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CHALLENGES
3.BRAIN STEM
4.CEREBELLUM
4 LOBES
1. Frontal – judgement
2. Temporal – comprehension; stock memory
3. Parietal – distance, temperature and pain
4. Occipital – vision (dizziness and blurring of vision)
SPINAL CORD
Basic part
1. sensory – things that receives the messages.
2.motor – will deliver messages.(pain)
3. connector – that’s link the two.
2
ASSESSMENT
• Why is it important?
a. To establish baseline neurological assessment to note
deviations and trends which part of the brain that tells
/control your awareness. “reticullar activating system”.
b. Detect changes in the neurologic status of the patient.
c. Minimize loss of function from neurologic deficits.
d. Determine effects of neurologic dysfunction on ADL.
e. Compare data from previous assessment to the present.
3
PARAMETERS TO BE USE OF NEUROLOGICAL
ASSESSMENT
• History taking
• Vital signs
• LOC
a. Alert – oriented to person, time & place.
b. lethargic- patient sleep most of a time but responded upon calling upon his/her name.
c. Abtended – sleep most of a time but responded by apply painful stimuli or by shouting after
applying to pain and back to sleep.
d. Drowsy/ stupor – to painful stimuli
e. semi-coma – flex or extend by applying pain
f. Coma – no response to all even in painfull stimuli.
• Pupillary assessment
size 2-3mm
Equality
Reaction
• Motor strength
5/5 normal movt. against gravity and resistance.
4/5 full range of motion against moderate resistance and gravity.
3/5 full range against gravity only not against resistance.
ASSESSMENT IN INCREASE INTRA CRANIAL PRESSURE
• RESTLESSNESS – initial signs of increase ICP.
• HEADACHE – due to traction or pressures.
• VOMITING – results from the pressure at the medulla oblongata it may be projectile.
• DIPLOPIA –pressures at the CN VI ( abducens) which controls lateral rectus muscles of the eye.
• DECREASE LOC – due to affection of ascending reticular activating system.
• CUSHING REFLEX – due to cerebral hypoxia.
• SYSTOLE – increase due to increase force of contractions.
• DIASTOLE – remains normal or decrease due to longer time required for the heart to relax
• WIDENING OF THE PULSE PRESSURE
• RESPIRATORY RATE – slow due to involvement of the medulla oblongata and pons.
• TEMPERATURE – increase due to involvement of hypothalamus.
• UNESOCORIA – due to CN 111 compression.There is ipsilateral pupil dilation.
• FIXED DILATED –indicate uncal hernation.Brain stem compression.
• PUPIL EDEMA - result from compression of the optic nerve or “choked disc)
• DECORTICATE – involvement of the mid brain-cerebral cortex
• DECEREBRATE – brain stem involvement
CEREBELLAR EXAMINATION
• Finger to nose test
NURSING MANAGEMENT
1. Impaired gas exchange
• Maintaining airway clearance.
• Pulmonary hygiene
• Oxygen
• Tracheostomy care
3. Body proportions
4. Anatomy
a. Airway face and mandible are small.
b. Trachea – short and soft.
c. Breathing – lungs are immature. Both upper and lower airways are relatively small and
are consequently obstracted.
5. Physiology
a. Airway and breathing ( infants have a greater metabolic rate and O2 consumption.
6. Psychology
a. Communication – infants and young children either have no longer ability or are still
developing their speech.
RECOGNITION OF SERIOUSLY ILL CHILD
1. HYPOXIA – cardiac arrest is usually secondary to hypoxia.
2. SHOCK – circulatory failure