what are the 5 main componets to a neuro assessment?
1) mental status
2) cranial nerves
3) motor system
4) sensory system
-seen w/ lesions that interupt corticospinal (motor) pathways between upper neurons in brain and spinal cord
-arms flexed, fists clenched, legs extended
-disruption of motor neurons of the brainstem and midbrain
-arms stiff and extended, forearms pronated, DTRs exaggerated
-may be seen w/ tetany, seizures (grand-mal), meningitis
What are the focus assessment areas of the Glascow Coma Scale, GCS? The scoring?
GSC= used to assess LOC, usually the first sign that is altered w/ incr. ICP
1) motor response (e.g. obeys commands, loczlized to noxious stimuli, withdraws from noxious stimuli...)
2) verbal response
3) eye opening (e.g. spontaneous, open to speech...)
Normal= 15, 7 or less = comatose, "less than 8, intubate!"
What are some main assessments we gain from mental status?
-thought content (e.g. delusions, hallucinations)
-ADL assessment = good baseline to evaulate progressive neuro disease
What is the function of the cranial nerves and what are some things that can impair them?
-sensory and motor function
-may be impaired by incr. ICP, surgery of head/neck tumor, trauma
What are the main CN affected by changes in ICP d/t their location?
2, 3, 4, 6
CN II (optic)
-incr. ICP causes direct pressure, assess w/ simple vision test (e.g. ask pt. to read something or put 2 fingers up and say how many?)
CN III (Oculomotor), IV (Trochanter), VI (Abducens)
-incr. ICP causes indirect pressure bc they exit at the brainstem at the level of the tetorial notch, so they are affected when the brain shifts
-these CN (3,4,6) are responsible for extraocular movements, and CN 3 is responsible for pupil constriction
ccomodation (pupils shouls slightly constrict as you move finger toward pt's face)
-evaulates the lower motor neurons (anterior horn cell and the motor fibers that leave it) and the sensory fibers within the particular levels of the spine
4+ hyperactive (may be assoc. w/ upper motor neuron disease of the cerebral cortex)
3+ brisker than normal (not necessarily pathologic)
1+ diminished (may be normal)
0 absent (assoc. w/ lower neuron disease, like Guillan-Barre)
Define abdominals, cremasteric, and plantar reflexes
-Abdominals- equal movement of umbilicus (absent movement = damage in pyramidal tract (pyramidal tract deals w/ regulation of fine muscle movements))
-Cremasteric- rising of the testicle and scrotum
-Plantar- (Babinski) fanning of toes (normal in baby, not adult), or dorsiflexion of great toe
Abbreviated neuro assessment
1) VS (checking for HTN, bradycardia, widened pulse pressure, change in resps)
2) pupil size, shape, reaction
3) eye opening
4) verbal response
5) motor response
6) extremity strength
the most accurate indicator of changing neurological status is LOC!!!
What is a Lumbar Puncture (spinal tap) and why is it used?
-insertion of spinal needle into subarachnoid space between 3rd and 4th or 4th and 5th lumbar vertabrae (=no danger bc spinal cord ends at L1-L2) but temporary leg pain or muscle twitching may result from spinal root irritation
-used to obtain CSF pressure readings or to relieve pressre in certain conditions, may be used to obtain CSF for analysis, inject contrast medium, inject anesthesia
What are the risks w/ a lumbar puncture?
-rusk of uncal herniation and infection, contraindicated w/ incr ICP or infection at the puncture site
What are some considerations w/ Lumbar puncture?
-bedrest in FLAT position for 4-8 hrs post procedure to prevent spinal cord HA
-icr. fluids to 3000 mL for 24-48 hrs
-post procedure: monitor for CSF leak, hematoma, infection, bleeding, numbness, decr. ability to move extremities, inability to void, signs of meningeal irritation (nuchal rigidity, photosensitiviey, Kernigs and Brudzinskis sign)
-lavel and number specimen tubes, transport to lab immediately
What is a electroencephelography (EEG)? Main uses?
-records activity of the cerebral hemisphere to: (main uses)
1)determine orgin of seizure activity
2)monitor cerebral activity during surgical anesthesia
3)determine brain death
What is the nursing care for an EEG?
-if the test is to be performed under sleep deprived conditions, tell pt to awaken at about 2 or 3 am and stay awake for rest of night
-instruct pt to aviod CNS depressants or stimulants, and withhold anticonvulsants only if prescribed by physicain
-tell pt not to drink caffeine on day of test (stimulant)
-have pt wash hair and not put sprays/oils in the day of test
What is a Positron Emission Tomography (PET scan)? Why is it used?
-provides info about the FUNCTION of the brain, specifically glucose and O2 metabolism and cerebral bloodflow (CT provides info about structure only)
-used to detect areas of metabolic alteration (dementia, epilepsy, psych and degenerative disorders, neoplasms, Alzheimers)
-Deoxyglucose is injected which is tagged to an isotope, the isotope emits activity (positrons) which are scanned and converted to a color image by the computer, the more aciteve a given part of the brain the more glucose uptake
What is the client care w/ a PET scan?
-no caffeine, ETOH, tobacco 24 hrs before test
-NPO for 4-12 hrs prior, if pt. is diabetic do not give insulin before test
-do not give glucose sln or other drugs that alter glucose metabolism
-IV line established
-client may be asked to perform functions such as counting, test takes 2-3 hrs
-icr. fluid intake after exam, no special urine precautions