neuro objectives

what is normal ICP

0-15

what factors influence ICP

brain tissue, blood, CSF

how does CO2 affect ICP

it is a vasodilator so it increases ICP

how does a brain tumor affect ICP

it occupies space so it increases ICP

what does untreated increased ICP lead to

brain herniation and death

what are the S/S of increased ICP

change in LOC, cushings triad, decreased eye reflexes, hemiparesis and hemiplegia, HA, projectile vomiting without nausea

what are some nursing interventions for increased ICP

elevate HOB, hyperventilation, suctioning, NG tube

how does mannitol work

hypertonic fluid/osmotic diuretic for plasma expansion and pulling fluid out of cells to decrease ICP

how dose lasix work

reduces blood volume and rate of CSF production

if a patient is experiencing increased ICP due to increased CO2, what nursing action can be taken

hyperventilate the patient

how does O2 affect ICP

decreases ICP

what does a glasgow coma score of 3 indicate

brain dead

what does a glasgow coma score of 8 or less indicate

coma

what nursing interventions are required for a patient with a glasgow coma score less than 8

monitor ICP

what does a glasgow coma score of 15 indicate

normal

what areas are assessed with the glasgow coma scale

verbal, motor, and eye-opening response

what is decadron

corticosteroid used to treat arthritis and test for cushings syndrome

what is excedrin used to treat

headaches and migraines

what is levadopa used to treat

parkinsons

how does levadopa treat parkinsons

increases dopamine in the brain

what is meningitis

inflammation of the brain and spinal cord that increases CSF production and increased ICP

what is the cause of meningitis

bacterial or viral upper respiratory infection

what are the early S/S of meningitis

fever, nuchal rigidity, HA

what are the severe S/S of meningitis

change in LOC, hemiparesis, abscess, hydrocephalus, waterhouse-friderichsen syndrome

what is waterhouse-friderichsen syndrome

petechiae, PIC, adrenal hemorrhage

what diagnostic test is used to diagnose meningitis

lumbar puncture

what are the nursing interventions for meningitis

low stimulating environment, high protein and calorie diet, ROM, warm baths, monitor vitals and ICP

what is a brain abscess

accumulation of pus in the brain

what diagnostics are used for a brain abscess

CT, MRI

what is the treatment for a brain abscess

antibiotics, incisions/drainage or removal of abscess

what are the S/S of a tension headache

bilateral pressure/tightness, mild-to-moderate severity, photophobia and phonophobia

what is the treatment for tension headaches

ASA, tylenol, ibuprofen

what are the S/S of a migraine

recurring, unilateral, trobbing, worsended with activity, associated with aura

what is the treatment for migraines and cluster headaches

imitrex, ergotamine, midrin, corticosteroids

what are the S/S of a cluster headache

severe, unilateral, abrupt onset, repeated over 2-3 months, facial swelling, lacrimation, rhinnorhea, ptosis

what nursing interventions should be completed after the tonic-clonic phase and during the post ictal phase

turn the patient on their side

when does suctioning and oxygen therapy begin

post-ictal phase

what should you not do for a patient having a seizure

restrain or put anything in the patients mouth

what is the primary seizure medication

tensilon

what is the therapeutic blood level for tensilon

10-20 mcg/ml

how does one monitor tensilon levels

monitor with blood draws prior to morning med

how do you administer tensilon through an IV

dilute and give slowly to prevent hypotension and cardiac dysrhythmias

what are the side effects of tensilon

gingival hyperplasia, slurred speech, confusion, blood dycrasias, hyperglycemia, alopecia, hirsutism

what patient education should be provided to a patient on tensilon

perform good oral hygeine

what is an important assessment question for a patient who arrives to the ER with stroke S/S

when was the patient last seen normal

what is the priority action for a pt with stroke S/S

stat CT to determine if its ischemic or hemorrhage

what is a hemorrhagic stroke

bleeding caused by rupture of a blood vessel resulting in the death of cells

what are the causes of hemorrhagic stroke

HTN and aneurysms

what is the tell-tale sign of a hemorrhagic stroke

worst headache of my life

what is an ischemic stroke

inadequate blood flow to part of the brain from an occlusion of an artery

what is a thrombotic stroke

clot formation due to narrowing of the arteries from plaque

what is an embolic stroke

clot comes from somewhere else in the body and gets stuck in an artery that is too small

what is the cause of an embolic stroke

a-fib

what is the treatment for an ischemic stroke

tPa

what is the treatment for transient ischemic attacks

plavix, aspirin (ASA), and coumadin

how do plavix and aspirin work

prevent platelet aggregation

what is the action of coumadin

anticoagulant

primary nursing diagnosis for tPa use

risk for bleeding

what are surgical interventions to prevent hemmorhagic strokes

clipping or coiling of an aneurysm, endartectomy

S/S of right sided stroke

reckless, impulsive, moves quickly

what are the S/S of a left sided stroke

language skills deficit, very cautious

what occurs in a wernicke deficit

receptive aphasia resulting in difficulty understanding

what occurs in a brocas deficit

expressive aphasia resulting in difficulty speaking and writing

what is the patho of parkinsons

deterioration of the basal ganglia

what are the S/S of parkinsons

tremors, pin-rolling, rigidity, bradykinesia

what is the treatment of parkinsons

levodopa

what are the S/S of levodopa overdose

akinesia (freezing and slow) and athetosis (writhing movement of the neck

what are nursing interventions for parkinsons

small frequent meals, declutter environment, simplify clothing

what is the patho of myasthenia gravis

autoimmune disease that attacks acetylcholine receptors

what are the S/S of myasthenia gravis

progressive weakness, ptosis, voice fading, respiratory problems

what are the causes of myasthenia gravis

stress, infection, extreme temps, hypokalemia

what is the treatment of myasthenia gravis

tensilon, neostigmine, atropine

what is the action of tensilon and neostigmine

cholinesterase inhibitor which increases acetylcholine

what is the action of atropine

blocks acetylcholine

what are the nursing interventions for myasthenia gravis

respiratory support, mechanical soft diet

what is the patho of multiple sclerosis

deterioration of the myelin sheath

what are the S/S of multiple sclerosis

muscle spasticity and stiffness, weakness and paralysis, diplopia, tinnitus, hermits sign (electric shock)

what is the treatment for multiple sclerosis

corticosteroids, immunomodulators, megavitamin therapy, baclofen pump

what is the patho of huntingtons disease

excess of dopamine

what are the S/S of huntingtons disease

involuntary movements (chorea), impaired speech and swallowing, deteriorating gait, intellectual decline

what are the nursing interventions of huntingtons disease

high calorie diet to accommodate chorea

what is the patho of ALS

progressive loss of motor neurons

what are the S/S of ALS

weakness of extremities, dysarthria, dysphagia, respiratory dysfunction

what is the prognosis of ALS

death in 2-6 years from respiratory infection secondary to compromised respiratory function

what is a cholinergic crisis

too much acetylcholinesterase drug that does not respond to tensilon

what med do you give for a cholinergic crisis

atropine

what is a myasthenic crisis

acute exacerbation that responds to tensilon and neostigmine

what is the patho of guillan-barre syndrome

post infectious polyneuropathy resulting in paralysis from the loss of myelin, inflammation of nerves, and loss of neurotransmission

what are the S/S of guillane-barre syndrome

paralysis from the lower extremities up, paresthesia, autonomic dysfunction, SIADH, respiratory failure

what is the treatment of guillane-barre syndrome

plasmapheresis, immunoglobin

what are nursing interventions for guillane-barre syndrome

assess and maintain airway and circulation, foley, passive ROM and repositioning, eye ointment and safety

what is the patho of bells palsy

facial paralysis involving cranial nerve 7

what are the nursing interventions for bells palsy

facial exercises and sling, protect eye from dryness, oral care, chew on unaffected side

what is the patho of trigeminal neuralgia

sensory disorder involving cranial nerve 5

what are the S/S of trigeminal neuralgia

severe, recurrent, sharp pain along nerve distribution in the tongue, gums, nose, and cheeks

what are common triggers for trigeminal neuralgia

cold, washing face, chewing, foods/fluids of extreme temp

what medications can be given for trigeminal neuralgia

elavil, baclofen, tegretol, valium, dilantin

how does alcohol injection help trigeminal neuralgia

produces anesthesia

how does a rhizotomy effect trigeminal neuralgia

severance of sensory root nerves

how does the jannetta procedure help trigeminal neuralgia

relocates artery that is compressing the trigeminal nerve