"motor "strip"

speech  

Voluntary eye movement

current sensory data

past information or experience

 judgment and foresight

long-term goals

 Reasoning, concentration, abstraction

Understand sensation, texture, size, shape, 

Three-dimensional (spatial) perception

singing, playing musical instruments

processing nonverbal visual experiences 

Perception 

Auditory center for sound interpretation

Complicated memory patterns

Wernicke's area for speech

Cardiac-slowing center

Respiratory center

Cranial nerves: IX (glossopharyngeal),

X (vagus),

XI (accessory),

XII (hypoglossal)  

VII (facial)  

VIII (acoustic)

Cardiac acceleration and vasoconstriction centers  Pneumotaxic center helps control respiratory pattern and rate

Four cranial nerves originate from the pons: V (trigeminal), VI (abducens),VII (facial), and VIII (acoustic)

Contains the cerebral aqueduct or aqueduct of Sylvius  Location of periaqueductal gray, which may abolish pain when stimulated 

Cranial nerve nuclei III (oculomotor) and IV (trochlear) located here

3

A score of 15 represents normal neurologic functioning. A score of 7 represents a comatose state.

The lower the score, the lower the patient's LOC.

abnormal posturing seen in the patient with lesions that interrupt the corticospinal pathways

arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.

associated with dysfunction in the brainstem area.

rigidity, extension of the arms and legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which body is bowed forward)

How long should a pt be NPO for before a

Cerebral angiography

Your head is immobilized during the procedure 

• Do not move during the procedure

• You will feel a warm or hot sensation when the dye is injected—this is normal 

• You will be able to talk to the physician—let him or her know if you are in pain or have any concerns

Check dressing for bleeding and swelling around site 

Apply ice pack to site

Keep the extremity straight and immobilized 

Maintain pressure dressing for 2 hours

Your pt had a Cerebral angiography. When you check the bandage sight there is bleeding.

What is your best action?

after a Lumbar puncture the nurse does not need to do neuro checks because the procedure does not affect ICP

True or False?

False

complications, especially increased intracranial pressure (severe headache, nausea, vomiting, photophobia, change in level of consciousness).

Obtain vital signs and complete neurologic checks.

This is not a normal finding

Notify the physician if it occurs.

After a Lumbar puncture your pt has a HA.

What is your best action?

lasting 2 to 5 minutes

begins with a tonic phase- rigidity of the muscles,  immediate loss of consciousness.

Clonic- or rhythmic jerking of all extremities follows.

more common in children

brief periods of loss of consciousness and blank staring as though the person is daydreaming.

Metabolic disorders • Acute alcohol withdrawal • Electrolyte disturbances (e.g., hyperkalemia, water in¬ toxication, hypoglycemia) 

• High fever • Stroke • Head injury • Substance abuse • Heart disease

Diazepam (Valium)

Monitor airway, breathing, circulation (ABCs)

Protect the patient from injury. 

• Do not force anything into the patient's mouth. 

• Turn the patient to the side to keep the airway clear. 

• Loosen any restrictive clothing the patient is wearing. 

• Maintain the patient's airway and suction as needed. 

• Do not restrain or try to stop the patient's movement; guide movements if necessary. 

• Record the time the seizure began and ended.

Take the patient's vital signs. 

• Perform neurologic checks. 

• Keep the patient on his or her side. 

• Allow the patient to rest. 

• Document the seizure

an inflammation of the meninges that surround the brain and spinal cord.

Bacterial and viral organisms are most common cause

possible nuchal rigidity

Photophobia • Nystagmus • Abnormal eye movements 

Hemiparesis, hemiplegia, and decreased muscle tone possible later 

• Cranial nerve dysfunction, especially CN III, IV, VI, VII, VIII 

• Severe, unrelenting headaches

• Generalized muscle aches and pain

• Nausea and vomiting • Fever and chills • Tachycardia • Red macular rash (meningococcal meningitis)

ABCs (airway, breathing, circulation).

Take vital signs and perform neurologic checks every 2 to 4 hours, as required.

Your pt with Meningitis needs stict I/O's

Why?

Decrease environmental stimuli: 

• Provide a quiet environment. 

• Minimize exposure to bright lights from windows and overhead lights.

Maintain bedrest with head of bed elevated 30 degrees.

Position carefully to prevent pressure ulcers.

Maintain Transmission Precautions per hospital policy (for bacterial meningitis). 

Increased intracranial pressure

 Vascular dysfunction

 Fluid and electrolyte imbalance

 Seizures

 Shock

nausea, vomiting, a stiff neck

High fever, Changes in mental status (e.g., agitation)

Photophobia, Fatigue

nuro dysfunction (e.g., dysphagia [difficulty swallowing])  Focal (specific) neurologic deficits

increased ICP (e.g., decreased LOC)

Your pt has increased ICP and respiratory status is compromised.

What is your best action?

What are the four cardinal symptoms

of Parkinson disease (PD)

tremor

rigidity

bradykinesia/akinesia (slow movement/no movement) postural instability

constipation- bowl regiment, stool softners, hydration

pressure ulcers- reposition Q2Hr, hydration

contractures- PT, ROM

Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board.

Refer to speech-language pathologist.

Pt at risk for aspiration

Monitor the patient's ability to eat and swallow. Monitor actual food and fluid intake. Collaborate with the nutritionist.

Pts with Parkinson disease offtin have insomnia, depression and anxiety.

True or False?

True

Assess for depression and anxiety. 

Assess for insomnia or sleeplessness.

High levels of beta amyloid are associated

with reduced acetylcholine

the onset, duration, progression, and course of the symptoms.

Ask about changes in memory or increasing forgetfulness and about the ability to perform ADLs.

Attention and concentration

Judgment and perception

Learning and memory

Communication and language

Speed of information processing

Impairment of all cognitive functions • Problems with handling or unable to handle money and finances

Disorientation to time, place, and event • Possible depression, agitated • Increasingly dependent in ADLs • Visuospatial deficits: difficulty driving, gets lost • Speech and language deficits: less talkative, decrease in use of vocabulary, increasingly non-fluent, and eventually aphasic • Incontinent • Wandering; trouble sleeping

increased fatigue and stiffness of the extremities

change in vision

Alterations in sexual function

decreased ability to solve problems

hyperactive deep tendon reflexes, clonus, positive Babinski's reflex,

Pts with MS may exibit dysdiadochokinesia.

What does this mean?

What drug is a chemotherapy drug, has also been shown to be effective in reducing neurologic disability.

It also decreases the frequency of clinical relapses in patients with secondary progressive, progressive-relapsing, or worsening relapsing-remitting MS.

cyclophosphamide (Cytoxan) 

methylprednisolone (SoluMedrol)

 Methotrexate (MTX)

Why wouls your pt with MS be taking:

(Lioresal), diazepam (Valium, Apo-Diazepam), or dantrolene sodium (Dantrium)

Why might your pt with MS be taking:

carbamazepine (Tegretol) or tricyclic antidepressants. Propranolol hydrochloride (Inderal) and clonazepam (Klonopin)

an adult-onset deterioration of motor neurons found in the spinal cord and brainstem

characterized by progressive weakness, muscle wasting, and spasticity eventually leading to paralysis.

Rapid progression 

Beginning in one area of the body, motor weakness and deterioration spread until the entire body is involved, including the ability to talk, swallow, and breathe.

Death typically occurs within 3 years of diagnosis

Pts with Amyotrophic lateral sclerosis (ALS) need mental stimulation because they are still mentaly intact.

True or False?

What is the only drug approved for treatment of ALS patients.

What is its affect?

Riluzole (Rilutek)

It is not a cure, but it does extend survival time.

pain, fatigue, spasticity, excessive secretions, sleep disturbances, immobility, loss of speech/swallow

 loss of respiratory control

demyelination

of the peripheral nerves, progressive motor weakness and sensory abnormalities occur.

1. The acute or initial period (1 to 4 weeks), which begins with the onset of the first symptoms and ends when no further deterioration occurs 

2. The plateau period (several days to 2 weeks)

3. The recovery phase (usually 4 to 6 months, maybe up to 2 years), which is thought to coincide with remyelination and axonal regeneration (Some patients do not completely recover and have permanent neurologic deficits, referred to as chronic GBS.)

Elevate the head of the bed to at least 45 degrees

provide suctioning at bedside

incentive spirometer if able

Oxygen by NC

usually insidious (slow), some instances of fairly rapid 

remissions and exacerbations

characterized by fatigue and weakness primarily in muscles innervated by the cranial nerves, as well as in skeletal and respiratory muscles.

What are the MOTOR MANIFESTATIONS

of Myasthenia Gravis

• Progressive muscle weakness (proximal) that usually improves with rest 

• Poor posture • Ocular palsies • Ptosis "drooping eyelid."        • Weak or incomplete eye closure • Diplopia • Respiratory compromise • Loss of bowel and bladder control • Fatigue

What are the SENSORY MANIFESTATIONS

Myasthenia Gravis

Muscle achiness

 Paresthesias

 Decreased smell and taste

immunosuppressive drugs or corticosteroids, plasmapheresis, and thymectomy

symptoms: anticholinesterases or cholinergic drugs

Increased pulse and respiration

Rise in blood pressure

Anoxia (decrease in the level of oxygen)

 Cyanosis

Bowel and bladder incontinence

Decreased urine output

Absence of cough and swallow reflex

Nausea Vomiting Diarrhea

Abdominal cramps

Blurred vision

Pallor

Facial muscle twitching

Pupillary miosis (pin point)

Hypotension

Your pt with Myasthenia Gravis has morphine 2 mg ordered for pain PRN Q4hr. 

Should the nurse question this order?

Why/Why not?

Yes

Opioids may cause MG to worssen 

TIA lasts a few minutes to fewer than 24 hours

RIND symptoms last longer than 24 hours but less than a week.

Both TIAs and RINDs may damage the brain tissue with repeated insults

What is a CEREBRAL VASCULAR ACCIDENT (CVA) [STROKE]

INTERRUPTION OF THE BLOOD FLOW TO THE BRAIN RESULTING IN DYSFUNCTION IN MOTOR, SENSORY, PERCEPTUAL, EMOTIONAL OR COGNITIVE ABILITIES

ALL strokes are unaviodable.

T/F?

False

SOME MAY BE PREVENTABLE

Why might the S/S of a stroke 

vary from person to person 

S/S VARY DEPENDING ON AREA OF THE BRAIN AFFECTED  

HEMORRHAGIC

ISCHEMICn  EMBOLUSn THROMBUS 

occur when a thrombus or embolus obstructs an artery carrying blood to the brain;

about 80% of strokes are the ischemic variety.

What risks are you worried about for a pt with a

HEMORRHAGIC CVA

 VERY HIGH MORTALITY RATE

n   CAN REBLEED IN TWO WEEKS

What factors predisose a preson to a HEMORRHAGIC CVA

HTN, AV MALFORMATION, CEREBRAL ANEURYSM, DISEASES THAT CAUSE COAGULOPATHIES, OVER USE OF ANTICOAGULANTS

  INTRACEREBRAL BLEED

"THIS IS THE WORST HA OF MY LIFE”

LOC CHANGES, NUCHAL RIGIDITY, PHOTOPHOBIA, RESTLESSNESS, IRRITABLE, N/V, FOCAL S/S IE HEMIPARESIS, PUPIL 

CT, MRI, LP (BLOODY FLUID), MAYBE ANGIOGRAM

What are the s/s of a L CVA 

DAMAGE ON L SIDE OF BRAIN

R HEMIPARESIS

   DYSFUNCTION OF SPEECH & LANGUAGE IN 95% PT.

SLOW & CAUTIOUS

MEMORY DEFICITS

Swallow DYSFUNCTION 

What are  the s/s of a R CVA

  L HEMIPARESIS, L SIDED NEGLECT

FALL RISK R/T QUICK, IMPULSIVE BEHAVIOR, POOR JUDGMENT

  MEMORY DEFICIT

Amnesia (loss of memory)

Seizure

Loss of consciousness or sleepiness/drowsiness Restlessness or irritability

Disorientation or confusion

Scalp bruising and tenderness

Personality changes

Diplopia

Gait changes

Pupil changes

 Bradycardia

Papilledema 

High blood pressure/widened pulse pressure

 Hypotension and tachycardia (hypovolemic shock)

 Nuchal rigidity (cerebrospinal fluid [CSF] leak)

any processes that occurs after the initial injury and worsen or negatively influence outcome.

hypotension, hypoxia, ischemia, and cerebral edema.

What is the cerebral perfusion pressure (CPP)?

What is the normal range?

the pressure gradient over which the brain is perfusedand is determined by subtracting the mean ICP from the mean arterial pressure.

CPP above 70 mm Hg is generally accepted as an expected outcome of therapy.

children and elderly

What is the first priority of a nurse who is admitting a pt to the ED with a TBI

loss of motor and sensory function, tenderness along the spine, and abnormal head tilt.

respiratory problems and diaphragmatic breathing, diminished or absent reflexes.

Head positioning should be based on both intracranial pressure (ICP) and systemic blood pressure.

If increasing head elevation lowers ICP but also significantly lowers systemic blood pressure, the patient does not benefit and may actually be harmed.

• Glasgow Coma Scale <3 • Apnea • No pupillary response • No gag and cough reflexes • No oculovestibular reflex (no eye movement after ice water is placed in ears) 

• No corneal reflex • No oculocephalic reflex ("doll's eyes")

Sense of smell • Ability to taste, swallow, or feel the presence of food within the oral cavity 

• Vision, pain, and temperature sensation

This syndrome is a group of clinical manifestations including, but not limited to: 

• Personality changes • Irritability • Headaches

• Dizziness • Restlessness • Nervousness • Insomnia

• Memory loss • Depression