Intracranial and Other Neurologic Disorders - Worksheet Study Guide

Intracranial and Other Neurologic Disorders – Worksheet Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Increased intracranial pressure Etiology/Pathophysiology (Possible Causative and Risk Factors) Causes: Increased blood= STROKE Head trauma “High pressure inside the Meningitis cranium” (head) which puts pressure on the BRAIN which controls BREATHING Tumor and HEART RATE. Clinical Manifestations Earliest sign of ICP: Altered level of consciousness: Irritability, Restlessness & agitation & Decreased mental status Sleepiness INCREASED pressure in the brain. Flat affect and drowsiness Headache – constant Sudden Vomiting “Emesis” without Nausea = REPORT TO PCP “PRIORITY” Late DEADLY sign: Lungs: Irregular respirations “Cheyne stokes respirations” Diagnostic Tests Imaging: CT scan “1st test” Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications I C P S: I: Immobilize head “C-spine” NO lumbar puncture (Spinal tap) ICP monitoring Normal: 5-15mmHG (High risk of infection) Head in neutral position Log roll “As one unit” C: CO2 LOW P: Positioning Head of the bed – Semifowler’s (30-35 Degrees or higher) No flexion or bending extremities No coughing, sneezing, blowing nose. No Valsalva Maneuvers or holding breath S: Suctioning Neck: Nuchal rigidity (Stiff neck) “Pt. 1 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications complains cannot FLEX chin toward chest” Brain stem affected: Eyes: Pupils FIXED & dilated” unequal 8mm (Norm 2-6mm) Foot: Babinski reflex (toes fan out when stimulated = BAD Seizures & coma Abnormal posturing Decorticate = (Extremities contracted to the core of body) Decerebrate = (arms flex out) Do not celebrate with Decerebrate 2 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Cushing triad = “crushing triad” brain stem is being crushed LOW HR & LOW RR Wide pulse pressure HIGH BP High systolic Low diastolic LOW HR LOW RR Brain Tumor      Headache— Worse at night and tend to awaken the pt. Seizures Nausea and vomiting Cognitive dysfunction Motor and/or sensory dysfunction MRI Surgical therapy—Is the preferred treatment. CT EEG Angiography Parts or all of the tumor are removed depending on the location and how deep the tumor is. Hydrocephalus – Obstruction of the ventricles preventing CSF fluid from moving along. Biopsy Radiation therapy/Radiosurgery— commonly used after surgery. Radiation seeds can be implanted. Can cause cerebral edema. 3 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations   Diagnostic Tests Aphasia Visual and/or spatial dysfunction Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Chemotherapy Monitor for increasing intercranial pressure (ICP) Tailor nursing interventions to avoid increases in ICP. Turning Suctioning Stimulation Seizure Precautions Prevent complications related to immobility Assist with motor and sensory dysfunctions Brain Abscess Meningitis Inflammation of the H-H-H: Positive Kernig’s Nursing care for Lumbar Increased ICP— 4 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) meninges “membranes that protects the brain and spinal cord” Clinical Manifestations H: Headache and photophobia H: Hard stiff neck This inflammation can “Nuchal rigidity” cause massive swelling in the CRANIUM putÝng lots H: High temp “Fever” of pressure in the BRAIN itself. Fever and chills Causes: Nausea and Head trauma vomiting Autoimmune disease Altered level of “Lupus” consciousness Immunosuppression Tachycardia Direct contamination of Hyperactive deep spinal fluid tendon reflexes Invasive procedure, skull Seizures fracture, or penetrating wound Red macular rash Environment (Meningococcal meningitis) Infection: Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications sign puncture: Positive Brudzinski’s sign -Before LP, tell the client to empty their bladder. Cerebrospinal fluid CSF analysis—Most definitive procedure CSF is collected during a LP (Lumbar puncture “Spinal Tap” -During LP, we have client ROUND to their back putÝng their knees on their chest. SIADH Place pt on DROPLET precaution – 1ST priority Prevention: To Test the CSFCerebrospinal fluid for infection. Septic emboli—can form during meningitis -After Monitor the insertion and travel to other site for CLEAR FLUID parts of body, —“Leaking CSF fluid out of the particularly the hands patient” but also in the feet as well. Can lead to disseminated REPORT to the PCP intravascular immediately coagulation or stroke. Viral –Very CLEAR CSF fluid Take blood cultures and Give antibiotics Bacterial = Bad cloudy CSF fluid LOW noise—Quite room LOW light—Photophobia LOW pressure—all over Elevated WBC and Elevated protein for both types of meningitis meningitis can cause ICP to increase, possibly to the point of brain herniation. NO coughing NO sneezing NO bending at the extremities Immunizations help prevent bacterial meningitis. Hib vaccine is given to infants. Meningococcal vaccine (MCVP) 5 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Bacterial: Bad news MOST contagious infection with a high mortality rate. Clinical Manifestations Decreased glucose (Bacterial) For pediatrics: High pitched cry Bulging fontalle Bacterial based infection OTITIS media, pneumonia, or sinusitis. Viral: very common MOST tested and commonly resolves without treatment. Viral illnesses such as mumps, measles, herpes and arboviruses (West Nile) There is no vaccine against viral meningitis. Fungal: Common in pt who have AIDS Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Implement seizure precaution vaccine is given to students living in dorms. Monitor S/S of worsening ICP Increased CSF pressure. Urine, throat, nose, and blood culture and sensitivity—To identity possible infectious bacteria and an appropriate broad-spectrum antibiotic CBC—Elevated WBC count CT scan –Before lumbar puncture— To identify ICP and/or abscess. Altered LOC W/ agitation, restlessness and irritability Altered mental status Pneumococcal polysaccharide vaccine (PPSV) primarily intended to prevent respiratory infection, also decreases the risk for CNS infection Medications: Ceftriaxone or cefotaxime in combination with Vancomycin—Antibiotics are given until culture and sensitivity results are available. Effective for bacterial infections. Phenytoin—Anticonvulsants given if ICP increase or client experiences a seizure Acetaminophen, ibuprofen— Analgesics for headache and/or fever. 6 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Encephalitis Etiology/Pathophysiology (Possible Causative and Risk Factors) Acute Inflammation of the Brain Sometimes fatal  Caused by a number of viruses  Ticks or mosquitoes can transmit epidemic encephalitis  Cytomegalovirus (CMV) encephalitis is common with AIDS Clinical Manifestations Nonspecific Fever Headache Nausea, vomiting Signs appear in 2 to 3 days May vary from minimal changes in consciousness or personality to coma Hemiparesis Tremors Seizures Cranial nerve palsies Diagnostic Tests    CT MRI PET  PCR tests for Herpes simplex virus (HSV) DNA/RNA  Blood test for West Nile viral RNA Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications  Education/prevention  Mosquito control for prevention  Treatment  Acyclovir (Zovirax), vidarabine (Vira-A) for HSV infection  Start before onset of coma  Anti-seizure drugs for seizures Personality changes Memory impairment Amnesia Dysphagia 7 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Ischemic Stroke / CVA Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Dysphagia and aspiration Unilateral neglect Hemorrhagic Stroke / CVA Tension-type headache Migraine headache Cluster Headache 8 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Seizure Disorders Etiology/Pathophysiology (Possible Causative and Risk Factors) Uncontrolled electrical discharge inside the brain. “Like a FIRE WORK show in the brain Neurons are randomly discharging when they are not supposed to. Epilepsy: Long term CHRONIC condition with frequent seizures. Seizures resulting from identifiable causes, such as substance withdrawal or fever, are not considered epilepsy. Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Two types of seizures: Generalized “all over the brain” & Partial “Only one part of the brain” Generalized seizure: Involves both cerebral hemispheres Can begin with an Aura—alteration in vision, smell, hearing, or emotional feeling. Causes: Anything that can cause swelling or Hypoxia in the brain Genetic Head trauma Tonic-clonic seizure: 9 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Cerebral edema Infection Exposure to toxins Brain tumor Hypoxia Stroke Fever Alcohol/drug withdrawal Fluid or electrolyte imbalances. Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Begins for only a few seconds with a TONIC episode Stiffening of muscle Loss of consciousness Factor that can TRIGGER a seizure: 4 S’ S: Stress S: Sleep deprived “Fatigue” S: Stimulants S: Sugar and Low sodium Breathing can stop A 1-2 min CLONIC episode -Rhythmic jerking of the extremities – follows the Tonic phase. -Breathing become irregular -Muscle Contract and relax. Atonic seizure: Loss 10 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications of muscle tone, resulting in FALLING. Myoclonic seizures: Short muscle convulsion “Twitching” Brief jerking or stiffening of extremities—Lasts for seconds Absence: Loss of consciousness for few seconds. “Spaced out” “DAY dreaming” Partial or “Focal”/Local seizures: Simple partial seizure: Fully conscious”—Body jerks and the pt knows the seizure is happening but can’t 11 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications do anything to stop it. Multiple Sclerosis Memory trick: M. S “Myelin sheath M.S. “Muscle spasm and Stiffness Autoimmune disorder where body attacks MYELIN SHEATH Fatty tissue around the nerves cells which helps the body move. Development of Plaques in the white matter of CNS which damages the Myelin sheath and interferes with impulse transmission between CNS and body. Complex partial seizure: “Impaired or loss of consciousness. Muscle spasticity* Ataxia/ Muscle weakness MRI/ CT – to see plaque on the brain and spinal cord. Patient education: Balance exercise with rest AVOID 4 S’s = Trigger flare up Cognitive changes Eye problems (Diplopia/ Nystagmus) Urinary retention 3-4 mm Sclerotic brain plaques on MRI= diagnosis for MS. Lumbar spinal puncture—High level of antibodies Hyperreflexia of extremities Causes: Specific cause is Unknown. Ear problem (tinnitus/ hearing issues/vertigo Age of onset is typically 20-40 Years. —More common in FEMALE. Environmental factors: Dysphagia S: Stress (exercise, surgery, injury) S: Sickness or sepsis S: Smoking S: Sun & extreme heat (Hot tub/sauna) * Elevated gamma globulin in CSF. Avoid extreme temperature* Fatigue Bowel/bladder 12 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Infection & vit D deficiency. Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management CT brain—cerebral atrophy wasting away or destruction of brain tissue Airway #1 Suction at bedside (Excess drooling) Possible Complications and Treatments/Interventions for Complications dysfunction Sexual dysfunction Family history: First degree relative of MS. Parkinson’s Disease “Movement disorder” Progressively debilitating disease that grossly affects MOTOR function Resting tremors Progressive death of Neurons in the brain resulting in: LOW Dopamine = Low movement HIGH Acetylcholine “High secretions ShufÒing gait & decreased arm swinging Risk factors: Onset of symptoms between age 40-70 Bradykinesia (Slow movement) Pill rolling Stopped posture Muscle rigidity Masklike expression More common in men Decreased motility in pt. upper GI tract Positive response to low dose carbidopa/levodopa Eating Pureed diet or “small bite sized pieces” Tissues readily available during eating Add thickening agents to the fluids Dysphagia: Monitor swallowing HOB up: High fowler’s Dysphagia Genetic predisposition Drooling Exposure to environmental toxins and chemical solvents Chronic use of Autonomic symptoms (Orthostatic hypotension, Include whole grains and fruits in diet—to prevent constipation and malnutrition. & Cut food into bite sized pieces Encourage exercise and ROM 13 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) antipsychotic meds. Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management flushing, diaphoresis) – Helps to release Dopamine and prevent joint stiffness. Cognitive impairment (Dementia) Meds: Possible Complications and Treatments/Interventions for Complications Levodopa—leaves dopamine in the brain Levodopa + carbidopa – carbidopa helps to conserve Dopamine Avoid protein with levodopa Anticholinergics Benztropine —to help control tremors and rigidity Myasthenia Gravis Amyotrophic Lateral Sclerosis Huntington’s Disease 14 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Alzheimer’s / Dementia Damage to the brain that is irreversible with longterm onset of confusion Delirium Short term confusion that is easily reversible. Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Causes: Infection (Sepsis) Hypoxia Spinal Cord Injury Trigeminal Neuralgia 15 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Bell’s Palsy Guillain-Barre Syndrome 16 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications Botulism Rabies Tetanus Restless Leg Syndrome Question: When client is admitted for bacterial meningitis with a BP of 78/56.. what is the priority action? --Administer IV bolus Normal saline. 17 Student Name: Date: Assignment Week/Day: Please fill-up the columns below with major take-away or focus points for each topic/disorder. Review materials from previous courses such as Pathophysiology, etc. Disorder/s Etiology/Pathophysiology (Possible Causative and Risk Factors) Clinical Manifestations Diagnostic Tests Nursing Interventions and Collaborative Management Possible Complications and Treatments/Interventions for Complications 18