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M6 13-005

Exam 15: Intro to Neuro

Physiological changes of the nervous system that occur with aging Loss of brain weight and neurons. Remaining cells have structural changes. ↓ in cerebral blood flow. ↓ in brain metabolism and oxygen utilization. ↓ in the velocity of nerve impulses. ↓ blood supply to the spinal cord resulting in ↓ reflexes.
Loss of brain weight and neurons (1% a year after age 50). The cortex loses cells faster than the brainstem
Remaining cells have structural changes a. Decreased interconnections of dendrites. b. Neurons may contain: senile plaques, neurofibrillary tangles, and lipofuscin (age pigment).
Effects of Physiologic changes (getting older) ↓ sense of touch & fine motor skills. Short-term memory affected. Stroke, dementia, organic brain syndrome & alzheimer;s ↑. Altered sleep/wakefulness ratio. ↓ ability control temp. Learning speed ↓. Many reach old age w/ no functional deterioration.
Comprehensive Hx (Subjective data) for diagnosing neurological disease HA, pain level & frequency. Loss of function. Visual changes. New or worsening seizure activity. Pain or numbness. Mood swing/ personality changes. Extreme fatigue or tiredness.
Comprehensive Hx (Subjective data) for Mental Status A&O x3. Mood & behavior. General Knowledge. Short & Long-term memory. Attention span. Ability to concentrate.
Assess level of consciousness: earliest and most sensitive indicator of patient’s neurologic status Altered LOC results from impaired cerebral blood flow. Consciousness: comprises arousal (wakefulness) and awareness. LOC. Need to evaluate type and degree of stimulus needed to evoke arousal. GCS. FOUR Score Coma Scale.
Arousal (wakefulness) responsiveness to auditory, visual, and tactile stimuli, the most fundamental part of LOC.
Awareness a higher function controlled by brainstem; reflected in orientation to person, place, and time; ability to interact with and interpret the environment.
Four Components of Awareness Orientation- person, place time and purpose Memory- short term memory, open questions Calculation- simple math problem Fund of Knowledge- what is in the news (eg.)
Level of Consciousness (5 levels) Alert. Disorientation. Stupor. Semicomatose. Comatose.
Level of Consciousness: Alert Appropriate responsiveness to auditory, visual, and tactile stimuli.
Level of Consciousness: Disorientation Unable to follow simple commands, thinking slowed, inattentive, flat affect
Level of Consciousness: Stupor Responds to verbal commands with moans or groans, if at all, seems unaware of surroundings
Level of Consciousness: Semicomatose Patient can only be aroused with energetic stimulation.
Level of Consciousness: Comatose Does not respond to external stimulation, cannot swallow or cough, absent corneal and papillary reflexes
3 Parts of the Glascow Coma Scale Eye Open. (4,3,2,1,U). Best Verbal Response. (5,4,3,2,1,U). Best Motor Response. (6,5,4,3,2,1,U).
FOUR Score Coma Scale Eye Response (4,3,2,1,0). Brainstem Reflexes (4,3,2,1,0). Motor Response (4,3,2,1,0). Respirations (4,3,2,1,0).
About FOUR Score Coma Scale a. Full Outline or Unresponsiveness Score: assesses patients with neurologic conditions that affect cognitive function e.g. stroke, craniotomy, and traumatic brain injury. b. The scores are not totaled. c. May be used as a complement to the GCS.
About Glascow Coma Scale Quick, practical and standardized system for assessing the degree of consciousness. Predicts the duration and outcome of coma. Stronger the stimulus needed to the obtain a patient response, the lower the score, the lowest is 3.
Neurological Diagnostic Testing: Blood and Urine assist in identifying causes for neurological impairment: a. Urine- rule out infection, diabetes, drug use. b. ABG- altered breathing pattern associated with GBS.
Neurological Diagnostic Testing: CSF a. Normal: 10 lymphocytes per milliliter. b. Increased whites may indicate infection. c. Glucose may be lowered in case of infection culture and smears.
Neurological Diagnostic Testing: Radiographs, Scans, and Grams CT Scan. Brain Scan. MRI. PET. Lumbar Puncture. Electroencephalography (EEG). Myelogram. Angiogram. Carotid Duplex. Digital Subtraction Angiography. Electromyography. Echoencephalogram.
Potential nursing diagnosis for a patient undergoing a neurological assessment. Knowledge deficit related to procedure. Anxiety related to procedure. Alteration in comfort related to procedure.
Created by: jtzuetrong