NURS 371 Lecture 35: NeuroPart1
Neuro part 1
1
Care of the Neurological Patient
Diagnostics
• Computed Tomography (CT): looks at tissue with cross sectional images. Used to dx bleeding,
tumors, edema, infarcts. Can be with or without contrast.
o Contrast: assess for allergies to shellfish or iodine. Assess renal function. Can be PO or IV. If
IV, may feel flushed. Need to increase fluids after.
o Spiral CT: fast scanning. Higher resolution. Continuously rotates. Can obtain 32 images per
second so there is a faster scan.
• Magnetic Resonance Imaging (MRI): very fine soft tissue
o Not appropriate for emergencies bc takes too long.
o Used to dx MS, herniation, trauma, spinal cord injury
o Using magnets, so no metal.
o Safer for pregnant women bc no radiation. Must remain still
• Cerebral Angiography/Angiogram
o Images of the blood vessels fo the brain.
o Allows for intervention during procedure.
o Go through femoral or brachial artery and inject contrast. See how contrast moves to the
brain.
o Need to assess for allergies. Assess renal function.
o NPO 8 hours before.
o After: need assessment of catheter site to ensure no bleeding. Check circulation distal to site.
Ensure good urine output. Assess neuro status.
o Performed in radiology.
• Lumbar puncture
o Sterile procedure.
o Side lying position. Spinal needle is inserted between 3 and 4 lumbar vertebrae. Fluid
obtained and sent to lab. Dressing applied. Pt must lay flat and on back for at least 2 hours
after. If raise head of bed too quickly, can cause headache.
o Encourage fluids. Assess neuro status. Assess puncture site. Watch for S&S of meningitis
(stiff neck, photophobia, fever, seizures.)
• Myelogram
o Subarachnoid space is injected with contrast via LP.
o Look for spinal lesions.
o NPO before
o Assess allergy to contrast.
o Pt must lay flat and on back for at least 2 hours after.
• Electrographic Studies
o EEG
▪ Used if seizure activity, sleep disorders, cerebral disorders.
▪ Takes about 1 hour.
▪ Looks at electrical activity in brain.
▪ Electrodes are placed on the head.
▪ Pre: no caffeine. Wash hair. No products in hair. Hold anti-seizure meds.
▪ May be exposed to flashing lights.
▪ Post: wash hair.
o Electromyography & nerve conduction studies
▪ Electromyography: Look at electrical activity by innervating the skeletal muscle.
Insert little needles and stimulate muscle.
▪ Nerve condition: stimulus applied and recorded over electrode.
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Neuro part 1
2
o Evoked potentials
▪ Record electrical activity by looking at nerve conduction pathways.
▪ Sensory stimulus and look at reaction of nerve pathway.
▪ Can look at visual, auditory, etc.
Glascow Coma Scale
• Total scores correlate with the degree or level of coma
• Helps to determine level of consciousness.
• If drops more than 2, notify MD.
• 15=normal, best possible score
• 8 or below = coma.
• 3=deep coma
• Eyes open
o Spontaneously = 4, to verbal = 3, to pain=2, no response = 1
o Brisk constriction to light is normal.
o Fixed, unresponsive to light= increased ICP
o Pinpoint pupils: pons hemorrhage, opioid OD, eyedrops
o Large pupils: eyedrops, decreased light
o Sluggish: pressure on cranial nerve 3
o If cranial nerve 3 compressed due to increased ICP, pupil on effected (ipsilateral) side is
larger. If ICP continues to increase, both eyes dilate.
o Dilated and no reaction: pressure on cranial nerve, late sign.
o
• Motor Response to verbal command
o Obeys = 6, localizes to pain = 5, flexion withdrawal =4, flexion abnormal (decorticate) =3,
extension abnormal (decerebrate) = 2, no response = 1
• Verbal
o Oriented & converses = 5, disoriented & converses = 4, verbalizes = 3, vocalizes = 2, no
response = 1. T= intubated.
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Neuro part 1
3
If fever does not go down with an antipyretic, it is due to a brain injury.
Concussion
• Most common type of traumatic brain injury
• Brain receives injury/trauma from direct impact or a sudden movement or momentum change
• May or may not experience brief LOC (< 5 minutes)
• Sx:
o HA, retrograde amnesia
• Let MD know if behavioral changes or other problems
• Dx: CT, H&P
• Post-Concussion Syndrome
o Secondary head injury
o May cause attention, memory, mood changes.
Contusion
• Bruise or bleeding on the brain
• Can be a result of direct impact to the head
• Concern for swelling and bleeding bc increased ICP.
• Large contusions may need surgical intervention
• May cause seizures esp in frist 7 days after injury.
• Assess for anticoagulant usage
• If large, go in and remove blood to decrease ICP. Drill a hole and put in drain.
• Coup – Contrecoup Injury
o Contusion at site of impact and causes another at opposite side bc brain is hit so hard.
o Causes shearing of subdural veins causing bleeding.
o Happen in one continuous motion.
o Head hits something= coup
o Brain hits within the skull = contrecoup.
A- Decorticate- flexion of the upper
extremitites. Extension and internal
rotation of lower extremities. Pull arms
into the center of the body. Shows severe
damage above midbrain.
B- Decerebrate- Arms and legs straight out
away from core. Muscle are tight and rigid.
Suggests damage at the midbrain. Wrists
pull out from the body and toes are
pointed. WORSE.
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Document Summary
Neuro part 1: computed tomography (ct): looks at tissue with cross sectional images. Can be with or without contrast: contrast: assess for allergies to shellfish or iodine. Need to increase fluids after: spiral ct: fast scanning. Must remain still: cerebral angiography/angiogram, images of the blood vessels fo the brain, allows for intervention during procedure, go through femoral or brachial artery and inject contrast. See how contrast moves to the brain: need to assess for allergies. Assess renal function: npo 8 hours before, after: need assessment of catheter site to ensure no bleeding. Assess neuro status: performed in radiology, lumbar puncture, sterile procedure, side lying position. Spinal needle is inserted between 3 and 4 lumbar vertebrae. Pt must lay flat and on back for at least 2 hours after. If raise head of bed too quickly, can cause headache: encourage fluids.
