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LEARNING OBJECTIVE
At the end of this lesson student should be able to:
1. Explain the causes, pathophysiology and sign/symptom of neurological disorder. 2. Explain the Surgical and Nursing management of
Cerebrovascular disease, Cerebro-Vascular Accident, Seizure disorders, GuilleinBarreSyndrome, Myasthenia Gravis, Head injury, Spinal cord injury, meningitis and altered level of consciousness.
Glial cells
Transmitter cells Carry messages to and from brain and spinal cord
Cerebrum lobe functions Diencephalon thalamus, hypothalamus Cerebellum balance, coordination Brain stem midbrain, pons, medulla oblongata
Controls:
Smooth Muscles Cardiac Muscles Glands
Neurological Assessment
History Headaches Loss of function Visual acuity Seizures Numbness
Neuro Assessment
Mental Status
Orientation Mood and behavior General knowledge Short term memory Long term memory
Neuro Assessment
Level of consciousness Glasgow Coma Scale
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www.studentbmj.com/back_issues/ 0500/education/140.html
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Neuro Assessment
Language and Speech Aphasia Sensory Expressive Global
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Cranial Nerves
I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Acoustic IX. Glossopharyngeal X. Vagus XI. Spinal Accessory XII. Hypoglossal
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Neuro Assessment
Motor Function
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Neuro Assessment
Sensory and Perceptual Status
Neuro Assessment
Blood and urine ABG Lumbar puncture Imaging EEG EMG Carotid Duplex
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Neurological Problems
Headache
Vascular migraine, cluster, hypertensive Tension stress Traction-inflammatory infection, occlusion vessels
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Neurological Problems
Increased Intracranial Pressure (IIP) Occurs slowly or rapidly May lead to brain stem herniation and death
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Assessment of IIP
Subjective
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Assessment of IIP
Objective Decreasing LOC
Posturing Wide pulse pressure Bradycardia Altered respirations Pupils fixed & dilated
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Assessment of IIP
Diagnostic tests:
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Internal monitoring
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Neurological DisordersSeizures
Seizures
Disorderly neuron discharges in brain Transitory Different types affect body differently Involuntary movement usually
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Seizures
Generalized: Tonic-clonic grand mal Absence - Petit mal Myoclonic Atonic or akinetic Localized: (Focal) Partial (Jacksonian) Psychomotor
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Seizures
Causes:
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Seizure Medications
Dilantin (Phenytoin) Phenobarbital Mysoline Tridione Valium (Diazepam) Depakene Clonopin Mesantoin Neurontin Lamictal Felbatol Cerebyx
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Seizure Medications
Nursing:
Medications Continue meds Medic alert ID Avoid alcohol, avoid driving, get adequate rest If on Dilantin, instruct on oral hygiene
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Lower to the floor; pad side rails; pillow under head; dont restrain No bite block or padded tongue blade Allow for post-ictal rest
Document everything
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Multiple Sclerosis
Common degenerative neurological disease. Myelin sheath is destroyed. Symptoms vary. Relapsing/remitting. Usually ages 20-40.
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Shakiness, difficulty walking Fatigue, muscle weakness Numbness, tingling Tinnitus Visual problems Difficulty chewing and speaking Incontinent; impotent
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Ataxia Changes in behavior & emotions Nystagmus Spasticity, tremors, dysphagia, facial palsy, speech impaired, fatigue Incontinence Impaired judgment
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Multiple Sclerosis-Treatment
Meds:
Anti inflammatory
Immuno Modifiers
Muscle Relaxants
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Parkinsons Disease
Unknown cause Lack of dopamine. Parkinsonism: encephalitis, toxic chemicals, meds, drugs
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Parkinsons
Symptoms include:
Muscular tremors and rigidity Emotional instability Judgment defects Heat intolerance Mask-like facial appearance Dysphagia and drooling
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Parkinsons Testing
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Surgery
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Alzheimers
Unknown cause, but genetic link Very common; risk increases with age Brain changes:
Alzheimers - Symptoms
1st memory lapses, difficult word finding, decreased attention span 2nd increased memory problems, disoriented to time, loses things, confabulates 3rd total disorientation, apraxia, wanders 4th severe impairment
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Alzheimers - Testing
No definitive test Family history Diagnosis: autopsy
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Memory:Cognex, Aricept Agitation: Mellaril, Haldol Folic Acid & Vitamin B12 Low fat diet NSAIDS
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Supplements
Other concerns
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Myasthenia Gravis
Autoimmune disorder Myoneural junction problem Symptoms:
ptosis, diplopia, weakness, dysarthria, dysphagia, difficulty sitting up, respiratory distress
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Huntingtons Disease
Nursing interventions are palliative
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3rd leading cause of death in the US All ages, but usually elderly
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Cerebral Thrombosis
Most common cause of CVA Most often:
Atheroclerosis
Thrombus
CVA
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Cerebral Embolism
2nd most common cause of CVA Most often:
Heart disease
Thrombus
Embolus
CVA
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Cerebral Hemorrhage
3rd most common cause of CVA Most often:
Hypertension
CVA
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CVA - Assessment
Motor changes
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CVA Assessment
Sensory Changes
Aphasia =cant speak or write Agnosia =cant recognize familiar objects/people Apraxia =cant perform purposeful acts or use objects properly Neglect Syndrome Visual problems, including hemianopsia
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CVA Assessment
Cognitive changes
denial impaired memory, judgment cant concentrate disoriented slow and cautious versus impulsive depressed, anxious versus euphoric angers quickly versus constantly smiling
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CVA - Testing
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CVA-Nursing Care
Assess LOC IV, NG, Foley, Vent. Nutrition Encourage perform ADLs Bladder and bowel training ROM Teaching and emotional support
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Guillain-Barr - Polyneuritis
Peripheral nerve disease Prior infection; autoimmune response
Weakness and paralysis, begins in extremities and works up Respiratory failure may occur
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Meningitis
Acute infection of the meninges Viral or bacterial
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Meningitis-Medical Management
Diagnosed by LP Medications Respiratory isolation Cool, dark quiet room Maintain hydration Prevent injury
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Dementia
Treatment depends on infection Treat symptoms, maintain safety
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Autonomic hyperreflexia
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Pathophysiology: Damage to the spinal cord ranges from transient concussion to contusion, laceration and compression of the cord substance, to complete transaction of the cord. Separated into 2 categories: Primary injuries - are the result of the initial insult or trauma and are usually permanent. Secondary injuries - are usually the result of a contusion or tear injury, in which the nerve fibers begin to swell and disintegrate.
Causes:
Trauma - such as automobile accidents, falls, gunshots, diving accidents, war injuries, etc. Tumor - such as meningiomas and metastatic cancer. Ischemia - resulting from occlusion of spinal blood vessels, including dissecting aortic aneurisms, emboli, arteriosclerosis. Developmental disorders - such as spina bifida & meningomyolcoele Others examples: Neurodegenerative diseases, Multiple Sclerosis, aneurysm and etc.
Treatment:
Acute Traumatic Spinal Cord Injuries : high dose methylprednisolone if the injury occurred within 8 hours.
Stem Cell Transplants - to help or cure paralysis caused by spinal injury.
HEAD INJURIES
Sapiah R 2012
HEAD INJURY
CLASSIFICATION: LACERATION OF THE SCALP SKULL INJURY BRAIN INJURY
INTRACRANIAL HEMORRHAGE
CONCUSSION CONTUSION LACERATION COMPRESSION
Pathophysiology
Brain suffers from traumatic injury Brain swelling or bleeding increases intracranial volume Rigid cranium allows no room for expansion of contents so ICP increases Cerebral blood flow decreases Intracranial pressure continues to rise. Brain may herniate Cerebral hypoxia and ischemia occurs
Pressure on blood vessels within the brain causes blood flow to the brain slowly
Scalp Injuries
They bleed profusely because of the abundance of blood vessels in the scalp. Infection is of major concern.
Sapiah R 2012
Skull Injuries
May occur with or without brain injury, Fracture usually caused by extreme force, Skull fractures considered closed if dura mater is intact; open if dura mater is torn.
Sapiah R 2012
Sapiah R 2012
Sapiah R 2012
Concussion
Transient neurological deficits caused by the shaking of the brain. Clinical manifestations may include immediate loss of consciousness lasting from minutes to hours, momentary loss of reflexes, respiratory arrest for several seconds, an amnesia afterwards.
Sapiah R 2012
Contusions
Surface bruises of the brain. Skin is cool and pale. Pulse, blood pressure, and respirations are below normal. Cerebral edema may occur in conjunction with widespread injury.
Sapiah R 2012
Cerebral Lacerations
Tearing of cortical tissue. Symptoms include deep coma from time of impact, decerebate posturing, autonomic dysfunction, nonreactive pupils, respiratory difficulty.
Sapiah R 2012
Clinical Manifestations:
Depend on the severity and the distribution of the brain injury. Persistent localized pain usually suggest that a fracture is present. Fractures of the cranial vault may or may not produced swelling in the region of the fracture Battles Sign - an area of ecchymosis (bruising) which is
seen over the mastoid. CSF Otorrhea - cerebrospinal fluid leaking through the ears. CSF Rhinorrhea - cerebrospinal fluid leaking through the nose. Halo Sign - it is a blood stain surrounded by a yellowish stain (CSF) which is usually seen on bed linens or pillows.
Back to topic
Hemorrhage
Intracranial hemorrhage is common complication of any head injury. Treatment is surgery to evacuate the hematoma, stop the bleeding, and relieve pressure on the brain.
Sapiah R 2012
HEAD INJURY
Nursing Care:
Emergency Care: airway supine straight, then turned to lateral or semi-prone possible cervical collar: no neck flexion & hyperextension keep pt covered, quiet & undisturbed
General Care:
airway prevent aspiration check cardiovascular complications search evidence of spinal injury check skull & scalp injuries
prophylactic tetanus observe csf leakage: otorrhea, rhinorrhea battles sign observe for s/sx of increased ICP control restlessness & pain: NO NARCOTICS maintain fluid &electrolyte, acid-base balance
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