Exam 15: Intro to Neuro
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| 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.
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| Loss of brain weight and neurons (1% a year after age 50). | The cortex loses cells faster than the brainstem
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| Remaining cells have structural changes | a. Decreased interconnections of dendrites.
b. Neurons may contain: senile plaques, neurofibrillary tangles, and lipofuscin (age pigment).
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| 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.
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| 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.
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| Comprehensive Hx (Subjective data) for Mental Status | A&O x3.
Mood & behavior.
General Knowledge.
Short & Long-term memory.
Attention span.
Ability to concentrate.
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| 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.
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| Arousal (wakefulness) | responsiveness to auditory, visual, and tactile stimuli, the most fundamental part of LOC.
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| Awareness | a higher function controlled by brainstem; reflected in orientation to person, place, and time; ability to interact with and interpret the environment.
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| 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.)
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| Level of Consciousness (5 levels) | Alert.
Disorientation.
Stupor.
Semicomatose.
Comatose.
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| Level of Consciousness: Alert | Appropriate responsiveness to auditory, visual, and tactile stimuli.
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| Level of Consciousness: Disorientation | Unable to follow simple commands, thinking slowed, inattentive, flat affect
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| Level of Consciousness: Stupor | Responds to verbal commands with moans or groans, if at all, seems unaware of surroundings
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| Level of Consciousness: Semicomatose | Patient can only be aroused with energetic stimulation.
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| Level of Consciousness: Comatose | Does not respond to external stimulation, cannot swallow or cough, absent corneal and papillary reflexes
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| 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).
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| 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).
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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