Skills related to neurological problems
Risk Factors for needing neurologic intervention
Trauma
Hemorrhage
Tumors
Infection
Metabolic disorders
Hypoxic Conditions
Hypertension
Cigarette Smoking- clogs the carotid artery and arteries that feed the brain
Stress
Aging Process
Chemicals
Diagnostic Tests to determine level of intervention
Radiographs
Computed Tomography (CT Scan) and Magnetic Resonance Imaging (MRI)
o Discern the many conditions that can cause increased ICP and asses the effect of tx
Lumbar Puncture- pressure and infection rt bacterial meningitis
Cerebral Angiography- subarachnoid hemorrhage and we are trying to determine cause (usually
aneurysm)
Electroencephalography (EEG)
o EEG, cerebral angiography, ICP measurement, brain tissue oxygenation measurement via
LICOX cath, PET, transcranial Doppler studies
Caloric Testing- test for vestibular-ocular reflex
o Specific to brain testing, each ear to tested separately with warm air and/or ice-cold
water
When cold water is shot in the ear the eye should move toward the cold
If cold water is shot in the left the eyes should move toward the left
Warm water is shot in the ear and the eyes should move away from the warm
If warm water is shot in the left ear the eyes should move away (to the
right)
Lumbar Puncture Basics
During lumbar puncture, the patient is placed in a side-lying position and a needle is inserted
into the arachnoid space of the spinal canal, usually between the third and fourth lumbar
vertebrae.
After the procedure, assess the patient for possible complications. Headache, temporary
paresthesia. Rarely, serious complications such as spinal or epidural bleeding or nerve root
trauma, may occur. Watch for weakness, loss of sensation, or paraplegia.
, o Severe HA after lumbar puncture could indicate a new epidural hematoma
o Assess for paralysis
o Decrease response to light tough
o Leaking at the insertion site
o decreased LOC
Assessment Findings – Depends on the Injury
o When any of these things are present first assess respiratory status and airway
protection
o Manifestations result from increased ICP
o Changing Neurological signs
o LOC
o Airway & Breathing Pattern Changes
o Vital Sign Changes
o Visual Changes (Pupils, Papilledema)
o Nuchal Rigidity
o CSF Drainage
o Weakness/Paralysis
o Posturing
o Decreased Sensation
o Reflex Changes
o Seizure Activity
o Prepare for diagnostic test and interventions
Assessment
o Level of Consciousness (LOC)= The most sensitive indicator of Neuro status
o Vital Signs- BP or Pulse changes
o Respirations
o Temperature
o Pupils
o Posturing
Decorticate and decerebrate
o Reflexes- cough, gag, corneal and pupillary response (if any are absent consider pt is
progressing to brain death)
Corneal- drop saline into their eyes and you want them to blink
o Meningeal Irritation
o Autonomic System
o Sensory Function
o Glasgow Coma Scale
o Cranial Nerves
Level of Consciousness Terminology
o Conscious- aware of and responding to one’s surroundings; awake
Risk Factors for needing neurologic intervention
Trauma
Hemorrhage
Tumors
Infection
Metabolic disorders
Hypoxic Conditions
Hypertension
Cigarette Smoking- clogs the carotid artery and arteries that feed the brain
Stress
Aging Process
Chemicals
Diagnostic Tests to determine level of intervention
Radiographs
Computed Tomography (CT Scan) and Magnetic Resonance Imaging (MRI)
o Discern the many conditions that can cause increased ICP and asses the effect of tx
Lumbar Puncture- pressure and infection rt bacterial meningitis
Cerebral Angiography- subarachnoid hemorrhage and we are trying to determine cause (usually
aneurysm)
Electroencephalography (EEG)
o EEG, cerebral angiography, ICP measurement, brain tissue oxygenation measurement via
LICOX cath, PET, transcranial Doppler studies
Caloric Testing- test for vestibular-ocular reflex
o Specific to brain testing, each ear to tested separately with warm air and/or ice-cold
water
When cold water is shot in the ear the eye should move toward the cold
If cold water is shot in the left the eyes should move toward the left
Warm water is shot in the ear and the eyes should move away from the warm
If warm water is shot in the left ear the eyes should move away (to the
right)
Lumbar Puncture Basics
During lumbar puncture, the patient is placed in a side-lying position and a needle is inserted
into the arachnoid space of the spinal canal, usually between the third and fourth lumbar
vertebrae.
After the procedure, assess the patient for possible complications. Headache, temporary
paresthesia. Rarely, serious complications such as spinal or epidural bleeding or nerve root
trauma, may occur. Watch for weakness, loss of sensation, or paraplegia.
, o Severe HA after lumbar puncture could indicate a new epidural hematoma
o Assess for paralysis
o Decrease response to light tough
o Leaking at the insertion site
o decreased LOC
Assessment Findings – Depends on the Injury
o When any of these things are present first assess respiratory status and airway
protection
o Manifestations result from increased ICP
o Changing Neurological signs
o LOC
o Airway & Breathing Pattern Changes
o Vital Sign Changes
o Visual Changes (Pupils, Papilledema)
o Nuchal Rigidity
o CSF Drainage
o Weakness/Paralysis
o Posturing
o Decreased Sensation
o Reflex Changes
o Seizure Activity
o Prepare for diagnostic test and interventions
Assessment
o Level of Consciousness (LOC)= The most sensitive indicator of Neuro status
o Vital Signs- BP or Pulse changes
o Respirations
o Temperature
o Pupils
o Posturing
Decorticate and decerebrate
o Reflexes- cough, gag, corneal and pupillary response (if any are absent consider pt is
progressing to brain death)
Corneal- drop saline into their eyes and you want them to blink
o Meningeal Irritation
o Autonomic System
o Sensory Function
o Glasgow Coma Scale
o Cranial Nerves
Level of Consciousness Terminology
o Conscious- aware of and responding to one’s surroundings; awake
