neurology 2
DESCRIPTION
Neurology 2. Part 1. History. Family member present Vaccination Major injuries Childhood illnesses Family Present illness. Complaints specific to neurology. Pain Location Quality Severity Duration Precipitating factors Associated symptoms Exasperation / diminished pain Onset. - PowerPoint PPT PresentationTRANSCRIPT
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Neurology 2
Part 1
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History
• Family member present• Vaccination• Major injuries• Childhood illnesses• Family• Present illness
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Complaints specific to neurology
• Pain– Location– Quality– Severity– Duration– Precipitating factors– Associated symptoms– Exasperation / diminished
pain– Onset
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Pain assessment
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Headaches
• Multiple causes• Not a good indicator of
neuro trouble
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Vertigo
• Sensation of moving around in space or objects moving around them
• Assoc symptoms
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Paresthesia
• Definition– Unusual sensation
• Examples– Numbness– Tingling– Burning
• Assessment– ? Weak– ? Intermittent or
constant
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Vision
• Diplopia• Clarity• Nystagmus
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Disturbances in…
• Thinking• Memory• Personality
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Nausea and vomiting
• Projectile
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Assessing Cerebral Function - PE
• Mental status• Intellectual function• Thought content• Emotional status• Perception• Motor ability• Language ability
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Mental Status
• Level of consciousness– Rostral-claudal
Progression• Dullness • Confusion • Lethargy • Stupor • Coma
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Alert
– Alert• Open eyes
spontaneously• Responds
appropriately, briskly• Oriented
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Lethargic
• Lethargic– Opens eyes to verbal
stimuli– Slow to respond, but
appropriate– Short attention span– Obtunded
• Sleepy
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Stupor
• Stupor– Responds to stimuli
(usually physical) with moans and groans
– Never fully awake– Confused– Conversation unclear
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Semi-comatose
• Semi Comatose– Responds to painful
stimuli– Conversation:
• none
– Protective reflexes• present
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Comatose
• Coma– Unresponsive except
to severe pain– Protective reflexes
absent– Pupils fixed– No voluntary
movement
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Unconscious
• Non-medical word• Ranges from stupor to
coma
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Persistent Vegetative State
• No cognitive brain function
• Wake sleep cycles• Very poor prognosis (if
> 3-6 months)
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Brain Dead
• No brain function• Only reflexive
movements
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Types of Stimuli response
• Voice• Touch• Shaking• Voice + Shaking• Noxious/painful stimuli
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Nature of response
• Eye opens• Remove stimuli• Abnormal posturing• No response
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Glasgow Coma Scale
• Eye Opening– Spontaneous – 4– To speech – 3– To pain – 2– Nil – 1
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Glasgow Coma Scale
• Best Motor Response– Obeys -6– Localizes – 5– Withdraws – 4– Abnormal flexion – 3– Extension response – 2– Nil - 1
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Glasgow Coma Scale
• Verbal response– Oriented – 5– Confused conversation –
4– Inappropriate words – 3– Incomprehensible
sounds – 2– Nil - 1
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Glasgow Coma Scale
A strong predictor of outcome13: mild brain injury9-12: Moderate brain injury< 8: Severe brain injury (coma)
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Sample Question
• The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT• Eye opening • Motor response • Pupillary reaction • Verbal performance
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Sample Question
• The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT• Eye opening• Motor response• Pupillary reaction• Verbal performance
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Small Group QuestionsA. Give 5 questions you might ask a neuro patient who is
complaining about a headache during an intake assessment B. Identify the rostral-caudal progression of consciousnessC. Identify the differences in patients in each of the stages of
consciousnessD. What is the lowest score a patient can get on a Glasgow
coma scale?E. What is the highest score a patient can get on a Glasgow
Come Scale?F. What is the most sensitive indicator on the Glasgow Coma
Scale?
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General Appearance
• How do they look?– Grooming– Dress– Aids– Eye deviation– Skin
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• Signs of trauma, wounds, scrapes, ecchymosis etc.
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Battle’s sign
• Bruising over the Mastoid– Where’s the mastoid?
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Battle’s sign
• Bruising over the Mastoid
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Battle’s sign
• Bruising over the Mastoid
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Battle’s sign
• Bruising over the Mastoid
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Battle’s sign
• Bruising over the Mastoid
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Battle’s Sign
• Bruising over the Mastoid area
• Suggests – Basal skull fracture
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Raccoon’s eyes
• Periorbital edema and bruising
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Raccoon’s eyes
• Periorbital edema and bruising
• Suggests:– Frontal-basal fracture
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Rhinorrhea
• Drainage of CSF from the nose
• Suggests– Fracture of the
cribiform with torn meninges
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Otorrhea
• Drainage of CSF from the ear
• Suggests:– Fracture of the
temporal bone with torn meninges
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Decorticate Posturing
• Flexed Posturing– Flexed arm/elbow– Flexed wrists/fingers– Adducted arms– Legs with internal
rotation– Foot: Plantar flexed
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Decorticate Posturing
• Suggests– Damage to the
cortico-spinal tract• More favorable than
decerebrate posture
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Decerebrate Posturing -
• Extension posturing– Extended arm/elbow– Flexed wrist/fingers– Adducted arm– Pronation of arm– Foot: Plantar flexed
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Decerebrate Posture
• Suggests– severe injury to the brain at the level of the
brainstem
• Opisthotonos – severe muscle spasm of the neck and back
• More ominous posture
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Orientation
• x 3– Person – Place– Time