Nursing management of patients with the neurological disorder and disease.
Explain the selected key terms.
1) Explain/Define Craniotomy. (Define craniotomy)
Craniotomy is a type of surgical procedure in which a small hole (opening) is made in the skull bone to perform different types of medical procedures in the brain.
2) Explain/Define craniectomy.
A craniectomy is a surgical procedure in which a small portion of the skull bone is removed.
3) Explain/Define Dysphagia. (Define dysphagia)
Difficulty in swallowing is called dysphagia.
4) Define/Explain photophobia. (Define photophobia)
Not being able to tolerate light is called photophobia.
When there is a condition of photophobia, when a person is exposed even in minor light, pain and discomfort is seen in his eyes.
5) Explain/ define Agnosia. (Define Agnosia)
Agnosia is a type of neurological disorder in which a person is unable to recognize any things or object through his sensory system is called agnosia.
6) Define/Explain Ataxia. (Define ataxia)
Ataxia is a condition in which a person’s muscle movements cannot be properly coordinated, causing difficulty in walking, speaking, and performing self-care activities.
7) Explain/Define Tone. (Define tone)
The tension present in the muscles at rest
Hoy is called tone.
8) Explain/ define the increased intracranial pressure. (Define increased intracranial pressure)
Intracranial pressure is the pressure that is present inside the skull. This pressure is mainly found between brain tissue and cerebrospinal fluid.
Increase intracranial pressure means when the pressure of CSF increases over the normal pressure of cerebrospinal fluid, it is called increased intracranial pressure.
Normal intracranial pressure is
5 – 15 mmHg.
In increase intracranial pressure the pressure of CSF is >15 mmhg.
9) Headache is also known as a:=
Cephalalgia
10) Explain/Define concussion.
A concussion is a minor brain injury.
A concussion is a temporary loss of neurological function and no structural damage is seen in any brain.
In a concussion, the patient’s consciousness is lost for five minutes or less.
Headache, dizziness, nausea, vomiting are mainly seen in concussion.
11) Explain/Define Contusion. (Define Contusion)
Bruising of brain tissue is seen in cerebral contusion.
The majority of contusions are found in the frontal and temporal lobes.
This contusion is mainly seen due to any blunt trauma and injury to the brain.
12) When the sensory and motor function of a person’s lower extremities is impaired, what is it called?
paraplegia
13) When the motor and sensory function of any person’s lower extremities and arms is impaired, what is it called?
Quadriplegia
14) When the motor and sensory function of any limb of any person is impaired, what is it called?
monoplegia
15) What is it called when a person is paralyzed in half of the body?
Hemiplegia
Explain the neurological assessment. (Describe Neurological Assessment)
In the neurological assessment, mainly the patient’s sensory and motor responses, specially the patient’s reflexes and whether any of the nervous system is impaired or normal, are assessed.
A complete health history of the patient is taken in the neurological examination.
A) present illness:=
Assess whether the patient has any signs and symptoms or not.
Ask the patient about the onset, duration, presentation, quality, quantity, precipitating and relieving factor of any signs and symptoms.
If the patient has pain present, ask about its location, intercity and radiation of pain or not.
Asking the patient about his daily routine activities.
Assess whether the patient has any difficulty in speaking, seeing, hearing, tasting and smelling.
Asking the patient about his sleep patterns.
Inquiring whether the patient is using any type of medication like antihypertensive, antidiabetic, sedative, mood elevating drug and over the counter medication.
B) Past health history:=
Assess whether the patient has any past history such as accident, fall down, any brain and spinal cord injury, and any chronic illness, epilepsy and any other neurological disorder.
C) Family health history :=
Asking if any of the family members have a chronic illness present or not.
And asking family members about any other complications.
The neurological assessment is divided into five components.
1) Level of consciousness and cognition
(Level of Consciousness and Cognition),
2) cranial nerve (cranial nerve),
3) motor function,
4) Sensory function,
5) Reflexes
1) Level of consciousness and cognition
A) Mental status:=
In mental status, patient’s behavior, appearance, dress, grooming, movement, and facial expression are assessed.
B) Cognitive assessment:=
In the cognitive assessment of the patient, whether the patient is oriented to time, place, and person or not.
C) Assess the memory of patient:=
In memory, patient’s 1) recent, 2) remote and 3) immediate memory are assessed.
1) Recent: = Recent memory asks what the patient ate for breakfast and lunch and dinner.
2) Remote := To assess when the patient’s date of birth occurs in remote memory and if he has any events in childhood that are memorable.
3) Immediate Memory := Provide five to six digits to the patient in immediate memory and then ask them to repeat it forward and backward.
D) Intellectual function:=
In this the IQ level of the patient is checked which is mainly assessed through an interview.
E) thought content:=
In this an inside check of the patient is done through an interview.
The thoughts that come in the patient’s mind are checked whether they are positive or negative.
F) Emotional status:=
In this, it is assessed whether the patient’s mood swings or not, whether the patient is irritable or not and whether he is angry or not.
g) Language ability:=
In language ability, ask which language the patient can understand and in which language he can write and speak.
H) impacts on lifestyle :=
In this, if the patient has a neurological disorder, then it is assessed whether there is any kind of impact in his life or not.
I) Level of consciousness assessed through the Glasgow Coma Scale (GCS).
In the Glasgow coma scale, any type of stimulus is provided to the patient and the type of response provided by the patient is assessed.
Mainly three components are assessed in GCS.
1) Eye opening
2) Verbal Response
3) Motor Response
1) Eye opening
A total of four scores are given in Eye Opening.
1) Spontaneous (Spontaneous:= In this, if the patient opens and closes the eye by himself) := { 4 }
2) To voice
(to voice:= in this the patient is asked to open and close his eyes and if the patient follows) := { 3 } ,
3) To pain
(to pain := in this if the patient is pinched in the body and the patient makes an eye expression):= { 2 }
4) No response
( NO RESPONSE := IF NO RESPONSE FROM THE PATIENT) := { 1 }
2) Verbal Response
Verbal response has a total score of five.
1) Oriented (Oriented:= if the person is asked about the time, place and person and the person gives the correct answer) := { 5 } ,
2) Confused (Confused:= if patient is asked about time, place and person and patient is confused):= { 4 } ,
3) Inappropriate word
(Inappropriate word:= if we ask a question to the patient and the patient gives a different answer) := { 3 },
4) Incomprehensive sound (incomprehensive sound := if the patient is asked any question and he only makes sound through mouth) := { 2 },
5) No response
( no response := if no response ) := { 1 }
3) Motor Response
There are mainly six scores in motor response.
1) Obey command
(obey command:= whatever the patient is told if the patient follows it properly) := { 6 } ,
2) Localized pain ( Localized pain := if the patient is pinched and the patient provides a response) := { 5 } ,
3) Withdraw pain (Withdraw pain := if the patient is pinched and the patient tries to withdraw the hand) := { 4 },
4) Flexion
( Flexion := When any mid area of the patient’s body is pressed and the patient’s body flexes) := { 3 } ,
5) Extension (Extension := if providing any stimulus causes extension of the patient’s body) := { 2 } ,
6) No response
(No response := if the patient does not provide any kind of response) := { 1 }
Thus Glasgow Coma scale has a minimum score of 3 and a maximum score of 15.
result:=
{ 3 } score achieve:= then the patient has severe neurological damage.
{ 7 } score Achieve:= So the patient is in coma condition.
{ 8-12} score Achieve:= then the patient has moderate neurological damage.
{ 13-14} score Achieve:= then the patient has minor neurological damage.
{ 15 } score Achieve:= So the patient is fully conscious and oriented.
Thus, the level of consciousness of the patient is assessed from the Glasgow Coma scale.
2) Explain about cranial nerves.
Cranial nerve examination assesses whether the patient’s cranial nerves are functioning properly or not.
1) Olfactory nerve
Type of nerve:= Sensory
The olfactory nerve functions to identify smells.
Assessment:=
For olfactory nerve assessment, the patient is asked to close his eyes and hold any object like coffee, tea, orange near his nostril and taste the smell if the patient a
If the smell can be recognized properly, its olfactory nerve functions properly.
2) Optic nerve
Type of nerve :=
Sensory
Optic nerve functions for visual acuity.
Assessment:= To assess the visual acuity, the patient is assessed through snellen chart, in which the patient is kept at a distance of 20 feet from the snellen chart, after which the patient is asked to read the printed material in it.
3) Oculomotor nerve
Type of nerve:= motor nerve
The oculomotor nerve functions for movement of the muscles of the eyelid, pupillary constriction, and accommodation of the lens.
Assessment:=
In the assessment of the oculomotor nerve, whether the eyelids move properly and
4) Trochlear nerve
Type of the nerve:= motor nerve
The trochlear nerve is responsible for the moment of the eye muscles.
Assessment:= In this, asking the patient to follow the letter drawn in the air with the eye, if it can follow properly, then the moment of the patient’s eye muscles is said to be proper.
5) Trigeminal nerve
Type of nerve:= (mix nine)
Trigeminal nerve A facial sensation,
It has a mixed function of corneal reflex and mastication.
Assessment:=
In this, the patient’s corneal reflux is assessed.
It is assessed whether the patient has sensation of pain or not. And giving advice to assess the ability of the patient to clean the teeth.
6) Abducent nerve
Type of nerve:= motor nerve
The abducens function for the movement of the eye muscles.
Assessment: In this the movement of the eye muscles is assessed.
7) Facial nerve:=
Type of nerve:= mixed nerve
Facial nerve functions for facial expression, salivation, tearing and test.
Assessment: In the assessment of the facial nerve, asking the patient to smile, puffing out the cheeks and raising and lowering the eyebrows, if the patient is able to do it properly, then his facial nerve is said to be functioning properly.
8) vestibulocochlear nerve
Type of nerve:= Sensory nerve (sensory nerve)
The vestibulo cochlear nerve functions for hearing and equilibrium.
Assessment: In order to assess the vestibulocochlear nerve, it is assessed whether the patient can properly hear the words spoken by a person or not.
9) glossopharyngeal nerve
Type of nerve:= Mixed nerve
The glossopharyngeal nerve works for the testes, sensation of the pharyns and tongue, and movement of the pharyngeal muscles.
Assessment:=
Ask the patient to perform sour, salty, and sweet tests for assessment of glossopharyngeal nerve.
10) vagus nerve
Type of the nerve:= Mixed nerve
The vagus nerve functions to moment the muscles of the farings, larynges and soft palate and for ear sensation.
Assessment:=
Assessment of the vagus nerve involves asking the patient to say “ah” and observing the movement of the patient’s palate and pharynx and assessing whether any hoarseness is present in the patient’s speech.
11) accessory nerve
Type of nerve:= motor nerve
The accessory nerve serves the sternocleidomastoid and trapezius muscles.
Assessment:=
Ask the patient to perform shoulder movements and assess accessory nerve function.
12) Hypoglossal nerve
Type of nerve:= motor nerve
The hypoglossal nerve plays an important role in the movement of the tongue.
Assessment:=
Assessment of the hypoglossal nerve involves asking the patient to stick their tongue medially and assess the hypoglossal nerve.
Thus 12 cranial nerves are assessed.
3) Assessment about motor function (motor function),
In this, the patient’s motor ability, balance, and coordination and gait are assessed.
A) Motor ability
In this, muscle size, tone, strength, coordination, balance, poster gate, symmetry are assessed.
The patient is assessed for any involuntary movements.
It is done whether the patient has rigidity and stiffness in the body or not.
B) Muscles strength:=
In this, the muscle strength of the patient is assessed and how much weakness the patient has.
C) Coordination
In this, the patient’s coordination is checked.
D) gait testing
It assesses whether the patient can walk properly or not.
1) touch sensation
To assess the touch sensation, the cotton is touched to the body part and then its sensation is assessed.
2) pain sensation (pain sensation)
After touching a sharp object in the patient’s body, the sensation of pain is assessed.
3) temperature sensation (temperature sensation)
In this, it is assessed whether the patient has the sensation of hot and cold thoughts or not.
4) Vibration
Vibration is primarily assessed using a low frequency Tunic fork.
5) Position sense
To assess position sense, ask the patient to close both eyes, then ask him to move the toes up and down and then assess his moment.
5) Assessment about Reflexes
In reflex testing mainly five reflexes are assessed.
1) Biceps reflex
In this test, the examiner holds the patient’s forearm, then places the thumb on the front part of the arm, then strikes the hammer on the thumb, after which the elbow flexes properly and the biceps muscles contract properly, then the biceps reflex is a normal response.
2) Triceps Reflexes
In this test, the examiner provides support to the arm and then identifies the triceps tendon, which is present 2.5 to 5 centimeters above the elbow in the upper arm, flicks it with a hammer, causing the triceps muscles to contract and the elbow to extend. If so, the triceps reflex is said to be normal.
3) Brachio radial
In this procedure, 2.5 to 5 centimeters above hemmer from the wrist, gentaly strick is done. If flexion of the forearm occurs, brachio radialis reflux is normal.
4) patteler reflux
In this the patient is provided supine position then the examiner facilitates the leg causing the muscles to relax if the knee is extended patteler reflux is normal.
5) Achilles reflux testing
In this, the patient is provided with a sitting position, then the patient’s feet are kept slightly above the floor, then the first hand of the examiner is placed under the part of the patient’s foot towards the toe, then the back of the ankle is sricked with a hammer if the patient’s foot is If it goes a little downward, the patient’s Achilles reflux is said to be normal.
Thus, the patient’s reflexes are assessed.
Explain the diagnostic evaluation of the patient with the neurological disease and disorder. State the diagnostic evaluation of a patient with neurological disease.
Diagnostic evaluation is primarily used to assess any disease.
The following diagnostic evaluations are performed to assess neurological disorders.
1) CSF (Cerebro Spinal Fluid) Analysis
In this test, cerebrospinal fluid (CSF) is aspirated by inserting a needle into the space between L3-L4 and L4-L5.
Then it is used to assess different types of diseases by aspirating.
Like:=
Alzheimer’s disease,
Bell’s Palsy,
cerebral palsy,
epilepsy,
motor neuron diseases,
multiple sclerosis,
Neurofibromatosis.
etc. This test is done to design.
2) Skull and Spinal X ray:=
This one is simple
X-rays are used to detect fractures, bone erosion, calcification,
Used to assess abnormal vascularity.
3) Cerebral Angiography:=
Cerebral angiography examines the blood vessels of the brain if any
Abnormalities of blood vessels are detected.
Ex:=
aneurysm,
Atherosclerosis.
4)Computed Tomography (Ct scan):=
This is a medical imaging technique in which multiple imaging of brain parts is taken.
Ct scan is mainly used to assess if there is haemorrhage, cyst, oedema, infraction, brain atrophy in the brain.
5) MRI (Magnetic resonance imaging)
MRI Scan is a medical imaging technique in which radiology is used to detect any changes in the anatomy and physiology of the body.
In MRI, images of the body are taken using strong magnetic fields, magnetic field gradients and radio waves.
MRI is mainly used to detect stroke, multiple sclerosis, tumor, trauma, herniation, seizure, etc.
6) Magnetic Resonance Angiography :=
This is a type of MRI procedure that is used to assess abnormalities of blood vessels.
Magnetic Resonance Angiography is less invasive and less.
7) Magnetic Resonance Spectroscopy:=
Nuclear magnetic resonance spectroscopy is a non-invasive ionizing radiation technique.
It is mainly used to assess changes in the brain.
It is mainly stroke, Alzheimer disease,
It is used to assess seizure, sclerosis and other diseases.
8) Myelography:=
Myelography is an imaging examination in which a spinal needle is inserted into the spinal canal and the spinal cord is examined.
It is used to detect any spinal lesion by providing an injection of contract medium.
9) PET (Positron Emission Tomography)
This is an imaging study in which radioactive materials are used to detect injury and damage in brain tissues.
PET is mainly used to assess Parkinsonism, Tumors, Alziemers and Seizures.
10) Single Photon Emission Computed Tomography (SPECT)
This test is mainly used to analyze the function of internal organs.
This is a type of nuclear imaging in which mainly radioactive substance and special camera are used and 3D picture is created and any abnormality is detected.
11) EEG (Electroencephalogram)
In EEG mainly electrodes are placed and the electrical activity of the brain is assessed.
EEG mainly involves placing electrodes in the scalp and assessing whether there is any abnormality in the electrical activity of the brain, mainly seizures, CNS. Used to assess effects and brain death.