Common neurological disorders

Increased intracranial pressure intracranial hypertension; cerebral edema Causes: A. increased intracranial blood volume B. increased CSF volume C. increased in bulk of brain tissue D. intracranial tumors E. increased production of CSF or blockage of ventricles; F. decrease in absorption of CSF

Increased intracranial pressure

Nursing Assessment A. swelling of optic disk B. headache, vomiting projectile C. decreasing level of consciousness D. pupillary signs ipsilateral pupil affected is dilated E. blood pressure increased systolic and decreased diastolic (widening pulse pressure) F. decreased PR and RR G. respiration cheyne-stokes H. temperature regulation increased

Increased intracranial pressure Nursing management: A. positioning HOB elevated 15-30o B. activites: no coughing, sneezing or straining at stool valsalva maneuver C. avoid hip, waist, neck flexion; avoid rotation of head especialy to right D. space out nursing activities E. perform suctioning only PRN

Increased intracranial pressure F. IV mannitol and dexamethasone Monitor fluid balance Restrict fluids Urinary output Watch for hypotension G. Craniectomy to provide room for expansion

Common Neurological Disorders Seizures (Convulsions) Brief cerebral storms associated with sudden excessive and disorderly electrical discharges from the brain. Nursing observations: A. Aura symptoms that occur during the prodome of seizure (numbness, dizziness, yawning, smells).

Seizures

B. During Never leave alone If standing, lower to floor to prevent injury Loosen constrictive clothing Do not restrain Do not pry jaw open to place padded tongue blade Pad side rails; no pillows C. Postictal phase normally groggy and confused; deep sleep also follows

Common Neurological Disorders CVA or stroke or apoplexy Disruption in cerebral circulation resulting in motor or sensory deficit Risk factors: A. hypertension B. heart disease C. DM D. hypercolesterolemia E. oral contraception F. obesity G. family history

CVA or stroke or apoplexy

Etiology: A. Thrombosis most common cause of cerebral infarct (atherosclerosis) B. Embolism increased incidence after 40 years

Common Neurological Disorders

Intracerebral hemorrhage Within brain substance most common cause rupture of arteriosclerotic hypertensive vessels most common cause of death in CVA Middle cerebral artery most common site

Extra or epidural outside dura mater Subdural beneath dura mater Subarachnoid in subarachnoid space

Intracerebral Hemorrhage
Nursing Assesment: A. mental confusion, drowsiness, headache, transient loss of speech, TIA, hemiplegia or paresthesias to paralysis B. typical headache, vomiting, seizures, coma, nuchal rigidity, fever, hpn, confusion disorientation C. Focal symptoms weakness, paralysis, sensory loss, language disorders, reflex changes D. Fatal increased temperature, PR and RR; increased depth of coma and collapse of vasomotor and heat regulating centers

Intracerebral Hemorrhage
Nursing management: A. Decrease salt diet, oxygen therapy B. intubation and mechanical ventilation C. GI decompression, NGT D. Semi-fowlers position E. Antacid, anticoagulants, anti-hpn F. Anticonvulsants

Intracerebral Hemorrhage
G. intracranial surgery Craniectomy portion of cranium is permanently removed to relieve pressure on brain structures to provide space for expansion Craniotomy surgical opening into skull Position not in operative site Supratentorial HOB elevated at 30o Infratentorial flat without head elevation to prevent pressure on brain stem structures

Neurologic Degenerative Diseases

Parkinsons disease Degeneration and destruction of nerve cells of the basal ganglia throughout the brain (loss of dopamine neurotransmitter with anticholinergic effect) Incidence: men and women (50-60 y/o) Cause: unknown Signs and symptoms: cogwheel rigidity; pill rolling or resting tremor; masklike appearance of face; slow

Parkinsons Disease

1. 2. 3. 4. 5.
C A P B L E

Nursing management:

Initiate exercise program and speech therapy Maintain nutrition Maintain safety precaution Use rocking chair to help to get up Administer drugs: Dopaminergic dopamine replacement e.g Levodopa (Sinemet) * avoid multivit.with pyrodoxine *side effect: depression Anti-parkinsonism agent may increase dopamine release. (e.g Symmetrel) Anticholinergics to decrease rigidity and tremors and drooling (e.g Cogentin, Artane) Dopamine Agonist mimics effect of dopamine (e.g Parlodel) 6. Surgery: Stereotaxix pallidotomy destroys part of the thalamus to decrease muscle contraction

Neurologic Degenerative Diseases

Multiple Sclerosis

Signs and symptoms: 1. Charcots triad nystagmus, intention tremor, scanning speech, 2. Spastic bladder 3. Difficulty with balance 4. Emotionally labile/depression 5. Diplopia

Multiple patches of demyelination or nerve degeneration throughout the brain and spinal cord Cause: unknown/auto-immune Incidence: women, young adults 20-40 yrs old

Multiple Sclerosis
Nursing management: 1. Encourage active and normal life as long as possible 2. Teach self catheterization techniques 3. Prevent injury 4. Teach self injection technique-for beta interferon 5. Drugs: During exacerbation give corticosteroids Immunosupressants: Immuran, Betaseron Baclofen (Lioresal)- for spasticity and

Neurologic Degenerative Diseases

Myasthenia Gravis Decreased secretion of acetylcholine or increase in cholinesterase at the myoneural junction leading to transmission failure Etiology: autoimmunity Incidence: young adults (women)

Myasthenia Gravis
Signs and Symptoms: Muscular weakness Fatigue Ptosis Weight loss Muscle atrophy Diagnostic assessment: Tensilon test injection of Tensilon or Prostigmin and muscle weakness disappears but comes back when medication wears off

Myasthenia Gravis
Nursing Management: Anticholinesterase prostigmin; mestimon to be taken at specified time; before meals Myasthenic crisis due to undermedication (management anticholenesterase) Cholinergic crisis due to overmedication (management atropine sulfate Brittle crisis receptors at neuromuscular junciton becomes insensitive to anticholinesterase

Myasthenia Gravis
Avoid muscle relaxants, barbiturates, morphine, tranquilizers and neomycin Avoid stress, colds and infection Never rush, provide rest periods Avoid unnecessary muscle activity Give medication on time Plan activities early in the day to avoid fatigue