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Neurological Assessment and Disorders, Lecture notes of Nursing

Saint Mary's University (SMU)Nursing

A comprehensive overview of the neurological assessment process, covering various aspects such as consciousness and cognition, cranial nerves, motor system, sensory system, and reflexes. It also delves into specific neurological disorders, including head injuries, spinal cord injuries, convulsive disorders, and seizures. The causes, signs and symptoms, diagnostic tests, and management strategies for these conditions. It offers valuable insights for healthcare professionals in understanding and addressing neurological issues, with a focus on maintaining brain homeostasis, preventing secondary damage, and managing complications. The detailed information presented can be useful for students and professionals in the fields of medicine, nursing, and allied health sciences.

Typology: Lecture notes

2023/2024

Available from 08/01/2024

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NCM 116
LEC
REVIEWER / SECOND SEMESTER
FUNCTIONS
Controls all motor, sensory, autonomic,
cognitive, and behavioral.
NEUROTRANSMITTER
Communicate messages from one
neuron to another or to a specific target
tissue.
Neurotransmitters can potentiate,
terminate, or modulate a specific action
or can excite or inhibit a target cell.
Many neurologic disorders are caused
by an imbalance in neurotransmitters.
HEALTH HISTORY
Assess to localize disturbances.
1. Pain (sternal rub/ stimulation/ pressure;
pressure on GREAT TOES; nail-bed
pressure; orbital pressure)
2. Seizure
3. Dizziness (abnormal sensation of
imbalance or movement) and vertigo
(illusion of movement, usually rotation)
4. Visual disturbances
5. Weakness
6. Abnormal sensations
7. Past health, family, social history
NEUROLOGIC ASSESSMENT
CONSCIOUSNESS AND COGNITION
Mental status
Intellectual function
Thought content
Emotional status
Language ability
Impact on lifestyle
CRANIAL NERVES
MOTOR SYSTEM
Muscle size
Muscle tone and strength
Coordination and balance
Romberg test
SENSORY SYSTEM
Tactile sensation
Superficial pain
Temperature
Vibration & position sense
(proprioception)
REFLEXES
DTRs (deep tendon reflexes)
0
No response
2+
Normal
3+
Hyper reflexic
4+
Hyperactive
GERONTOLOGIC CONSIDERATIONS
Important to distinguish normal aging
changes from abnormal changes.
a) Structural and physiologic changes
b) Motor and sensory alterations
c) Temperature regulation and pain
perception
d) Determine previous mental status for
comparison.
e) Assess mental status carefully to
distinguish delirium from dementia.
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NCM 116 LEC

REVIEWER / SECOND SEMESTER

FUNCTIONS

 Controls all motor, sensory, autonomic, cognitive, and behavioral. NEUROTRANSMITTER  Communicate messages from one neuron to another or to a specific target tissue.  Neurotransmitters can potentiate, terminate, or modulate a specific action or can excite or inhibit a target cell.  Many neurologic disorders are caused by an imbalance in neurotransmitters. HEALTH HISTORY  Assess to localize disturbances.

  1. Pain (sternal rub/ stimulation/ pressure; pressure on GREAT TOES; nail-bed pressure; orbital pressure)
  2. Seizure
  3. Dizziness (abnormal sensation of imbalance or movement) and vertigo (illusion of movement, usually rotation)
  4. Visual disturbances
  5. Weakness
  6. Abnormal sensations
  7. Past health, family, social history NEUROLOGIC ASSESSMENT CONSCIOUSNESS AND COGNITION  Mental status  Intellectual function  Thought content  Emotional status  Language ability  Impact on lifestyle CRANIAL NERVES MOTOR SYSTEM  Muscle size  Muscle tone and strength  Coordination and balance  Romberg test SENSORY SYSTEM  Tactile sensation  Superficial pain  Temperature  Vibration & position sense (proprioception) REFLEXES  DTRs (deep tendon reflexes) 0 No response 2+ Normal 3+ Hyper reflexic 4+ Hyperactive GERONTOLOGIC CONSIDERATIONS  Important to distinguish normal aging changes from abnormal changes. a) Structural and physiologic changes b) Motor and sensory alterations c) Temperature regulation and pain perception d) Determine previous mental status for comparison. e) Assess mental status carefully to distinguish delirium from dementia.

DIAGNOSTIC TESTS

a) Computed tomography (CT ): may consent; done immediately; 1-3 days; outer part of the brain; may dye. b) Magnetic resonance imaging (MRI) : may consent; done as per request (5- 7days); tissues; may dye. c) Cerebral angiography : more on visualizations (blood flow). d) Myelography : disorders of the spinal e) Noninvasive carotid flow studies f) Transcranial Doppler : blood flow in the brain; painless g) Lumbar puncture, analysis of cerebrospinal fluid HEAD INJURY  A broad classification that includes injury to the scalp skull, or brain  The most common cause of death from trauma  Most common cause of brain trauma is falls.  Groups at highest risk for brain trauma include: a) Children 0 to 4 years old b) Adolescents ages 15 to 19 years c) Adults 65 years and older SIGNS AND SYMPTOMS  Headache  Bleeding  Nausea and Vomiting  Fever and chills  Convulsion / Seizure  Numbness / Tingling  Reduced LOC / unconsciousness  Discharge of fluid from ears, nose, or mouth (wag na ireport since expected naman na yan lagi sa head injury)  Bruising around eyes  Breathing stops / Slow breathing CLOSED BRAIN INJURY (BLUNT TRAUMA)  acceleration/deceleration injury occurs when the head accelerates and then rapidly decelerates, damaging brain tissue. OPEN BRAIN INJURY  object penetrates the brain or trauma is so severe that the scalp and skull are opened. CONTUSION  More severe injury with possible surface hemorrhage (give CPR; 90% motorcycle riders w/o helmet)  Symptoms and recovery depend on the amount of damage and associated cerebral edema.  Longer period of unconsciousness with more symptoms of neurologic deficits and changes in vital signs CONCUSSION  A temporary loss of consciousness with no apparent structural damage  Patient may be admitted for observation or sent home.  Observation of patients after head trauma; report immediately  Observe for any changes in loc  Difficulty in awakening, lethargy, dizziness, confusion, irritability, anxiety

RISK FACTORS

a) Young age b) Alcohol and drug abuse c) Male AFFECTATION Cl — C4 Respiratory Depression C1 — C8 Quadriplegia (with some arm and hand movement) T1 — T6 Paraplegic, some trunk movement, legs paralyzed T7 — T12 Paraplegic, good upper back and abdominal strength, may function well in wheelchair Thoracic Abdomen and sexual function. Lumbar Leg muscles Sacral Bladder, bowel DIAGNOSTIC TESTS  X-ray  CT Scan  MRI COMPLICATIONS  Spinal and Neurogenic Shock  Deep Vein Thrombosis  Pressure Ulcers  Orthostatic Hypotension  Autonomic Dysreflexia MANAGEMENT

  1. Respiratory function is the first priority especially in cervical spinal cord injury.
  2. Immobilization (flat, firm surface)
    1. Cervical collar (if cervical injury is suspected)
    2. Transport client as a unit.
    3. Do not attempt to realign body parts
    4. Suctioning may be indicated, but used with caution
    5. Position change at least every two hours
    6. Intermittent catheterization for bladder distention
    7. Diet: High-calorie, High protein, High- fiber
    8. Anticoagulants
    9. Anti-embolism stockings
    10. Adequate hydration
    11. Bowel Training program (depending on the affectation) Spinal & Neurogenic Shock SPINAL SHOCK  A sudden depression of reflex activity below the level of spinal injury  Muscular flaccidity  lack of sensation (wag mo na pagagalawin kasi baldado na yung patient forever) and reflexes NEUROGENIC SHOCK  Caused by the loss of function of the autonomic nervous system.  Blood pressure, heart rate, and cardiac output decrease  Venous pooling occurs because of peripheral vasodilation.  Paralyzed portions of the body do not perspire

COMPLICATION

 Autonomic Dysreflexia  Acute emergency!  Occurs after spinal shock has resolved and may occur years after the injury.  Occurs in persons with SC lesions above T6.  Autonomic nervous system responses are exaggerated. SYMPTOMS  Severe pounding headache  Sudden increase in blood pressure  Profuse diaphoresis (pawis na pawis so immediately check vs then provide cpr)  Nausea  Nasal congestion  Bradycardia NURSING INTERVENTIONS

  1. Place patient in seated position to lower BP.
  2. Rapid assessment to identify and eliminate cause.
  3. Empty the bladder using a urinary catheter or irrigate or change indwelling catheter.
  4. Examine rectum for fecal mass.
  5. Examine skin.
  6. Examine for any other stimulus.
  7. Administer ganglionic blocking agent such as hydralazine hydrochloride (Apresoline) IV
  8. Label chart or medical record that patient is at risk for autonomic dysreflexia.
  9. Instruct patients in prevention and management.
  10. Roto Rest Bed
  11. Cervical Collar CONVULSIVE DISORDERS SEIZURE OR EPILEPSY  Is a disorder marked by disturbances of electrical impulse in CNS.  Sudden abnormal and excessive electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation. EPILEPSY  It is a chronic neurological disorder characterized by recurrent seizure activity CAUSES  Tumor  Genetics  Head injury secondary to trauma (dahil may cerebral swelling)  Stress trigger. TYPES GENERALIZED SEIZURES  Entire cerebral cortex is involved TONIC CLONIC (GRAND MAL)  Lasts for 30 to 60 seconds  Characterized by rigidity, fixed & dilated.  pupils, hands, and jaws are clenched.  Patient's breathing may temporarily stop.  Urinary incontinence  With or without aura  Fall, with shaking activity. INITIAL SIGN: Epigastric pain

 Protect the head of the patient.  Maintain airway and promote safety (first priority)  Maintain side rails.  Observe and note for the duration, parts of the body affected, behaviors before and after the seizure.  Loosen constrictive clothing.  Turn head to prevent aspiration (to side)  Do not restrain to prevent fracture, or attempt to place tongue blade or insert oral airway  Tongue guard to prevent biting.  Avoid precipitating factors (wag itutok yung lights sa harap ng pt kasi mag sseizure siya)  Loud noise AFTER SEIZURE  Document the events during and after the seizure.  Side-lying position (prevent aspiration). MEDICATIONS PHENYTOIN (DILANTIN) SIDE EFFECTSGINGIVAL HYPERPLASIA so encourage the pt to use soft- bristle brush DIAZEPAM (VALIUM)  Given for status epileptus PHENOBARBITALS (LUMINAL)  Post-seizure  O2 inhalation  Suction apparatus DOCUMENT a) Onset b) Duration c) Type of seizure d) Duration of post-ictal sleep FOR 1 YEAR OLD  Do not give mouthpiece (since the pt has no teeth yet)  Pillows to support the head.