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Download Nursing Care for patients with neurosensory problems
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Nursing Care for patients with neurosensory problems Session 9 & 10 Nadeeka Jayasinghe CONTENT • • • • • Diagnostic studies Neurological assessment Stroke – assessment, nursing management Infectious diseases – menengitis Reading: Cranial nerve function Brain Needs… • Blood flow • Glucose • Oxygen Diagnostic Studies • • • • • • • Skull and Spinal Radiology CT (Computerized Tomography) MRI (Magnetic Resonance Imaging) PET (Positron Emission Tomography) EEG (Electroencephalogram) EMG (Electromyelogram) Cerebral Blood Flow Studies Neurological Assessment • • • • • • • Level of Consciousness (LOC) Pupils Vital Signs (VS) Neuromuscular status Response to stimuli Posturing Glasgow Coma Scale (GCS) STROKE Types of Stroke • Ischemic: embolic or thrombotic ▫ blocked blood flow to the brain • Hemorrhagic: ICH, SAH, ruptured cerebral aneurysm • TIA: This is a stroke, although symptoms resolve within an hour Signs and Symptoms of Stroke • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden dizziness, loss of balance or coordination or trouble walking • Sudden severe headache with no known cause Risk Factors • • • • • • • • • • • • High blood pressure Carotid artery disease Physical inactivity Excess alcohol intake Atrial fibrillation Diabetes Heart disease Smoking Family history Prior stroke/TIA High cholesterol Obesity Treatment for Ischemic Stroke ▫ tPA=Thrombolytic agent ▫ Document time of symptom onset. (If awoke with symptoms, must go by time when last seen normal) ▫ Immediate head CT (check for blood) ▫ Evaluate for tPA administration (review exclusion/inclusion criteria) Treatment Cont… ▫ If not a tPA candidate, ASA in ED. Rectal ASA if fails swallow eval. or if swallow eval. not complete. ▫ Keep NPO, until a formal swallow eval. is done. ▫ Admit as Inpatient and perform diagnostic testing: Carotid US, Echo, TEE, ECG monitoring for a-fib, MRI, fasting Lipid, Clotting disorder blood work (Antiphospholipid, Factor V, Antithrombin III) ▫ Rehabilitation Hemorrhagic Stroke Treatment • Do not give antithrombotics or anticoagulants • Monitor and treat blood pressure greater than 150/105 (Table 6, 2005 Guidelines update) • NPO, until swallow eval is completed • Anticipate Neurosurgical consult • Possible administration of blood products Treatment Cont… ▫ If not a tPA candidate, ASA in ED. Rectal ASA if fails swallow eval. or if swallow eval. not complete. ▫ Keep NPO, until a formal swallow eval. is done. ▫ Admit as Inpatient and perform diagnostic testing: Carotid US, Echo, TEE, ECG monitoring for a-fib, MRI, fasting Lipid, Clotting disorder blood work (Antiphospholipid, Factor V, Antithrombin III) ▫ Rehabilitation Meningitis • An inflammation of the meninges of the brain and spinal cord ▫ Bacterial Causes:Meningococcus and pneumococcus ,Haemophilusinfluenza Organisms enter brain by: Blood stream Respiratory tract Penetrating wounds of skull It is secondary to another infections such as otitismedia, upper respiratory infection,pneumonia Viral (aseptic): less severe than bacterial Clinical Presentations ▫ High fever, tachycardia, chills, petechial rash ▫ ▫ ▫ ▫ ▫ ▫ headache, photophobia, stiff neck Nausea, vomiting papilledema (> ICP),confusion, altered LOC Restlessness and irritability Seizures Brudzinski’s: passive flexion of the neck produces pain & increased rigidity ▫ Kernig’s: Flex hip and knee and then straighten the knee…pain or resistance? complication of Meningitis Seizures Sepsis Cranial nerve dysfunctions Cerebral infarction Coma Death Collaborative care • Bacterial menigitis is a medical emergency • Treatment focus on rapid diagnosis and starting IV antibiotic therapy immediately(7-21 days) • Isolation • Antipyretics • Analgesics • Anticonvulsants • Osmotic diuretics • IV fluids Diagnosis • lumbar puncture :collect samples of CSF • Bacterial: ▫ ▫ ▫ ▫ ▫ Cloudy csf Elevated protein level Increased WBC Decreased glucose level Elevated CSF pressure ▫ C&S OF CSF ▫ CBC ▫ Cultures from Blood, urine, throat, nose Cranial Nerve function • Reading: Perry, A & Potter, A 2010, “Clinical Nursing Skills & Techniques”, 7th edition, Mosby Elsevier, St Louis, pg 764.
