Adult II Nursing

Neurological Nursing

NEUROLOGICAL NURSING
Introduction:
The care of a neurological patient may be complex. Successful nursing care
requires preparation, sound clinical skills, and systematic approach to the
nursing process
1. Nervous System:

1. Regulates system
2. Controls communication
3. Coordinates Activities of body system
Divisions

Central nervous system ( CNS) : brain and spinal cord interprets

incoming sensory information and sends out instruction based on past
experiences

Brain:

Cerebrum-Largest part of brain:outer layer called cerebral cortex

composed of dendrites and cell bodies : controls mental processes:
highest level of functioning

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Cerebellum: controls muscle tone coordination and maintains equilibrium

Diencephalon:Consist of two major structures located between cerebrum
and midbrain
Hypothalamus: regulates the autonomic nervous system: controls blood
pressure: hepls maintain normal body temperature and appetite: controls
water balance and sleep
Thalamus: acts as a relay station for incoming and outgoing nerve
impulses:produces emotions o pleasantness and unpleasantness
associated with sensations

Brainstem:
Connects the cerebrum with the spinal cord
Midbrain- relay center for eye and ear reflexes
Pons- connecting link between cerebellum and rest of nervous system
Medulla oblongata- contains center for respiration, heart rate, and
vasomotor activity
Spinal Cord:

Inner column composed of gray matter, shaped like a H, made up of

dendrites and cell bodies: outer part composed of white matter, made up
of bundles of axons called tracts
Functions: sensory tract conducts impulses to brain motor tract conducts
impulses from brain: center for all spinal cord reflexes
Protection for CNS:

Bone- vertebrae surround cord: skull surrounds the brain

Meninges: three connective tissue membranes that cover the brain and
spinal cord
1. Dura mater: white fibrous tissue: outer layer
2. Arachnoid: delicate membranes: middle layer : contains subarachnoid
fluid
3. Pia mater: inner layer contains blood vessels
Cerebrospinal Fluid: acts as a shock absorber: acts in exchange of
nutrients and waste materials

Peripheral nervous system (PNS): Cranial and spinal nerves extending

out from brain and spinal cord---carry impulses to and from brain and
spinal cord. Caries voluntary and involuntary impulses

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Cranial nerves:
I olfactory
II optic

Nose to brain
Eye to brain
Brain to eye and eye
muscles

III oculomotor

IV Trochlear
V trigeminal
VI Abducens
VII Facial
VIII Acoustic

Brain to external eye

muscles
From skin & mucous
membranes of head & teeth
to chewing muscles
From brain to external eye
muscles
From taste buds & facial
muscles to muscles facial
expression
From organ of corti to brain

From pharynx & tongue to

IX
brain
Glossopharyngeal From brain to throat muscles
and salivary glands
From throat & organs in
thoracic & abdominal
X Vagus
cavities
XI Accessory
XII Hypoglossal

From brain to shoulder and

neck muscles
From brain to tongue

Smell
Vision
Contraction of upper
eyelid
Maintain position of
eyelid
Pupillary reflexes
Eye movements
Sensations of head &
teeth
Muscles of chewing
Eye movements
Taste
Facial expressions
Hearing
Sensations of tastes&
swallowing
Secretion of salvia
Important in swallowing,
speaking, peristalsis and
production of gastric
juices
Rotation of head and
raising shoulders
Movement of tongue

Spinal nerves: 31 Pairs: conduct impulses necessary for sensation and

voluntary movements: each group named for the corresponding part of
spinal column
Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Autonomic nervous system (ANS): functional classification of the

PNS---regulates involuntary activities. Part of PNS: controls smooth
muscle, cardiac muscle, and glands
It has two divisions;
1. Sympathetic-flight or fight response: increases heart rate and blood
pressure; dilates pupils
2. Parasympathetic : dominates control under normal conditions:
maintains homeostasis

Somatic nervous system (SNS) : Functional classification of the PNS:

--allows conscious or voluntary control of skeletal muscles
Neurons or nerve cells
Respond to a stimulus, connect it into a nerve impulse (irritability), and
transmit the impulse to neurons, muscle, or glands (conductivity),
consists of three main parts

Neurons main parts

1. Cell body: contains nucleus and one or more fibers or process
extending from the cell body
2. Dendrites: conduct impulses toward cell body: neurons has many
dendrites
3. Axons: conduct impulses away from cell body: neuron has one axon
Types of neurons
1. Motor (efferent ): conduct impulses from CNS to muscle and glands
2. Sensory (afferent): conduct impulses toward CNS
3. Connecting ( interneuron): Conduct impulses from axon to dendrites

Synapse-chemical transmission of impulses from axon to dendrites

Myelin sheath protects and insulates the axon fibers: increases the rate
of transmission of nerve impulses
Neurilemma sheath covering the myelin: found in PNS : function is
regeneration of nerve fiber

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Neuroglia- connective or supporting tissueimportant in reaction of

nervous system to injury or infection
Ganglia-clusters of nerve cells outside CNS
White Matter-bundles of myelinated nerve fibers conducts impulses
along fibers
Gray matter- clusters of neuron cell bodiesfibers not covered with
myelin distributes impulses across selected synapses

Neurological Terms:

Anesthesia- complete loss of sensation

Aphasia-loss of ability to use language
Auditory/receptive aphasia- loss of ability to understand
Expressive aphasia- loss of ability to use spoken or written word
Ataxia- uncoordinated movements
Coma- state of profound unconsciousness
Convulsion- involuntary contractions and relaxation of muscles
Delirium- mental state characterized by restlessness and disorientation
Diplopia- double vision
Dyskeinesia- difficulty in voluntary movement
Flaccid- without tone- limp
Neuralgia- intermittent, intense pain, along the course of a nerve
Neuritis- inflammation of a nerve or nerves
Nuchal rigidity-stiff neck
Nystagmus- involuntary, rapid movements of the eyeball
Papilledema- swelling of optic nerve head
Paresthesia- abnormal sensation without obvious cause, with numbness
and tingling
Spastic- convulsive muscular contractions
Stupor- state of impaired consciousness with brief response only to
vigorous and repeated stimulation
Tic-spasmodic, involuntary twitching of a muscle
Vertigo- dizziness

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Transient Ischemic Attacks

TIA
Definition:
Altered cerebral tissue perfusion related to a temporary neurologic
disturbance. It is manifested by sudden loss of motor or sensory function. It
lasts for a few minutes to a few hours, caused by temporarily diminished
blood supply to an area of the brain
Treatment:

Control hypertension
Low sodium diet
Possible anticoagulant therapy
Stop smoking
Cerebro Vascular Accident
(CVA)(Stroke)

Definition:
It is defined as decreased blood supply to
a part of the brain, which caused by
rupture, occlusion, or stenosis of the
blood vessels. Its onset may be sudden or
gradual
Right CVA results in Left side
involvement often associated with
safety/ judgment
Left CVA results in Right side
involvement often associated with
speech problems
Approximately 50% of survivors
permanently disabled
High proportion experiencing
recurrence within weeks to years
Chances for complete recovery
depending an circulation returning to
normal soon after the initial stroke
Third most common cause of neurological disability
Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Pathophysiology/Etiology:
1. Partial or complete occlusion of a
cerebral blood vessel resulting from
cerebral thrombosis (due to
arteriosclerosis) or embolism.
2. Ischemia related to decreased blood
flow to an area of the brain secondary
to systemic disease, such as cardiac or
metabolic disease.
3. Hemorrhage occurring outside the dura
(extradural), beneath the dura mater
(subdural), in the subarachnoid space
(subarachnoid), or within the brain
substance (intracerebral).
4. Risk factors include hypertension,
TIAs, heart disease, elevated
cholesterol, diabetes mellitus, obesity,
carotid stenosis, polycythemia,
cigarette smoking.
Predisposing factors-CVA:

Cigarette smoking

Family history

Incidence increased with aging

Atherosclerosis

Embolism

Thrombosis

Hemorrhage from ruptured

cerebral aneurysm

Hypertension

History TIAs

Hypertension

Arrhythmias

Atherosclerosis

Rheumatic Heart Disease

MI

DM
Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

High serum triglyceride levels

Lack of exercise
Signs and Symptoms:

Altered LOC
Change in mental status
Decreased attention span
Decreased ability to think and reason
Difficulty following simple
directions
Communication; motor and sensory
aphasia difficulty with reading
,writing, speaking, or understanding
Bowel and bladder dysfunction
retention impaction or incontinence
Seizures
Limited motor function; paralysis,
dysphgia, weakness , hemiplegia,
loss of function or contractures
Loss of sensation/ perception
Headaches and syncope
Loss of temp regulation elevated TPR
and BP
Absent of gag reflex ( aspiration)
Unusual emotional responses;
depression, anxiety, anger, verbal
outburst, and crying: emotional
lability
Problems related with immobility
Diagnostic test:

Physical assessment
Pt and family history
EEG
CT scan
Lumbar puncture
Cerebral angiogram
Carotid ultra sonogram

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Treatments:
Remove cause, prevent complications,
and maintain function, rehabilitation to
restore function
Medications
Anti-hypertensive
Anticoagulants
Stool softeners
Surgical removal of clot, repair of aneurysm, carotid

endarterectomy or balloon angioplasty

Nursing Interventions:

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Patent airway
O2 with humidity
Suction PRN
Keep head turned to side
Place in semi- fowlers
Maintain therapeutic bed rest
Use turn sheet
Footboard
Firm mattress
Pillow and torchanter rolls
Maintain proper body alignment
Place items within reach
Reposition q2h
ROM passive and active
Flotation mattress or sheepskin
Skin assessment
Prevent complications of immobility
ADLs
Assess nutrition daily with I&O, WT, %diet, calorie count
Provide N/G or PEG feedings if needed
Maintain IV fluids
Progress to soft diet PRN
TPN as ordered
Aspiration precautions
Dietary consult & Speech for swallowing

Dr: Hanan Yossef

Adult II Nursing

Neurological Nursing

Establish means of communication

Call bell pad and pencil

Nonverbal gestures

Use simple commands

Speak slowly

Explain all care

Speech therapy

Be nonjudgmental about personality changes

Encourage family participation

Provide diversional activities

Be realistic

Assess LOC
Maintain safety
Use side rails

Restrain only as necessary

Seizure precautions

Observe for ICP

V/S & Neuro CKS q 4 h
Ensure elimination
Assess bowel sounds

Monitor bowel movements

I&O

Indwelling catheter PRN

Bowel and bladder training

Family support
Begin discharge teaching early
Rehabilitation therapy

Physical therapy (see figures).

Speech therapy

Occupational therapy

Dr: Hanan Yossef

10

Adult II Nursing

Neurological Nursing

PHYSICAL EXERCISES & RANGE OF MOTION

Dr: Hanan Yossef

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Adult II Nursing

Dr: Hanan Yossef

Neurological Nursing

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