Neuro 9-15.txt

monitor for excessive amounts of drainage

if large tumor has been removed, place pt on nonoperative side

keep pt NPO for 24 hours, check head dressing every 1-2 hours for signs of drainage; monitor for hypovolemic shock and let surgeon know if drainage ism>50 ml/8 hr

assess every 15-20 minutes for first 4-6 hours and then every hour

diabetes insipidus, especially procedures involving the pituitary gland or hypothalamus

leads to failure of renal tubules to reabsorb water

hyponatremia in the neuro population and is charactereized by hyponatremia, decreased serum osmolality and decreased blood volume

Na replacement and isotonic fluid volume

increased ICP, subdural hematoma, intracranial hemorrhage, severe headache

Ventriculostomy (IVC)

nasal packing is inserted after the incision is closed and a mustache dressing is applied

watch for nasal drip, do not cough or anything else that might cause pressure, sneeze through mouth, don’t bend at waist, can’t brush teeth, don’t strain for poop

metabolic disorders, acute alcohol withdrawal, electrolyte disturbances, high fever, stroke, head injury, substance abuse, heart disease

diazepam

main component of mgmt.; teach pts to take their drugs on time to maintain therapeutic drug levels and manimum effectiveness

O2 and suctioning are always available

take VS, neuro check, keep pt on side, allow pt to rest, document seizure

airway (may need to intubate), O2, IV access

medical emergency and prolonged seizure lasting longer than 5 minutes or repeated seizures over 30 minutes

sudden withdrawal from antiepileptic drugs, infection, booze or drug withdrawal, head trauma, cerebral edema, metabolic distrurbances

lasts 2-5 minutes; tonic=stiffening or ridigity; clonic=jerky movements

fatigue, acute confusion and lethargy

blank stare, kids, may have automatisms (involuntary behaviors such as lip smacking or picking at clothes)

sudden loss of muscle tone lasting for seconds followed by post seizure confusion; pt usually falls; this seizure is most resistant to drug therapy

focal or local (one part of cerebral hemisphere)

may cause loss of consciousness

oxygen, suction, airway, IV, siderails up, no tongue blades

phenytoin

inflammation of the meninges that surround the brain and spinal cord caused by bacterial and viral organisms

usually life threatening and there is exudate (pus) produced by the organism as it travels through the CNS; treat bacterial

meningococcal

droplets (if N, meningitides and H. influenza)

fever, HA, photophobia, indications of increased ICP, nuchal ridigity, +Kernig and Brudinski’s, decreased in mental status, focal neuro deficits, N/V

cloudy, increased WBC, increased protein, decreased glucose, elevated CSF pressure

clear, increased WNC, slightly increased protein, varied CSF pressure

CT, LP, blood, polymerase chain reaction, xrays

broad spectrum anti, hyperosmolar agents, anticonvulsants, maybe steroids, prophylaxis

inflammation of the brain and often surrounding meninges that affects cerebrum, brainstem and cerebellum; usually caused by virus

no exudate with encephalitis but does have demyelization

antiviral like acyclovir

increased ICP resulting from cerebral edema, hemorrhage and necrosis

encephalitis

hyperflexion (head on collision), hyperextension (hit from behind), vertical compression (jumping), excessive head rotation, penetration

hemorrhage, ischemia, hypovolemia, neuro shock, trauma (leading cause of SCI)

nonsurgical, immobilization, drugs, surgical mgmt., community resources

difficulty breathing, potential for neuro shock, potential for further SC injury, impaired physical mobility, bowel and bladder, impaired adjustment

monitor pt for severe bradycardia, warm dry skin and severe hypotension; patients above T6 within 24 hours potential for neuro shock

eliminates all innervation below level of injury

injury that allows some function or movement below the level of the injury and are more common

don’t pull on it, do not adjust screws, check pt’s skin, make sure one finger can be easily inserted, monitor neuro status

place his or her hands on either side of rib cage; as pt inhales, push upward to help expand the lungs and cough

perform valsava maneuver or tighten ABD muscles; not always successful; may have to do bladder ultrasound

elevate (sit them up)

excessive, uncontrolled sympathetic output; severe HTN, bradycardia, severe HA, nasal stuffiness and flushing; usually caused by distended bladder or constipation

small number of SC tumors but are usually cancerous

emotional support

methylprednisone

burning, prickly sensation associated with irrestible urge to move; incidence is higher in patients with DM and chronic kidney disease

worse in evening, night, and when pt is still for a period of time

risk for falls, thermal injuries, skin breakdown