Neuro

Grey matter; surface of cerebrum

Involuntary movements of voluntary movements; ie: coordination, balance, etc.

Medulla, pons, mid brain; auto nervous system ie: controls resp, heart rate, b/p, coughing, etc.

transmits impulses to and from brain

Connective tissue that protects CNS. Made up dura mater (outer layer; thick), arachnoid mater (middle layer; web-like), and pia mater (inner layer; thin).

Eye opening, verbal response, & motor response.

• - Best=15 (spon. eye opening, orientatedx3 (verbal), follows commands.
• - Worst=3 (No open eyes, no verbal resp, no respond to stim or pain)

Level of consciousness (orientatedx3). Can detect changes from neuro baseline much sooner

Pupils equal, round, and reactive to light & accommodation

Normal pupil response to light will be to constrict then return to previous size (adjusts to light)

Involuntary, jerking movements of the eyes (typically twitching)

Protecting core; elbows bent to chest

Extremities extended out and away

Interruptions in neuro impulses; chaotic

Effects one area/side of the brain

Effects both hemispheres of brain/multiple areas

• - Never put anything in pts mouth or restrain pt.
• - Provide pillow under head and turn pt on side (maintain airway)
• - Assist to the floor
• - Remove anything harmful from room

• - Events prior to seizure (possible aura?)
• - Time seizure started and ended
• - Type of seizure/pt movement during seizure

• - Level of conciousness (is pt orientated, drowsy or difficult to arouse?)
• - Pt behaviors
• - Vitals signs

• - Meds do not cure seizures and seizures still possible even on meds
• - Drugs levels will need to be monitored
• - Never discontinue meds suddenly

Seizure lasting longer than 30 minutes

TBI, cerebral edema, tumors, hydrocephalus, bleeding

Decreased level of consciousness, headace, cushings triad, hypertension

Decreased LOC

Excessive CSF

• - leads to bleeds (subdural, epidural)
• - caused by direct trauma to head/brain (car accidents, assaults, falls, etc.)

Swelling in brain

• - caused by TBI, CVA, aneurysms
• - Pt may loose consciousness then regain it
• - watch vitals signs for increased b/p, bradycardia, and irreg resp.

• - Widening pulse pressure, irreg resp, and bradycardia
• - signals possible brain herniation
• - late indicator of increased ICP

• - Dark , quiet room
• - stool softners
• - NO ROM, suctioning, coughing, or straining
• - NO morphine/narcotics (will mask s/sx of ICP)

Caused by stress and muscle contractions of the head &/or neck

Unilateral pain, photophobia, aura, n/v

Bacterial/Viral organisms within the meninges

Fever, nuchal rigidity, brudzinksi sign, kernig's sign

Painful ext of knee when hip bent & knee @ 90 degrees

Pt flexes hips when nurse flexes neck (ie bridge)

Neck stiffness

• - Lumbar Puncture (will increase pressure)
• - Characteristics of CSF (cloudy due to WBC and organisms)

• - Procedure where needle is inserted into subarachnoid space where CSF is withdrawn
• - Can also be done to admin rx (chemo, epidural)

Side-laying; knees to chest (fetal)

Lie flat on back for 6 hours (prevents spinal headache)

Assess pt's allergies to contrast, iodine, and seafood/shellfish

Cervical (7), thoracic (12), lumbar (5), sacral

• - Extent of paralysis related to location of injury, partial/full transection of cord, or compression of cord
• - can cause loss of bowel function
• - can cause spinal shock

3 days

loss of motor and sensory function to both lower extremities due to spinal cord injury

loss of motor and sensory function to all 4extremities due to spinal cord injury

• - Only perform jaw thrust to perform CPR/maintain airway
• - immobilize column with neck collar
• - immobilize with Gardener Wells Tongs

• - Loss of sensory, motor, reflexive, and autonomic function of nervous sys below the spinal cord injury
• - can start in 30 min and last for weeks
• - return of reflexes (involuntary) = end of spinal shock

• - pins attached to the skull (can be used in traction)
• - used to immobilize and align cervical vertebrae

• - medical emergency
• - occurs with injuries above T6
• - exaggerated sympathetic response with no parasympathetic response

• - main: seizures, bradycardia, HTN
• - secondary: nasal congestion, sweating, skin blotching, nausea, restlessness, goose bumps

• - Noxious stim below the level of the injury
• - most common cause is overfilling bladder

• - HOB elevated 40 degrees
• - remove noxious stim
• - Prn htn rx

• - Pt teaching of reducing noxious stim
• - ensure catheter patency and proper drainage

• - Dilatin (mouth care essential due to gingival hyperplasia)
• - Keppra

Excessive gum tissue

- Mannitol (used to decrease ICP; tanks b/p; A LOT of urine output)

• - Anti-inflamm steroid
• - reduces dmg to spinal cord

• - usually clear
• - will test positive for glucose
• - can leak from ears, nose, LP
• - Blood can be present from LP, but will fade over time