1 / 67

NCLEX RN Preparation Program

NCLEX RN Preparation Program. Neurologic Disorders Module 5, Part 1 of 3. Brain Attack (Cardiovascular Accident/CVA or Stroke). Thrombosis – most common Embolus Small vessel occlusion (lacunar) Hemorrhage Aneurysm Hypertension Blood thinners (coumadin, heparin).

arlene
Download Presentation

NCLEX RN Preparation Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. NCLEX RN Preparation Program Neurologic Disorders Module 5, Part 1 of 3

  2. Brain Attack (Cardiovascular Accident/CVA or Stroke) • Thrombosis – most common • Embolus • Small vessel occlusion (lacunar) • Hemorrhage • Aneurysm • Hypertension • Blood thinners (coumadin, heparin)

  3. Clinical Manifestations • Headache (25%) • Nausea, Vomiting • Aphasias • Paresis • Hemianopsia • Dysarthria • Dysphagia

  4. Collaborative Care • Aspirin? • Vitamin K? • Oxygen • Anti-convulsants • Blood pressure control • Thrombolytics

  5. Prevent Re-bleed (hemorrhage) • 24-48 hours post hemorrhage • 7-10 days post hemorrhage • Keep BP low • Head up • Vitamin K (Aquamephyton)?

  6. Clipping and Coiling Clipping: The most common surgical treatment for a cerebral aneurysm involves placing a metal clip around the neck of the aneurysm to prevent rupture Coiling: Endovascular therapy in which a neuroradiologist passes a catheter through an artery and deposits detachable platinum coils in the aneurysm. This prevents bleeding and protects against subarachnoid hemorrhage. Web resource: http://www.mayoclinic.org/cerebral-aneurysm/treatment.html

  7. Prevent Vasospasm • Nimodipine (Nimotop) • Triple H Therapy • Hypertension • Hypervolemia • Hemodilution

  8. Monitor Airway Aspiration pneumonia Cerebral edema Motor/Sensory changes Psychosocial Swallowing Skin, incontinence Monitor fluid/electrolyte balance

  9. Intervene • Position • Activity • Prevent complications • Communication • Environment

  10. Teach Prevention • Hypertension • S&S Stroke • Early treatment • Healthy lifestyle • Treat Transient Ischemic Attack (TIA)

  11. Seizures • Prodromal phase • Aural phase • Ictal phase • Manifestations seen • Postictal phase

  12. Generalized Seizures • Tonic/clonic • Absence • Myoclonic • Atonic

  13. Partial Seizures • Complex • AKA psychomotor • AKA temporal lobe • Simple

  14. Nursing Care • Onset • Movements • Airway • Position • Teach

  15. Collaborative Management • Anti-seizure medication • Monitor serum levels • Toxic effects • Alcohol • Status epilepticus • Airway • Lorazepam (Ativan)

  16. Traumatic Brain Injury • Open • Closed Photo Source: U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, http://training.seer.cancer.gov/index.html

  17. Open Head Injuries • Linear skull fracture • Depressed skull fracture • Open fracture • Basilar skull fracture

  18. Basilar Skull Fracture • Watch! • Clear nasal or ear drainage • Battle Sign • Raccoon sign

  19. Closed Head Injury - Concussion • Signs & Symptoms • Brief loss of consciousness • Amnesia • Headache • Post-concussive syndrome • Persistent headache • Lethargy • Personality/intellectual changes • Decreased attention span

  20. Brain Contusion • Coup • Contrecoup • Signs

  21. Brain Lacerations • Epidural hematoma Brief loss of consciousness Period of lucidity Rapid decrease in LOC Watch! pupils, extremity movements Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

  22. Subdural Hematoma • Acute • Subacute • Chronic • Signs & Symptoms Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

  23. Cerebral Edema • Brain tissue + Blood + CSF • CPP = MAP - ICP • Autoregulation • Chemical autoregulation

  24. Assessment for Edema • LOC • Orientation • Pupils • Motor • Vital Signs

  25. Diagnostic Tests • CT scan • EEG • ABGs • Electrolytes • CBC • Osmolality • Lumbar Puncture? Photo Courtesy of the Indian Health Service/U.S. Department of Health and Human Services.

  26. Craniotomy • Postoperative assessment • Peri-orbital edema, ecchymosis • Strict I&O • Positioning • Dressing • Drainage

  27. Monitor Sodium Levels • Low Na+ = salt wasting syndrome • 3% saline • High Na+ = Diabetes insipidus • 0.45% saline

  28. Postoperative Complications • Increased ICP • Hematomas • Hydrocephalus • Respiratory problems • Wound infection • Meningitis • Fluid/electrolyte imbalances

  29. Intracranial Pressure • CSF leaks • Head up • Body in neutral alignment • Control pCO2 • Prevent hypoxia • Suction airway? • Sedation

  30. Intracranial Pressure(continued) • Intubated – paralytics • Barbiturate coma • Anticonvulsants • Diuretic therapy • Prevent hyperthermia • Manage osmolality • Ventricular drainage Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

  31. Spinal Cord Injury • Prevention • Common areas injured Photo Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD) http://images.niams.nih.gov/SearchResults.cfm?start=All

  32. Types of Lesions • Complete • Incomplete • Central cord syndrome • Anterior cord syndrome • Brown-Sequard syndrome • Cauda equina

  33. Initial Assessment/Care • Stabilize neck/back • Watch! Respiratory failure C2-3 • Assess Motor signs • Assess Sensory signs • Incontinence • Superficial signs • Pain

  34. Spinal Shock • Flaccid paralysis below injury • Bradycardia • Hypotension

  35. Ongoing Assessment • ABCs • Bleeding • Glasgow Coma Scale • Motor/sensory status http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/learnem/dermat/main_der.htm

  36. Glasgow Coma Scale

  37. Collaborative Management - Neurological • Methylprednisolone (Solu-Medrol) • Traction • Log roll • Treat spasticity, pain

  38. Collaborative Mgmt - Circulation • Bradycardia – atropine • Hypotension – dopamine • Fluids/blood products • Vasovagal response • Fluid/electrolyte imbalances • Promote blood return

  39. Collaborative Mgmt - Oxygen • Lesions above C4 • Pulmonary “toilet” • Aspiration prevention • Bronchodilators

  40. Collaborative Mgmt - Nutrition • Paralytic ileus • Stress ulcers • Histamine-2 blockers • Total parenteral nutrition • Constipation

  41. Collaborative Mgmt - Temperature • Poikilothermia • Control room temperature • Warming measures • Cooling measures

  42. Collaborative Mgmt - Renal • Bladder reflex loss • Calcium stones • Urinary tract infection

  43. Skin-tissue Integrity • Kinetic beds • Inspect skin – Where? • Protective devices Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

  44. Psychosocial Care • What to expect • Hope, reassurance • Verbalize feelings • Fear of the unknown: be accurate • Touch areas with sensation • Offer stimulation

  45. Autonomic Dysreflexia • Injuries above T6 • Late complication • Causes • Signs, symptoms • Prevention • Treatment

  46. Bacterial Meningitis • Nuchal rigidity • Brudzinski’s sign • Kernig’s sign Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp

  47. Meningitis • Chills and high fever • Vomiting • Signs of increased intracranial pressure • Photophobia • Petechial rash • Diplopia (double vision) • Seizures

  48. Diagnosis • CSF: ↑ pressure, ↑ protein, cloudy, ↓ glucose • High WBC • Blood cultures • Sodium

  49. Collaborative Management • Assess for neurologic deterioration • Respiratory isolation x 24 hours • Seizure precautions • Antibiotics • Dark room • Headache • Hydration

More Related