scholarly articles about when a patient should report neuro changes and why

Why a second article on neurological symptoms and signs?

The second article will cover frequently encountered neurological symptoms and signs to enable the practitioner to develop a safe and comprehensive system to decide which patients need immediate treatment and/or referral and which may safely be treated at home.

What are the benefits of using a neurologist's report?

It is beneficial in a variety of ways as it allows the localization of neurologic diseases and helps in ruling in or ruling out differential diagnoses. Neurological diseases can present a myriad of ways, including cognitive/behavioral, visual, motor, and sensory symptoms.

What is the clinical significance of a basic neurologic examination?

Clinical Significance A basic neurologic examination can be performed rapidly with practice. The presence of an abnormal result usually warrants further investigation and referrals to specific specialties. It helps to recognize and therefore manage diseases earlier in their course.

Why are neurological observations important in the care of trauma patients?

DOI: 10.12968/bjon.2018.27.19.1110 Abstract Trauma to the brain from injury or illness can cause sustained, raised intracranial pressure. In such patients, neurological observations are a fundamental aspect of nursing care and the ability to make and record such observations accurately is an essential nursing skill.

Why would you perform a neurological assessment?

A neurological exam is used to help find out if you have a disorder of the nervous system. Early diagnosis can help you get the right treatment and may decrease long-term complications.

What are the indications for a neurological assessment?

A complete neurological exam may be done:During a routine physical.Following any type of trauma.To follow the progression of a disease.If the person has any of the following complaints: Headaches. Blurry vision. Change in behavior. Fatigue. Change in balance or coordination. Numbness or tingling in the arms or legs.

Why is a rapid assessment of neurological function important in an emergency situation?

Why is a rapid assessment of neurological function important in an emergency situation? If an ischemic event has occurred, nervous tissue may be compromised, but quick intervention—possibly within a few hours—may be the critical aspect of recovery.

How would you monitor for neurologic change?

IndexMonitor Neurological Status.Perform Spinal Testing.Determine Glasgow Coma Score (GCS)Maintain Spinal Precautions.Prevent Increases in ICP.Monitor the Patient with Raised ICP.Monitor Intraventricular Pressure.Monitor Lumbar CSF.More items...

Why neurovascular assessment is important?

Assessment of neurovascular status is essential for the early recognition of neurovascular deterioration or compromise. Delays in recognising neurovascular compromise can lead to permanent deficits, loss of a limb and even death. Neurovascular deterioration can occur late after trauma, surgery or cast application.

Why are neurological observations important?

Neurological observations collect data on a patient's neurological status and can be used for many reasons, including in order to help with diagnosis, as a baseline observation, following a neurosurgical procedure, and following trauma.

What tests cerebellar function related to gait?

The cerebellum is responsible for equilibrium, coordination, and the smoothness of movement. Specific tests used to evaluate cerebellar function include assessment of gait and balance, pronator drift, the finger-to-nose test, rapid alternating action, and the heel-to-shin test.

Which cranial nerve is responsible for regulating visceral activity?

Brain & Cranial NervesQuestionAnswerWhich cranial nerve is responsible for regulating visceral activity?VagusWhich cranial nerve is responsible for facial expression?FacialThis structure controls body temperature.HypothalamusWhere is the pineal gland found?Epithalamus35 more rows

Which of the following nerves controls movements of the neck?

Accessory nerveAccessory nerve. Your accessory nerve is a motor nerve that controls the muscles in your neck. These muscles allow you to rotate, flex, and extend your neck and shoulders.

When should neurological observations be completed?

As stated above, RN Lilly advised that neurological observations should be conducted for at least 24 hours following a fall where an injury to the head is sustained.

How often should a neurological assessment be performed?

Frequency of neurological assessment If the patient's condition is deteriorating, observations may need to be carried out as frequently as every 10-15 minutes. Clinicians' professional knowledge and judgement will dictate the necessary timing interval for the assessment.

How often should neuro checks be done?

Guidelines for the neurological observation of patients with a head injury from the National Institute for Clinical Excellence (NICE) suggested neurological observation every 30 minutes until a GCS of 15 was achieved, then every hour for two hours, followed by every two hours thereafter4.

Why are certain maneuvers incorporated into neurologic examinations?

Certain maneuvers can be incorporated to increase the sensitivity of an exam for a certain symptom; an elderly patient with memory deficits will require a more in-depth cognitive assessment than a young patient with ptosis. Clinical Significance. A basic neurologic examination can be performed rapidly with practice.

What is neurological examination?

Definition/Introduction. The neurological examination is an assessment tool to determine a patient's neurologic function. It is beneficial in a variety of ways as it allows the localization of neurologic diseases and helps in ruling in or ruling out differential diagnoses. Neurological diseases can present a myriad of ways, ...

Why are red flags important in neurology?

Certain red flags during examination allow early detection of life-threatening neurologic diseases and recognize disorders that may negatively impact the quality of life.[1] The neurological examination is an assessment tool to determine a patient's neurologic function. It is beneficial in a variety of ways as it allows the localization ...

How to tell if a person has sensorineural hearing loss?

The vestibulocochlear nerve (Cranial nerve VIII) supplies functions in hearing and equilibrium. Gross assessment of function can be done by whispering words behind the patient, or rubbing fingers or hair together close to the ear, and asking if the patient can hear. If a hearing deficit is established, doing a Weber and Rinne test can differentiate a sensorineural from a conductive hearing loss. A normal Rinne exam will exhibit air conduction (AC) greater than bone conduction (BC). A conductive hearing loss will show BC greater than AC. In patients with sensorineural hearing loss, AC will be greater than BC, but for a shorter duration when compared to a normal subject. A normal Weber test shows hearing the sound/vibration equally in both ears. A conductive hearing loss will lateralize the sound to the abnormal ear while a sensorineural hearing loss will lateralize to the normal ear. [16]

What is the purpose of proper diagnosis in pediatrics?

In the examination of a pediatric patient, proper diagnoses begin with understanding which specific age groups are prone to developing certain disease processes. It is also important to keep in mind that the manifestation of certain neurologic illnesses can be vastly different in children and adults.

What is NCBI bookshelf?

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

When was the neuromythology of silicone breast implants published?

The neuromythology of silicone breast implants. [Neurology. 1996 ]

What is neurofeedback review?

Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications

What is neurofeedback in psychology?

Neurofeedback is a kind of biofeedback, which teaches self-control of brain functions to subjects by measuring brain waves and providing a feedback signal. Neurofeedback usually provides the audio and or video feedback. Positive or negative feedback is produced for desirable or undesirable brain activities, respectively.

How do cerebral neurons produce electrical pulses?

Activities of cerebral neurons have rich information about neuronal activities. When neurons are activated, they produce electrical pulses. By placing electrodes on the scalp , the electrical activity of the brain, known as EEG, can be recorded. In turn, EEG is generated by a specific type of synchronous activity of neurons which are known as pyramidal neurons and the electrical output is thus reflected in the following areas of the skin where the electrodes are located. Different patterns of electrical activity, known as brain waves, could be recognized by their amplitudes and frequencies. Frequency indicates how fast the waves oscillate which is measured by the number of waves per second (Hz), while amplitude represents the power of these waves measured by microvolt (μV).

How to tell if a brain wave is fast?

Frequency indicates how fast the waves oscillate which is measured by the number of waves per second (Hz), while amplitude represents the power of these waves measured by microvolt (μV).

Which hemisphere of the brain is responsible for coding physical and cognitive tasks?

Neurologists have mentioned that the motor cortex helps the cerebral cortex to encode both physical and cognitive tasks. Therefore, subjects who have trouble seeing the logical sequence of cognitive tasks may benefit from neurofeedback training along the left hemisphere sensorimotor cortex (C3).

Is neurofeedback a non-invasive procedure?

Neurofeedback, like other treatments, has its own pros and cons. Although it is a non-invasive procedure, its validity has been questioned in terms of conclusive scientific evidence.

Is neurofeedback a complementary therapy?

Nevertheless, neurofeedback is known as a complementary and alternative treatment of many brain dysfunctions. However, current research does not support conclusive results about its efficacy. Keywords: Brain diseases, Brain waves, Complementary therapies, Electroencephalography, Neurofeedback. 1.

What is evidence of cognitive decline?

Evidence of cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1.

How many people will have dementia by 2050?

However, the number of individuals developing a neurocognitive disorder (NCD) is increasing as the population ages: the number of individuals with dementia is doubling every 20 years and will reach over 115 million worldwide by 2050.

What is a major NCD?

The definition for a major NCD in the DSM-5also includes NCDs that occur in younger patients, such as those with traumatic brain injury and human immunodeficiency virus (HIV). The DSM-5criteria for the mild and major NCDs are outlined in Box 1.

What is the difference between a mild and a major NCD?

aThe main distinction between a mild and a major NCD is that people with major NCDs have impairment on neuropsychological testing more than two standard deviations below the norm and a decrease in their ability to live independently. Criteria reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,5th ed. Washington, DC, American Psychiatric Association, 2013. Copyright 2013, American Psychiatric Association. Used with permission.

Does aging affect cognitive function?

Conversely, improved cognitive functioning with aging has been correlated with intact neuroanatomic structures, most notably in the hippocampus and the frontal lobes (12). However, intact neuroanatomic structures may be only one component of improved cognitive aging. Studies linking the size of neuroanatomic structures to functioning have had mixed results (12). The model of the relationship of neuroanatomic structures to cognitive functioning should account for neural connectivity and functional measures such as the response to mental challenges, which can be assessed by modern neuroimaging techniques, including positron emission tomography (PET) and functional magnetic resonance imaging.

Can fBiomarkers increase the certainty of a diagnosis?

fBiomarkers are generally not considered in the diagnosis but can increase the certainty of a diagnosis if the clinical criteria are met.

Do cognitive deficits occur exclusively in the context of delirium?

The cognitive deficits do not occur exclusively in the context of a delirium.

Who brought affective neuroscience to the forefront?

Richard Davidson brought affective neuroscience to the forefront by showing the neuroplastic gains in humans associated with thought (Davidson and Lutz, 2008; Ferrarelli et al., 2013). Mindfulness meditation could have antiinflammatory influences similar to those targeted by prescription drugs with a faster response noted in experienced meditators (Kaliman et al., 2014).

How does music affect neuroplasticity?

Music is a complex and multisensory form of enrichment that has a positive influence on neuroplasticity in several regions of the brain because it requires integration of audiovisual information as well as appreciation of abstract rules (Paraskevopoulos et al., 2012; Kuchenbuch et al., 2014).

How does social network affect aging?

A rich social network of friends and family stimulates and enhances healthy aging . In contrast, neurogenesis in animals is reduced with stress and depression. In humans hippocampal volume loss is predicted by depression but not age (Sheline et al., 1999). Training such as cognitive therapy and meditation could enhance wellbeing and other prosocial elements of the human experience and positive plasticity (Davidson and McEwen, 2012).

How does cognitive training help elderly people?

(2002)found that as little as ten 60- to 75-min sessions over a 5- to 6-week period of cognitive training helped normal elderly humans improve function on the specific skills of training with effect sizes that were “comparable with or greater than the amount of longitudinal decline that has been reported in previous studies;” this suggests that “these interventions have the potential to reverse age-related decline.” These humans received training in reasoning, memory, or speed of processing. Computerized speed of processing training showed immediate gains regardless of age, gender, mental status, health status or education with gains maintained over 5 years (Ball et al., 2013). Participants having four 1 h booster sessions at 11 and 35 months had gains beyond those found at immediate measures and “counteracted nearly 5 months of normative age-related decline in processing speed.” With completion of all training and booster sessions, these people demonstrated about 2.5 standard deviations of gain in their speed of processing. Ten years after their initial training, gains were evident in the targeted cognitive skills of reasoning and speed of processing but not for memory. All participants at 10 years reported less difficulty with instrumental activities of daily living (Rebok et al., 2014). This was a randomized, controlled, single blind trial involving 2,802 humans in six cities in the USA, the largest trial to date. A recent small study with people 65 and older who were cognitively intact found that less daily computer use was associated with a smaller percent of hippocampal volume (Silbert et al., 2016). Pairing the use of these training programs with aerobic exercise could increase brain gains (Anderson-Hanley et al., 2012).

Is neuroplasticity a discipline?

Since 2011, our Director of NIMH has encouraged “the 21st century discipline of clinical neuroscience” to include brain-plasticity based strategies in providing clinical care (White, 2011). Neuroplasticity, the capacity of brain cells to change in response to intrinsic and extrinsic factors, can have negative or positive influence at any age across the entire lifespan. How can these factors be influenced in clinical settings? In keeping with the increasing shift in focus from illness to what maximizes wellness, psychologists are uniquely trained to use evidence based behavioral techniques as effective methods for driving neuroplasticity in a positive direction.

Is physical activity part of health care?

It is clear that physical exercise prescriptions need to be part of healthcare to enhance brain health (Hallal and Lee, 2013; Ryan and Nolan, 2016). Without such, the harms that can accrue are similar to those of smoking and obesity. Willey et al. (2016)found that, independent of vascular risk factors, low or no leisure physical activity was associated with greater decline in processing speed and episodic memory across 5 years as compared to individuals with moderate to heavy intensity of physical exercise.

Is exercise good for the brain?

All things considered it is URGENT to prescribe exercise at any age (Colcombe and Kramer, 2003) because it can be considered beneficial for body and brain (Diamond et al., 1971; Malkasian and Diamond, 1971; Eriksson et al., 1998; Gage, 2002; Pereira et al., 2007; Angevaren et al., 2008; Larson, 2008; Snyder et al., 2009; Lojovich, 2010; Voss et al., 2010, 2013; Erickson et al., 2011, 2014; Kohman and Rhodes, 2012; Simpson et al., 2012; Hallal and Lee, 2013; Barnard et al., 2014; Burzynska et al., 2014; Jessberger and Gage, 2014; Nagamatsu et al., 2014; Tian et al., 2014; Gajewski and Falkenstein, 2016; Ryan and Nolan, 2016). There is no reason to hold back on these prescriptions while evolving research attempts to establish guidelines on preferred dose, timing and method.

Why is new behavior so hard?

This includes mapping out the steps to take and having the skill to execute an action, as well as related cognitive processes such as attentional focus, inhibitory control, and working memory capacity. Because it reflects the means used to achieve a goal, I refer to the first dimension as the way. The second dimension captures the desire for and importance of a behavior. This includes wanting to achieve a goal and prioritizing it over other goals, as well as related motivational processes such as volition, intention, and the nature and strength of the drive for achievement. Because it relates to the motivation to engage in a behavior, I refer to the second dimension as the will.

How to facilitate behavior change?

In light of this framework, the first step to facilitating behavior change is to diagnose the source of the difficulty. Consultants and coaches can do foundational work with their clients early in the behavior change process to pinpoint the nature of the behavior change and identify how the new behavior is different from old patterns. The first step to helping a client with behavior change can involve answering these questions:

How does behavior change?

Behavior change typically involves moving from left-to-right, from bottom-to-top, or both. Moving from left-to-right increases the motivational demand (why) of an action, whereas moving from bottom-to-top increases the skill level (how). It is useful to identify the vector of change required during goal pursuit and to target motivational (horizontal) and cognitive (vertical) processes as necessary.

What is the second step in a change strategy?

Once the most relevant dimension of change is identified, the second step is to drill down to learn more about the specific nature of the motivation or skills/capacities that will be the target. For example, consider the questions:

What are the vital signs of a patient?

respiratory rate, oxygen saturation, pulse, blood pressure and temperature, are regarded as an essential part of monitoring hospitalized patients. Changes in vital signs prior to clinical deterioration are well documented and early detection of preventable outcomes is key to timely intervention. Despite their role in clinical practice, how to best monitor and interpret them is still unclear.

Why are vital signs important?

Today, vital signs play an important role in emergency departments (ED) and on the wards, to determine patients at risk of deterioration [6–11]. Even though it is accurately predicted by vital sign changes, clinical deterioration often goes unnoticed, or is not detected until it is too late to treat [12–15]. This is mainly caused by inadequate recording of vital signs or as a result of an inappropriate response to abnormal values [1, 14–16]. Among nurses and doctors there is insufficient knowledge and appreciation of vital sign changes and their implications for patient care [17–20]. The importance of monitoring vital signs in clinical practice is indisputable, but how to best monitor and interpret them and how frequently they should be measured is still unclear [21, 22].

What is reference handling and duplicate screening?

Reference handling and duplicate screening was performed using EndNote and Covidence. After removal of duplicates, titles and abstracts were screened independently by two authors (LHP and IJB). Disagreements regarding inclusion were resolved through discussion. In case of continued disagreement, inclusion was decided by a third author.

How often are vital signs collected?

Vital signs collected on average every 4 h analysed using discrete-time survival analysis. Variables at the beginning on each 4 h interval used to predict risk of event during that time block.

What are the inclusion criteria for a study of intermittent vital signs?

Inclusion criteria: all studies based on intermittent vital sign trends in acutely ill adult patients on hospital wards and in EDs, including all observational studies and controlled trials assessing prognosis. Trends were defined as the changes between two or more consecutive measurements of vital sign values, with a minimum of 3 hours and a maximum of 24 hours between measurements. Articles in English, Danish, Norwegian or Swedish were included.

How many trend models were tested in Churpek et al.?

aimed to compare the accuracy of different methods of modelling vital sign trends for detecting clinical deterioration on the wards using discrete-time survival analysis. Six different trend models were tested against the predictive value of current vital signs alone (Table 1). Transfers to intensive care unit (ICU), cardiac arrests and deaths on the ward were analysed as a composite outcome. Vital signs were averaged for each four-hour time block, and the variables at the beginning on each interval used to predict risk of deterioration during that time block.

What is the purpose of vital signs?

To evaluate the ability of vital sign trends to predict clinical deterioration in patients hospitalized with acute illness.

Why is neurobiology important for addiction?

While the individual patient, rather than his or her disease, is the appropriate focus of treatment for opioid abuse, an understanding of the neurobiology of dependence and addiction can be invaluable to the clinician. It can provide insight about patient behaviors and problems, help define realistic expectations, and clarify the rationales for treatment methods and goals. As well, patients who are informed about the brain origins of addiction can benefit from understanding that their illness has a biological basis and does not mean they are “bad” people.

What are the brain changes that are a result of opioid abuse?

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures ...

How does change set point affect drug addiction?

One variant, by Koob and LeMoal (2001), is based on the idea that neurons of the mesolimbic reward pathways are naturally “set” to release enough DA in the NAc to produce a normal level of pleasure. Koob and LeMoal suggest that opioids cause addiction by initiating a vicious cycle of changing this set point such that the release of DA is reduced when normally pleasurable activities occur and opioids are not present . Similarly, a change in set point occurs in the LC, but in the opposite direction, such that NA release is increased during withdrawal, as described above. Under this model, both the positive (drug liking) and negative (drug withdrawal) aspects of drug addiction are accounted for.

How does opioid withdrawal affect the brain?

Neurons in the LC produce a chemical, noradrenaline (NA), and distribute it to other parts of the brain where it stimulates wakefulness, breathing, blood pressure, and general alertness, among other functions. When opioid molecules link to mu receptors on brain cells in the LC, they suppress the neurons’ release of NA, resulting in drowsiness, slowed respiration, low blood pressure—familiar effects of opioid intoxication. With repeated exposure to opioids, however, the LC neurons adjust by increasing their level of activity. Now, when opioids are present, their suppressive impact is offset by this heightened activity, with the result that roughly normal amounts of NA are released and the patient feels more or less normal. When opioids are not present to suppress the LC brain cells’ enhanced activity, however, the neurons release excessive amounts of NA, triggering jitters, anxiety, muscle cramps, and diarrhea.

How do opioids affect the brain?

In this article we describe how opioids affect brain processes to produce drug liking, tolerance, dependence, and addiction. While these processes, like everything else that happens in the brain, are highly complex, we try to explain them in terms that can be easily understood and explained to patients.

Why do people continue taking opioids?

For individuals who do continue, the opioids’ ability to provide intense feelings of pleasure is a critical reason.

What are the brain abnormalities of heroin?

Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use).

Which box should a full neurological examination be performed?

A full neurological examination should be performed as summarised in Box 6.

Why should patients be assessed according to ABC principles?

All patients should be assessed according to ABC principles in order to identify any immediately life-threatening conditions.

How often do febrile seizures occur?

Simple febrile seizures often occur only once in the first 24 hours of a febrile illness. If the seizure recurs your child should be re-evaluated. A febrile seizure may manifest as body stiffening, twitching of the face or limbs, eye rolling, jerking of the arms or legs, staring or loss of consciousness.

How long does it take for a seizure to recur?

In the case of a first seizure, if the seizure is prolonged or recurs within a 24 hour period or if there are abnormal clinical findings, the child should be transferred to hospital for a full assessment. If there is a history of previous febrile seizures and the parents are happy and confident to manage the patient at home they may be discharged. Febrile seizures may recur in around 25%–30% of patients at 2 years therefore it is important that parents are given advice after any episode (Box 4). 2

What is unconscious patient?

The unconscious patient is traditionally defined as having a GCS of 8 or less. It is very difficult to make an accurate neurological assessment of these patients and they will require a full hospital assessment. Arrange a 999 paramedic ambulance to transfer these patients to hospital.

Why do patients need careful assessment?

Whilst the practitioner may commonly encounter conditions such as stroke and the fitting patient, all patients will require careful assessment to avoid the pitfalls of missing a serious underlying diagnosis.

Do not forget to check blood glucose?

Do not forget to check the blood glucose. It is important to try and obtain a history to establish whether there may be a serious underlying cause such as CNS infection or trauma, and whether there is any history of previous seizures or neurological conditions.