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RNSG 1327 – Transition to Professional Nursing Unit V– Care of the Patient Experiencing Commonly Occurring Health Problems Part C – Neurological Problems 1. Behavioral Objectives Apply the terms listed in the content column appropriate to the patient situations involving the neurological system. I. Content Outline Application of terms A. Aphasia B. Dysphagia (hemiplegia/hemiparesis) C. Increased intracranial pressure D. Sensorium E. Syncope F. Thrombolytic G. Vertigo 2. Compare and contrast the normal anatomy and physiology to the pathophysiology of selected neurological disease processes in the content column. II. Anatomy & Physiology of Neurological system A. Developmental considerations 1. Infant 2. Child 3. Adolescent 4. Adult 5. Older adult B. Pathophysiology of neurological system 1. Altered cerebral tissue perfusion 3. Analyze factors included in the assessment of the patient experiencing commonly occurring neurological problems, including the developmental and cultural considerations. III. Selected commonly occurring neurological problems A. Interview 1. Chief complaint 2. Precipitating event 3. Medical history 4. Family/ Social/Occupational history 5. Medication history 1. Prescription 2. Nonprescription 6. Knowledge of health maintenance 7. Risk factors B. Physical exam – neurological 1. Level of consciousness 2. Motor function 1. Strength 2. Symmetry 3. Tone 68 Clinical Objectives Learning Opportunities Readings: Adams Lewis McKinney Estes RNSG 1327 – Transition to Professional Nursing Unit V– Care of the Patient Experiencing Commonly Occurring Health Problems Part C – Neurological Problems Behavioral Objectives Content Outline Posture Reflex (1) Gag (2) Swallow (3) Babinski 3. Sensory 4. Vital signs (breathing pattern) 5. Glasgow coma scale 6. Pupillary response C. Diagnostic tests 1. Radiology 1. Computed axial tomography (CT) 2. Magnetic Resonance Imaging (MRI) 3. Magnetic Resonance (MRA) 4. Cerebral arteriogram 2. Laboratory studies 1. PT/PTT 2. INR 3. Other 1. Carotid Doppler studies 2. Lumbar puncture D. Risks 1. Cultural influences 2. Hereditary 3. Environmental 4. Health beliefs/practices 5. Developmental (1) Age specific assessment data (2) Vital signs (3) Fluid /electrolytes (4) Nutritional (5) Behavioral/emotional response to health care providers 4. 5. 3. Differentiate between the etiology, pathophysiology, and clinical manifestations of selected IV. Common Occurring Neurological Problems A. Neurological / Cerebral Vascular Disease 1. Cerebral Vascular Accident (CVA) 69 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of the Patient Experiencing Commonly Occurring Health Problems Part C – Neurological Problems 4. Behavioral Objectives commonly occurring neurological disease processes. Content Outline 1. Ischemic 2. Hemorrhagic 2. Transient Ischemic Attack (TIA) Discuss analysis, planning, implementation, and evaluation for the nursing management of patients with commonly occurring neurological disease processes. V. Selected Nursing Diagnoses/Implementation/ Evaluation A. Altered Cerebral Tissue Perfusion 1. Independent Interventions 1. Monitor neurological status (Glasgow Coma Scale) 2. Positioning (1) Prevention of aspiration (2) Prevention of contractures (3) Decrease intracranial pressure 3. Range of Motion (ROM) 4. Safety Issues: prevention of injuries 5. Monitor VS 2. Collaborative interventions 1. Oxygen support 2. Administer medications and monitor for desired/adverse/side effects (1) Antihypertensives (2) Steroids (3) Anticonvulsants (4) Anticoagulants (a) Low Molecular Weight Heparin (b) Low Dose Heparin (5) Antiplatelets 3. Nutritional support (1) Prevention of aspiration: Thickening agents (2) Enteral feedings 4. Collaborate with other health care professionals (1) Physical therapy (2) Occupational therapy 70 Clinical Objectives Learning Opportunities RNSG 1327 – Transition to Professional Nursing Unit V– Care of the Patient Experiencing Commonly Occurring Health Problems Part C – Neurological Problems Behavioral Objectives 3. 4. Content Outline (3) Speech therapy Recognition of complications 1. Aphasia 2. Contractures 3. Aspiration pneumonia 4. Death Evaluation of Outcomes: The patient will have improved cerebral tissue perfusion as evidenced by: 1. Level of consciousness 2. Motor function 3. Sensory function 4. Glasgow coma scale 5. Vital signs 6. Breathing pattern N:\ADN/Transition/RNSG 1327/Unit V – C/ Neurological Clinical Objectives Learning Opportunities Reviewed 03/12 Reviewed 03/13 71