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Chapter 40: Caring for Clients w/ Neurologic Deficits

front 1

a condition in which one or more functions of the central peripheral nervous systems are decreased, impaired, absent

  • ex. paralysis, muscle weakness, impaired speech, inability to recognize objects, abnormal gait or difficulty walking, impaired memory, impaired swallowing, or abnormal bowel and bladder elimination

back 1

Neurologic deficit

front 2

3 phases of a sudden neurological event?

back 2

  1. Acute
  2. Recovery
  3. Chronic

front 3

During this phase, client is usually critically ill, with many s/s of LOC, hypertension, hypotension, fever, difficulty breathing, and paralysis

back 3

Acute phase

front 4

Medical and Surgical Management for clients in acute phase of a sudden neurological event?

back 4

  • stabilize the client and prevent further neurological change
  • manage hypo/hypertension w/ drug therapy
  • mechanical ventilation or surgical intervention to stabilize the injured area
  • surgery just depends on the situation

front 5

Nursing management for clients in an acute phase of sudden neurological event?

back 5

  • frequent neuro assessments
  • Glasgow Coma Scale
  • Mini-Mental Status Exam
  • vital signs
  • maintain vitals, esp. BP, to ensure adequate cerebral oxygenation
  • measure intake and output/electrolyte imbalances and dehydration
  • frequent position changes and prevention of skin breakdown and contractures
  • prevent complications that may interfere w/ the client's potential to recover function

front 6

This phase begins when the client's condition is stabilized

  • it starts several days or weeks after the initial event and lasts weeks or months

back 6

Recovery phase

front 7

Medical and surgical management for recovery phase of a sudden neuro event?

back 7

aims at keeping the client stable and preventing/treating complications, such as pneumonia, and further neurological impairment

front 8

In this phase, the client shows little to no improvement, remains stationary, or progressively worsens

  • results are prolonged or lifelong
  • ex. Amyotrophic lateral sclerosis (ALS) or Alzheimer Disease

back 8

Chronic phase

front 9

Medical and surgical management for clients in chronic phase of a sudden neuro event?

back 9

  • control BP
  • physical therapy
  • dietary management
  • tx of complications related to disuse and mobility
  • surgery

front 10

Nursing management for clients in chronic phase of neurological event?

back 10

  • focuses on preventing physical and psychologic complications
  • therapy in rehab

front 11

the inability to produce language, but may be able to write information

back 11

Expressive aphasia

front 12

inability to understand spoken or written language, but may retain the ability to understand very common words that are used most often

back 12

Receptive aphasia

front 13

difficulty using the tongue, lips, palate, vocal cords, larynx, or breathing to produce speech

back 13

Dysarthria

front 14

Techniques for interacting w/ clients w/ receptive aphasia

back 14

  • gain the client's attention
  • provide sensory aids such as glasses
  • limit environment attention
  • use gestures, facial expressions, drawings, pictures
  • speak in a normal tone of voice
  • use simple language

front 15

Techniques for interacting w/ clients w/ expressive aphasia

back 15

  • provide a list of words for the client's reference or use a communication board
  • allow time for response
  • guess the word the pt has difficulty saying, and ask if it is correct
  • Don't interrupt when client is speaking
  • admit when you don't understand
  • limit questions to yes/no answers

front 16

Techniques for interacting w/ clients w/ dysarthria

back 16

  • consult w/ a speech therapist
  • practice exercises recommended by speech therapist
  • use a communication board
  • encourage changing rate of speech
  • suggest pausing briefly b/t words
  • have client write the word that is not understood
  • utilize prosthetics such as a dental retainer

front 17

REVIEW CLIENT AND FAMILY TEACHING 40-1: HOME CARE FOR THE CLIENT W/ A NEUROLOGIC DEFICIT

back 17

REVIEW CLIENT AND FAMILY TEACHING 40-1: HOME CARE FOR THE CLIENT W/ A NEUROLOGIC DEFICIT

front 18

REVIEW NURSING PROCESS FOR CLIENT WITH A NEUROLOGICAL DEFICIT

back 18

REVIEW NURSING PROCESS FOR CLIENT WITH A NEUROLOGICAL DEFICIT

front 19

REVIEW NURSING GUIDELINES 40-2 AND 40-3

back 19

REVIEW NURSING GUIDELINES 40-2 AND 40-3