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Neurological Disorders

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on 24 April 2014

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Transcript of Neurological Disorders

Neurological Disorders
Step 4
Central nervous system (CNS)
Brain and spinal cord
Peripheral nervous system
Somatic nervous system
Sends messages from the CNS to the skeletal muscles; voluntary
Autonomic nervous system
Sends messages from the CNS to the smooth muscle, cardiac muscle, and certain glands; involuntary
Cells of the nervous system
Neuron: Transmitters; carry messages to and from the brain and spinal cord.

Acetylcholine: plays role in nerve impulse transmission
Norepinephrine: has an effect on maintaining arousal, awakening from a deep sleep, dreaming, and regulation of mood
Dopamine; affects motor function, involved in gross subconscious movements of skeletal muscles
Serotonin: induces sleep, affects sensory perception, controls temperature, and has a role in conrol of mood.
Central Nervous System
Composed of the brain and spinal cord.
Brain: One of the largest oragns, weighs approximately 3 pounds, diveded into four main parts:
Four lobes: Frontal, parietal, occipital, and
Frontal: Written speech, motor speech, motor ability, intellectualization, and judgment formation
Parietal: Sensory; touch, pain, skin, and temp, recognition of body parts, determination of left from right, shapes, sizes and distances
Occipital: vision
Temporal lobe: Wernicke's area: Langauage comprehension
Contains the thalmus and the hypothalmus
Thalamus: Sensory impulses; pain, ;ight touch and pressure
Hypothalamus; controls body temp, fluid balance, appetite, sleep, and emotions such as fear, pleasure, and pain
Mainly responsible for coordination of voluntary movement and maintenance of balance, equilibrium and tone.

Automatic Pilot of the body, it adjust and corrects the voluntary movement, but operates below the conscious level.

Sensory messages from the semicircular canals in the inner ear send their messages here.
Contains midbrain, pons and medulla oblongata.
Midbrain: Associated with cranial nerves III and IV; responsible for motor movement, relay of impulses and auditory and visual impulses
Pons: Associated with cranial nerves V and VIII; contains respiratory center
Medulla Oblongata: Associated with cranial nerves IX and XII; controls heartbeat, rhythm of breathing, swallowing, coughing, sneezing, vomiting, and hiccups, and regulates diameter of blood vessels.
Cranial Nerves
pg 1893 FAHN
I: olfactory
II: Optic
III: Oculomotor
IV: Trochlear
V: Trigemninal, Opthalmic Branch, Maxillary branch, Mandibular Branch
VI: Abducens
VII: Facial
VIII: Acoustic
IX: Glossophayngeal
X: Vagus
XI: Spinal Accessory
XII: Hypoglossal

Neurological Assessment
Pt History
Mental Status: LOC ( most sensitive indicator of neuro status)
Glascow Coma Scale: Assess degree of impairment in critically ill: The stinger the stimulus needed to provoke a reaction the lower the score. (pg 1895 FAHN)
Language and Speech
Cranial Nerves
Motor Function: Paresis (incomplete paralysis); Flaccid (weak, soft, flabby, and lacking nirmal muscle tone); Spastic (involuntary sudden movement or muscular contraction)
Sensory and perceptual status: Proprioception ( spatial position and muscular activity) Unilateral Neglect ( individual is perceptually unaware of one side of the body); Hemianopia ( defective vision or blindness in half of the visual field)
Pupils: Perrla, fixed, dilated, constricted
V/S: BP ( indicator of ICP: rise in BP with widening pulse pressure, elevated temp, abnormal resp)
Resp Status: Cheyne-Stokes, Neurogenic Hyperventilation, Apneustic, Ataxic, Cluster (Pg 799 NCLEX-PN)
Refelxes: Babinski's, Corneal, Gag
Lab and Diagnostics
Blood and Urine: Urine = rule out infection, drug involvement Blood = ABG, rule out infection
Cerebrospinal Fluid (CSF); Lumbar puncture pg 1897 FAHN: Nurisng interventions: after procedure pt lies flat in bed for several hours, assess site for leakage, instruct patient that headache is common
Brain Scan
MRA: evaluates extra-cranial and intra-cranial blood vessels
PET scan
EEG: Measures electrical activity of the brain
Angiogram: detects arterial aneurysms, vessel abnormalities, ruptured vessels and displacement of vessels by tumors.
Carotid Duplex: Most commonly used for TIA

Effects of Normal Aging on the Nervous System
Slowed reflex and reaction time
Altered sleep/ wakefulness ratio
Decrease ability to regulate body temp
Learning is slower
Prevention of Neurological Problems
Maintaing a healthy and active lifestyle
Avoidance of smoking, drug or alcohol use
Prevent Injury: Practice safety, wear seat belts, helmets..etc
Neuro Disorders
Seizure Disorders
Types of Seizures
Atonic or Akinetic

Partial Seizures:
Simple Partial
Complex Partial
Data Collection
Type and duration
Prodominal Signs
Loss of motor activity or bowel and bladder Function
Postical State: Headache, loss of consciousness, sleepiness, impaired speech or thinking
If client is having a seizure, maintain patent airway. DO NOT force jaws open or place anything in patients mouth.
If client is standing: place on floor and protect head and body
ABC's prepare for O2 administration
Prepare to suction secretions
turn client to side to allow secretions to drain
Do not restrain Client
Loosen Restrictive clothing
Document Characteristics of Seizure, and monitor behavior after seizure
Stroke V.S Transient Ischemic Attack
Think FAST:
F: Face
A: Arm
S: Speech
T: Time to get help ( Very important to note onset of symptoms)
Expressive: Client understands but is unable to communicate verbally
Receptive: Unable to understand spoken and often written language
Global or Mixed: occurs in expression and recpetion
Provide repetitive directions, break task down into steps, allow time for client to communication tools

Right Sided Brain Damage:
Effects left side
Spatial-perceptual deficits
Tends to deny or minimize problems
Rapid performance short attention span
impulsive, safety problems
Impaired Judgement
Impaired Time Concept

Left Side Brain Damage:
Effects right side
Impaired Speech/ Language
Slow performance
Aware of defecits (Depression, anxiey)
Imparied comprehension to language, math
Interventions During Acute Phase
Maintain BP
Suction secretions
Monitor of increased ICP during first 72 Hours
Proper Client positioning
Monitor Mental status
Maintain Quiet environment, minimal stimulation, to prevent further bleeding.
Establish means of communication
Post Acute interventions
Postion Client q2 hr, on the unaffected side, affected side 20 minutes
Provide skin, mouth, and eye care
Monitor gag reflex, ability to swallow
Slowly advance diet as tolerated, monitor for aspiration
When feeding position client up right with head slightly forward and flexed, place food in back of mouth on unaffected side.
Episode of cerebrovascular insufficiency with temporary episodes of neurological dysfunction lasting less than 24 hours and often less than 15 minutes. Most resolve within 3 hours.
Considered a warning sign for a stroke.
Parkinson's Disease

Degenerative disease caused by depletion of dopamine, resulting in a dysfunction of the extra pyramidal system.

Signs and Symptoms
Bradykinesia: abnormal slowness of movement and sluggishness of physical and mental responses which can lead to Akinesia (loss of control of voluntary movements)
handwriting that becomes progressively smaller
Jerky movements
restlessness and pacing
Blank Facial expression
Shuffling steps
Monitor Neuro status
Check ability to swallow and chew
High-calorie, high protein, high fiber soft diet with Small frequent feedings
fluid intake of 2000mL/day
Don't rush this patient
Instruct client to rock back and fourth to initiate movement
Lift feet while walking
Promote PT
Avoid foods high in B6
avoid monoamine oxidase inhibitors
Bell's Palsy
Caused by a lower motor neuron lesion of cranial nerve VII that may result from infection, trauma, hemorrhage, meningitis, or a tumor

Characterized by paralysis of one side of face

Recovery usually occurs in a few weeks without residual affects
Head Injury pg 803 NCLEX-PN
Open: scalp lacerations, fractures in skull, interruption of the dura mater Closed: Concusion, contusion, fractures
Increased ICP
HOB Elevated
neutral head postion
Monitor for drainage of CSF
Keep client calm, avoid suctioning, coughing (increases ICP)
Data Collection
Altered LOC
Abnormal Respiration
Increased BP
Slow Pulse
Elevated Temp
Pupil Changes
BP changes, widened pulse pressure
abnormal reflex signs
Monitor Resp status
avoid administration of morphine
Maintain body temp
prevent shivering
decrease environmental stimuli
Monitor electrolyte levels
limit fluid intake to 1200 mL/ day
avoid straining activities
HOB elevated 30-40 degrees
Antimyasthenic Medications:

AKA: anticholinesterase
Mech of Action: Relieve muscle weakness associated with Myasthenia Gravis by blocking acetylcholine breakdown at the neuromuscular junction.
Used to treat or diagnose myasthenia gravis or distinguish cholinergic crisis.
Prostigmin, Mestinon, and Mytelase, are used to treat Myasthenia Gravis.
Enlon used to diagnose and distinguish Myasthena Gravis from cholinergic crisis.
Pt teaching:
Take medications on time to maintain therapeutic blood level.
Take medications with small amount of food to prevent GI symptoms.
Eat 45-60 min after taking medication
Client should wear a Medical Alert bracelet
Antimyasthenic therapy is life long therapy
Neuromuscular status (reflexes, gait, and muscle strength)
S&S of med overdose (cholinergic crisis) and underdose (Myasthenia Gravis)
Evaluate med effectiveness: improvement of neuromuscular sympotms or strength without cholinergic S&S.
Antiparkinsonian Medications:
Restore the balance of the neurotransmitters acetylcholine and dopamine int the CNS, decreasing signs and symptoms of Parkinson's disease.
Medications include dopaminergics (stimulate dopamine receptors) and Anticholinergics ( block the cholinergic receptors)
Affecting Dopamine:
Trihexyphenidyl hydrochloride
Side Effects
Involuntary movements
chest pain
urinary retention
sleep disturbances
Orthostatic Hypotension
Mood changes
Dry Mouth
Monitor VS
Determine risk for injury
Check for S&S of Parkinson's (rigidity, tremors, akinesia, bradykinesia, stooped posture...etc.
Pt Teaching
Take with food if N/V occur
Teach S&S of dyskinesia
Change positions slowly
Do not discontinue meds abruptly
Avoid alcohol
Urine and sweat may be discolored
DM clients (no urine glucose)
Anticonvulsant Medication
Depress abnormal neural discharges and prevent the spread of seizures to adjacent neurons.
Pts taking anticoagulants, aspirin, sulfonamides, Tagamet, and antipyschotic meds.
Seizure precautions
Monitor: Urinary output, liver/renal function, med toxicity (CNS depression, ataxia, nausea, vomiting, drowsiness, dizziness, resltesness, and visual disturbances)
Protect client from hazards in the environment during seizure.
Box 58-5 pg 827 NCLEX-PN
(used to treat partial and general tonic-clonic seizures
phenytonin (Dilantin)
(Used for tonic-clonic seizures and status epilepticus)
amobarbital (Amytal)
mephobarbital (Mebaral)
phenobarbital (Luminal)
s: Used to treat absent seizures (except for
and Ativan, these are used for
status epileptics
anxiety and skeletal muscle spasm.)
Valium (diazepam)
Side effects:
Gingival Hyperplasa (reddened gums that bleed easily)
Slurred speech confusion
Sedation Drowsiness
Blurred vision
sedation, ataxia, and dizziness (initially)
mood changes, hypotension, Resp depression
Tolerance to medication
Sedation, drowsiness, dizziness, blurred vision
Bradycardia (when administered too rapidly IV)
Med tolerance and dependency
Blood dyscrasias
Other Meds:
Keppra: Used in combination therapy for seizures.
May cause weakness, drowsiness, and dizziness
caramazepine (Tegretol): Anticonvulsant
Instruct patient to report rash, or puritus immediately and withhold additional doses pending approval by health care provider.
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