Neuro exam Med surg 2

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components of basic neuro assessment

loc, orientation, motor response (weakness, tremmors, paresis, speech)

Normal vs Abnormal findings

Mores stimulation required to elicit response
Loosing orientation

Frontal lobe

Affect, intellect, judgment

Temporal

Memory, understanding, speech

Broca's

expressive aphasia

Wernickes

receptive speech

Motor strip

leg, hip, turnk, arm, hand, neck, face

Parietal

sensory discriminaiton

occipital

registers visual images and interpretation (writing)

function of brainstem and complications with injury

deep coma, decerbrate posturing and death

care of pt post lumbar puncture

prone, pillow under abd 1 hr, remain flat 4 few hrs, inc fluids to replace csf

critera for cerebral death

eeg flat line, no cerb blood flow, no response to pain, flaccid muscles, no brainstem reflexs, pupils fixed

S/S of ICP

dec loc, pupillary changes from brisk 2 sluggish 2 non reactive (fixed and dilated),

NI's for ICP

improve ventilation: mild hyperventilation keeps slightly alkalatioc to help constrict bv's

meds used for ICP

manitol-osmo diuresis, lasix- lowers csf prod and diuresis, dilantin-antio convulsant, phenobarb-anti seiz

epidural hemotoma

bleeding btwn skull and dura. Brief loss of loc then alertness regained for a few 2 24 hrs then coma and death

subdural hemotoma

bleed btw dura and arachnoid usally venous symptoms with in a few days

S/S of subarachnoid hemmorage

severe HA, phototobia, nuchal rigidity, Kernig and Brudzinskis signs

Kernig

pain when bending legs 90 degrees

Brudzinski's

bend neck hip will flex

S/S of autonomic hyperflexia

profuse sweating, flushing and blotchiness above injury, inc B/P, HA, nasal stuffiness. pale and cool below level of inj

What is spinal shock

sympathetic NS pathways are blocked by the injury unable to vasoconstrict below level of inj, vessels vasodilate causing vasogenic shock

TIA

transient ischemic attach-episodes of ischema lasting 5-30 mins up to 24 hrs

Symptoms of Right CVA

left paralysis, socially innappropriate, poor judgment, impulse motor performance, denies deficits, left side neglect

Left CVA symptoms

intellect & language impairment, thought process not imparied just mechanics, Right side neglect and weakness, depression, frustration

positioning and support for hemipalegia

unaffected side first
support affected side

hemianopsias

vison impaired on affected side need to turn head

TIA meds

antiocoags, thrombolytics, ccb, nimodipine (lowers vasospasam and infarcts)

complications of caratoid endarterctomy

cerebral embolus, neck hemotoma, crainal nerve damage and rupture

S/S od meningitis

nuchal ridigity, HA, dec loc

olfactory

smell #1

optic

visual fiels and acuity 2

oculomotor

3 pupil restriction eyelid elevation medial eye movement

trochlear

4 oblique eye movement, visually follow fingers

TRIGEMINAL

5- 3 areas of face sensation. temporal and masseter muscles

abducens

6- lateral eye movement

facial

7- taste facial expression, raise and lower eyelids, frown, smile

acoustic

8-sensory hearing and balance

glossalpharyngeal

9-gag reflex, pharynx, parotid gland

vagus

10-swallowing, assess for horseness (larynx)

assessory

11- turning head and shrugging shoulders

hypoglossal

12 stick out tongue ck for deviation

normal ICP

0-15

normal ccp

70-80

formula for ccp

map-icp=ccp

acute phase of aids

1-3 wks after exp flu like symptoms developing antibodies to hiv

early chronic phase of aids

aprox 11 yrs, cd4= greater than 500, asymptomatic, low grade fever, night sweats

late chronic phase of aids

cd4 count less that 200, fungal, viral and bact infect, pneumonia, k. sarcoma, wasting syndrome

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