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• Infectious Disease

• Meningitis
• Brain abscess
• Encephalitis
• Neoplastic disease

IMPLEMENTATION PHASE
Increased Intracranial pressure
Altered level of consciousness
Seizures
Autonomic dysreflexia/hyperreflexia
Spinal shock
Cognitive impairment
Bowel incontinence
Impaired physical mobility
Impaired swallowing
Disturbed sensory perception

INCREASED INTRACRANIAL PRESSURE


Intracranial pressure more than 15 mmHg
Brunner: Normal ICP 10-20 mmHg
Causes:
Stroke
Head injury
Inflammatory lesions
Brain tumor
Surgical complications
Intracranial Components
80% Brain tissue
10% CSF
Key to Success! 10% Cerebral blood
Confidence
Test taking strategies The Monro-Kellie Hypothesis
Ample test preparation and study habits The skull is a closed vault. Any increase in
Review of frequent board examination topics one component will increase ICP.
Focus on your GOALS
Above all- PRAYERS Any increase or alteration in these structures
will cause increased ICP
Neurology Course Outline An increased ICP diminishes the functioning
Brief review of Anatomy and Physiology of various cranial areas vital centers.
Application of the Nursing process in the Increased Intracranial pressure
approach of neurologic problems:
ASSESSMENT – relevant techniques and lab Pathophysiology
procedures Compensatory mechanisms:
DIAGNOSIS 1. Increased CSF absorption
PLANNING 2. Blood shunting
IMPLEMENTATION 3. Decreased CSF production
EVALUATION
• Trauma and related accidents Decompensatory mechanisms:
• Traumatic brain injury 1. Decreased cerebral perfusion
• Spinal cord injury 2. Decreased PO2 leading to brain hypoxia
• Cerebrovascular Accidents 3. Cerebral edema
• Neurology Course Outline 4. Brain herniation
• Degenerative disorders- Demyelinating
• Multiple sclerosis Decreased cerebral blood flow
• Guillain-Barre’ syndrome
• Degenerative disorders- Non- Vasomotor reflexes are stimulated initiallyà
demyelinating slow bounding pulses
• Alzheimer’s disease Increased concentration of carbon dioxide
• Parkinson’s disease will cause VASODILATION à increased flowà
• Neurology Course Outline increased ICP
• Motor dysfunction- CNS
• Epilepsy Cerebral Edema
• Motor dysfunction- cranial nerve Abnormal accumulation of fluid in the
• Bell’s palsy intracellular space, extracellular space or
• Trigeminal neuralgia both.
• Motor dysfunction- peripheral
• Myasthenia gravis Herniation
Results from an excessive increase in ICP Orientation to time, place and person
when the pressure builds up and the brain Motor function
tissue presses down on the brain stem Decerebrate
Cerebral response to increased ICP Decorticate
Steady perfusion up to 40 mmHg Sensory function
Cushing’s response Altered level of consciousness
Vasomotor center triggers rise in BP to Patient is not oriented
increase ICP Patient does not follow command
Patient needs persistent stimuli to be awake
Sympathetic response is increased BP but COMA= clinical state of unconsciousness
the heart rate is SLOW where patient is NOT aware of self and
Respiration becomes SLOW environment
Increased Intracranial pressure Altered level of consciousness
Etiologic Factors
CLINICAL MANIFESTATIONS Head injury
Early manifestations: Stroke
Changes in the LOC- usually the earliest Drug overdose
Pupillary changes- fixed, slowed response Alcoholic intoxication
Headache Diabetic ketoacidosis
vomiting Hepatic failure
Increased Intracranial pressure Altered level of consciousness
Behavioral changes initially
late manifestations: Pupils are slowly reactive
Cushing reflex- systolic hypertension, Then , patient becomes unresponsive and
bradycardia and wide pulse pressure pupils become fixed dilated
bradypnea Glasgow Coma Scale is utilized
Hyperthermia Altered level of consciousness
Abnormal posturing
Increased Intracranial pressure Nursing Intervention
1. Maintain patent airway
Nursing interventions: Elevate the head of the bed to 30 degrees
Maintain patent airway Suctioning
1. Elevate the head of the bed 15-30 2. Protect the patient
degrees- to promote venous drainage Pad side rails
2. assists in administering 100% oxygen Prevent injury from equipments, restraints
or controlled hyperventilation- to reduce the and etc.
CO2 blood levelsàconstricts blood Altered level of consciousness
vesselsàreduces edema Nursing Intervention
Increased Intracranial pressure 3. Maintain fluid and nutritional balance
Nursing interventions Input an output monitoring
3. Administer prescribed medications- IVF therapy
usually Feeding through NGT
Mannitol- to produce negative fluid balance 4. Provide mouth care
corticosteroid- to reduce edema Cleansing and rinsing of mouth
anticonvulsants-p to prevent seizures Petrolatum on the lips
Increased Intracranial pressure Altered level of consciousness
Nursing interventions Nursing Intervention
4. Reduce environmental stimuli 5. Maintain skin integrity
5. Avoid activities that can increase ICP like Regular turning every 2 hours
valsalva, coughing, shivering, and vigorous 30 degrees bed elevation
suctioning Maintain correct body alignment by using
Increased Intracranial pressure trochanter rolls, foot board
Nursing interventions 6. Preserve corneal integrity
6. Keep head on a neutral position. AVOID- Use of artificial tears every 2 hours
extreme flexion, valsalva Altered level of consciousness
7. monitor for secondary complications Nursing Intervention
Diabetes insipidus- output of >200 mL/hr 7. Achieve thermoregulation
SIADH Minimum amount of beddings
Altered level of consciousness Rectal or tympanic temperature
It is a function and symptom of multiple Administer acetaminophen as prescribed
pathophysiologic phenomena 8. Prevent urinary retention
Causes: head injury, toxicity and metabolic Use of intermittent catheterization
derangement Altered level of consciousness
Disruption in the neuronal transmission Nursing Intervention
results to improper function 9. Promote bowel function
Altered level of consciousness High fiber diet
Stool softeners and suppository
Assessment 10. Provide sensory stimulation
Touch and communication 3. Check for Fecal impaction and other
Frequent reorientation triggering factors like skin irritation, pressure
ulcer
SEIZURES 4. Administer antihypertensive medications-
Episodes of abnormal motor, sensory, usually hydralazine
autonomic activity resulting from sudden Spinal Shock
excessive discharge from cerebral neurons Pathophysiology
A part or all of the brain may be involved The sudden depression of reflex activity in
SEIZURES the spinal cord below the level of injury
The muscles below the lesion are flaccid, the
PATHOPHYSIOLOGY skin without sensation and the reflexes are
An electrical disturbance in the nerve cells in absent including bowel and bladder functions
one brain sectionà EMITS ELECTRICAL Spinal Shock
IMPULSES excessively Nursing Interventions
SEIZURES 1. Assist in chest physical therapy
2. Manage potential complication- DVT
ETIOLOGIC FACTORS Cognitive Impairment
Idiopathic Nursing Interventions
Fever Assist or encourage the patient to use
Head injury eyeglass, hearing aid or assistive devices
CNS infection Reorient the patient by calling his name
Metabolic and toxic conditions frequently
SEIZURES Provide background information as to date,
time, place, environment
Nursing Interventions Cognitive Impairment
During seizure Nursing Interventions
1. remove harmful objects from the 4. Use large signs as visual cues
patient’s surrounding 5. Post patient's photo on the door
2. ease the client to the floor 6. Encourage family members to bring
3. protect the head with pillows personal articles and place them in the same
4. Observe and note for the duration, area
parts of body affected, behaviors before Bowel and Bladder incontinence
and after the seizure Establish a regular pattern for bowel care
5. loosen constrictive clothing Place the patient on potty every other day
6. DO NOT restrain, or attempt to place Use of stool softeners
tongue blade or insert oral airway Maintain a dietary intake. Avoid foods that
can cause excessive gas production
Nursing Interventions Impaired Swallowing
POST seizure Elevate the head of the be 90 degrees during
1. place patient to the side to drain meals and 30 minutes after
secretions and prevent aspiration Serve foods that are soft and small sized
2. help re-orient the patient if confused Keep suction equipment on bedside
3. provide care if patient became Consult with rehabilitation team as to
incontinent during the seizure attack assistive devices that can be utilized
4. stress importance of medication
regimen CONGENITAL DISORDERS:
HYDROCEPHALUS
AUTONOMIC Excessive CSF accumulation in the brain’s
DYSREFLEXIA/HYPERREFLEXIA ventricular system
Seen commonly in spinal cord injury above In infants, head enlarges
T6 In children and adults- brain compression
An exaggerated response by the autonomic
system resulting from various stimuli most Non-communicating hydrocephalus results
commonly distended bladder, impacted from CSF outflow obstruction
feces, pain, skin irritation Communicating hydrocephalus results from
Autonomic Dysreflexia/hyperreflexia faulty absorption or increased CSF
Clinical MANIFESTATIONS production
1. Hypertension
2. Bradycardia ASSESSMENT
3. severe pounding headache 1. irritability
4. diaphoresis 2. change in LOC
5. nausea and nasal congestion 3. infants- enlargement of the head, thin
Autonomic Dysreflexia/hyperreflexia scalp skin
NURSING INTERVENTIONS 4. sunset eyes
1. Elevate the head of the bed
immediately DIAGNOSTIC TESTS
2. Check for bladder distention and empty 1. Skull x-ray
bladder with urinary catheter 2. ventriculography
Involves widespread damage to the neurons
NURSING INTERVENTION Patient has decerebrate and decorticate
1. monitor neurologic status posture
2. teach parents to watch for signs of shunt Traumatic brain injury
malfunction, and periodic surgery to 4. Intracranial hemorrhage
lengthen the shunt as child grows Epidural Hematoma- blood collects in the
epidural space between skull and dura
CONGENITAL DISORDER- Spinal cord defects mater. Usually due to laceration of the
1. Spina bifida occulta- incomplete closure of middle meningeal artery
one or more vertebrae without protrusion of Symptoms develop rapidly
the spinal cord or meninges Traumatic brain injury
2. Spina bifida with meningocele- a sac 4. Intracranial hemorrhage
contains meninges and CSF Subdural hematoma- a collection of blood
3. Spina bifida with meningomyelocele- a sac between the dura and the arachnoid mater
contains spinal cord substance, meninges caused by trauma. This is usually due to tear
and CSF of dural sinuses or dural venous vessels
CONGENITAL DISORDER: Spinal cord defects Symptoms usually develop slowly
Causes Traumatic brain injury
1. environmental factors 4. Intracranial hemorrhage
2. radiation Intracerebral Hemorrhage and hematoma-
3. folic acid deficiency in a pregnant woman bleeding into the substance of the brain
4. possibly genetic resulting from trauma, hypertensive rupture
of aneurysm, coagulopahties, vascular
ASSESSMENT abnormalities
1. a dimple or tuft of hair in the vertebral Symptoms develop insidiously,
area beginning with severe headache and
2. external sac neurologic deficits
Traumatic brain injury
DIAGNOSIS
1. Spinal x-ray MANIFESTATIONS
2. myelography 1. Altered LOC
2. CSF otorrhea
NURSING INTERVENTION 3. CSF rhinorrhea
1. cover the defect with sterile dressing 4. Racoon eyes and battle sign
moistened with sterile saline HALO SIGN- blood stain surrounded by a
2. position the patient on prone or side to yellowish stain
protect the fragile sac Traumatic brain injury
3. place a diaper under the infant and
change it often NURSING MANAGEMENT
4. avoid the use of lotion 1. Monitor for declining LOC- use of
5. avoid frequent handling Glasgow
6. Measure the child’s head circumference 2. Maintain patent airway
daily Elevate bed, suction prn, monitor ABG
7. check anal reflex Traumatic brain injury
8. support family members 3. Monitor F and E balance
9. prepare the parents for the possible Daily weights
outcome of eh defect IVF therapy
10. Post-operative care Monitor possible development of DI and
Position on abdomen SIADH
Check post-operative dressings 4. Provide adequate nutrition
Place infant’s hips in abduction and feet in 5. Prevent injury
neutral position Use padded side rails
Monitor intake and output Minimize environmental stimuli
Check for urine retention Assess bladder
Asess infant frequently as he recovers from Consider the use of intermittent
the surgery catheter
6. Maintain skin integrity
TRAUMATIC BRAIN INJURY Prolonged immobility will likely cause
1. CONCUSSION skin breakdown
Involves jarring of head without tissue injury Turn patient every 2 hours
Temporary loss of neurologic function lasting Provide skin care every 4 hours
fore a few minutes to hours Avoid friction and shear forces
Traumatic brain injury 7. Monitor potential complications
2. CONTUSION Increased ICP
Involves structural damage Post-traumatic seizures
The patient becomes unconscious for hours Impaired ventilation
Traumatic brain injury Spinal cord injury
3. Diffuse Axonal injury
The most frequent vertebrae – C5-C7, T12 Aphasia
and L1 Dysphagia
Concussion HEMIPARESIS on the OPPOSITE side- more
Contusion severe on the face and arm than on the legs
Compression Localization
Transection Anterior cerebral artery:
Spinal cord injury Weakness
Numbness on the opposite side
Clinical manifestations Personality changes
1. Paraplegia Impaired motor and sensory function
2. quadriplegia Localization
3. spinal shock Posterior cerebral artery:
Spinal cord injury Visual field defects
DIAGNOSTIC TEST Sensory impairment
Spinal x-ray Coma
CT scan Less likely paralysis
MRI
Spinal cord injury CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
EMERGENCY MANAGEMENT There is disruption of the cerebral blood flow
A-B-C due to obstruction by embolus or thrombus
Immobilization RISKS FACTORS
Immediate transfer to tertiary facility Non-modifiable
Spinal cord injury Advanced age
Gender
NURSING INTERVENTION race
1. Promote adequate breathing and airway Modifiable
clearance Hypertension
2. Improve mobility and proper body Cardio disease
alignment Obesity
3. Promote adaptation to sensory and Smoking
perceptual alterations Diabetes mellitus
4. Maintain skin integrity hypercholesterolemia
5. Maintain urinary elimination Pathophysiology of ischemic stroke
6. Improve bowel function Disruption of blood supply
7. Provide Comfort measures Anaerobic metabolism ensues
8. Monitor and manage complications Decreased ATP production leads to impaired
Thromboplebhitis membrane function
Orthostatic hypotension Cellular injury and death can occur
Spinal shock
Autonomic dysreflexia DIAGNOSTIC test
Spinal cord injury 1. CT scan
9. Assists with surgical reduction and 2. MRI
stabilization of cervical vertebral column 3. Angiography

CEREBROVASCULAR ACCIDENTS CLINICAL MANIFESTATIONS


An umbrella term that refers to any 1. Numbness or weakness
functional abnormality of the CNS 2. confusion or change of LOC
related to disrupted blood supply 3. motor and speech difficulties
CEREBROVASCULAR ACCIDENTS 4. Visual disturbance
Can be divided into two major 5. Severe headache
categories Motor Loss
1. Ischemic stroke- caused by thrombus Hemiplegia
and embolus Hemiparesis
2. Hemorrhagic stroke- caused Communication loss
commonly by hypertensive bleeding Dysarthria= difficulty in speaking
Aphasia= Loss of speech
The stroke continuum Apraxia= inability to perform a previously
1. TIA- transient ischemic attack, temporary learned action
neurologic loss less than 24 hours Perceptual disturbances
duration Hemianopsia
2. Reversible Neurologic deficits Sensory loss
3. Stroke in evolution paresthesia
4. Completed stroke
NURSING INTERVENTIONS: ACUTE
General manifestations Ensure patent airway
Localization Keep patient on LATERAL position
Middle cerebral artery: Monitor VS and GCS, pupil size
IVF is ordered but given with caution as not Usually due to rupture of intracranial
to increase ICP aneurysm, AV malformation, Subarachnoid
NGT inserted hemorrhage
Medications: Steroids, Mannitol (to decrease Sudden and severe headache
edema), Diazepam Same neurologic deficits as ischemic stroke
Loss of consciousness
NURSING INTERVENTIONS: Hospital Meningeal irritation
1. Improve Mobility and prevent joint Visual disturbances
deformities
Correctly position patient to prevent DIAGNOSTIC TESTS
contractures 1. CT scan
Place pillow under axilla 2. MRI
Hand is placed in slight supination- “C” 3. Lumbar puncture (only if with no increased
Change position every 2 hours ICP)
2. Enhance self-care
Carry out activities on the unaffected side NURSING INTERVENTIONS
Prevent unilateral neglect- place some items 1. Optimize cerebral tissue perfusion
on the affected side!!! 2. relieve Sensory deprivation and anxiety
Keep environment organized 3. Monitor and manage potential
Use large mirror complications
3. Manage sensory-perceptual difficulties
Approach patient on the Unaffected side MULTIPLE SCLEROSIS
Encourage to turn the head to the affected  An auto-immune mediated
side to compensate for visual loss progressive demyelinating
4. Manage dysphagia disease of the CNS
Place food on the UNAFFECTED side  The myelin sheath is destroyed
Provide smaller bolus of food and replaced by sclerotic tissue
Manage tube feedings if prescribed (sclerosis)
5. Help patient attain bowel and bladder  MULTIPLE SCLEROSIS
control  CAUSE- unknown
Intermittent catheterization is done in the  Multiple factors- viral infection,
acute stage environmental factors, geographic
Offer bedpan on a regular schedule location and genetic predisposition
High fiber diet and prescribed fluid intake  Common in WOMEN ages 20-40
6. Improve thought processes  MULTIPLE SCLEROSIS
Support patient and capitalize on the PATHOPHYSIOLOGY
remaining strengths  Sensitized T cells will enter the brain
7. Improve communication and promote antibody production that
Anticipate the needs of the patient damages the myelin sheath
Offer support  Plaques of sclerotic tissues appear on
Provide time to complete the sentence the demyelinated axons interrupting
Provide a written copy of scheduled activities the neuronal transmission
Use of communication board  MULTIPLE SCLEROSIS
Give one instruction at a time  The most common areas affected are
8. Maintain skin integrity  Optic nerves and chiasm
Use of specialty bed  Cerebrum
Regular turning and positioning  Cerebellum
Keep skin dry and massage NON-reddened  Spinal cord
areas  MULTIPLE SCLEROSIS
Provide adequate nutrition CLINICAL MANIFESTATIONS
9. Promote continuing care  1. visual problems such as
Referral to other health care providers diplopia, blurred vision and
10. Improve family coping nystagmus
11. Help patient cope with sexual  2. motor dysfunction-
dysfunction mono/qudradiplegia
 3. Fatigue, sensory impairment
MEDICAL MANAGEMENT  4. Mental changes like mood swings,
Pharmacologic: depression
Aspirin  5. spasticity, ataxia
Diazepam to prevent seizures  MULTIPLE SCLEROSIS
Thrombolytics DIAGNOSTIC TESTS
Stool softeners  1. MRI- primary diagnostic study
Antihypertensives  2. CSF Immunoglobulin G
Analgesics, Muscle relaxants, STEROIDS  MULTIPLE SCLEROSIS
NURSING INTERVENTIONS
Normal brain metabolism is impaired by 1. Promote physical mobility
interruption of blood supply, compression  Exercise
and increased ICP  Schedule activity and rest periods
 Warm packs over the spastic area  1. Ascending weakness and
 Swimming and cycling are very useful paralysis: Leg affected first
2. Prevent injuries  2. diminished reflexes of the lower
 Wide stance walking extremities
 Use of walking aids  3. paresthesia
 Wheelchair  4. potential respiratory failure
3. Enhance bladder and bowel control LABORATORY EXAMINATION
 Set a voiding schedule 1. CSF protein level is INCREASED
 Intermittent bladder catheterization but the WBC remains normal in
 Use of condom catheter the CSF
 Adequate fluids, dietary fibers and 2. EMG and nerve conduction
bowel training program velocity studies
4. Manage speech and swallowing
difficulties NURSING INTERVENTIONS
 Careful feeding, proper positioning, 1. Maintain respiratory function
suction machine availability  Chest physiotherapy and
 Speech therapist incentive spirometry
5. Improve Sensory and Cognitive  Mechanical ventilator
function  Guillian-Barre’ Syndrome
 Vision- use eye patch for diplopia 2. Enhance physical mobility
 Obtain large printed reading materials  Support paralyzed extremities
 Offer emotional support  Provide passive range of motion
 Involve the family in the care exercise
6. Strengthen coping mechanism  Prevent DVT and pulmonary
 Alleviate the stress embolism
 Referral to the appropriate agencies  Padding over bony prominences
7. improve self-care abilities 3. Provide adequate nutrition
 Modify activities according to physical  IVF
strength  Parenteral nutrition
 Provide assistive devices  Assess frequently return of gag
8. promote sexual functioning reflex
 Refer to sexual counselor 4. Improve communication
MEDICAL MANAGEMENT  Use other means of
Pharmacotherapy communication
 Interferons 5. Decrease fear and anxiety
 Immunomodulators  Provide Referrals
 Corticosteroids  Answer questions
 BACLOFEN for muscle spasms  Provide diversional activities
 NSAIDS for pain 6. Monitor and manage complications
 Antidepressants  DVT, Urinary retention,
pulmonary embolism,
GUILLIAN-BARRE’ SYNDROME respiratory failure
 An auto-immune attack of the
peripheral nerve myelin MEDICAL MANAGEMENT
 Acute, rapid segmental  ICU admission
demyelination of peripheral  Mechanical Ventilation
nerves and some cranial nerves  TPN and IVF
 POTENTIALLY FATAL!  PLASMAPHERESIS
 Guillian-Barre’ Syndrome  IV IMMUNOGLOBULIN
 CAUSE: post-infectious
polyneuritis of unknown origin ALZHEIMER’S disease
commonly follows viral infection  A progressive neurologic disorder
 PATHOPHYSIOLOGY that affects the brain resulting in
 Cell-mediated immune cognitive impairments
attack to the myelin sheath
of the peripheral nerves CAUSES:
 Infectious agent may elicit  Unknown
antibody production that  Potential factors- Amyloid plaques
can also destroy the myelin in the brain, Oxidative stress,
sheath of the PERIPHERAL neurochemical deficiencies
NERVES!!
 Because this syndrome causes CLINCAL MANIFESTATIONS
inflammation and degenerative  1. Forgetfulness
changes in the posterior and  2. Recent memory loss
anterior nerve roots, MOTOR and  3. Difficulty learning
SENSORY losses occur  4. Deterioration in personal hygiene
SIMULTANEOUSLY!  5. Inability to concentrate
CLINICAL MANIFESTATIONS
LATE CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS
 6. Difficulty in abstract thinking  1. Tremor- resting, pill-rolling
 7. Difficulty communicating  2. Rigidity- cog-wheel, lead-pipe
 8. Severe deterioration in memory,  3. Bradykinesia- abnormally slow
language and motor function movement
 9. repetitive action- perseveration  4. Dementia, depression, sleep
 10. personality changes disturbances and hallucinations
 5. excessive sweating, paroxysmal
DIAGNOSTIC TEST flushing, orthostatic hypotension
 Neurologic examination
 PET scan Medical management
 EEG, CT and MRI  1. Anti-parkinsonian drugs- Levodopa,
 Other tests to rule out Vit B Carbidopa
deficiencies and hypothyroidism  2. Anti-cholinergic therapy
 Biopsy is the most definitive  3. Antiviral therapy- Amantadine
 4. Dopamine Agonists- bromocriptine
DRUG THERAPY and Pergolide, Ropirinole anmd
 1. drugs to treat behavioral Pramipexole
symptoms- antipsychotics  5. MAOI
 2. anxiolytics  6. Anti-depressants
 3. Donepezil  7. Antihistamine
 4. Tacrine
NURSING INTERVENTIONS
Nursing Interventions  1. Improve mobility
 1. Support patient’s abilities  2. Enhance Self- care activities
 2. Provide emotional support  3. Improve bowel elimination
 ALZHEIMER’S disease  4. Improve nutrition
3. Establish an effective  5. Enhance swallowing
communication system with the patient  6. Encourage the use of assistive
and family devices
 Use short simple sentences,  7. improve communication
words and gestures  8. Support coping abilities
 Maintain a calm and consistent
approach EPILEPSY
 Attempt to analyze behavior for  A group of syndromes characterized
meaning by recurring seizures
4. protect the patient from injury 
 Provide a safe and structured CAUSES
environment 1. idiopathic 6. brain tumors
 Requests a family member to 2. Birth trauma 7. head Injury
accompany client if he wanders 3. perinatal infection 8. metabolic
around disorders
 Keep bed in low position 4. infectious disease 9. CVA
 Provide adequate lightning 5. ingestion of toxins
 Assign consistent caregivers
5. Encourage exercise to maintain EPILEPSY
mobility  Recurring seizures may be classified
as GENERALIZED or PARTIAL SEIZURES
PARKINSON’s Disease  Generalized Seizures- cause a
 A slowly progressing neurologic generalized electrical abnormality
movement disorder within the brain
 The degenerative idiopathic form  Partial seizures- these seizures arise
is the most common form from a localized part of the brain and
cause specific symptoms
CAUSATIVE FACTORS: unknown
 Potential factors: genetics, GENERALIZED SEIZURES
atherosclerosis, free radical  1. General Tonic-Clonic seizure-
stress, viral infection, head (Grand mal) characterized by loss of
trauma and environmental factors consciousness and alternating
movements of the extremities
Pathophysiology  2. Absence Seizure (Petit mal)-
 Decreased levels of dopamine due to common in children, begins with a
destruction of pigmented neuronal brief change in the LOC, indicated by
cells in the substantia nigra in the blinking, rolling of eyes and blank
basal ganglia stares
 Clinical symptoms do not appear until  3. Myoclonic seizure- characterized by
60% of the neurons have disappeared brief, involuntary muscular jerks of
body extremities
 4. Akinetic seizure- general loss of
postural tone and a temporary loss of TRIGEMINAL NEURALGIA
consciousness- a drop attack  Also called Tic Douloureux
PARTIAL SEIZURES  Painful disorder that affects one or
 1. Simple partial seizure- typically more branches of the fifth cranial
limited to one cerebral hemisphere nerve
 2. Complex partial seizure- begins with
an aura, then with impaired CAUSES: repetitive pulsation of an artery as
consciousness, with purposeless it exits the pons is the usual cause
behaviors like lip-smacking, chewing
movements ASSESSMENT
 1. Pain history
DIAGNOSTIC TESTS  2. Searing or burning jabs of pain
 1. EEG lasting from 1-15 minutes in an area
 2. CT innervated by the trigeminal nerve
 3. MRI DIAGNOSTIC TESTS
 4. LP Skull x-ray or CT scan
 5. Angiography
NURSING INTERVENTIONS
Medical treatment  1. provide emotional support
 1. Anticonvulsants- most commonly  2. encourage to express feelings
phenytoin, phenobarbital and  3. provide adequate nutrition in small
carbamazepine frequent meals at room temperature
 Ethosuximide and valproic acid for  Myasthenia gravis
absence seizure  A sporadic, but progressive
 2. surgery weakness and abnormal
fatigability of striated muscles
Nursing Intervention which are exacerbated by exercise
 1. Care of patients during seizure and repetitive movements
 2. care of patients after seizures
 3. patient teaching MYASTHENIA GRAVIS

BELL’S PALSY ETIOLOGY


 Autoimmune disease
CAUSES  Thymoma
 1. infection Women suffer at an earlier age and are more
 2. hemorrhage affected
 3. tumor
 4. local traumatic injury Pathophysiology:
 1. Acetylcholine receptor antibodies
MANIFESTATIONS interfere with impulse transmission
 1. Unilateral facial weakness  2. Follows an unpredictable course of
 2. Mouth drooping periodic exacerbations and remissions
 3. Distorted taste perception  Myasthenia gravis
 4. Smooth forehead  CAUSE: autoimmune disorder that
 5. Inability to close eyelid on the impairs transmission of nerve
affected side impulses
 6. Incomplete eye closure
 7. excessive tearing when attempting ASSESSMENT FINDINGS
to close the eyes 1. Gradually progressive skeletal muscle
 8. Inability to raise eyebrows, puff out weakness and fatigue
the cheek 2. Weakness that worsens during the day
3. Ptosis, diplopia and weak eye
Diagnostic tests closure
 EMG 4. Blank, mask-like facies
5. Difficulty chewing and swallowing
Medical management 6. Respiratory difficulty
 1. Prednisone  Myasthenia gravis
 2. Artificial tears
DIAGNOSTIC TESTS
Nursing Interventions  1. EMG
 1. Apply moist heat to reduce pain  2. TENSILON TEST (Edrophonium)
 2. Massage the face to maintain  3. CT scan
muscle tone  4. Serum anti-AchReceptor antibodies
 3. Give frequent mouth care  Myasthenia gravis
 4. protect the eye with an eye patch.
Eyelid can be taped at night MEDICAL THERAPY
 5. instruct to chew on unaffected side
 Anticholinesterase drugs-
pyridostigmine and neostigmine NURSING INTERVENTIONS
 Corticosteroids  1. Frequent monitoring of neurologic
 Immunosuppresants status
 Plasmapheresis  2. Monitor intake and output
 Thymectomy  3. Administer antibiotics
 Myasthenia gravis  4. Administer mild laxative to prevent
constipation
NURSING INTERVENTIONS  5. maintain quiet environment
 1. Administer prescribed medication
as scheduled Neoplastic diseases
 2. Prevent problems with chewing and  A brain tumor is a localized
swallowing intracranial lesion that occupies space
 3. Promote respiratory function within the skull
 4. Encourage adjustments in lifestyle  Primary brain tumors originate from
to prevent fatigue cells and structures within the brain.
 5.maximize functional abilities  Neoplastic disease
 6. Prepare for complications like  The cause of brain tumors is unknown
myasthenic crisis and cholinergic crisis  The only risk factor accepted is
 7. prevent problems associated with radiation exposure to ionization rays
impaired vision resulting from ptosis of  Neoplastic disease
eyelids
 8. provide client teaching CLINICAL MANIFESTATIONS
 9. promote client and family coping  1. increased ICP
 Vomiting
CNS INFECTIONS  Headache. Especially early in
the morning
MENINGITIS  Vomiting
 Infection or inflammation of the  Visual disturbances
meninges covering the brain and  2. Localized symptoms
spinal cord.  Hemiparesis
 Caused by bacterial, viral and fungal  Seizures
agents  Mental status changes

BRAIN ABSCESS DIAGNOSTIC TESTS


 A free or encapsulated collection of  1. CT scan
pus in the brain parenchyma  2. MRI
 Causes: usually secondary to another  3. PET
infection like- sinusitis, meningitis,  4. EEG
dental abscess, mastoiditis,
bacteremia and trauma MEDICAL MANAGEMENT
ENCEPHALITIS  Surgery
 Intense inflammation of the brain  Chemotherapy
tisssue with lymphocytic infiltration,  Radiotherapy
cerebral edema, degeneration of brain
cells and diffuse nerve cell destruction NURSING INTERVENTIONS
 CNS infections  1. promote self-care independence
 2. improve nutrition
ASSESSMENT FINDINGS  3. relieve anxiety
 Meningitis  4. enhance family processes
 1. fever, headache, vomiting  5. provide pre-operative and post-
 2. positive meningeal sings operative care
 6. manage pain
 Brain abscess
 1. headache, N/V, seizures, changes in
LOC
 2. Focal neurologic deficits

DIAGNOSTIC TESTS
 1. CT scan
 2. MRI
 3. EEG

MEDICAL TREAMENT
 1. Antibiotics
 2. Surgical drainage
 3. Drugs to reduce increased ICP