1. Nursing Care for patients with neurosensory problems Session 9 & 10 Nadeeka Jayasinghe

2. CONTENT Diagnostic studies Neurological assessment Stroke – assessment, nursing management Infectious diseases – menengitis Reading: Cranial nerve function

3. Brain Needs… Blood flow Glucose Oxygen

4. Diagnostic Studies Skull and Spinal Radiology CT (Computerized Tomography) MRI (Magnetic Resonance Imaging) PET (Positron Emission Tomography) EEG (Electroencephalogram) EMG (Electromyelogram) Cerebral Blood Flow Studies

5. Neurological Assessment Level of Consciousness (LOC) Pupils Vital Signs (VS) Neuromuscular status Response to stimuli Posturing Glasgow Coma Scale (GCS)

7. STROKE

8. 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

9. 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

10. Risk Factors 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

11. 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)

12. 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

13. 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

14. 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

15. Meningitis An inflammation of the meninges of the brain and spinal cord ▫ Bacterial Causes: Meningococcus and pneumococcus,Haemophilus- influenza 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

16. Clinical Presentations ▫High fever, tachycardia, chills, petechial rash ▫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?

17. complication of Meningitis Seizures Sepsis Cranial nerve dysfunctions Cerebral infarction Coma Death

18. 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

19. Diagnosis lumbar puncture :collect samples of CSF Bacterial: ▫ Cloudy csf ▫ Elevated protein level ▫ Increased WBC ▫ Decreased glucose level ▫ Elevated CSF pressure ▫ C&S OF CSF ▫ CBC ▫ Cultures from Blood, urine, throat, nose

20. Cranial Nerve function Reading: Perry, A & Potter, A 2010, “Clinical Nursing Skills & Techniques”, 7 th edition, Mosby Elsevier, St Louis, pg 764.