Neurologic Deficit:
Acute Phase
What are some causes of a acute phase neurologic Deficit?
Sudden neurologic event:
Cerebrovascular Accident
Head Injury
Spinal Cord injury
The client present w/
Altered level of consciousness LOC
Hypertension/Hypotension
Fever
Difficulty Breathing
Paralysis
Neurologic Deficit
Acute Phase
Medical TX for Acute Phase of Neurologic Deficit
Stabilize the client and prevent further damage
CVA: manage hyper/hypotension w/drug therapy
Head or Spinal Cord injury: required respiratory support through mechanical ventilation or surgical intervention to stabilize the injured area or remove bone fragments, blood clots, or foreign objective.
What are nursing management for the Acute Phase of Neurologic Deficit?
Neurologic Assessment (evaluate the client status)
Check the need for additional medical or surgical intervention and response to treatment
Glasgow Coma Scale or Mini-Mental Status Exam
report significant changes to provider
Assesses VS and BP (ensure adequate cerebral oxygenation)
I's/O's observe for electrolyte imbalance and dehydration
report UOP <500mL/day or urinary or bowel incontinence
Begin basic rehabilitation (Position changes, Skin breakdown, and Contractures are essential )
Goal is to prevent complication that will interfere with recover function
Neurologic Deficit
Recovery Phase
The recovery Phase begin when the client is?
Condition is stabilized
Several days or weeks after the initial event
can last or weeks or months
Medical TX's for recovery phase of neurologic deficit?
Aim to keep the client stable
prevent or treating complications (Pneumonia, or further neurologic impairment)
What are nursing intervention for neurologic deficit recovery phase?
work with team members to plan a rehabilitation program according to the clients abilities and limitations.
Review Table 40-1 Domain of neurologic impairment
Review Table 40-1 Domain of neurologic impairment
Neurologic Deficit
Chronic Phase:
How long is is neurologic phase?
Long standing or For life
What diseases are consider to be a chronic phase of neurologic deficit?
Amyotrophic lateral Sclerosis (ALS) AKA Lou Gehring disease
Alzheimer disease
The client present w/ the below are in what neurologic deficit phase
little or no improvement
remains stationary
progressively worsens
Chronic Phase
Why does physical and Psychologic rehabilitation continue in the Chronic Phase?
Prevent pressure ulcers and muscle contractures
Medical TX's for Chronic Phase of neurologic deficit?
Control of BP
Physical Therapy
Dietary management
Treatment of complication related to Disuse(not being use) and immobility
Surgery is done to correct deformities or problems that developed
Ex. muscle and skin graft to close pressure ulcer removal or kidney stones(stones from the immobility)
What are nursing management for the chronic phase of neurologic deficit?
Focus on preventing physical and psychologic complication
In the Chronic phase of neurologic deficit what does rehabilitation therapy consist of?
retraining in skill like using telephone, handling money, shopping, using public transportation, maintain household, vocational training
Why are client in the chronic phase of neurologic deficit are transferred to skilled and long-term care facility?
When family member can't no longer care for them or the disease has worsen.
What are some nursing management with psychosocial issues and home management?
listen to client and family's adaptation to the client's change in functional status
Ask direct question to identify problems and needs
evaluate the clients ability to perform self-care and resume their role in the family and call on support team
take steps to help client and family to maintain a home life near normal as possible
help with getting aid for home like wheelchairs, shower chair, cane walker
encourage family to help plan for client return home
What coping intervention can a nurse do to help client with a Neurologic deficits disease?
Offer reassurance and emotional support for the client
provide encouragement and praise through out rehabilitation, no matter how small helps client to accept what they cannot or never will be able to do
give client time to talk about their problems, fears, and concerns
encourage client to set reachable goals will help with independence.
work with family and client to develop solution and alternatives
suggest support groups for client with neurologic deficit for emotional social and support.
Socialization Nurse intervention for client w/ Neurologic deficit are?
encourages socialization with others
communication difficulties
may create barriers
What problems affect communication in neurology deficits clients?
expressive aphasia, the inability to produce language, but may be able to write information;
receptive aphasia, the inability to understand spoken or written language, but may retain the ability to understand very common words that are used most often
dysarthria, difficulty using the tongue, lips, palate, vocal cords, larynx, or breathing to produce speech
What interacting technique can you do for Client with Receptive Aphasia?
Gain the person's attention's
provide sensory aids such as glasses
limit environmental distractions, such as background noise
or multiple people talking
use gestures, facial expressions, drawings and pictures
speak in a normal tone of voice
use simple language on one topic at a time
What interacting technique can you do for Client with Expressive Aphasia?
Provide a list of words for the client's reference or use a communication board
Allow time for a response
Guess the word that the client has difficulty saying, and ask if it is correct
Do not interrupt when the client speak
admit that you do not understand
limit questions to yes or no answers
What interacting technique can you do for Client with Dysarthria?
Consult with a speech therapist
practice exercises recommended by speech therapist such as a whistling: blowing bubbles, balls, or through straws
Use a communication board or software
Suggest pausing briefly between words
Have the client write the word that is not understood
utilize Prosthetics such as Dental retainer
Enlist the aid of speech generating device for creating a synthetic voice
How should the nurse encourage socialization with the family or care team?
By discussing current events and motivate the client to response
Nurse allows:
the family time to deal with and accept the changes
provides the family with opportunities to talk and openly express their anger fear guilt and helplessness
The nurse way of helping the family to process the changes.
Client and family teaching 40- 1 page 687
Home care for clients with a Neurologic deficit
Client and family teaching 40- 1 page 687
Home care for clients with a Neurologic deficit
What should you do for a client with dysphasia who takes pills?
Liquid medications (in syrup form) can be an alternative
be aware that many of these contain sorbitol.
cause diarrhea if multiple medications are given in syrup form.
NURSING PROCESS FOR THE CLIENT WITH A NEUROLOGIC DEFICIT. 687-690
NURSING PROCESS FOR THE CLIENT WITH A NEUROLOGIC DEFICIT 687 - 690
NURSING GUIDELINES 40-2 and 40-3 690 page
NURSING GUIDELINES 40-2.and 40-3 690 page