Transcript Nursing Care for patients with neurosensory problems

Nursing Care for patients with
neurosensory problems
Session 9 & 10
Nadeeka Jayasinghe
CONTENT
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Diagnostic studies
Neurological assessment
Stroke – assessment, nursing management
Infectious diseases – menengitis
Reading: Cranial nerve function
Brain Needs…
• Blood flow
• Glucose
• Oxygen
Diagnostic Studies
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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
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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
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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
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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:
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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.