2014nursing assessment and interventions for the patient with

Nursing Assessment and Interventions for the Patient with Altered Neurological Function

Fall 2014Nursing 53Lewis 8th Ed

Anatomy, Physiology, and Function of the Nervous System

Neurons Action Potentials

Na (extracellular) K (intracellular)

Neurotransmitters Acetylcholine Norepinephrine Cholinergic Adrenergic GABA Dopamine

Cerebrum, page 1409 Diencephalon Brainstem Cerebellum Parietal Lobe Occipital Lobe Temporal Lobe Frontal Lobe Motor Area Speech Area Motor Speech Area

Brain StemVentriclesCerebrospinal FluidMenigesCerebral Circulation and the Blood –Brain

Barrier, page 1412Limbic and Reticular Formation

Spinal Cord

Functions of the Spinal Cord and Spinal Roots Upper and Lower Motor Neurons Spinal Nerves

Cervical, Thoracic, Lumbar, Sacral, Coccygeal Cranial Nerves

12 pairs page 1411 Reflexes

Autonomic Nervous System

Sympathetic DivisionParasympathetic

Diagnostic Tests of the Neurologic System

CT MRI MRA MRS PET Cerebral Angiogram Carotid Duplex Study EEG EMG LP Myelogram

GlasgowComa Scale, p. 1513

Eyes OpenBest Motor ResponseBest Verbal response

Total score 15

Neurological Assessment

Page 1416, page 1419 box 56-6Reflex Assessment, page 1418Common abnormalities

ALOCAnosognosiaAphasia/dysphagiaDysarthriaAnisocoriaDipolia

Homonymous HemianopsiaDysphagiaOpthalmoplegiaPapilledemaApraxiaDyskinesiaHemiplegiaNystagmusAnalgesia

AnesthesiaParathesiaAsterognosisExtensor plantar responseDeep tendon reflexesBladder dysfunctionParaplegiaTetraplegia

Variations in the Older Adult

Decrease number of brain cells

Slower conduction Slower retrieval of

information Slower response to

balance Less readiness to learn More easily distracted

Needs additional time Forgetfulness Increase risk for falls Set time limits Table 56-4

Seizures

Epilepsy (also called seizure disorder) Sometimes called a convulsion Common affects 2.5 million people Increases dramatically in older adults Not a mental disorder Alterations in the excitability of neurons Scarring Inbalances of excitatory and inhabitory

nuerotransmitters

Manifestations

PartialSimpleComplexGenerilizedAbsence (petit mal)Tonic clonicStatus Epilepticus

MedicationsKee, Chapter 22 7th ed. Anticonvulsants

Anticonvulsants Hydantoins

Phenytoin, Cerebryx Benzodiazepines

diazepam Iminostilbenes

tegretol Valproate

Valpoic acid Iminostilbenes

Carbamazepine Miscellaneous

Keppra,

Nursing Interventions for drugs

Monitor serum drug levels Compliance Monitor CBC, BUN, Creatinine Protect environment Nutrition, anorexia Oral contraceptives nullify History of herbs Check urinary output Oral mucous membranes Phenytoin may inhibit insulin release

Status Epilepticus

ValiumAtivanDilantinPhenobarbVersedDiprivanThen high dose barbituates

Drug Interactions

Valproic acid and phenobarbPhenobarb and coumadinAntabuse and phenobarbCarbamazepine and oral contraceptivesASA, diamox, antacids, folic acid,narcotics

Surgery considerations

Meds held day of surgeryMay give a partial dose, depends on

surgeonMay be ordered parentally until fluids poSteroids for first three days to decrease

cerebral edema

Pathophysiology

Meningitis-inflammation of the pia mater, the archnoid, and the subarachnoid space

Encephalitis-acute inflammation of the parenchyma of the brain or spinal cord

Manifestations

Restlessness, agitation, and irritability Severe headache Meningeal irritation

Nichal rigidity Positive Brudzinski’s sign Positive Kernig’s sign

Chills and high fever Confusion, altered LOC Photophobia Seizures Increased ICP, widened pulse pressure, bradycardia, respiratory

irreg, decreased LOC, headache and vomiting Petichial rash

Causes

Viral vs bacterialNursing care plan, page 1454Collaborative Therapy, 57-17 page 1453