NURS 3120 Lecture Notes - Lecture 9: Myasthenia Gravis, Viral Meningitis, Trigeminal Neuralgia

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31 Mar 2017
School
Department
Course
Neurologic*Assessment*
General*Health*History**
Past%Health%%
Any*injuries*to*head/spinal*cord*
Surgeries*on*brain,*spinal*cord*or*nerves*
Strokes?*
Seizure*disorders?*
Anti-seizure*meds?*
Compliant?*
Present%Health%%
Any*changes*to*move/ADL’s*
Chronic*conditions?*
Ø HTN*
Ø Myasthenia*Gravis*
Ø Multiple*Sclerosis*
Ø Medications?*
Ø Recreational*drugs/ETOH*use*
Problem*Based:*Headaches**
Describe*headache*
What*does*it*feel*like*
Location*
Duration*
Any*recent*surgeries*that*required*spinal*anesthesia/LP/epidural*anesthesia*
Problem*Based:*Dizziness**
How*do*you*feel*when*dizzy/light*headed?*
Feel*faint?*
How*often*do*you*experience*dizzy*spells?*
Sudden?*Gradual?*
Objective%Vertigo:*room*feels*like*it*is*spinning*
Subjective%Vertigo:*person*feels*like*they*are*spinning*
Problem*Based:*Seizures*
How*often?*
When*was*your*one?*
What*are*they*like?*Feel*them*coming*on?*
Loss*of*consciousness?**
Precipitating*events?*Stress/meds*
After*the*event?**
Ø Headache*
Ø Muscles*ache*
Ø Sleepy*
Ø Loss*of*time*or*memory*of*event*
Ø Can*you*work?*
Ø Identification*med*alert*band*
Person/People*who*Observed*the*Seizure*
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Describe*movements*you*saw*
Changes*of*color*to*face*or*lips*
Loss*of*consciousness*
Loss*of*bladder/bowel*function*
How*long*did*it*take*for*the*seizure*to*break?*
Was*the*person*able*to*tell*you*what*happened*
What*measures*were*taken*to*protect*person*from*harm*during*the*seizure*
Problem*Based:*Changes*in*Movement**
Changes*in*mobility*
Continuous*
Intermittent*
Tremors/numbness*
Shaking*of*hands*
When*did*you*first*notice*a*change*
Anxious/anxiety*disorder*
What*relieves*the*tremors*
Can*you*work/dress/drive*
Weakness*in*a*part*of*the*body*
Coordination*or*balance*issues*
Legs*suddenly*give*way*
Problem*Based:*Swallowing/Speech**
Dysphagia%%
Difficulty)in)swallowing*
Ø Problems*with*swallowing*all*types*of*food/drink*
Ø Excessive*drooling*or*saliva*production*
Ø Coughing/choking*when*eating*
Aphasia/Dysphasia%%
Difficulty)with)speaking*
Ø Trouble*with*forming*words*or*finding*the*right*words*to*say*
Ø Trouble*concentrating/understanding*
Ø Changes*in*handwriting*
Routine*Exam**
Assess*mental*state*&*level*of*consciousness*
Speech*articulation*
Quality*of*voice*
Comprehension*during*conversation*
Cranial*nerves*are*not*routinely*assessed*unless*an*abnormal*finding*is*identified*during*
exam*
Observe*gait*for*balance/symmetry*
Muscle*strength*of*extremities*
CNS*Conditions:*Multiple*Sclerosis*(MS)*
Progressive*demyelination*of*nerve*fibers*of*the*brain*&*spinal*cord*
Autoimmune*disorder*initiated*by*virus*attacks*on*myelin*throughout*the*CNS*
Symptoms%will%be%dependent%on%which%area%of%the%CNS%is%being%attacked*
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Ø Fatigue,*depression*
Ø Paresthesia*
Ø Focal*muscle*weakness,*ocular*changes*
Ø Gait*instability*
Ø Bowel/bladder*dysfunction*
CNS*Conditions:*Meningitis**
Inflammation*of*the*meninges*that*surround*the*brain*&*spinal*cord*
Invasion*may*occur*due*to**
Ø Bacterias*
Ø Viruses*
Ø Fungi*
Ø Parasites*
Bacterial%meningitis%most%common%–%may%be%FATAL!*
Viral*meningitis*is*a*self-limiting*infection*usually*with*full*recovery*
Clinical*Findings*in*Meningitis**
Severe*headaches*
Fever*&*Malaise*
Stiff*neck*with*+%Brudzinski’s*&*Kernig’s*signs*
Alterations*in*LOC*–*stupor/coma*
Confusion,*agitation*
Photophobia*and*phonophobia**
Neck:*muscle*tone*and*stiffness**
Red*or*purple*rash**
Cold*hands*and*feet*
Gastric:*nausea*and*vomiting**
CNS*Conditions:*Encephalitis**
Inflammatory*process*involving*brain*tissue*&*the*meninges*
Caused*by*bacteria,*viruses,*fungi*&*parasites*
Viral%encephalitis%is%the%MOST%COMMON*
S/S*depend*on*the*invading*agent*and*part*of*the*brain*attacked*
Onset*may*be*gradual*or*sudden*
Clinical*findings*similar*to*meningitis*plus*seizures,*aphasia*&*positive*Babinski*sign*over*
several*days*
CNS*Conditions:*Spinal*Cord*Injury*(SCI)*
Traumatic*disruption*of*SC*
Vertebral*fractures*&*dislocations*–*seen*in*MVA’s,*sports*injuries*&*any*violent*impact*
Injury*to*Cervical*SC:*quadriplegia*
Injury*to*Thoracic*or*Lumbar*SC:*paraplegia*
Paralysis*is*below*level*of*injury*
Loss*of*bowel/bladder*control*
Spastic*paralysis*
CNS*Conditions:*Head*Injury*
Craniocerebral*injury*to…*
Ø Scalp*
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Document Summary

Problem based: headaches: describe headache, what does it feel like. Location: duration, any recent surgeries that required spinal anesthesia/lp/epidural anesthesia. Gradual: objective vertigo: room feels like it is spinning, subjective vertigo: person feels like they are spinning. Loss of time or memory of event. Person/people who observed the seizure: describe movements you saw, changes of color to face or lips. Loss of bladder/bowel function: how long did it take for the seizure to break, was the person able to tell you what happened, what measures were taken to protect person from harm during the seizure. Problem based: changes in movement: changes in mobility, continuous. Intermittent: tremors/numbness, shaking of hands, when did you first notice a change, anxious/anxiety disorder, what relieves the tremors, can you work/dress/drive, weakness in a part of the body, coordination or balance issues. Problems with swallowing all types of food/drink. Trouble with forming words or finding the right words to say.

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