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DISTURBANCES OF THE NERVOUS SYSTEM (Series 2)

By Franklin C. Barberan R.N. 2nd Place Board Topnotcher Michelle A. Barberan R.N. 3rd Place Board Topnotcher

DISTURBANCE #3: CEREBROVASCULAR ACCIDENT (CVA)/ STROKE DEFINITION: Sudden loss of brain function due to disruption of blood supply ETIOLOGY: Thrombosis Cerebral embolism Ischemia Cerebral hemorrhage RISK FACTORS: Hypertension is the major risk factor Cardiovascular disease High cholesterol Increased hematocrit increases risk to cerebral infarction Diabetes mellitus Oral contraceptives especially when occurring with smoking and high cholesterol levels Smoking Drug abuse especially cocaine Alcohol consumption Family history MANIFESTATIONS: signs and symptoms depends on: 1. the location of the lesion 2. size of area with impaired perfusion 3. amount of collateral circulation Motor loss, the most common is HEMIPLEGIA HEMIPARESIS: weakness of one part of the body K! Initially during the early stage, there is Flaccid paralysis Decreased to absent deep tendon reflexes K! When the deep tendon reflexes returns (48 hours later) there is increased tone and spasticity Communication loss. dysarthria- (difficulty of speaking due to paralysis of the muscle of phonation) dysphasia or aphasia defective speech/ loss of speech, mainly expressive or receptive apraxia inability to perform previously learned actions. Perceptual disturbances Homonymous hemianopsia loss of half of the visual field ( NOTE: Affected side of the field of vision corresponds with paralyzed side). Amorphosynthesis.- patients head is turned away from the affected side and tends to neglect that side and the space on that side. Disturbances in visual- spatial relationships. (perceiving the relationships of two or more objects in spatial area) Sensory losses. NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676

Health Ambassadors Nursing Review Home of Credible Mentors Impairment of cognitive function and psychologic effects. K! If damage is on the frontal lobe: o impaired learning capacity. o impaired memory o impaired higher cortical intellectual functioning. DISTURBANCE #4: MIGRAINE DEFINITION: A symptom complex characterized by periodic and recurrent attacks of severe head ache. ETIOLOGY AND INCIDENCE: Not clearly demonstrated Primarily a vascular disturbance Common in women PATHOLOGY: K! starts with vasoconstriction of scalp arteries, cerebral and retinal blood vessels (cortical ischemia) dilation of intracranial and extracranial vessels hyperpermeability of dilated vessels local sterile inflammatory reaction in dilated vessels severe headache

PRECIPITATING/ AGGRAVATING FACTORS: Tyramine MSG containing foods Ex. Aged cheese, chocolates & many Nitrites processed foods Milk MANIFESTATIONS: K! Often HEAD ACHE on awakening (but may also occur anytime) 1. Aura Phase (may last for 30 minutes) K! Characterized by sensory manifestations Light flashes Numbness and tingling sensation of the face and hands Mild confusion Slight weakness Dizziness 2. Headache phase K! When initial signs and symptoms recedes, it is replaced by UNILATERAL THROBBING HEAD ACHE. N! photophobia Nausea and vomiting 3. Recovery phase Period of muscle contraction in the neck and scalp Muscle ache and localized tenderness NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676

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DIAGNOSIS: CT scan and MRI MANAGEMENT: K! For acute attacks: Ergotamine tartrate Cafergot (ergotamine + caffeine) Sumatriptan (Imitrex) Analgesics Sedatives Anti emetics N! Patient should lie quietly in a darkened room with head slightly elevated. PREVENTIVE APPROACH: K! propranolol (Inderal) a beta blocker brain. Methysergide (Sansert)

stops dilation of the blood vessels in the

PATIENT EDUCATION: K! Evidence suggests that hard driving and compulsive perfectionist is more vulnerable. K! Stress and tension can trigger an attack K! Instruct about diet. K! Avoid long intervals between meals K! Suggest regular periods of relaxation and exercise.

DISTURBANCE #5: BRAIN TUMORS DESCRIPTION: A localized intracranial lesion within the skull. Can be benign or malignant ETIOLOGY: Multifactorial Hereditary or familial tendency MANIFESTATIONS: Symptoms of increased intracranial pressure Headache (deep or expanding, dull but unrelenting) Vomiting (related to the irritation of the vagal centers in the adrenal medulla). Papilledema (edema of the optic disc) K! In general, the signs and symptoms depends on the location of the tumor in the brain. DIAGNOSTIC EVALUATION: CT- scan MRI Computer Assisted Stereotactic (three dimensional biopsy) EEG Cerebral angiography Cytologic Studies of the CSF MANAGEMENT: K! The treatment of metastatic brain tumor is palliative. Chemotherapy Radiation therapies using radioisotopes 131-Iodine SURGERY NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676

Health Ambassadors Nursing Review Home of Credible Mentors craniotomy Stereotactic approaches to radio surgery

NURSING CONSIDERATIONS: K! focus: Help patient to adapt to weakness, paralysis, visual and speech loss, seizures Monitor anthropometric measurements Improve nutrition Assist patient through the stages of the grieving process DISTURBANCE #6: MENINGITIS DESCRIPTION: Inflammation of the meninges ETIOLOGY and PATHOLOGY: Viral and bacterial infections Iatrogenic causes Inflammatory reaction to meninges Meningeal irritation Hypoperfusion, vasculitis, meningeal exudates Increased permeability of the blood-brain barrier Increased ICP impaired cerebral function

MANIFESTATIONS: Head ache Fever S/S of increased ICP Changes of the level of consciousness Signs of meningeal irritation Nuchal rigidity (stiff neck) K! Forceful flexion of the head, causes in due to spasms of the muscle of the neck Kernigs sign K! patient is lying down with thigh flexed on the abdomen, leg can not be completely extended. Brudzinskis sign K! flexion of the neck results to flexion of the knees and hips OR Passive flexion of the lower extremities of one side, RESULTS TO the same movement on the other side. Photophobia (due to unknown reason). seizures MANAGEMENT: treatment of underlying cause (antibiotic therapy): ampicillin penicillin chloramphenicol for seizures, diazepam phenytoin for cerebral edema; osmotic diuretic (mannitol) NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676 4

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NURSING INTERVENTIONS: Continuous monitoring of vital signs, airway, and oxygenation status. Implement seizure precautions.

DISTURBANCE #7: MULTIPLE SCLEROSIS DESCRIPTION: Chronic, degenerative, and progressive demyelination of the brain and the spinal cord. ETIOLOGY AND INCIDENCE: Cause is unknown K! Research suggests viral infection early in life resulting to immune process later in life. defective immune response Common among young adults (20-40 years old) K! Women commonly affected than men. PATHOLOGY: Scattered, irregular demyelination throughout the CNS plaques or patches in involved areas are sclerosed interruption of nerve impulses variety of manifestations depending on which nerve is affected MANIFESTATIONS: The Charcots Triad 1. Nystagmus 2. Intention tremor. 3. Scanning or staccato speech. Primary symptoms: Fatigue Weakness Numbness Difficulty in coordination (including phonation) Loss of balance Lesions in the optic nerve: Blurring of visions Diplopia Patchy blindness (Scotoma) Total blindness Lesions on main motor path ways (pyramidal tract) Spastic weakness of the extremities Loss of abdominal reflexes NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676 5

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Lesions involving the cerebellum or basal ganglia Ataxia (defective muscle coordination) and tremors Frontal and parietal lobe involvement Cognitive and psychosocial problems including depression. Bowel and sexual problems are also common. K! Exacerbation and remission are characteristic of MS K! There is evidence that re-myelination occurs in some patients. DIAGNOSTIC EVALUATION: 1. electrophoresis of CSF reveals presence of oligoclonal banding (several bands of IgG (reflects immunoglobulin abnormalities). 2. CT scan may reveal cerebral atrophy 3. MRI MANAGEMENT: 1. Corticosteroids/ ACTH anti inflammatory agents may improve nerve conduction 2. Beta-interferon (Betaseron) for relapsing remitting MS 3. Baclofen an anti spasmodic, drug of choice for spasticity NURSING INTERVENTIONS: Promote physical mobility through a balance between rest, and exercise. Prevent injury, teach patient to walk with feet wide apart to widen base of support. (Rationale: patient has problems with coordination or ataxia) Promote bladder and bowel control. Patient may have urinary frequency, urgency, and incontinence. Improve sensory and cognitive function. Eye patch or eyeglass occluder to block vision for those patients with diplopia. Strengthen coping mechanisms. Assist client to adapt or adjust with sexual dysfunction.

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NEED FURTHER EXPLANATION? YOUR MENTORs AT HAU ARE ..... TOPNOTCHERS they can help you! 0928-956-6676