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M6 13-005
Exam 15: Intro to Neuro
Term | Definition |
---|---|
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. |