Alt. Communication/ Motor Function

Mrs.
Travis 01-18-07
Alt. Communication/ Motor Function

Nursing Assessment
• Altered communication patterns
• Impaired swallowing
• Motor function
• Motor dysfunction
Altered Communication pg. 1890 in Brunner
• Aphasia
o Expressive-can’t speak
o Receptive-can’t understand what someone else is saying
o Global/mixed-both
• Nursing Care
o Encourage patient to repeat sounds of the alphabet
o Speak slowly and clearly
o Speak in simple sentences, use gestures pictures
o Allow patient time to communicate
• Dysphagia
o Difficulty swallowing
• Nursing Care
o Test pharyngeal reflexes
o Assist with meals
o Place food on unaffected side
o Allow ample time to eat
o Make sure patient stays in upright position
Motor Function
• Assessment
o Muscle tone-look for flaccidity
o Muscle strength-grip test
o Coordination-finger-nose test
o Balance-gait, Romberg’s test (eyes closed, feet together)
o Muscle size-wasting/atrophy
• Gerontologic Considerations
o Brain weight decreases
o Deep tendon reflexes decreased
o Muscle atrophy
o Flexed posture
o Shuffling gait
o Rigidity of movement
• Infants
o Immature
o Movements uncoordinated
o May “short circuit”
Motor Dysfunction- Motor Lesions
• Upper motor neurons (UMN)
o Above T12
o Reflex arch is intact
o Loss of voluntary control
o Increased muscle tone
o Muscle spasticity
o Little or no muscle atrophy

Mrs. Travis 01-18-07
o Hyperactive and abnormal reflexes
• Lower motor neurons (LMN)
o Below T12
o Loss of voluntary control
o Decrease in muscle tone
o Flaccid paralysis
o Muscle atrophy
o Absent or decreased reflexes
Abnormal Posturing
• Decortication
• Decerebration-poor prognosis due to brain stem involvement
• Flaccidity
Brain Tumors
• Malignant vs Benign
• Grades I-IV, IV being the worst
• Types
o Gliomas
 Most common
 Arise from brain tissue
 Nonencapsulated
 Highly malignant
 Grows rapidly
 Tend to infiltrate and invade
• Astrocytoma
• Glioblastoma
• Medulloblastoma
o Meningiomas
 Twenty percent of brain tumors are this type
 Arises from covering from brain
 Slow growing
 Encapsulated
 Compresses
 Benign
 Can reoccur
o Pituitary adenoma
 Tumor of the pituitary gland
 8-12% of all brain tumors
 Causes symptoms as a result of pressure on adjacent structures

or hormonal changes
 Good prognosis
 Causes visual disturbances due to pressure on the optic nerve
o Acoustic neuromas
 Affects cranial nerve eight

 Slow growing
 Hearing and balance disturbances
o Secondary Tumors
 Develops from structures outside of the brain (lungs, breast,

etc.)
 20-40%
Clinical Manifestations
• Headache
• Vomiting
• Papilledema-edema of the optic disc
• Local disturbances-mental status changes, hemapurisis, language/memory

problems
• Pituitary dysfunction
o Diabetes insipidus
o Syndrome of inaapropriate antidiuretic hormone
Diagnostic Tests
• MRI-best test for brain tumors
• CT scan
• EEG
• Cerebral Angiography
• Lumbar Puncture
Management
• Chemotherapy before and after surgery
• Radiation therapy
• Drug therapy
• Surgery
• Gamma Knife surgery
Cranial Surgery
Operative Procedure
• Craniotomy-incision into the brain
• Burr holes-relieve pressure
• Crainectomy-take portion of skull
• Cranioplasty-repair the skull
Location of Surgery
• Supratentorial-above area to be operated on
• Infratentorial-below the area to be operated on
• Transphenoidal- through the upper lip (pituitary tumors)
Preoperative care
• Radiological studies
• Medications
o Anticonvulsants
o Corticosteroids
o Diuretics
• Baseline assessment
Postoperative care
• Reducing cerebral edema
• Relieving pain
• Preventing seizures
• Monitoring ICP
• Proper positioning
o Supratentorial-not on the operative side, HOB up

o Infratentorial-flat, not on operative side
Nursing Management
• Respiratory rate/ pattern/ ABG’s
• Vital Signs
• Neuro checks
• Surgical dressing
• Managing sensory deprivation
• Monitor for potential complications
o Increased ICP
o Fluid and Electrolyte abnormalities
o Infection
o Seizures
o Thromboembolic
o Pressure ulcers
Transsphenoidal Surgery
• Used in pituitary surgery
• Incision beneath upper lip
• Preoperative care
o Eye exam
o Endocrine test
o Sinuses and nasal exam
o Corticosteroids
o Antibiotics
• Postoperative care
o Vital signs
o Visual acuity
o Antibiotics
o Analgesics
o Corticosteroids
o HOB elevated
o No nose blowing
o No straining
o I&O
o Urine specific gravity
o Daily weight
o Monitor nasal packing
o Oral care
Complications
• Diabeted Insipidus
o Decreased secretion of the ADH
o Excessive urine output
o Hyperosmolarity
o Treatment
 Fluid volume replacement
 Electrolyte replacement
 Desmopressin (vasopressin, DDAVP)
• SIADH
o Increased secretion of ADH
o Decreased urine output
o Hyponatremia
o Fluid volume overload
o Treatment
 Fluid restriction
 3% hypertonic saline solution
 Lithium, democlocycline
Seizures
• Episode of abnormal motor, sensory, autonomic, or psychic activity resulting
from sudden excessive discharge from cerebral neurons
• All or part of the brain may be involved
• Most are sudden or transient
• Loss of consciousness, sometimes
• Excessive movement or loss of muscle tone or movement
• Disturbances
Causes
• Idiopatic
• Acquired
o Hypoxia
o Fever
o Cerebrovascular disease
o Drug and alcohol withdrawal
o Head injuries
o Metabolic and toxic conditions
o CNS infections
o Brain tumor
o Hypertension
• Epilepsies-recurrent seizures
o May be primary or secondary
o Onset before age 20
Classifications
• Partial
o Simple-local, no loss of consciousness
o Complex-brief loss of consciousness
• Generalized (Grand-Mals)
o Tonic-Clonic contractions
o Epileptic cry
o Tongue chewing
o Incontinent of urine and stool
o Difficult to arouse afterwards, lie in deep coma
o Noisy breathing
o Complains of headache and sore muscles afterwards
Management
• Goal is to control the seizure and determine the cause
• Refer to guidelines for seizure care
o Pg. 1875 in Brunner
• Drug Therapy
o Anti-seizure meds
o Dilantin
o Cerebyx
• Surgery
Status Epilepticus
• Acute prolonged seizure activity
• Lasts longer than 30 minutes
• Causes
o Abrupt withdrawal of anti-seizure meds
o Fever
o Concurrent infection
• Treat as a medical emergency
• Same safety measures as for other seizures
• ABC’s
• Fast acting medications
o Valium
o Ativan
o Cerebryx
• Other medications
o Dilantin- phynytoin
o Luminal-phenobarbital

Alt. Communication/ Motor Function

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Mrs.

Alt. Communication/ Motor Function

• Altered communication patterns

Altered Communication pg. 1890 in Brunner

o Receptive-can’t understand what someone else is saying

o Encourage patient to repeat sounds of the alphabet

o Speak slowly and clearly

o Speak in simple sentences, use gestures pictures

o Allow patient time to communicate

o Test pharyngeal reflexes

o Assist with meals

o Place food on unaffected side

o Allow ample time to eat

o Make sure patient stays in upright position

o Muscle tone-look for flaccidity

o Muscle strength-grip test

o Balance-gait, Romberg’s test (eyes closed, feet together)

o Brain weight decreases

o Deep tendon reflexes decreased

o May “short circuit”

Motor Dysfunction- Motor Lesions

• Upper motor neurons (UMN)

o Reflex arch is intact

o Loss of voluntary control

o Increased muscle tone

o Little or no muscle atrophy

o Hyperactive and abnormal reflexes

• Lower motor neurons (LMN)

o Loss of voluntary control

o Decrease in muscle tone

o Absent or decreased reflexes

• Decerebration-poor prognosis due to brain stem involvement

• Grades I-IV, IV being the worst

 Tend to infiltrate and invade

 Twenty percent of brain tumors are this type

 Arises from covering from brain

 Tumor of the pituitary gland

 8-12% of all brain tumors

 Causes symptoms as a result of pressure on adjacent structures

 Causes visual disturbances due to pressure on the optic nerve

 Affects cranial nerve eight

 Hearing and balance disturbances

 Develops from structures outside of the brain (lungs, breast,

• Papilledema-edema of the optic disc

• Local disturbances-mental status changes, hemapurisis, language/memory

o Syndrome of inaapropriate antidiuretic hormone

• MRI-best test for brain tumors

• Chemotherapy before and after surgery

• Craniotomy-incision into the brain

• Burr holes-relieve pressure

• Crainectomy-take portion of skull

• Cranioplasty-repair the skull

• Supratentorial-above area to be operated on

• Infratentorial-below the area to be operated on

• Transphenoidal- through the upper lip (pituitary tumors)

• Reducing cerebral edema

o Supratentorial-not on the operative side, HOB up

o Infratentorial-flat, not on operative side

• Respiratory rate/ pattern/ ABG’s

• Managing sensory deprivation

• Monitor for potential complications

o Fluid and Electrolyte abnormalities