![Medical Management
• Administration of thiamine (at least100 milligrams [mg]), glucose, and an
opioid antagonist is suggested when the cause of coma is not immediately
known.
• Intravenous fluid replacement and vasopressors
• Maintaining Ph with in normal range and electrolyte management is often
complex because of alterations in the neuro-hormonal system.
• Reduce drug toxicity or increase drug excretion, Anticonvulsant therapy
may be necessary to prevent further ischemic damage to the brain.](https://image.slidesharecdn.com/lecture5ccngneurologicpartone2023-2024-241119204556-576bebe9/85/lecture-5-CCNg-Neurologic-Part-One-2023-2024-ppt-15-320.jpg)
lecture 5 CCNg Neurologic Part One 2023-2024.ppt
- 1. Neurologic System: Part I CRITICAL CARE NURSING COURSE (NRS422)
- 2. OUTLINE OUTLINE 1. Neurologic Anatomy & Physiology 2. Neurologic Assessment & Physical Exam 3. Neurologic Assessment and Monitoring 4. Neurologic disorders: Coma.
- 3. Neurologic Anatomy & Physiology
- 4. Neurologic Anatomy & Physiology
- 5. Neurologic Assessment & Physical Exam History (neurologic symptoms, Events Preceding Onset of Symptoms, Progression of Symptoms, medical, surgical, family, medication, trauma). Focused Physical examination (1) level of consciousness, (2) motor function, (3) pupillary function, (4) respiratory function, (5) vital signs. Lab investigations (CSF analysis, Routine lab). Radiology (x-ray, CT, MRI, Cerebral Angiography, Lumbar Puncture, Electrophysiology Studies, Carotid Ultrasonography, transcranial Doppler).
- 6. Focused neurological Physical examination “unconscious”
- 7. Focused neurological Physical examination “conscious” 1. Level of consciousness: orientation questions; focus on questions about recent and past events. 2. Facial movements: for symmetry, and listen to speech patterns for evidence of slurred speech. 3. Pupillary function and eye movements: pupil check and extraocular eye movements. 4. Motor assessment: Assess movement and strength in upper and lower extremities. 5. Sensory: ask the patient to identify what is touched and any difference in sensation between the two sides. 6. Vital signs: alterations in blood pressure, heart rate or rhythm, respiratory pattern, or temperature. 7. Change in status
- 8. Neurologic Assessment and Monitoring 1. Intracranial Pressure Monitoring (To monitor IC hypertension, brain herniation) 2. Cerebral Blood Flow Monitoring (as Transcranial Doppler) 3. Cerebral Perfusion Pressure Monitoring (normal values 60-70 mmHg. (CPP = MAP - ICP) 4. Cerebral Oxygenation and Metabolic Monitoring ( as oxygen saturation in the jugular bulb (SjvO2) ). 5. Continuous Electroencephalography Monitoring (To monitor non- convulsive status epilepticus).
- 9. Neurologic Assessment and Monitoring Intracranial Pressure Monitoring Sites Pupillometer
- 10. Neurologic disorders: Coma • Coma is characterized by the absence of both wakefulness and awareness. • The patient cannot be aroused and does not demonstrate any purposeful response to the surrounding environment. • Coma is a symptom rather than a disease, and it occurs as a result of some underlying process
- 12. Neurologic disorders: Coma Pathophysiology Diffuse dysfunction of both cerebral hemispheres and diffuse or focal dysfunction of the RAS (Reticular Activating System) can produce coma.
- 13. Neurologic disorders: Coma Assessment and Diagnosis A. History “events precedes the alteration in LCO” B. neurologic examinations “detailed” C. Lab “blood, urine, CSF, cultures” D. Diagnostic studies “CT, MRI”
- 15. Medical Management • Administration of thiamine (at least100 milligrams [mg]), glucose, and an opioid antagonist is suggested when the cause of coma is not immediately known. • Intravenous fluid replacement and vasopressors • Maintaining Ph with in normal range and electrolyte management is often complex because of alterations in the neuro-hormonal system. • Reduce drug toxicity or increase drug excretion, Anticonvulsant therapy may be necessary to prevent further ischemic damage to the brain.
- 16. Nursing Management • Monitoring for changes in neurologic status and clues to the origin of the coma, • Maintaining surveillance for complications • Providing comfort and emotional support • Initiating rehabilitation measures
- 17. Nursing Management Measures to support body functions •Promoting pulmonary hygiene •Prevention of aspiration •Maintaining skin integrity / Patient safety. •Initiating range-of-motion exercises •Managing bowel and bladder functions •Ensuring adequate nutritional support •Eye care