interventions with antibiotics m- will not wait for

• Bacterial has more complicatio ns and higher in mortality rate Risk factors: contamination through LP, Surgical Procedure, close spaces (college), Spread through throat secretions Viral – Varicella, Herpes Simplex or Herpes Zoster
• Photophobia
• Irritable
• Auditory sensitivity
• Kernig’s (neck down and knees go up) and Burdinsky (Hip flexion)
• High fever
• Confusion
• Changes in LOC

WBC,

Elevated Protein, and decreased glucose

• Clear – WBC’ s slightly elevated, protein elevated, normal glucose = viral lumbar punctiure
• Earlier the better for patient outcomes
• Isolation precautions
• Acyclovir for viral meningitis
• Supportive Care for viral – interventions to decrease ICP
• Pain management
• Antiseizure medications – seizure precautions
• Steroids
• Fever control Encephalitis Affects the brain matter Inflammation of brain tissue Viral in cause – herpes, EEE, west nile virus
• Flu like symptoms
• Altered LOC
• S/S of increased ICP
• Lumbar Puncture
• Blood Culture
• systemic
• R/O if not bacterial
• Acyclovir
• Isolation precautions

Frequent Neuro Checks Prevent increased ICP Seizure precautions Traumatic Brain Injuries: Closed Head Injury Blunt Trauma Damages the brain tissue but there is no opening Acceleration Deceleration/Croup Prevention for concussion

• helmets, concussion protocol in sports Glascow coma scale (3-

15. – 3 primary areas: eye

• Countercoup opening to stimuli, verbal, motor; less than 8 = intubate If you have a brain injury expect a cervical injury as well ( C – collar and body alignments) Neuro Checks – arosement (w/ concussions) Concussion - Loss of COnsticousne ss
• Headache
• Short term memory issues
• Vomiting
• Confusion
• Seizure if severe
• Difficult to diagnose
• CT will be normal
• Based on signs and symptoms Concussion
• Post concussion syndroms: long term effects of concussion
• Symptom management – decrease ICP, Seixure precautions and antiseixure medications Contusion
• Signs of herniation
• Decadron is given DAI
• Medications: mannitol (ICP), Steroids Contusion (^) Major head trauma Involves the surface of the brain
• Stipor
• Confusion
• Associated Amnesia

- CT/MRI

Diffuse Axonal Injury (DAI) Caused by rotational injury to the head Car accident, Boxing Axons separate and diffuse bleeding occurs

• Primary: immediate coma! - MRI can show shearing of axong - EEG for seizures - ABG - Glucose **Intracranial Hemorrhage/ Hematomas:
• Epidural
• Subdural
• Intracerebr al** Typically r/t skull Epidural: laceration of the middle meningeal artery Subdural: brain atrophy (chronic) or spontaneous bleeding r/t antigoas Related to trauma Epidural
• Initial LOC, lucid, and repeat LOC (ask if they loss consciousness ) Subdural
• Stroke like symptoms
• Aute: 24- hours after the
• CT for bleeding in the brain
• Surgical: craniotomy/ craniostomy
• STOP THE BLEEDING Epidural: emergency (early recognitions) Glucose Dilantin Respiratory support
• Continue to monitor
• Seizure precaurions
• EARLY IDENTIFICATIO N
• REDUCCE ICP
• MONITOR FOR HERNIATION (LATE SIGN)
• Monitor VS<
• Respiratory support
• Monitor

onset of bleeding

• Chronic: weeks to months
• Can be the same
• Difficult to diagnose in demetia pts
• Intermitent headate, altered LOC, mental deteroiation, focal seizures
• Decrease motor and sensory involvement Temperature (pressure on the hypothalamus Open Head Injury: Scalp injuries and Skull fractures Penetrating injury that may expose brain matter
• Scalp Lacerations tend to bleed
• Risk for infection Linear, Open, Depressed, and Basilar
• Open laceration to the head
• Localizes persistent pain
• Basilar: #1 – battle signs (echymosis behind the ear), leakage fo CSF through nose and ears, racoon eyes Monitor for further signs of brain damage Halo’s signs Monitor for s/s of infection Test drainage for glucose Protect Head if depression is felt SPINAL CORD INJURIES Primary: result of Back Pain Testing sacral Decomprssion Stabilization/

the initial trauma – effects right then and there are usually permanent Secondary: spinal cord contusions or tears Incomplete: loss of movement and sensation below the level of injury (findings are inconsistent) Complete: Complete loss of all movement and sensation below the level of injury C1-C3: may not have respiratory function The higher the injurys the more severe the injury is going to be Report Sparing – test the tone of the rectum -If they have tone – they have sacral sparing – incomplete lesion (good news) CT XRAY MRI ASAI to show long term effects of the injury

• Crutfield tongs
• Halo tractions
• TSL brace Surgical procedure:
• Spinal fusion
• Laminectomy Medication
• Steroids
• Anticoagulatio ns
• Pain immobilization (c collar) Rapid assessment Protection of cervical Log roll patient Safety Telemetry monitoring Frequent Vital Signs Monitor for respiratory involvement with injuries within the cervical region Airway Management Positioning – log roll Prevent complications of immobility – skin, DVT, and Respiratory Pin/Ton/Collar Care
• Sterile procedure
• Loose pins
• Difficulty swallowing Monitor for complications: Shock, ADR, Assist with ADL’s, bladder distention, paralytic ileus Tetraplegia Cervical down Paraplegia From lumbar down Lumbar Paraplegia Spinal Shock Can happen 30 Complete loss of Made by the signs Inflammatory Based on supportive

minutes after the primary injury Can last up to weeks Complication of a spinal cord injury r/t the inflammation response Can occur at any level sensory, motor, and reflexes bbelow the level or injury

• Flaccid paralysis and sensation below injury line
• Loss of relflexes below the injury line
• Paralytic ileus: can lead to bowel obstruction (abd. Pain, nausea, distention and symtpoms response - Steroids (decadron) Return of bladder tone and reflexes and the presence of hyperreflexia care
• Steroids
• Skin care
• DVT prevention
• Monitor Respirations Neurogenic Shock A true systemic response Hypotension Bradycarda Loss of ability to sweat below the injury Warm flushed skin Fluids and vasoconstrictors as needed (level T and higher) Autonomic dysreflexia Overstimulation of the sympathetic response Triggers; constipation, bladder disfuction, skin stimulation Extremely high blood pressures Bradycardia Headache Diaphoresis Flushed Nausea Pylo Erection (goosebumps)

ELEVATE THE HEAD

OF THE BED TO

IMPORVE VENOUS

PRESSURE

Find the trigger (bladder scan, bowel sounds, Take off restrictive closing, wrinkle free sheets Administer antihypertensives

(hydralizing) Provide education on triggers Label the chart – put it in the medical history Degenerative Disk CRANIAL NERVE Trigeminal Nerve (^) Compression of cranial nerve Extreme pain Face Based on the symptoms Pain management Antiseizure medications Treat the symtpoms Prevention Pain: hot/cold, brushing teeth, washing face (during acute episodes) Bell’s Palsy Inflammation Cranial nerve 7 Weakness and paralysis of the the affected side of the face Rule out stroke Based on the symptoms Steroids Pain medications Protect the affected eye from injury AUTOIMMUNE Myasthenia Gravis (MG) Damage to the acetylcholine receptor sites Chronic muscle fatigue Chronic muscle fatigue Difficulty eating Tensalon tests EMG Mestinon (Generic name) – give before they eat and in the morning! Watch for complications Assess respiratory status Guillian-Barre Syndrome (GBS) Inflammation of the myeline sheath of the peripheral nervous system Symmetrical paralysis in the feet that ascends bilaterally Based off of symptoms Lumbar puncture – elevated protein system Diaphragm involvement IvIG txs – autoimmune Anticoags to prevent DVT Assess respiratory function Telemetry monitoring