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Neuro Test Review Stroke- (Ischemic) lack of blood supply where cells directly causes cellular necrosis (Hemorrhagic) blood vessels ruptures and leaks into brain Priority of care Maintain an open airway Interven>ons based on assessment findings Maintain an open airway, Fluids and an9hypertensives, Temperature control, Alteplase or systemic 9ssue plasminogen ac9vator and other medica9ons, Surgical procedures, Cerebral Angiogram Difference between TIA Brief interrup9on in blood flow; Symptoms generally last no more than 1 hour and completely resolve without residual deficits and Stroke interrup9on of blood flow to a specific area of the brain causing brain death Lifestyle modifica>ons to prevent stroke: no smoking, exercise, diet, medica9on regimen Warning signs of a stroke: Sudden weakness, numbness, 9ngling, or loss of feeling in the face, arm, or leg / Sudden trouble seeing in one or both eyes; double vision / Sudden confusion, slurred speech, trouble talking, or difficulty understanding what others are saying / A sudden, severe headache for no known reason / Sudden trouble walking, dizziness, or a feeling of spinning around / Loss of balance or coordina9on / Blackouts Complica>ons of Stroke-what does the nurse do? Extension of hemorrhage or rebleed- Monitor neurologic signs & LOC, keep pa9ent quiet, minimize outside s9muli / Seizures- Treat with an9 seizure medica9on / Hydrocephalus (Prevent ICP)- shunt fluid out of brain; catheter is placed lateral ventricle tunneled down to right atrium or peritoneal cavity to drain excess fluid Treatment: An9-cholinergic, Dopamine agonists, Monoamine oxidase inhibitors (MAOIs block the metabolism of dopamine, leaving more dopamine in circula9on), Physical therapy, Emo9onal support, Complementary and alterna9ve therapies, Surgical treatment, Deep brain simulator Homonymous hemianopsia- nursing interven>ons to accommodate the visual changes place items in loca9on that is visible Guillain- Barre Demyelina9on, inflamma9on, edema, and nerve root compression. Causes unknown, but usually follows a viral respiratory infec9on or gastroenteri9s in adults within 10-21 days. Possible cell-mediated immunologic response s9mulated by viral infec9on, trauma, surgery, viral immuniza9ons, HIV, or lympha9c system neoplasm. S/S Orthosta9c hypotension / Hypertension / Abnormal vagal responses Bowel and bladder dysfunc9ons Facial flushing / Diaphoresis / Mild sensa9ons of numbness and 9ngling in the feet and hands followed by muscle pain, tenderness, and aching (especially shoulder, pelvis, thigh) / Progressive muscle weakness usually star9ng in lower extreme9s and moving upwards over 12-72 hrs / Sensory loss can occur / Pain – paresthesias, muscle aches and cramps, hyperesthesia; o\en worse at night

nursing interven>ons Acute phase Vital signs, cardiac monitoring, Respiratory issues then suc9on, tracheostomy care, ar9ficial ven9la9on (goal is sustain life, prevent complica9ons, r/t immobility and promote rest and comfort Sta9c Phase 1 - 3 weeks a\er onset of illness can last few days to few months / Prevent complica9ons of immobility / help pa9ent deal with feelings of anger, depression, and anxiety / Exercise limited to PROM or gentle ROM and stretching exercise / balance and rest / No sudden posi9on change / Me9culous skin care d/t immobility / monitor for thrombophlebi9s / elas9c stockings and SCDs, an9coagulant therapy Rehabilita9on phase gradual recovery / prevent overexer9on/ level of exercise slowly increased / can take up to 2 years to get back to normal how soon aOer will symptoms be present usually follows a viral respiratory infec9on or gastroenteri9s in adults within 10-21 day (2 to 4 weeks) Seizure any 9me the brain is deprive of oxygen. Epilepsy reoccurring seizures; abnormal neurons fire spontaneously that causes excessive excita9on or loss of exhibi9on Types Focal/simple seizure- only affect one part of the brain; localized clinical symptoms Generalized seizure- involve both sides of the brain whole body motor clinical symptoms Absence seizure twitching around the eyes and mouth, lapse of acen9on, blank stare Most common in children, change in LOC (Blinking, blank staring), no motor ac9vity, last only seconds Tonic When muscles become rigid, Only has the tonic phase, sudden loss of LOC, muscle rigidity, can present with arrhythmia, apnea, vomi9ng, incon9nence, and saliva9on.Lasts several seconds to mins. Tonic-clonic Lasts only a few seconds, Loss of consciousness and muscle s9ffening, rhythmic jerking for 1-2 mins, cyanosis can occur, bi9ng of cheek or tongue, incon9nence followed by pos9ctal phase (confusion, weakness, and sleepiness for several hours a\er). Atonic/Akine9c seizures-drop acack; person suddenly falls loss of body muscle tone nodding of the head, weakness of the knees, or total collapse; recover and regain consciousness a\er 10 secs to a minute Status Epilep9cus Rapid, unrelen9ng series of convulsive seizures without intervening periods of consciousness, and an absence of respira9on Irreversible brain damage can occur if the seizures are not controlled. Causes Gene9cs, Febrile state, Head trauma, Cerebral edema, infec9on, exposure to toxins, stroke, heart disease, Brain tumor, Hypoxia, withdrawal, fluid and electrolyte imbalance.and s/s, (see above yellow highlights for S/S) Injury preven>on **Prevent injury, protect the head, never pry open the mouth** Pa>ent Educa>on Self care requires understanding nature of disorder / purpose of taking medica9ons, side effects, signs of toxicity / must understand compliance of taking meds to prevent seizure / develop coping mechanisms / avoid triggers / meds taken on 9me same 9me daily/ schedule to take labs / medical bracelet / keep appointment/ dangers swimming alone / refrain from driving / avoid alcohol / consult HCP before use OTC / and nursing considera>ons Ensure that the environment is SAFE :Pad bed and side rails / Never try to open the pa9ent’s mouth or insert anything to the jaw that is clamping down / Do not move them during the seizure / Remove restric9ve clothing and glasses / Turn the head to the side to the prevent aspira9on / Administer supplemental oxygen if needed / Turn pa9ent to the side and suc9on airway a\er them a\er seizure / Stay with pa9ent un9l they gain consciousness / Encourage rest and

sleep what needs to be documented when a seizure occurs Time the seizure began and the 9me it ended / What the pa9ent was doing just before the seizure / Where in the body the seizure began; what parts of the body are involved / Which way the eyes are moving, whether they constrict or dilate, deviate to the right or the le\, or roll upward / Which side the head turns toward / Whether the pa9ent cries out or screams as the seizure begins / Whether there is evidence of repe99ve movements: lip smacking, chewing, grimacing, tapping, or “pill rolling” / Whether movements are bilateral and symmetrical / Incon9nence of urine or stool, vomi9ng, frothing at the mouth, or bleeding / Whether the pa9ent becomes apneic or cyano9c / Changes in skin color or profuse perspira9on / Be able to differen>ate between the different types of seizures: specific signs and symptoms See above TYPES Phases: Aura an event before seizure begins Prodromal event during seizure Pos>ctal event a\er seizure Seizure Precau>ons, Medica>ons given: Dilan>n watch for gingival hyperplasia, monitor levels, don’t stop abruptly, bradycardia Tegretol visual problems, ataxia, ver9go, Depakote: an>convulsants GI upset, hepatotoxicity Aneurysm An abnormal ballooning of an artery wall S/S of condi>on severe headache but if bleeding slow gradual progression of headache, neck s9ffness, blurred vision nursing interven>ons surgery angioplasty with stent if found before rupture and implica>ons ( and signs of worsening condi>on (Sudden headache, worst headache, pass out) ALS A progressive neuromuscular disease characterized by degenera9on of the gray macer in the anterior horns of the spinal cord and the lower cranial nerves. Electrical and chemical messages from brain can't reach muscles.Disease progresses rapidly. 3 year life expectancy – death usually from respiratory infec9on and dysfunc9on S/S 1st – weakness of voluntary muscles – especially distal muscles of the extreme9es / Difficulty swallowing and speaking clearly / Atrophy of muscles / Spontaneous contrac9ons or spas9city of the muscles and abnormal sensa9ons (paresthesias) / pain / Mentally alert / No sensory impairment Phases of coping (Be suppor9ve) Nursing diagnoses for this pa>ent Impaired mobility / Impaired communica9on / High risk for aspira9on / Ineffec9ve breathing pacern Parkinson’s Pathology Degenera9on of the dopamine-producing neurons in the substan9a nigra of the midbrain Gene9c predisposi9on, reduced uptake of dopamine, toxins. Affects motor structures in basal ganglia. The part of the brain that controls balance and coordina9on. S/S Onset is gradual, Slow, monotonous speech, Cons9pa9on, May involve one side of body ini9ally, Difficulty with enuncia9on, Incon9nence, Decreased sexual ability, Drooling, Excessive perspira9on, DOES NOT AFFECT INTELLECT, Mask- like/blank face, Decreased tearing, Heat intolerance symptom management (An9-cholinergic, Dopamine agonists, Monoamine oxidase inhibitors (MAOIs block the metabolism of dopamine, leaving more dopamine in circula9on), Physical therapy, Emo9onal support, Complementary and alterna9ve therapies, Surgical treatment, Deep brain simulator)

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triad s/s (Tremor / Bradykinesia / Rigidity )Complica>ons (Dysphagia, Limited mobility, Immobility related problems, Cons9pa9on, Urinary incon9nence, Insomnia ) and progression of the dz ( Onset is gradual) Nutri>on recommenda>ons (High-Calorie, high-protein) stages (THE FIVE STAGES OF PARKINSON’S Stage I •Unilateral shaking or tremor of one limb Stage II •Bilateral limb involvement, making walking and balance difficult Stage III •Physical movements slow down significantly Stage IV •Tremors can decrease but akinesia and rigidity make ADLs more difficult Stage V •Unable to stand or walk, dependent on care S/S of demen>a present Carbidopa- Levodopa treat seizures Brain tumor Earliest indicators Severe headache, Seizures- first sign of a brain tumor Brain tumor complica>ons: hydrocephalus obstruction of CSF Treatment- shunt to drain excess CSF from the ventricles to the peritoneal cavity or atrium of the heart intracerebral hemorrhage bleeding in the brain that occurs because the tumor causes blood vessel necrosis.Treatment- stop bleeding and reduce ICP and seizures first sign of a brain tumor. Common in primary and metasta9c brain tumors. treat with an9convulsants Tensilon test Used to diagnosis MYASTHENIA GRAVIS Bacterial Meningi>s (Meningi9s is an inflamma9on of the membranes covering the brain and spinal cord and is caused by an infec9ous agent) S/S (Sudden onset Fever, Severe and persistent headache aggravated when moving the head, pain, s9ffness in neck, photophobia, Brudzinski sign Kernig sign interven>ons preven9on of permanent disability, an9bio9cs, Dexamethasone for inflamma9on, An9convulsant, acetaminophen for headache Brudzinski sign Bend neck, hips, and knees flex Kernig sign Knees cannot extend due to pain when hip flexed 90 degrees nuchal Rigidity pain and s9ffness of the neck when flexing the neck priority in assessment and care Conserve the strength of the pa9ent. Prevent seizures. Promote healing diagnos>c tests for confirma>on Lumbar puncture and CSF examina9on Headaches- Types (differen>ate between a tension occurs when the neck and scalp muscles become tense or contract. Pa9ent’s may say “feels like a 9ght band around forehead”. cluster sudden, excruciating headaches that may occur during sleep, several times a day, and last 2-3 months (clusters) or migraine headache) Light and sound sensi9vity Lifestyle modifica>ons Oxygen, wear protec9on ear plugs, Relaxa9on, massage, or yoga, Tension-reducing medica9ons, Analgesics, Muscle relaxants , iden9fy triggers Help with migraine preven>on

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Riboflavin (vitamin B2) coenzyme Q10 (CoQ10) magnesium bucerbur root extract (Petasites hybridus), feverfew (Tanacetum parthenium)

Bell’s Palsy Weakness or paralysis is supplied by the facial nerve s/s numbness, par9al, and/or total paralysis (weakness on one side of face, can be caused by herpes zoster stress, numbness, Exposure to cold causes intense pain. Stress is a factor. MAOI (Monoamine Oxidase Inhibitor) - special dietary instruc>ons—Avoid/Cau9on Tyramine (wine, aged cheese, salami, aged cheeses, fermented, smoked fish or meat, yeast extract , some imported beers, Chian9 wine, dietary protein supplements Mul>ple Sclerosis plaques form along the myelin sheath, causing inflamma9on. When myelin is eroded by inflamma9on and replaced by scar 9ssue, nerve impulses cannot travel along the damaged neurons Cause Exact cause unknown – possible environmental plus gene9c predisposi9on S/S Motor dysfunc9on: weakness or paralysis of limbs, trunk, and neck; diplopia, and spas9city of the muscles. Sensory dysfunc9on: numbness, 9ngling, burning, and painful sensa9ons, Patchy Blindness, dizziness; ringing in the ears; and hearing loss. Problems of coordina9on: Unsteady Gait, slurring of speech, and dysphagia Mental changes depression and cogni9ve problems, impaired judgment, decreased ability to solve problems Fa9gue- worsened by heat Other Problems urinary and bowel incon9nence and altered sexual func9on Educa>on to maintain health Discuss coping mechanisms and support for family as disease progresses, Encourage fluids, ROM exercises, energy conserva9on, home safety, Do NOT expose pa9ents to excessively hot baths, Monitor for s/s of UTI Myasthenia Gravis An autoimmune disease in which a T cell– dependent immune acack is directed against the postsynap9c ACh receptors at the neuromuscular junc9on “Grave muscle weakness” S/S Diplopia, difficulty chewing, and swallowing, and ptosis / voice tends to be hoarse or nasal in quality, and voice volume decreases toward the end of a sentence / Muscle weakness- neck, shoulders, limbs, hands, diaphragm, and abdomen / Respiratory muscle weakness may require mechanical ven9la9on.The muscular weakness can be so mild that it causes a minor inconvenience or so severe that it is life threatening because of its effect on the muscles used for breathing and swallowing diagnos>c tes>ng and how it is done A Tensilon test is a diagnos9c test used to evaluate myasthenia gravis, which is a neuromuscular condi9on characterized by muscle weakness. The test involves an injec9on of Tensilon (edrophonium), a\er which your muscle strength is evaluated to determine whether your weakness is caused by myasthenia gravis or not Poten>al complica>ons Dysphagia, mobility becomes severely limited, Cons9pa9on, urinary incon9nence, and insomnia Alzheimer’s dz Slow onset, progresses at varying rates of speed through several stages, and is eventually fatal. Pathologic changes in the brain 9ssue of the pa9ent nursing considera>ons (Observe pa9ent behaviors to determine risk factors • Provide safe environment • Provide frequent walks • Small, frequent meals, finger foods, encourage fluids • Check skin integrity • Maintain sleep schedule and bowel and bladder program • Keep pa9ent cogni9vely s9mulated, do not over s9mulate • Provide consistency • Memory training • Promote self care • Speak in direct, short, and concise sentences • Reduce agita9on) family Educa>on Family focused • Home safety- Door

locks, water heater, thermostat, good ligh9ng, place macress on the floor, clear hallways, install handrails, GPS tracker, reduce caregiver stress...