Neurology 2

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Neurology 2

• Part 1

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History

• Family member present
• Vaccination
• Major injuries
• Childhood illnesses
• Family
• Present illness

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Complaints specific to neurology

• Pain
• Location
• Quality
• Severity
• Duration
• Precipitating factors
• Associated symptoms
• Exasperation / diminished pain
• Onset

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Pain assessment
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Headaches

• Multiple causes
• Not a good indicator of neuro trouble

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Vertigo

• Sensation of moving around in space or objects
  moving around them
• Assoc symptoms

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Paresthesia

• Definition
• Unusual sensation
• Examples
• Numbness
• Tingling
• Burning
• Assessment
• ? Weak
• ? Intermittent or constant

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Vision

• Diplopia
• Clarity
• Nystagmus

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Disturbances in

• Thinking
• Memory
• Personality

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Nausea and vomiting

• Projectile

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Assessing Cerebral Function - PE

• Mental status
• Intellectual function
• Thought content
• Emotional status
• Perception
• Motor ability
• Language ability

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Mental Status

• Level of consciousness
• Rostral-claudal Progression
• Dullness ?
• Confusion ?
• Lethargy ?
• Stupor ?
• Coma

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Alert

• Alert
• Open eyes spontaneously
• Responds appropriately, briskly
• Oriented

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Lethargic

• Lethargic
• Opens eyes to verbal stimuli
• Slow to respond, but appropriate
• Short attention span
• Obtunded
• Sleepy

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Stupor

• Stupor
• Responds to stimuli (usually physical) with moans
  and groans
• Never fully awake
• Confused
• Conversation unclear

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Semi-comatose

• Semi Comatose
• Responds to painful stimuli
• Conversation
• none
• Protective reflexes
• present

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Comatose

• Coma
• Unresponsive except to severe pain
• Protective reflexes absent
• Pupils fixed
• No voluntary movement

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Unconscious

• Non-medical word
• Ranges from stupor to coma

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Persistent Vegetative State

• No cognitive brain function
• Wake sleep cycles
• Very poor prognosis (if gt 3-6 months)

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Brain Dead

• No brain function
• Only reflexive movements

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Types of Stimuli ? response

• Voice
• Touch
• Shaking
• Voice Shaking
• Noxious/painful stimuli

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Nature of response

• Eye opens
• Remove stimuli
• Abnormal posturing
• No response

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Glasgow Coma Scale

• Eye Opening
• Spontaneous 4
• To speech 3
• To pain 2
• Nil 1

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Glasgow Coma Scale

• Best Motor Response
• Obeys -6
• Localizes 5
• Withdraws 4
• Abnormal flexion 3
• Extension response 2
• Nil - 1

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Glasgow Coma Scale

• Verbal response
• Oriented 5
• Confused conversation 4
• Inappropriate words 3
• Incomprehensible sounds 2
• Nil - 1

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Glasgow Coma Scale

• A strong predictor of outcome
• 13 mild brain injury
• 9-12 Moderate brain injury
• lt 8 Severe brain injury (coma)

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Sample Question

• The nurse is caring for an adult client who was
  admitted unconscious. The initial assessment
  utilized the Glasgow Coma Scale. The nurse knows
  that the Glasgow Coma Scale is a systemic
  neurological assessment tool that evaluates all
  of the following EXCEPT
• Eye opening
• Motor response
• Pupillary reaction
• Verbal performance

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Sample Question

• The nurse is caring for an adult client who was
  admitted unconscious. The initial assessment
  utilized the Glasgow Coma Scale. The nurse knows
  that the Glasgow Coma Scale is a systemic
  neurological assessment tool that evaluates all
  of the following EXCEPT
• Eye opening
• Motor response
• Pupillary reaction
• Verbal performance

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Small Group Questions

1. Give 5 questions you might ask a neuro patient
   who is complaining about a headache during an
   intake assessment
2. Identify the rostral-caudal progression of
   consciousness
3. Identify the differences in patients in each of
   the stages of consciousness
4. What is the lowest score a patient can get on a
   Glasgow coma scale?
5. What is the highest score a patient can get on a
   Glasgow Come Scale?
6. What is the most sensitive indicator on the
   Glasgow Coma Scale?

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General Appearance

• How do they look?
• Grooming
• Dress
• Aids
• Eye deviation
• Skin

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• Signs of trauma, wounds, scrapes, ecchymosis etc.

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Battles sign

• Bruising over the Mastoid
• Wheres the mastoid?

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Battles sign

• Bruising over the Mastoid

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Battles sign

• Bruising over the Mastoid

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Battles sign

• Bruising over the Mastoid

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Battles sign

• Bruising over the Mastoid

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Battles Sign

• Bruising over the Mastoid area
• Suggests
• Basal skull fracture

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Raccoons eyes

• Periorbital edema and bruising

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Raccoons eyes

• Periorbital edema and bruising
• Suggests
• Frontal-basal fracture

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Rhinorrhea

• Drainage of CSF from the nose
• Suggests
• Fracture of the cribiform with torn meninges

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Otorrhea

• Drainage of CSF from the ear
• Suggests
• Fracture of the temporal bone with torn meninges

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Decorticate Posturing

• Flexed Posturing
• Flexed arm/elbow
• Flexed wrists/fingers
• Adducted arms
• Legs with internal rotation
• Foot Plantar flexed

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Decorticate Posturing

• Suggests
• Damage to the cortico-spinal tract
• More favorable than decerebrate posture

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Decerebrate Posturing -

• Extension posturing
• Extended arm/elbow
• Flexed wrist/fingers
• Adducted arm
• Pronation of arm
• Foot Plantar flexed

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Decerebrate Posture

• Suggests
• severe injury to the brain at the level of the
  brainstem
• Opisthotonos
• severe muscle spasm of the neck and back
• More ominous posture

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Orientation

• x 3
• Person
• Place
• Time