Blue print for chapter 27 Neurological Disorders

1. Early to late signs of increased intracranial pressure

a. Early - decreasing LOC : become lethargic, talkative or quiet, or
restless and irritable. May have trouble remembering things,
experience a change in personality, or complain of nausea and
vomiting. Symptoms may progress to confusion or diminished
responsiveness
b. Late - increased systolic blood pressure, widened pulse pressure,
and slowed heart rate. Irregular respiratory patterns may develop,
and the patient's temperature may rise
c. Nursing Interventions d. prevention of complications
2. Lumbar puncture
a. Why is it done - an invasive procedure that is most often used to
detect infections and other disorders of the CNS, tumors, and
hydrocephalus.
b. Pre procedure - patient in a flexed position to maximize the space
between vertebrae, the lumbar puncture needle is inserted between
L4 and L5 to gain entry to the subarachnoid space. STERILE TECH!!!
c. post procedure bed rest for several hours
d. Complications post LP HA, back discomfort, bleeding, brainstem
herniation
e. Patient teaching - must lay flat and increase fluids to help reduce
HA
f. nursing interventions with complications - Neurological checks
3. Comatose a patient who cannot be aroused even by powerful stimuli
4. Postictal - Following a seizure.
5. Stupors decreased responsiveness accompanied by lack of spontaneous
motor activity
6. Semi-comatose if a pt is stuporous but can be aroused
7. Lethargy - excessive drowsiness
8. Neural synapse - a junction between two nerve cells, consisting of a
minute gap across which impulses pass by diffusion of a
neurotransmitter.
9. Aura - Dizziness, numbness, visual or hearing disturbance, noting an
offensive odor, or pain may precede a seizure
10.
Myasthenia gravis
a. what is it a chronic, progressive disease in which the amount of
acetylcholine available at the neuromuscular junction is reduced
b. describe the illness - Insufficient receptor sites at the junction of
the motor nerve with the muscle, With repeated stimulation, muscle
becomes exhausted; eventually unable to contract at all
c. S/S early to late - Weakness of voluntary muscles, particularly those
of chewing, swallowing, and speaking, Ptosis and diplopia, patient
becomes unable to perform any activity that demands sustained
muscular contractions, such as brushing the hair, walking upstairs,
or holding the hands over the head.

d. Complications - If respiratory muscles involved, death from

respiratory insufficiency or arrest possible
e. nursing considerations f. crisis S/S - Difficulty breathing or speaking, retractions, Weak cough
with increased secretions (mucus or saliva) or an inability to clear
secretions, Weak tongue, trouble swallowing or chewing, and
weight loss
11.
Assessment of a patients alertness highest priority
12.
Parkinson Disease
a. What is it a progressive degenerative disorder that results in an
eventual loss of coordination and control over involuntary motor
movement
b. S/S tremors at rest, rigidity, bradykinesia, stooped posture,
masklike facies, sort shuffling steps, hips and knees slightly flexed,
arms flexed at elbows and wrists
c. family teaching - exercising, avoid fall
d. nursing considerations e. diet - nutritionally balanced diet that contains plenty of fruits,
vegetables and whole grains. Eating foods high in fiber and drinking
an adequate amount of fluids can help prevent constipation that is
common in Parkinson's disease
13.
Most reliable indicator of cerebral status level of consciousness
14.
Decorticate Posturing (describe) abn flexion of the upper
extremities with extension of the lower ext.
15.
Decerabrate Posturing (describe) abn extension of the upper ext
with extension of the lower ext
16.
Dyskenesia
a. Define - distortion or impairment of voluntary movement
b. Characteristics - movements especially of the mouth, tongue, trunk,
and limbs and occurring especially as a side effect of prolonged use
of antipsychotic drugs
17.
Head Injuries
a. Scalp injuries - Lacerations, contusions, abrasions, and hematomas
b. Concussion - Trauma with no visible injury to the skull or brain
c. Contusion - Bruising and bleeding in the brain tissue
d. Hematoma - Subdural hematoma or epidural hematoma
e. Intracerebral hemorrhage From lesions within the tissue of the
brain itself
f. Penetrating injuries - Sharp objects penetrate the skull and brain
tissue
18.
Multiple Sclerosis
a. Describe a chronic, progressive degenerative disease attacking
the myelin sheath, disrupting motor pathways of the CNS
b. S/S - Fatigue, weakness, and tingling in one or more extremities;
visual disturbances; problems with coordination; bowel and bladder
dysfunction; spasticity, dizziness, tremor, slurred speech
c. Pt teaching get plenty of rest, exercise, east a balanced diet,
relieve stress, maintain normal daily activities, support group

d. nursing interventions e. complications muscle stiffness or spasms, paralysis, mental

changes, problems with bladder, bowel or sexual functions,
depression and epilepsy
19.
Age-related problems nerve cells decrease in #, brain wgt is
reduced, size of ventricle increase, pupillary response to light is slower,
pupil of the eye is smaller, reaction time increase, Lipofuscin, increased
plaques and tangled fibers, tremors in head, face, and hands are
common, problems with balance
a. What would be considered normal in the older adult? Achilles
tendon jerk is often absent this is normal!!
20.
Head injury in the older adult
a. Possible complications
b. assessment of the patient
21.
Brudzinski sign - When the nurse flexes the patients neck, hip
flexion occurs.
22.
Kernigs Sign - When the patients leg is flexed the patient is unable
to completely extend the leg.
23.
Mannitol
a. Uses osmotic diuretic; used to reduce swelling and pressure inside
the eye or around the brain.
b. Contraindications anuria, active intracranial bleeding, severe
dehydration, HF, Pulmonary congestions or edema
c. indicator the medication is working decreased ICP
24.
Cushings Triad - set of three primary signs that often indicate an
increase in intracranial pressure
a. A change in respirations, often irregular and deep, such as cheyne
stokes
b. A widening pulse pressure (the difference between the Systolic and
the Diastolic BP)
c. Bradycardia (slow heart rate).
25.
Epidural Hematoma - accumulation of blood between the inner table
of the skull and the stripped-off dural membrane.
a. S/S - pt may or may not lose consciousness. If he or she becomes
unconscious, the patient may awaken or remain unconscious,
Severe HA, vomiting and Sz
b. Tx close observation, if increased ICP osmotic diuretics
c. Complications permanent brain damage and SZ
26.
Subdural Hematoma - collection of blood below the inner layer of
the dura but external to the brain and arachnoid membrane
a. S/S - Decreased LOC, HA, difficulty with gait or balance, memory
loss, personality change, motor deficit, aphasia
b. Tx prompt surgical evacuation of hematomas
c. Complications - underlying brain injury
27.
St. John's wort
a. Uses - Mild to moderate depression

b. Contraindications pts with prolonged Q-T intervals, hemorrhage,

breast cancer, DM, hypoglycemia, mania, manic depression and
mental disturbance
c. Pt teaching d. complications in clients with Parkinsons can interact with
Levodopa (L-dopa)
28.
Neurotransmitters :( What are they responsible for?) powerful
chemicals that regulate numerous physical and emotional processes such
as mental performance, emotional states and pain response.
a. Acetocholynie - primary function of mediating the synaptic activity
of the nervous system and skeletal muscles.
b. Dopamine - responsible for motivation, interest, and drive. It is
associated with positive stress states such as being in love,
exercising, listening to music, and sex
c. Epinephrine - essential to metabolism. It regulates attention,
mental focus, arousal, and cognition.
d. Norepinephrine - excitatory neurotransmitter; High levels are linked
to anxiety, stress, high blood pressure, and hyperactivity. Low
levels are linked to lack of energy, focus, and motivation.
29.
L-Dopa
a. Uses tx Parkinsons disease
b. nursing considerations c. how does it work - is converted in the brain to dopamine
30.
Seizures
a. different types
i. Simple - Part of one cerebral hemisphere; consciousness not
impaired
1. Focal Sz - abnormal brain activity remains localized to a
specific motor area.
ii. Complex - Consciousness impaired; may exhibit bizarre
behavior
iii. Generalized seizures
1. Tonic-clonic sz - is characterized by stiffening of the
muscles or extremities with loss of consciousness
followed by a rhythmic movement of the extremities.
2. Absence seizures (previously called petit mal) are brief
periods of loss of consciousness in which the person may
appear to be daydreaming
3. Myoclonic seizure - the person has only brief jerking or
stiffening of the extremities.
4. Atonic seizures - formerly called drop attacks because
a sudden loss of muscle tone causes the patient to
collapse.
b. nursing priorities with seizures cradle head, airway, call a medical
emergency if a generalized tonic-clonic sz lasts more than 4 min
c. seizure precautions remove any objects that could cause harm,
NEVER RESTRAIN, padded side rails, bed in lowest position,

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33.

d. Tx - Resolution of the underlying condition, Anticonvulsant drug

therapy, Sx treatment (Removal of seizure foci in the temporal lobe
and pallidotomy or vagal nerve stimulator)
Motor function assessment
Meningitis
a. What is it inflammation of the coverings of the brain and spinal
cord caused by either viral or bacterial organisms
b. S/S - Headache, nuchal rigidity (stiffness of the back of the neck),
irritability, diminished level of consciousness, photophobia
(sensitivity to light), hypersensitivity, and seizure activity
c. nursing interventions WASH HANDS, immunizations
d. complications brain damage, learning disabilities, gait problems,
Sz, kidney failure, shock, death, memory difficulty, hearing loss
e. Tx - Bacterial infections usually respond to antimicrobial therapy,
but no specific drugs effective against most viral infections and
Anticonvulsants used to control seizure activity if necessary
Guillain-Barre syndrome (GBS)
a. What is it a rapidly progressing disease that affects the motor
component of the peripheral nervous system
b. S/S - Symmetric muscle weakness: begins in lower extremities;
ascends to trunk and upper extremities
i. Visual and hearing disturbances, difficulty chewing, and lack of
facial expression
ii. Mild paresthesia or anesthesia in feet and hands in a glove or
stocking distribution pattern
iii. Hypertension, orthostatic hypotension, cardiac dysrhythmias,
profuse sweating, paralytic ileus, and urinary retention
c. history assessment recent viral infection or vaccination,
progression of s/s, Physical examination focuses on cranial nerve,
motor, respiratory, and cardiovascular function
d. complications breathing difficulties, residual numbness, pain,
bowel and bladder function problems, blood clots, pressure sores,
heat and Bp problems and relapse
e. Pt teaching P.T., adaptive devices and continue with exercise