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Nursing Management of the Adult Client with Neurologic Alterations NURS 228 Janie Best, MSN, RN, APRN, BC
Objectives ,[object Object],[object Object],[object Object],[object Object]
The Nervous System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Brain Requirements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Studies – Cerebral Angiography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Studies – Myelography / Lumbar Puncture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],LP is contraindicated if suspected IICP
Neurological Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Abnormal Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Text: 1839-1840
Abnormal Findings ,[object Object],[object Object],[object Object],[object Object]
[object Object],http:// connection.lww.com/Products/morton/documents/images/Ch33/jpg/Ch33-006B.jpg
 
No motor tone or function, limp Cerebellar function Flacid posturing Extension & external rotation of arms & wrists, extension, plantar flexion, internal rotation of feet Cerebellar function Decerebrate posturing Internal rotation of arms &wrists, extension, internal rotation & plantar flexion of the feet Cerebellar function Decorticate posturing Eyes fail to follow normal movements Brainstem Doll’s eyes
Altered LOC - Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Altered LOC ,[object Object],[object Object],[object Object],[object Object]
Altered LOC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glasgow Coma Scale ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Score < 7 is consistent with significant alteration in LOC (coma)
Assessment of Respirations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessment of other Vital Signs Spinal shock Metabolic coma Drug overdose Brainstem lesions Decrease Temperature CNS infection Subarachnoid hemorrhage, hypothalamic lesions, hemmorhage of hypothalamus or brainstem Increase Temperature Implications ↑ /  Vital Sign
Assessment of other Vital Signs Cerebral trauma – Cushing’s triad HTN Blood Pressure Poor cerebral oxygenation Late stages of IICP Increase Decrease Pulse Implications ↑ or  Vital Sign
Brain Death ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Altered LOC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Altered LOC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Assume the unconscious patient CAN hear!
Intracranial Pressure (ICP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intracranial Pressure (ICP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intracranial Pressure (ICP) ,[object Object],[object Object],[object Object]
Intracranial Pressure (ICP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blood-Brain Barrier ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cerebral Blood Flow / Volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
↑ Brain Volume ,[object Object],[object Object],[object Object],[object Object],[object Object],http://www.uth.tmc.edu/radiology/test/er_primer/skull_brain/skull.html
Cerebrospinal Fluid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Effect : ↑ cerebral blood volume Hydrocephalus
Intracranial Pressure (ICP) ,[object Object],[object Object],[object Object],[object Object]
Cycle of malignant progressive brain swelling ↑ ICP  Cerebral brain flow Tissue hypoxia ↑ pCO 2  pH Cerebral vasodilation & edema from From: Hudak, C.: Critical care nursing: p. 640
IICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
IICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
IICP - Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Complications DI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Complications - DI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Complications - SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Complications - SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Complications - SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Medical Management ,[object Object],[object Object],[object Object],[object Object]
IICP – Medical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],IICP – Medical Management
IICP – Medical Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Osmotic Diuretics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
IICP – Nursing Diagnoses ,[object Object],[object Object],[object Object],[object Object]
IICP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IICP – Expected Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Critical Thinking Case Study ,[object Object]
References ,[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object]

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NurseReview.Org - Nursing Management of the Adult Client with Neurologic Alterations

  • 1. Nursing Management of the Adult Client with Neurologic Alterations NURS 228 Janie Best, MSN, RN, APRN, BC
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  • 18. No motor tone or function, limp Cerebellar function Flacid posturing Extension & external rotation of arms & wrists, extension, plantar flexion, internal rotation of feet Cerebellar function Decerebrate posturing Internal rotation of arms &wrists, extension, internal rotation & plantar flexion of the feet Cerebellar function Decorticate posturing Eyes fail to follow normal movements Brainstem Doll’s eyes
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  • 24. Assessment of other Vital Signs Spinal shock Metabolic coma Drug overdose Brainstem lesions Decrease Temperature CNS infection Subarachnoid hemorrhage, hypothalamic lesions, hemmorhage of hypothalamus or brainstem Increase Temperature Implications ↑ /  Vital Sign
  • 25. Assessment of other Vital Signs Cerebral trauma – Cushing’s triad HTN Blood Pressure Poor cerebral oxygenation Late stages of IICP Increase Decrease Pulse Implications ↑ or  Vital Sign
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  • 38. Cycle of malignant progressive brain swelling ↑ ICP  Cerebral brain flow Tissue hypoxia ↑ pCO 2  pH Cerebral vasodilation & edema from From: Hudak, C.: Critical care nursing: p. 640
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