Nursing Management of the Adult Client with Neurologic Alterations

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Nursing Management of the Adult Client with
Neurologic Alterations

• NURS 228
• Tracy Heberlig, MSN, RN

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Head Injuries
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Brain Injury

• Concussion
• Contusion
• Intracranial Hemorrhage

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Intracranial Hemorrhage

• Epidural Hematoma
• Subdural Hematoma
• Intracerebral Hematoma
• Intracerebral Hemorrhage

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Intracranial Hemorrhage
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Intracranial Hemorrhage
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Brain Injury - Management

• Assessment/Diagnosis
• Presumed Cervical Spine Injury Until R/O
• Preservation of Homeostasis
• Prevention of Secondary Brain Injury
• Treatment of IICP
• Surgical Management
• Supportive Measures

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Brain Injury

• Medical Management
• Corticosteroids
• Osmotic diuretics
• Anticonvulsants

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Brain Injury

• Brain Death
• Potential organ donation
• Uniform Determination of Brain Death Act
• Cardinal Signs
• Coma
• Absence of brain-stem reflexes
• Apnea

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Brain Injury Nursing Diagnoses

• Ineffective Cerebral Tissue Perfusion
• Ineffective Airway Clearance
• Risk for Injury
• Risk for Imbalanced Body Temperature
• Interrupted Family Processes
• Deficient Knowledge
• PC
• ? Cerebral Perfusion, Cerebral Edema, Aspiration

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Brain Injury Goals

• Maintenance of
• Patent airway
• Adequate CPP
• Fluid/electrolyte balance
• Nutritional status
• Normal body temperature
• Skin integrity
• Improved cognitive function
• Prevention of sleep deprivation
• Effective family coping, Increased knowledge

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Brain Injury Nsg. Interventions

• Prevention and Health Promotion
• Interventions
• Monitoring for declining neuro function
• Maintaining the airway
• Monitoring fluid and electrolyte balance
• Promoting adequate nutrition
• Preventing injury
• Maintaining body temperature, skin integrity

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Brain Injury Nsg. Interventions

• Interventions
• Improving cognitive functioning
• Preventing sleep pattern disturbance
• Supporting family coping
• Monitoring for post-traumatic seizures
• Promoting home and community-based care

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Brain Injury Expected Outcomes

• Effective airway clearance, ventilation,
  oxygenation, normal body temperature
• Fluid and electrolyte balance
• Adequate nutritional status
• Avoid injury
• Intact skin integrity

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Brain Injury Expected Outcomes

• Improvements in cognitive function
• No seizures
• Adaptive family processes
• Compliance with regimen
• Participates in rehab

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Spinal Cord Injury (SCI)

• Prevalence
• Risk Factors
• Incidence

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SCI

• Pathophysiology
• Transient concussion temporary loss of sensory
  and/or motor function
• Contusion bruising
• Laceration severing or tearing
• Compression pressure on spinal cord
• Complete transection

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SCI

• Pathophysiology
• Primary vs. Secondary
• Clinical Manifestations
• Lowest level at which sensory and motor function
  are normal
• Below the level
• Sensory and motor paralysis
• Loss of bladder and bowel control
• Loss of perspiration and vasomotor tome
• BP reduction

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SCI

• Emergency Management
• Scene of injury
• Rapid assessment
• Immobilization
• IV access
• Transportation

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SCI Medical Management

• Diagnostic
• Lateral C-spine, CT, MRI, Telemetry
• Assessment for Other Injuries
• Acute Phase
• Pharmacologic therapy
• Respiratory therapy
• Skeletal traction
• Surgical management

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SCI - Nsg. Management

• Assessment
• Neurologic Exam
• Bladder Assessment
• Abdominal Assessment
• VS
• Respirations

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SCI Nsg. Diagnoses

• Ineffective breathing patterns
• Ineffective airway clearance
• Impaired mobility
• PC
• DVT, Orthostatic hypotension, Autonomic
  dysreflexia

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SCI Nsg. Management

• Planning and Goals
• Interventions
• Promoting adequate breathing and airway clearance
• Improving mobility
• Promoting adaptation to sensory and perceptual
  alterations
• Maintaining skin integrity

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SCI Nsg. Management

• Interventions
• Maintaining urinary elimination
• Improving bowel function
• Providing comfort measures
• Monitoring and Managing PCs
• Thrombophlebitis
• Orthostatic hypotension
• Autonomic dysreflexia

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SCI Complications

• Autonomic Dysreflexia Lesions Above T6
• Emergency HTN
• Can lead to cerebral vessel rupture and IICP
• Cause - Stimulus
• Usually tolerated in those without SCI
• Distended bladder (most common), Constipation or
  impaction, Skin stimulation (tactile, pain,
  ulcer, thermal)
• Creates excess responses from nervous system

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SCI - Complications

• Autonomic Dysreflexia
• Symptoms
• Pounding HA, profuse sweating (forehead), nasal
  congestion, piloerection, bradycardia, HTN
• Intervention
• Rapid assessment
• Identification and removal of trigger
• Apresoline (if measures do not relieve HTN and
  HA)
• Label chart

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SCI Complications

• Spinal Shock
• Sudden depression of reflex activity (areflexia)
  below level of injury
• Neurogenic Shock
• Loss of ANS function below level of lesion
• Hypotension, Bradycardia
• Peripheral vasodilation
• Lack of perspiration
• DVT, PE

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SCI Nsg. Management

• Preventive Measures and Education
• Teaching Self-Care
• Ultimate Goal for Rehabilitation Process -
  Independence

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SCI

• Expected Outcomes
• Improved gas exchange, clearance of secretions
• Moves within limits of dysfunction
• Adaptation to sensory and perceptual alterations
• Optimal skin integrity
• Urinary/Bladder function
• Absence of pain/discomfort
• Free of complications

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Neoplasms

• Brain Tumors
• Localized intracranial lesion
• gt 50 malignant
• Glial tumors most common
• Astrocytomas glioma

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Neoplasms Clinical Manifestations

• Generalized
• IICP
• Headache
• Vomiting
• Visual disturbances
• Focal
• Hemiparesis
• Seizures
• Mental status changes

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Neoplasms

• Assessment
• Neuro exam
• Diagnostic Findings
• CT, MRI, PET, EEG, CSF cytologic studies

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Neoplasms Medical Mgmt.

• Treatment
• Surgical removal
• Radiation, Brachytherapy
• Chemotherapy, Corticosteroids
• Goals/Outcomes
• ICP WNL
• Maximal neurological functioning
• Free of pain/discomfort
• Aware of long-term prognosis

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Craniotomy

• Surgical Opening
• Skull
• Performed for
• ? ICP relief
• Blood clot evacuation
• Hemorrhage control
• Tumor removal

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Craniotomy

• Preoperative Management
• Baseline Neuro Assessment
• Client and Family Understanding
• Prep for Surgical Site
• Medications
• Antiseizure, Corticosteroids, Osmotic/Loop
  diuretics

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Craniotomy

• Postoperative
• Reducing Cerebral Edema
• Pain Relief
• Seizure Prevention
• Monitoring ICP, VS
• Infection Prevention
• Sensory/Cognitive

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Infectious Neurologic Disorders

• Meningitis
• Septic (Bacterial)
• Aseptic (Viral)
• Most Significant Bacterial Meningitis

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Bacterial Meningitis
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Bacterial Meningitis
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Bacterial Meningitis

• Diagnostic
• Blood cultures
• Lumbar puncture
• Bacterial culture
• Gram staining
• Prevention
• Vaccinations

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Bacterial Meningitis

• Goals/Outcomes
• Return of baseline neuro function
• Resolution of Infection
• Decreased pain/discomfort
• Treatment Patient and those in close contact
• Antibiotics (patient/close contact)
• Dexamethasone, IV fluids

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Bacterial Meningitis Interventions