S/S of ICP: Decreased LOC, restlessness, irritability, disorientation, lethargy

Cushing Triad (bradycardia, arterial hypertension[wide pulse- systolic increases and

diastolic remains the same], irregular respirations)
Supratentorial shift: as pressure continues it will eventually invade surrounding structures
of lesser pressure.
Later Signs of ICP
Papilledema swelling of the optic nerve from interference w venous drainage of eye and
Crushing Triads (VS)
Decorticate: flexion (nonfunctioning cortex)
Decerebrate: extension (brainstem lesion)
TX: osmotic diuretics pulls h2o from affected area to decrease fluid on brain.
TX: corticosteroids decrease cerebral edema
NI: HOB 30-45 supine, neck in midline, avoid hip flexion
Agnosia: inability to recognize objects or persons
Seizures
May affect all or part of the body.
Tonic: continued contraction of all muscles, rigid
Tonic-Clonic: alternate contraction, rhythmic jerking. Grand Mal (presence of an aura
that precedes the seizure
Absence: Petit Mal
Reasons Seizures occur: trauma, tumor, hypoglycemia (brain needs glucose).
Impaired Vita D leads to Calcium imbalance
NI: protect from injury, turn head to side to prevent aspirations, do not restrain
Document: b4 seizure, what caused it, how long did it last, parts of body involved, VS
Parkinsons
Rare in blacks. Intellectual ability is not impaired. Diet high in fiber to prevent
constipation
A decreased production of dopamine, which is needed for the control of posture, support
and voluntary motion
Normally dopamine and acetycholine are balance in the brain. Parkinsons interrupts this.
1

S/S: tremors, muscle rigidity and bradykinesia (slow movement), Pill Rolling,
Hypophonia (low vol of speech), micrographia (small handwriting)
Dopamine cannot cross the blood brain barrier but levodopa can and once across it is
converted to dopamine. protein affects its absorption.
NI: frim bed w/o pillow
Guillain-Barre Syndrome
Inflammation and demyelination of PNS caused by autoimmune response to some type of
viral infection or to certain vaccines. Affects all ages
Causes progressive muscle weakness and paralysis in all ages. Starts in lower and moves
up.
Tx: Plasmapheresis: plasma is removed and washed to remove antibodies bc they attack
schwann cells.
NI: monitor respiratory status and sign of hypoxia
Meningitis
S/S Increased temp, sever headache, nuchal rigidity (stiff neck)
Bacterial: spread per direct contact: Kernigs and Brudzinski
Kernigs: inability to extend leg when thigh is flexed on abs
Brudzinski: flexion of the neck produces flexion of the knees and hip
CSF is norm clear, bacteria causes it to become purulent

Viral: flu like symptoms

Multiple Sclerosis
T cells found in spinal fluid. T cells defend against intruders. In MS T cells attack their
own body
Demyelination: myelin sheath and cells are destroyed. Hard plaque like lesions replace
the destroyed myelin.
Periods of remission and exacerbation
Assessment: Pain is not common, Diplopia (double vision), seeing spots, blindness,
nystagmus, dysphagia.
NI: High fiber, change pos freq, exercise and bedrest, Avoid Heat
Alzheimers
Loss of the ability to perform tasks that require ACh

An elevated plasma level of homocystenie is associated with Alzheimers. Lower levels

by eating food rich in Folic Acid (fruits and green leafy)
NI: finger foods, freq feedings, constant supervision

Anomia: trouble remembering words

Agraphia: unable to write down own thoughts
Aphasia: trouble verbally expressing self
Alexia: trouble understanding written language
Agnosia: inability to recognize objects or persons
Apraxia: cannot put on shirt, althought muscle and motor movement are fine.
Myasthenia Gravis

autoimmune disease. Aggravated by activity and relieved by rest. Lack of ACh

acetylcholine.
Nerve impulses do not pass through the myoneural junction
Most common sign: Unilateral ptosis: drooping of the upper eyelid, Diplopia.
Skeletal muscle weakness: hallmark sign increased muscle weakness during activity.
Improved strength after rest.
NI: teach chin tuck and double swallow to prevent airway obstruction and aspiration.
ALS = Lou Gehrigs
Cerebrovascular Accident (brain attack)
Stroke, lack of O2 for 3-7mins the brain and its cells begin to die
Cerebellum: balance and coordination
Brain Stem: breathing, BP and HR
Ischemic Stroke: formation of an embolus or thrombus.
Thrombotic: caused by plaque buildup w the formation of a clot. #1 cause of
stroke and athrosclerosis. Occurs during sleep or soon after wakening
Embolic: a blood clot or debris circulating in a blood vessel
Hemorrhagic Stroke: #1 cause is aneurysm. The eyes deviate towards the affected side
of brain
Tx: Craniotomy to repair aneurysm, place in semi-fowlers
Stroke right side of brain, left side paralysis, food on left side is not seen.