Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Chapter 47 Neurological Function, Assessment, and Therapeutic Measures

Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Review of Normal A&P

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Synapse

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Cross Section of Spinal Cord

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Brain

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper       Olfactory Optic Oculomotor Trochlear Trigeminal Abducens

Cranial Nerves

      Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Autonomic Nervous System

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Aging

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Basic Neurological Assessment

     Level of Consciousness Vital Signs Pupil Response to Light Extremity Strength and Movement Sensation Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper       Symptoms Medication Use Surgical History Family History Life Style WHAT’S UP?

History

Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Subjective Data

       Mental Status Intellectual Function Thought Content Perception Language Ability Memory Pain Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Physical Assessment

     Level of Consciousness Mental State Examination Pupillary Response Muscle Function Cranial Nerve Function Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Glasgow Coma Scale

   Eye Opening Verbal Response Motor Response  Posturing Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Abnormal Posturing

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Pupil Assessment

    Equal Round Reactive to Light Reactive to Accommodation Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Diagnostic Tests

 Laboratory Tests     Thyroid B12 ESR CBC  Electrolytes      Hormone Levels Creatine Kinase VDRL Liver Function Renal Function Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Lumbar Puncture

 Pre-Procedure Nursing Care   Verify Informed Consent Assist with Positioning  Post-Procedure Care     Maintain Flat Bedrest 6 to 8 Hours Encourage Fluids Monitor Puncture Site Monitor Movement, Sensation, Headache Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Lumbar Puncture (cont’d)

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Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper 

CT Scan

Pre-Procedure  Administer Contrast if Ordered  Check Allergies  Check BUN, Cr  Request Order for Sedation if Indicated   Teach  Contrast May Cause Feeling of Warmth  Signs and Symptoms of Allergic Reaction to Report Post Procedure  Encourage Fluids if Dye Used Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

MRI

 Pre-Procedure Nursing Care    Assure No Pacemaker or Metal on Patient Administer Analgesic or Sedative as Ordered Teach Relaxation  Post-Procedure Care  No Special Care Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Angiogram

 Pre-Procedure Nursing Care    Verify Informed Consent Give Clear Liquid Diet Insert IV Needle   Check BUN/Cr Check PT and PTT  Administer Sedation as Ordered Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Angiogram (cont’d)

 Post-Procedure Care   Keep Flat in Bed 6 to 8 Hours Monitor  VS  Catheter Insertion Site  Pulses  Encourage Fluids Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Myelogram

 Pre-Procedure Nursing Care    Check Allergies to Contrast Assess History of Seizures Verify Informed Consent  Post-Procedure Care  Similar to LP   Encourage Fluids HOB Elevated 30 Degrees Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Electroencephalogram

 Pre-Procedure Nursing Care   Assure Hair Clean and Dry Check Medication Orders  Post-Procedure Care  Wash Hair Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Therapeutic Measures

 Moving and Positioning  Maintain Functional Positions    Avoid Injury Prevent Contracture Mobilize ASAP Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Activities of Daily Living

   Encourage Independence Based on Functional Level Maintain Routine Provide Assistance as Needed Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper 

Communication

Problems    Dysarthria Expressive Aphasia Receptive Aphasia  Interventions  Use Care with Yes-No Questions  Correct Substituted Words    Anticipate Needs Use Gestures Be Patient!

Copyright © 2011. F.A. Davis Company

Understanding Medical Surgical Nursing, 4th Edition

Linda S. Williams / Paula D. Hopper

Nutrition

  Evaluate Swallowing Interventions for Impaired Swallowing     Thicken Liquids Position Upright for Eating Monitor Meals Tube Feedings Copyright © 2011. F.A. Davis Company