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Reviews key neurological diagnostic tests and focuses on lumbar puncture preparation and post-procedure care. Also explains focused versus comprehensive neurological assessments.
so it's four so tally up here out of ten and you could just inbox me your score now if you see my screen let's go into neuro let's keep it on so we did cover all the um diagnostictests already any question on any of these i say evoke potential tests don't even bother with that um lp any question in lp lp is on nclex i can guarantee you that um it's it's invasive so consent needto be signed positioning is one of the questions they ask you a lot how do you position a patient for lp remember if it's an adult you have them lay lateral could any side is okay but it's ontheir side and they need to have you know bring their knees all the way up and tuck their chin so that they can you know push out your back this is done on the sterile technique so the nurse
will be in front of the patient with a surgical mask on supporting the patient if it's a child you'll have the child straddle you they have put their head on your shoulder and of course you will you knowpunch their back out for a baby because babies get especially those neonates um you just roll them up like a little teddy bear again post lp what is absolutely important is you're going to be doing vital signs butthe patient should lay flat supine head should not be elevated no more than 15 degrees flat supine for anywhere from six to 12 hours your entire shift why do we have them supine
i think we're gonna want the fluid to come out and it caused some headache or something exactly because they get what's called a post uh spinal headache very common post lp so very very common if they're complaining ofincreasing headache if they complain of the headache you know like a nagging headache that's like that's expected you give them some tylenol but if they complete enough uh complaining of increasing headache headache is getting worse and now they'restarting to talk about blurred vision now your situation is changing so make sure you notify the provider here if they need to use a bathroom they'll get a bedpan until that time period has passed occasionally you'll turn themover and you'll look at the site to see if they're leaking any cerebral spinal fluid other than that that's until this whole thing is done it will be supine the head remember no more than 15 degrees flat because
some patient cannot take their head flat all the way so you just put a little pillow and get them at 15 degrees mri ct scan emg all those other tests any any any questions and those neuro assessment nowmost of the time or your neural assessment will be focused focus neurological assessment focus on what they're complaining about a comprehensive neurological assessment is done only when the patient is having you know issues of neurological symptoms over aperiod of time and they go see a neurologist and they do a comprehensive but usually for us it's a focused neural assessment so you're focusing on they're coming in and they're completing up any headaches symptoms of meningitis youfocus your assessment on that area just lean into what they're complaining about now remember for please remember for the the glacial coma scale what are we checking again
Covers the Glasgow Coma Scale and the three components assessed. Then reviews the cranial nerves most commonly tested, including gag reflex, pupillary response, and hearing.
level of consciousness level of consciousness what three things are you checking with the gcs just just all those that's the only thing i want you to know what three things are you checking motor response
i respond
verbal i i open now you don't have to know the score is like four three two one you don't have to remember all that just know that the three things you're checking is if you say their name theyopen their eyes spontaneously ask them a question you speak to them they're oriented times three four or they're confused or they garble they incomprehensibly do not understand what they're saying verbal responses just say how are you doing todayand they go incomprehensible motor response obey command squeeze my hand they can do it easily so what three things are you checking i verbal motor eye open verbal response motor response
make sure the cranial nerves i sent it to you um now which ones are the ones that they zero in on a lot they are of course the optic cranial nerve nine and ten for gag reflex
so cradle nerve nine and ten because we do that a lot for gag reflexoculomotorthis is the one for pupillary response
and thetrigeminaland acoustic or cranial nerve h the hearing when you have patient that has um medication that are auto toxic cranial nerve eight
but make sure you know nine and ten nine and ten always get checked together that's the vagus and the
glossopharyngeal and optic
and you uh your current trigeminal nerves for trigeminal neuralgia also facial because we're seeing a lot of um bells falsely belswazy's facial nerve with the virus itself and the vaccine
Explains the Romberg test, how it is performed, and what a positive result means. Emphasizes safety and the connection to balance problems or intoxication.
anyone remember the romberg test
it sounds familiar in a very distant part of my brain living there's anything about the rumburg i think he has to do with your walking movement yes
yes i call it the drunk test you're checking balance and how do you check the rumburkus oh you tell them to walk and towards you no you mean in a straight line towards you yeah no no they likeone foot behind each other and putting your arms out something like that they stand together feet together go ahead nevin well i was going to say it wasn't when they uh they're standing and then um with their feettogether and then they have to like open their eyes and close their eyes and then if they sway you know a mild sweat is okay because once you put your feet together you may sway but if they youknow can't stand if you have a person who you don't know the status or the order um because safety is big with this test patient could fall so make sure you're right there to catch them in just in
case because usually if they sway unable to maintain their balance and that's the negative romberg sorry it's a positive romberg so they failed the romberg test and usually there's something going on in the brain and it could alsobe because they massively intoxicated so you we do that too when they come in um to the emergency room and they have they complain of some neurological deficits you can do that right there at the bedside so now
Introduces stroke terminology, ischemic versus hemorrhagic stroke, and the FAST warning signs. Also covers TIA as a precursor and reviews major stroke risk factors and prevention.
what i want to do what i want to go into now we're going to go straight into stroke we got to stroke this thing because it is what they are asking a lot so let's talk about stroke andthen we can wheel in icp and seizure and tbi right into stroke so cerebral vascular accident or stroke or brain attack you will hear it that's how they'll describe it theta one is the same thing cva cerebrovascular accidenta stroke or a brain attack now we have a patient could have either an ischemic stroke or a hemorrhagic stroke two types of stroke ischemic or hemorrhagic ischemic is where they have in decreased oxygen supply to their bloodcells in the brain and hemorrhagic is basically uh you know aneurysm bleedingischemic can be on could be some broken down into an embolic like a clot a clot is causing it that's what we see a lot it's very common in patients with like uh afib
but either way it's still considered ischemic stroke so it's two types of stroke ischemic hemorrhagic now we will not know what type of stroke it is until we work the patient up so the symptoms will be the samepretty much complaining of the same thing now does anyone remember in nursing school for stroke what's the pneumonic we use when we teach the patient to report stroke or at risk for stroke to report stroke symptoms
i think it's like fast personal fast exactly and what is the fast what what's the acronym for just fine fast malia
you say think fast when it comes to stroke if you um call a stroke center you'll hear that that commercial all the time i don't remember this they f is for face facial drooping a arm weakness or asymmetricor symmetry s is for speech difficulty and t is time timing if everything would stroke going to explain that a little further so we use that mnemonic fast for stroke you teach the patient who are at risk forstroke fast think fast so you wake up with any facial drooping weakness acid your arms to put their arms out one is is you know um weak and drops down or asymmetrical and the speech pattern has changed thenthey need to call 9-1-1 teach your patient who is having a stroke or is choking out not to drive themselves to the hospital please don't do it teach them not to wait it out because timing is everything the
sooner you get there now neuro is one of those things that i call that end stream it's not my favorite topic at all because i always say this is the situation where you have a neurological deficit everybody knowsyou have a problem you have diabetes nobody knows you have a husband nobody knows do anything neurological it's like we call it location locations like real estate location location location wherever the lesion is you're going to see thedeficit you're going to walk funny you're going to talk funny so we'll have you'll see it so timing is everything so we're not going to be able to stop the stroke per se but we'll be able to slowthings down and to increase the function you know after so that's why you need to seek medical attention as soon as you see any of these happening now before i get into subdividing these strokes let's talk about a
precursor to a stroke and it's called a tia transient ischemic attack
now it's transient it's ischemia and it's an attack it's not a stroke it's a precursor to a stroke some people call it a mini stroke but it's not a stroke it's a warning sign though because the report hasshown that if you had had a tia and you don't change the risk factors that predispose you to that you will have a stroke within the next 10 years and also it is true that if you had onestroke you'll stroke out again
especially if you don't change the things that has caused you to get the stroke in the first place now with that going backwards what are the risk factors for stroke malia
i think smoking is one of them always blame it on the smoking yep smoking um hypertension hypertension number one cause attention and um what else again you could blame it on illicit drug use too yeah drugs yes strugglescan stroke you out and what's after hypertension what comes right upon that what what always wraps up with hypertensionlike they kind of diabetes
that's why you need to keep your a1c where do we want the a1c kim to be considered controlled with
diabetes
the higher the a1c the more your risk for stroking out and or getting a heart attack so hypertension number one and then followed by your diabetes smoking is in there too and illicit drug use when they're two thoseare your risks common risk factors for stroke so tia again it's a precursor they still need no they no we don't know that they having a tia because they have the same symptoms of the patient with a strokebut the thing the difference between a tia and a and this and a stroke in the tia the symptoms last an hour 30 minutes to an hour 30 minutes to an hour and then it goes away with noresidual so they will not have any weakness any speech the difficulties it would just say you were warned basically it's a warning sign and so we typically will observe them when they come into the hospital for 24 hours
and then discharge them on if they have no risk factors and because it can happen to people with with no risk factors you know stress stress is the risk factor for stroke we forget that one so we youknow you would discharge him on like an anti-platelet preferably an aspirin a day and decrease your stress level if possible if it's hypertension have them control and follow up with your doctor that's the treatment for tia now let's
Describes the emergency response to suspected stroke, including rapid triage, CT scan without contrast, and determining eligibility for tPA. Reviews contraindications and treatment differences for hemorrhagic stroke, plus blood pressure goals for neuro patients.
go back to stroke the patient comes in and those symptoms we just mentioned as fast the first thing you want to do when they come in and they tell you that they haven't or you see it you're gonnasee it you're gonna see the facial drooping once you see a person a person stroking out you'll never forget it it's classic it's textbook so you see these symptoms the only thing you're going to do is get aset of vital signs really fast as a triage nurse you're going to want a patient back or roll the patient back and you're going to tell the doctor this patient is having a stroke and we're going straight tocat scan kim we're not even putting in an iv we don't have time for that we don't have time to draw our bloods we don't have time to do nothing we get a set of vital signs including o2
side to make sure the airway is stable and straight to cat scan cat scan without contrast why because we did not check your kidneys so we don't know if you can tolerate it and we didn't even have timeto ask you about allergies because timing is everything so we just need new and we need this cat scan in order to treat in order to figure out what type of stroke is this patient having so the soonerand that's one of the reason why you should tell them to call 9-1-1 because they should go to a stroke center not all hospitals are considered stroke center if they want up in the wrong place it can delaycare and you know the outcome won't be that good so call 9-1-1 they'll take you to a stroke center so the cat scan we're going to get the results back at least the preliminary like stacked you're in a
stroke center and now this is going to tell us whether it's an ischemic stroke or an hemorrhagic stroke and and again it goes back to the treatment protocol so if it's an ischemic stroke we can give the tpathe thrombolytics the clot buster it's the same medication we talked about when we were talking about pe pulmonary embolism the same drug will give efficient ischemic stroke and if it's in a hemorrhagic stroke we would not go thereand that's why we need the cat scan so fastwe don't want it so we get it back cat scan comes back and it's an ischemic stroke let's deal with this kidney stroke now by the time they get back from cat scan you'd have had your iv innow you've got your blood's drawn now you have all the information and everything um what's the time frame that you remember that can we we can give tpa
i think right before 4.5 hours after onset yeah so four to five for nflex so you have 45 hour window the onset of symptoms not when they got to you onset of symptoms so when so when you askthem when did the symptoms start now stroke is choking out so sometimes they could have started you're gonna be surprised what they tell you started yesterday you just showed up today um because it started with mild little symptomsand they thought it was going to go away stroke um it's more common in guys more common in guys
so you need to know so we get it there um so they get the cat scan back and it says it's an ischemic stroke so we're going to set the station up for the tpa now we need toknow are they a candidate and what's the um what would rule what are some of the things that you remember that i told you would make them not beside the fact that they came in too late remember theyit has to be within that four to five hour window in order to get tpa so what what would make you not this patient not be considered a candidate for tpa besides the time and the hemorrhagic strokes
contraindication for tpa in other words if they had any um previous um head trauma
maybe increased icp chris icp yes
kathy king
gi bleed history of gi bleed we're not giving them tpa they're currently on anticoagulation then warfarin not anti-platelets not aspirin we still give them tpa but anti-coagulant so they're on a pixel bat no xerol to oil no they'regoing to bleed even more and then another big one they recently had surgery surgery in the last 14 days absolute contraindication also they pregnant absolute contraindication and they older than age 80 80 they cut off
absolute contraindication so if that you know if that's not the case then we'll go ahead and we'll give the tpa um also also also another contraindication if the blood pressure is it is um severely elevated and what doi mean by that you're talking about sbp over 200 uh and the cis diastolic over 100 that's too high blood pressure is too high that that pressure is just waiting to pop so you wouldn't give them tpa
that's the upsetting part because usually come in and they're stroking out because their blood pressure is high
for emerging stroke in addition to all the other symptoms that we talked about the facial asymmetry the arm drooping are they going to describe this as the worst headache of my life they have usually with hemorrhagic stroke theycomplaining of a severe headache and they describe it as the worst headache of my life
for hemorrhagic stroke they're not a candidate for tpa so for those patient depending on the degree of bleed because usually they're bleeding in the brain so if you know it all depends on the how much bleeding if it'sif it's severe then they need to go to the or to get a craniotomy just open up and get some of that blood out if it's it's not then we these are the patients we give calcium channel blockerto in nursing school in my i'm sure they told you about 9 metapedian but for nclex it's just a catholic channel blocker calcium channel blocker relax the vascular smooth muscle so it will it really relax those very irritableirritated um blood vessels in the brain so that's your treatment of choice for hemorrhagic stroke now stroke patients are going to either icu or a stroke unit and it depends again on the severity of symptoms
now all neural patients all tbi stroke all your neuro patient we want to keep their blood pressure slightly the higher side don't want and this is very important do not drop their blood pressure too low if they're comingin hypertensive crisis we're going to lower it but not too low so normally you want to keep the systolic over 140 and the diastolic should be over 80.slightly on the higher side for cpp cerebral perfusion tissue perfusion we don't need to calculate cpp and all this other stuff that you had to do with nursing school but remember they it's map versus ic map times icpthat will give you several um pressure and you want that number to be by magic number 15 to 20 10 to 20.oh it's your issue of your number all the time so the higher the slightly higher blood pressure will increase the math and the map will give you that number and that's why with stroke patient or tbi patient you
want the blood pressure to be a little on the higher side and you'll see questions like that and you go but why would you want a blood pressure to be over one over one system to be over 140to maintain tissue perfusion cerebral perfusion
Explains early rehabilitation, swallow precautions, and positioning for stroke and TBI patients. Then transitions into seizure precautions, depression risk, and early and late signs of increased intracranial pressure.
now with stroke as soon as we make sure airway breathing circulation is okay the the next thing we're going to do we're going to start the physical therapy let's start physical therapy occupational therapy and speech and because wewant to maximize the outcome because we know they're going to stroke this stroke the term we use in stroke is choking out and the reason why we say stroking out is because a patient with a stroke can walkin the hospital and by the time everything has evolved and this thing they stop going through this you know the stroke and it can be completelyimmobile and i'm sure if you you know anyone with a stroke they walk in and they didn't walk out so maintain airway airway breathing circulation i see you and then we start me once airway is stabilized we starttherapy
also bear in mind you do not want to feed a stroke patient until they have had a swallow study because we don't know if the swallowing was you know affected by the stroke and it's the same for tbitraumatic brain injury no do not give them anything to eat or drink until they've had a swallow study which they'll be seen and evaluated by the speech pathologist and then they will decide okay after the swallow study whattype of food they can have and consistency if any maybe they know they stay swallow reflex has been severely damaged and they may have to do until feeding
but we need to wait to get that information now positioning for stroke patient or neural patients this same thing we don't position them higher than 30 degrees you need to have to drain you know the venous system butyou do not need increased intracranial pressure so positioning them positioning them higher than 30 degrees will increase into cranial pressure so position is 15 to 30 no more than 30.
stroke patients tbi patients brain patients neural patients are all at risk for seizures so you would put them on seizure precaution
and we know what thoseare
make sure you have all your equipment readily available just in case uh another thing that's very common with post stroke patients is that they almost all get depressed
it's the disease it's a stroke the stroke is accounting for about 80 percent of that it's not you know the patient because this affect the brain especially depending on what area of the brain that got affected
so you are obsessing them for signs and symptoms of icp what are early symptoms of icp early early symptoms of icp kathy
mm-hmm
blurred
vision i think is one vomit in yes because vomiting is like one of the signs that tells you that they go again getting ready to go into icp and the vomiting by the way is projectile sudden projectile vomitingsudden projectile vomiting irritability restlessness
fijidi all those other signs of icp because the brain is not getting enough oxygen what about late signs of icp now because you missed the early what are late signs of icp
the cushions triad the headache i've gotten worse so now it's worse than headache now we start to have some significant visual changes pupillary changes where one pupil is this is a very bad sign near any newer patient whereyou see the pupil size change one bigger than one people bigger than the other that's bad that's because there's signs of brain herniation one side of the brain is moving in the wrong direction so cushing's triad is thelate side of icp late and bad i say if you missed the ball and they got there good luck bringing them back because cushions triode is three things we say that hypertension would widen pulse pressure let me giveyou an example of what this what is a widening pulse pressure so now we have let's say a blood pressure of 190 over 70.see the big difference between the systolic and the diastolic so that's the widening pulse pressure and then bradycardia neuro by the way and neuro and spinal cord will be bradycardia because they don't have the spinal the autonomic tone
is completely off with neuron spinal cord so in neurogenic shock in the one time you see shock with bradycardia so why so it's hypertension whitening pulse pressure bradycardia and slow irregular respiration james token
and what do you do if you see that what's your initial what's your first what's your priority intervention
kathy rapid response rapid responserapid response to that patient that's the rapid response moment blood pressure is way high the the sub bradycardia and remember rapid response to a heart rate less than 50 zero the rapid response and in in christian striat theheart it will be less than 50.kim don't give a trapeze it's not going to help
rapid response to patient
tbi traumatic brain injury they're going to present similar to stroke patients tbi patients are um you know a lot of times they could have a bleed going in their brain so they can list similar to hemorrhagic stroke they'regonna need a cat scan before anything you need a cat scan because we want to know what's going on what's the degree of damage and what how to treat do we need can we treat with medication can wejust treat supportive care or should we take this person to the or
by the way just moving back a little bit um stroke patients uh they get as they get that initial ct scan and they also after that they get serial ct scan and mri because they're stroking out so let'ssay that when they first came in they got a ct without contrast if they could get if you know the kidneys are working and they're not allergic to iodine or shellfish maybe in another eight hours or so they'llget another 50 scan because we want to see if you know if the damage is getting
worse
Covers classic concussion symptoms, CT imaging, and discharge warning signs. Also explains how to reduce stimulation for neuro patients through quiet environments and limited clustering of care.
let's talk about concussion so concussion um what are the symptoms of concussionclassic symptoms of concussion
headachesmemory loss confusion yes we call it retrograde amnesia get everything that happened right before loss of consciousness less than an hour loss of consciousness now with concussion they could they they will be getting a ct scan as wellall these patients get ct scan because we don't want to miss anything if you are working in the er and you have a patient comes in with this brain issue and they don't get a ct scan that's malpracticebecause even with a concussion the symptoms could be they could say they fell and hit their head but other things could be going on in there too so you don't want to miss it so they all get act scan now we usually discharge concussion patients after they you know recover and they back they because usually they come they you know takes an hour they back and alert they still have this this is a headache though
um this nagging headache and this and they it's still there it is constant headache we discharge them with that but what do you tell them when do you tell them to return to the er or call your doctorif what they discharge on post concussion
vision work let's say um i said if they have blood vision worsening yes what else if the headache gets more severe yes forcing a headache yes what else
difficulty with their gate ataxia now they've fallen down and as nevin said earlier vomiting sudden projectile vomiting back to the er you're getting
worse
and usually post concussion when they discharge you want to tell them to decrease stimulation now every neuro patient i have to use the word every will you will the nurse you will decrease stimulation so neuro if you've everbeen in a neural floor it is quiet it is dark it is dim and it's away from all the noise of the hospital and i always say it's closer to the morgue than any place else because you don'twant no extra stimulation you don't want to hear the escalator you don't want to hear the elevator opening neural patient do not need all the stimulation so guys this is a patient you do not cluster care you don'twant to be in there for too long so you go and do what you have to do and you're going to say but i'm going to be going in and out and you don't have to go in and
out of the patient room especially if you organize yourself and do what you have to do and get out you don't want to close your care so do not cluster care for neural patients any neuro patient and allneural patients do not cluster care make sure their light is turn it's dim the light is dim and they're on okay no tv you're post concussion patient no tv no reading so they can listen to podcast or listento radio but no no no stimulation and this this is the protocol for about a week or so post concussion
Reviews classic meningitis symptoms, assessment findings, and droplet precautions. Explains antibiotic treatment, lumbar puncture, vaccination, and discharge teaching.
now let's segue into meningitiswhat are the symptoms of meningitis the classic that their nclex will ask you in a form of assad headache giver and stiff neck headache fever stiff neck what do you what what's the other word for the stiff necknevin
you um with the n no yeah a new core rigidity okay yeah yeah um and then upon assessment what are the other two things you're going to find the kernick sign and the brudinsky sign does that sound familiarpositive kernic positive brudinski
so it's the it's the classic the headache fever they could be vomiting too and they have this the stiff neck the nuclear rigidity and on your physical assessment you'll find a positive karenic sign the chronic sign is basicallywhen you um let's say you're trying to do a crunch and you lift their leg they had everything just bend with that move in the opposite direction and so it's a kernick sign bredinskyside nuclear rigidity they're not ableto talk their chin they're not able to turn their neck and of course the headaches now what do you do if you suspect it's meningitis what's what what's the initial nursing interventionthank you droplet precaution droplet precaution do nothing else until you'll isolate don't do vital signs until you isolate isolate isolate isolate so droplet precaution what are the work of what are you going to get
probably get a like a narrow workup for like increasing icp you and you're going to be monitored so you have them in droplet you're going to darken their room decrease stimulation and yes they can get a neural workupum but they these patients are going to get lp lumbar puncturenow how do we treat meningitis
antibiotics antibiotics whether it's viral or bacterial we don't know but they all going to get antibiotics and they get antibiotics and and we get into lp lp could be the next day or same day but we don't waiton the lp we just start antibiotics they on isolation and this is an nclex moment they will be in isolation until they receive at least 24 hours of iv antibiotics then you can clear the isolation or or thelumbar puncture said there's really nothing in there so one of two either 24 hours of iv antibiotics or a negative lp
so there's still so now they're going to be an um oral antibiotics after the 24 hours but they 24 hours of iv antibiotics how to prevent
meningitis
kim are you still with
me
and hygiene i'm gonna go to kim is not here come to took a break how do we prevent meningitis washing your hands that too but vaccine meningococcal vaccine the one you can't go to nobody's college without remember thatyeah i had to get it before you go to college and you shut you you shut you down my son just got his second it's like okay come to our school without this an indicator because meningitis is likevery common in very dense they're very dense populations so you see the dorms you see it in nursing homes you can see it in of course prisons so very common um that it can spread so prevention vaccine wouldthat be a primary intervention very good vaccines are considered primary okay yeah it's a very good point yes primary prevention yes so any question of meningitis
so when they're going home you're going to teach them about meticulous hand hygiene um what to report because even though you know they are better now they can still have some you know fever some inflamed some headaches sothey can still go into icp so they can still have seizures so you go over all that discharge teaching what to report and when to return back to the hospital antibiotics they should take the entire course not whenthey're feeling better take it until you complete the entire course if you're still you know things are not feeling better and follow up with your primary care provider
Summarizes spinal cord injury levels and their effects on respiration and mobility. Focuses on autonomic dysreflexia, its triggers, presentation, and the priority nursing response.
the next thing i want to talk about is spinal cord injury and now what i'm going to keep very brief spinal cord injury we talk about spinal cord remember we have c cervical area thoracic lumbar sacral so anythingin the cervical area c1 to c3 is very high and that affects respiration
the matter of fact c1 and c2 that patient with spinal cord injury for c1 and c2 um probably most likely will not make it and if they do they'll be completely vent dependent
thoracic so after see the in the thoracic area um from t5 and up t5 that patient is considered a um a quad a paraplegic so they can they operate they have extremity use of the upper extremity but nouse of the lower in the from t5 and below sorry t5 and below t above t5 they are quadriplegic completely quadriplegic they can't do anything for themselves
so with spinal cord injury it depends on the location again the location of the injury but the big thing that we worry about with spinal cord injury patient is autonomic dysreflexia because if they are if it's if it'st5 and above then they're not able to pee on their own they need to be straight cat so if they if the bladder get descended they can get autonomic dysreflexia if they also have difficulty with their bowels sothey'll need laxatives they'll use two softener and if they're not able to get the stool out they get impacted or severely constipated they can get autonomic dysreflexia if for whatever reason their clothes is too tight they can alsoget autonomic dysreflexia um what is autonomic dysreflexia kathy that sounds familiar it definitely does i'm trying to like pull back to my amp and try to think of what it is so this is uh um calling a friend
uh nevin you remember or now this reflects here yeah um that's when i know that's the really high blood pressure yes and i know it can like lead to like yeah like strokes or seizures yes if we don'tdo anything about it yeah so how do they present what's the presentation of all knowledge beside the youth really high blood pressure is one of them correct and bradycardia bradycardia yes
plus okay yeah vasodilation so they have they get flushed um and they said say it again seizures they could but before we get there so they normally will present with you know severe hypertension they haven't and headaches verybad headache because the blood pressure is high blood pressure is high you get headaches and they i said they get vasodilation so they look um flushed it looks like they're sweating and so how do we treat them whatis the into so you suspect because of their because they have spinal cord injury and you suspect this autonomic just reflects here what's your initial intervention what are you gonna do first i'll leave this one for kim
kim is out the room so malia what are you to do first you suspect i don't know i'm an id autonomous reflects here i think i think you give them the drugs of choice is a trophy into thatthat's what you do first um i get for autonomic distress yeah would it be one of the yeah like the nitroglycerin can you guys stop with the medication first please um i think people like send them to thebathroom or something like that i think you want to set them up i was just going to say elevate the head of the bird yeah like i am always hearing these medical interventions and that's what's holding us backin this exam because you guys are constantly ready to do what doctor tell you to do and not what you learned to do can we please stop it set them up sit them up spinal cord injury a.d they
go up they go all the way up 90 degrees sit them up that's what you do first if that's not a choice remove the causative agent what is the problem don't give them medication don't give them medication don'tgive them medication because the problem will go away if you remove the costs so if you take out the urine out of their bladder then there will be no need for medication if you get the stool out oftheir rectum then there will be no need for medication if you loosen their tight clothes they'll be no need for medication so do the nursing interventions first oh unless it's not in the choices if it's not in thereif you go on nclex and there's a nursing intervention and that's not the answer come back i'll give you all your money back that is always the answer but you guys don't want to do it because you don't
feel like your action is enough to save the patient well let me tell you news flash yes you save patience you nurses save lives we take care of patients that to take care of disease so always go giveme the basic basic stuff first if there's nothing you can do kathy if it's out of my hands i've done everything there's nothing i can do about this what do you do then you get medication then you givemedication or rapid response to them because there's nothing else i can do the situation is way out of my hand but please i had someone sit the nclex this week and all she got was nursing intervention and shewas so she's kept telling me all i want to do i was like this can't be right it can be the simplest can be right it can't be the simplest can't be right it can be just simple i
said because they know you're going to want to give the meds i know you're going to shoot some atropine in there already you know you want to give some um because that's what they teach you to do innursing school kathy excara
how about clamp the chest tube he told you guys that go clamp what like brand new clamping chest tube like you're an experienced nurse anyway so that's the intervention did cat did did kim come back to the roomi don't think so okay all right so let's move on so that's you that's your gist for spinal cord injury spinal shock and neurogenic and neurogenic shock will present exactly the same way they will remember i told youthose are the two the only two times you see a shock with bradycardia because remember shock is always tachycardia but for spinal and neural which is the same thing is bradycardia then you can give the matcha feed and
Briefly covers Guillain-Barré syndrome, myasthenia gravis, and ALS, then moves into Parkinson's disease. Reviews hallmark symptoms, fall prevention, and levodopa-carbidopa teaching.
then shock you need to speed up that heart rate all right so the other um all these other msmg gbs oh gosh we won't even go into these gbs is under eyes gbs is under rise because we've seenit as a side effect of the the vaccine and also the disease the kobe itself um kathy you remember about gbs
i remember it but not fully no what is what is uh like unique about gbs
the way they present right that's the one that presents with the
weakness from the ascendant so from their foot up now they get further and then they recover in the descending format
with my senior gravis the only thing i want to mention about that is that make sure that they take their medication um before they eat because you want to uh make sure that their muscles they're eating the diaphragmis strengthened so they don't aspirate because my senior grab is big thing with gbs and m and mg is that they could aspirate another thing i want to stress about my senior gravis is that that those patients willneed more medication during times of stress so they should carry extra medication around with them and you should instruct instruct them they know it's times of strength we're talking about physical stress psychological stress whatever it is you mayneed to increase your medication so it wouldn't it's not unusual for them to have extra medication at their bedside or even in their car
and when it comes to mg gbs and you know it's most of the time is priority like who do you see first also with als als is lou gehrig's disease this is the one that there's no cure andbasically we don't really have any treatment we have the expensive and a very expensive drug now that has shown very little therapeutic effects so with als basically the patient progressed very fast and it's complete paralysis of the neuralmuscle of the all the neural muscles so diaphragm so eventually they're going to be on a vent they're at risk for aspiration especially when they start to disease start to accelerate and they have difficulty articulating their speech wecall it this arthica increased risk for aspiration
so als is basically we say uh advanced directives it usually affects very young wealthy people so we don't really know why a lot of the new a lot of these neurological disorder we don't know why
we call them idiopathic unknown
but we need to talk about parkinson's disease so parkinson's disease pd as we call it how does that present what's the classic symptoms of parkinson's
disease
uh so parkinson's would be the like the tremors staggering gate um
doing good maybe like the the like slow they're like walking really slow mm-hmm shuffling the shuffling gate they have that you said the tremors what changes in speechas the disease progresses yes they start to drool and they have this mask like face is that the pin rolling one that's the pin rolling the throat the unintentional tremors pin rolling yeah they have a stoop posture likeif you see them they look like they bent over all the time that there's two posture now parkinson's is a disease of mobility it's lack of dopamine in the brain dopamine is the neurotransmitter from motion so it's it'sa disease of mobility so we you want to teach them early in the disease so parkinson's is it's slow now everything here a neuro everything except for als let's not even talk about that everything here is they progressslow we talk we say progressively progressing it's gonna it's gonna go there but it's it's you know medications or whatever we use it is slowing it down it's not really curing gds is not one of them because gbs
is a syndrome it's not a disease but parkinson's mgms so with parkinson's eventually they're gonna get to that place where they're gonna uh at risk for aspiration because they julie now can't handle the jewel they also start toget confused they they couldn't you know their mobility gets so poor they become wheelchair-bound but early in the disease when they have this shuffling gate one of the basic nursing intervention one of the basic teaching that you needto tell them is to pretend that you're stepping over an imaginary line pick up your feet because this shuffling that they're doing they can fall remember i said it's a disease of mobility
so they love to ask you about that early in the disease tell the patient to pretend that you're stepping over an imaginary line as they progress so they will need physical p t therapy t this is interdisciplinary careand definitely medication the cinnamon leave a dopa
carbidopa let's talk about levodopa carbidopa while we're here for parkinson's disease that medication is been around for years old it's an anticholinergic and it can cause orthostatic hypotension that's why the question we had earlier you make sure youcheck their blood pressure early on because they can get you can drop their blood pressure and they get orthostatic and they already have a disease of mobility so they this will increase their risk of falling the other bigthing that is nclexy for that drug is that it can turn the urine or um brownish that's suspected now we got brown urine that's what that drug can do brown ish tell them that to drink more fluids anotherbig thing with the levodopa carbidopa is that high protein decreases the absorption so if you don't have a high protein diet the medication is not going to work so they need to be on low to moderate protein diet
so this is the other thing i wanted to tell you the nclex had gotten bigger on foods you know how much they were on all about foods foods foods and i'm sitting there going why are they so bigon foods but you know what food is really a problem when it comes to disease so make sure you know what foods are high in protein and which food you would take off their tray or you would tellthem to eat in moderation when they're on the levodopa carbidopa so number one it's the high protein diet decreases the absorption so watch out for the type of food they're eating the medication can drop the blood pressure itcan cause ultrastatic hypertension and it changes the urine color brownish
Summarizes the most important neurological priorities, including ICP signs, stroke response, and concussion care. Reinforces the need for rapid CT scanning in suspected stroke.
and that's neuro and click style
everything else falls into place icp know the signs of early signs of icp know the signs the late signs of icp know the signs of a stroke know what to teach the patient about stroke and what when toreport it and what to do if they having these symptoms of stroke remember what to do first when they've initially appeared and in triage when they come to your er what do you do first after you get avital signs you need to get them to cat scan
Introduces sensory-neural assessment with cranial nerve testing, hearing evaluation, and age-related changes. Covers otitis media, otitis externa, hearing loss types, and bedside hearing tests.
concussion we also remember your neural patients you want to keep things quiet calm do not over stimulate
now let's go to sensory neural
so this is a spin-off of neuro sensory so again you need to know the cranial nerves here to go into sensory now an assessment i when earlier when we were talking about the cranial nerves i forgot to askabout a six cardinal gaze you remember the six cardinal games where you're checking to see if the patient has ex um what do we call it again where the eyes bounce when you move your finger kathy help meout here it's the neural tuff nice deepest nice thickness yes yes yes yeah that's when they you know so one bounce of the eyeball one little bounce is normal but if it's bouncing then there's could be a lesionsomewhere in the brain or they could be drunk and we test that with the six six cardinal gaze this is where you uh tell the patient to hold your head straight and you move your finger up you move
your finger out it should the eyeball should be following your finger not the head and you move your finger down now which cranial nerves are we checking there in six cardinal game i'm going to nevin for this one
um perennial nerve two it's three of them uh so two two three and four two four and six six two four and six what are those what are those cranial nerve again malia two four six it's greater nervetwo four sixyou can show the old factory old factory is one of them abducin what's the other one
old factory is number one so it's number two which is optimal not olfactory it's uh it's oculomotor two oculum two four absorption yeah choke here okay two four six six oculomotor abducin and choclair i'm only i'm only talkingabout this because i was shocked to find out that they brought that up on the nclex so ocular motor is threenumber two is two uptick two four six create the six card the six cardinal gazes two four
sixkathy you with me i am not i'm not i'm not leaving you am i no i'm just a little overwhelmed but it's going to be okayit happens it's it it happens but you know especially with neuro you go what is what is all this again yeah um and and i keep saying that i failed you guys i'm sounding like a broken record it'snot my favorite topic but you know what you still have to know it so i still have to deal with whether i like it or not 100 that's why we show up every every weekend and we're here istill have to deal with it so now let's talk about the vision for sensory neural so the thing that we're going to be checking of course as you get older remember we have normal visual changes is accommodation decreaseswhen you switch from light to dark it takes a little longer to accommodate so decrease accommodation um as you get older we also have press biopia this is how i say you can't hide your age because people act
like you're 20 all you want why are you putting that stuff all the way out there to read itit's why you need all that light to read we need more light so this normal part of aging also since we're doing sensory neural norm um oppressed by cuspid is here diminish now um hearing impaired is not anormal part of him of aging but hearing um low pitched sounds as you get older you hear more low pitched sound than high pitch and what do we always do anyway we always turn the volume up way upand we can't hear it and we wonder why we can't hear it because if you turn it down as you get older you will hear it betterso normal part of aging they are more sensitive to low pitched sounds that's what they hear so then it makes sense to speak to them in a lower time higher tone right it's exactly okay they're they're all yelling
at my grandma like they thought i really like they they yelling because they hearing the low sound and they think they think you need to talk louder that's why they're yelling back at you but you continue to talkat a low pitch regular don't exaggerate don't exaggerate it don't be too low and too slow no low and a normal tone and and also they can have hearing impaired like you know could happen with as you getolder too and they so normally a lot of times i don't know if you've experienced this the older adults will turn the ears that they can hear out of like they talk to you that and they they're verygood lip readers so you need lighting they need light because they need to see your lips so they can read it and then as soon as it's time to say something they turn the good ears to you so
you can talk into it and that's that's the nclex momentyou'll say why do you need to increase the lighting for it's and they it's hearing impaired so they read your lips so they can see your lips of course we know we do that for the visually impaired
so we're going to do here in first and then then we're gonna do the eyes so with the the ears again um the two big problem that we have uh is otitis media or titus externaotitis media that's middle ear infection and i'm not going to say it's more common in pediatrics because it happened in adults too
externa is out is the inner ear canal and that's what one we call swimmer's ears
now once the eardrum is still intact we can give an artic solutionnow remember there's a connection between the brain and the ears so with otitis media the patient can have some ataxia they can have some dizziness it can have some vertigo they can have some lightheadedness there's a direct connectionbetween the brain and the
ears so if they if they are diagnosed with otitis media you want to tell them that to do activities that that you know they should move their head like rapid like you know movement um try to be carefulwith their gait and they balance
also an assessment let's go back to that assessment of the eardrum the air under normal circumstance the eardrum should look pearly gray we say pearly gray with a coat of light like you look at it and you seelike a sun shining back at you that's a normal eardrum pearly gray with a cone of light if of course they have a tightest media you'll see like redness in flames it could also be serous or tidies wherethey just have fluids accumulated and you'll see the bulging of the eardrum an assessment
whenever they have otitis media or serous or ties and the eardrum perforate of course they're going to have fluids coming out of their ears and the pain is going to be alleviated with that now once they have uha perforation of the eardrum you cannot give them any um attic so no solution in the ears once the eardrum is perforated so in this case now we'll have to do the antibiotics by mouth
for people who get otitis media chronic otitis media they can get the medriotomy this is where they put the ear tubes in their ears to drain it adults get this too not just kids and if you look intheir ears it looks like they have a little straw that's that's the normal experience normal finding now the tube stay in there for up to a year and most of the time it falls out on its ownif it doesn't then they'll remove it under conscious sedation right there at the bedside or in the doctor's office so it's good for about a year and then they'll remove it and if god forbid they have to they'llput a new set in sophia question all right so the middle ear infection you said you would see redness and inflammation but would you see it in the ear canal or more towards the ear drum the eardrum okay
the other media is the eardrum hotel is externa in the air canal okay that's why we call it swimmers because they get water in there so much that the whole thing gets excoriated and also people who keep puttingum q-tips in their ears to clean out their ears can also get others external okay remember nothing in the ears nothing in the ears if they need to clean out their ears no equipment i mean they need toclean out their ears they can just put some warm water in a hot that cold and they could just you know rub the side of the the tragus and let it run out
speaking of that we have two types of hearing loss we have conduction hearing loss and we have sensory neuro conduction is the most common that's the one that all of us get or you know by but by thetime we're really up and out again we're all gonna have conduction hearing loss this is because of too loud sounds are too loud um sometimes in the older adults they have wax in their ears so conduction is notpermanent sensory neural though it is permanent that's the cranial nerve and that's usually caused by disease or medication like the autotoxic medications other toxic affects the cranial nerve
Explains visual assessment, including the Snellen chart and legal blindness. Gives nursing interventions for visually impaired patients, including communication, room setup, and safe ambulation.
so by the way an assessment for your elderly patient or any patient who they answering the question incorrectly before you con you say they're confused assess their earring maybe they're not hearing you what are some bedside tests thatyou learned in nursing school that we did for to assess the hearing
go ahead kathy that was you yeah the whisperer's house the whisper test and what's the other one
the one with the two the fork yeah yeah where you do the running and the the rhine test where you put it in the front and on the forehead something on the floor and then you put it uhbut by the ears all you need to know for nclex for assessment is once you put it in the middle of the patient forehead right there which one is that is that weber orin or renny whatever you howeveryou pronounce it everybody has a different way of saying itisn't it the right between the back back of the air like an indian right is by the ears webber is in the middle of the head okay
levin are you there yep okay so that's enough of the ears let's go let's let's go to the eyes okay so we check the eyes we assess it okay let's talk about snelling chart remember that checking the whatwhat just doing the snailing chart which cranial nerve are you checking
two and how do you do the snelling chart again i think you put one eye one hand over the eye yes one eye at a time if they were corrective lenses they're supposed to do with the corrective lensesand that includes glasses or contacts they're supposed to stand 20 feet away and then you we have the line at 20 feet and that's where you start and they read it so remember it's one eye at a timeso the numbers may be different per one eye could be 20 20 may not be both eyes one eye could be 20 next one could be 40.what's considered legally blind is 200 200 that's considered legally blind that's all you need to know about that can you repeat that one more time legally blind 20 200 20 to 200.yeah yeah so 20 feet they see things at 200.
so that's the one who would extend the 20 feet and they're the ones who have to read the big stuff because they can't see if you if you can visualize the snail chart they can't see and you knowthings that are lowered down so 20 so once a day you mark them as 2200 than that considered legally blind
for your patients who are visually impaired basic nursing intervention announce yourself tell them when you're coming in the room tell them when you leave in the room any noise that's going on in their environment identify it because theywill freak out things are going on and they don't know the patients who are visually impaired are not necessarily cognitively impaired so when they get admitted to a hospital setting you want to make sure that you know theirroom setup is what they used to and you you and them you and the patient not the family you and the patient go over the room set up this is over here where do you want your over bedtable where do you want your car bell you go over that with them
and i stress make sure you tell them when you're coming in what you get ready to do when you're gonna touch them they you know they jump easily if you're walking this is another basic one and they askthis you ambulated a patient who is visually impaired you stay one feet ahead of the patient slightly ahead you have them hold on to your arms and so you're slightly ahead and you tell them when you're coming upon like okay where there's gonna be a stair so you're gonna have to step up so you can let them know what the environment is like
Covers cataracts, glaucoma, retinal detachment, and their treatments. Emphasizes postoperative positioning, activity restrictions, and distinguishing cataract care from retinal detachment care.
of course so disease that we have with the eyes cataract cataract is common as you age and mahalia i'm going to put you on the spot because that's what we do here on saturdays what what medication do youcan you you um know that can cause cataract off the top of your head and somebody can help her out if they can think about it i know what medical
medication common side effects for medication
medication that we use a lot and we talk about it a lotkim is one of the antibody
you're in the right direction vancomycin the steroids is that right okay did that ring a bell just steroids side effects of steroids cataract long-term use of course but we don't worry about steroid use unless we use it longterm the only treatment for cataract is surgery done no that we don't have i don't have anything else to tell you one lens at a time we do not do this both eyes they have cataract in both eyesyou don't do both eyes there's one post-op this is where you it's important now post-op cataract surgery one they should lay on the unaffected side
two they can perform light duty lighthouse duty but nothing where they're gonna move their heads sudden head movements shouldn't not allowed for up to 14 days so no sexual intercourse do not wash your hair do not exercise vigorouslyso any anything that's going to cause sudden head movement no um we also do not want anything that's going to increase intraocular pressureso no tight clothing no straining no coughing no season now what do you do if you have allergies and if the allergy season what do you do what what 11
um maybe take take your allergy bill take your allergy pills you don't want exposure yes what about coffinsay god forbid they have a cold and they have a cough
we give them anti-toxin medications so they won't cough oh by the way this is the time this is the time you correct the lpn or the new grad who's teaching the patient who's post eye surgery to cough anddeep breathing they can deep breathe but not cough and what about um nuts training what would be some intervention to prevent them from strainingstill softener full softener so no coughing no straining no tight no turtleneck no bow ties
let's go to glaucoma what about glaucoma what are the risk factors for
glaucoma kathy
i'm here just thinking that diabetes leave it in the diabetes
hypertension hypercholesterolemia is that this glaucoma is pretty much diet it's pretty much hypertension in the eyes so glaucoma um will be on medication for life they don't want they get the same the same timolol um any medication thatyou're given for hypertension and so on you'll be given for glaucoma now we have something called open handle glaucoma closed angle glaucoma let me explain the difference close angle is acute is if you if you want to thinkof close angle glaucoma think of the boxer who got punched in the eye you see how that thing swallowed and he gets increased iop so glaucoma is increased iop so that's a close angle glaucoma it has traumatized openangle is chronicso with close angle we have to get in there fast and we got to decrease the pressure into ocular pressure what's our drug of choice for iop and ifbb which i did not mention
would it be mennoton manitoba yes and when you're given manitol nevin what's your priority um nursing assessment do you want to make sure for sure for sure when you're given mandatoryum you want to make sure that theyhave um
actually i'm not sure remember it's a diuretic it's a very potent one it's very strong one so you're gonna do this trick and take an output okay got it yeah this is a very straight we don't roll thatout unless we have a situation like this as a matter of fact this is a manitoba is icu and er settingslet's go back to cataract for a minute post-op cataract surgery eyes will be patched at night not during the day during the day there were the dark glasses for a couple of days now don't freak out about thepatch that they're gonna give you if they say metal patch if they say clawed patch if they say whatever patch patch the eyes
and it's usually at night during the day time they can wear sunglasses those big sunglasses that they wear for a few days otherwise they're okay uh patients describe glaucoma as looking through a dirty window and then they describepost-top surgery and someone clean it with some windex and now they can really see also when we talked about post-op um no stimulation so no watching the tv no computers none of that similar to the lasik surgery noreading for a couple of days
when you said the patch eyes did you say that was for cataracts yeah post-op cataract surgery yeah okay got it got it
retinal detachment how do we that's that's acute that's sudden that's usually trauma so um the person with the close angle glaucoma is probably have retinal detachment too the boxer and how do you typically describe retinal detachment in yourtextbook mahalia it says like curtains or light or floaters or something like that yes exactly fishnets something come down in front of their eyes and this is acute they have a lot of pain too so it's very painfulso this is a or moment you got to go to the or and they tip so what they do here is that they're going to use a gas bubble to put the retina back in place and this gasbubble is like a balloon or it's like a compressed so for post retinal detachment post this gas bubble surgery they lay on the affected side because they want we want to keep pressure to keep that retina in place
so let's clear this up so we don't get confused post-op retinal detachment on patient is on the affected side for pressure postup cataract do not lay on that side you're on the unaffected side right now detachment you needto keep the retina in place so you're going to put pressure on it so that's why you're going to be on it
Describes macular degeneration, loss of central vision, and how to adapt the environment for affected patients. Ends with a recap of exam strategy and encouragement for the next study session.
are we clear on that retinal detachment surge post op versus cataract postop kimyes okay now let's talk about macular degeneration the last sensory neural problem macular degeneration is the number one cause of blindness in the united statesnow this is the one where they lose their central vision no central vision so they feed things to the periphery so anything in front of them is all blurred out very common as they get older more common incaucasians
so no central vision so this patient if you're carrying participation with macular degeneration now we we don't have to date for nclex we do not have any treatment for macular degeneration they have all this experimental nonsense but tofor something that really works no treatment so since they don't they have peripheral vision so you put the nurse you'll put everything to their side because they see nothing in front of them so the tray would be tothe side the tv would be to their side everything to this to the to the periphery but not directly in front of
them and i know i overwhelmed you guys today so we're not going to do musculoskeletal we'll complete all of that tomorrow because with tomorrow we'll do musculoskeletal and go into psych psych we need to talk about the differentpersonality disorders because they are basing this exam of what's going on right now unfortunately site used to be about five percent of nclex it has now gone up to 15.so i have to go over those drugs in detail i have to go over those personality disorders because those personality disorders are um we used to tame them but since the pandemic we can't tame them anymore so youneed to know the difference between borderline personality histrionic narcissistic um so all those things we got to go over tomorrow so go make whatever i gave you today your own um take it easy do not overwhelm yourself go
to your world and do all the you world neural sensory questions not before tomorrow though because you don't want to rush through them just do as much as you can and i'll see you back here tomorrow at 10a.m um mainly you can stay back okay
um done yes we're done yes question any question nevin no question okay so go make all this information your own you know put it together you know most of the stuff already just gotta you guys just gotta seeit in the format of a question and what to you but guys please make sure if basic nursing intervention is there select your basic nursing intervention you can't go wrong with doing what you were taught to do soyou know unless it's not there then you go for the other stuff but this what do you do first what do you do first what you do first now after we complete all this content content content or whenwe have a private meeting it's all about these things that i go over with you guys how to answer these questions so don't get overwhelmed kathy we get in there it's one step at a time
i'll see you guys tomorrow council's affair thank you thank you you're
welcome