Nervous System

DEAN JANE L. OLID

Neuron
Central Nervous
System
Brain
Cerebrum
Cerebellum
Brain stem
Midbrain
Pons
Medulla oblongata
Spinal cord
 Nervous System

1. Central Nervous System

 Brain
 Spinal Cord

2. Peripheral Nervous System

 Cranial Nerves

 Spinal Nerves
 •BRAIN

The Brain is divided into 3 major

areas:
2. Cerebrum

3. Brain Stem

4. Cerebellum
External surface of the brain
 BRAIN- 1. Cerebrum
 The largest part of the brain.
 Composed of:
 2 hemispheres- the right and left, and the
basal ganglia.
 The hemisphere is connected by corpus
callosum, a band of fibers.
 Each hemisphere is divided into 4 lobes.
Structure of the Brain
 The 4 Lobes of the
1. Frontal LobeCEREBRUM
 Largest lobe
Largest lobe
 location: front of the skull.
 contains the primary motor cortex and
responsible for functions related to motor
activity.
 The left frontal lobe contains Broca’s
area (control the ability to produce spoken
words)
 The frontal lobe controls higher
intellectual function, awareness of
self, and autonomic responses
related to emotions.
2. Parietal
 Sensory lobe
 location: near the crown of the head.
 Contains the primary sensory cortex.
 One of its major function is to process
sensory input such as position sense,
touch, shape, and consistency of objects.
3. Temporal
 Location: around the temples.
 Contains the primary auditory cortex.

 Wernicke’s area is located on left

temporal lobe.
 Contains the interpretative area where auditory,
visual and somatic input are integrated into thought
and memory
 Lobes-cont.

4. Occipital
 Location: lower back of the head
 Contains the primary visual

cortex
 Function: responsible for visual

interpretation.
 THE 4 LOBES
 Frontal- motor
/controls higher
intellectual function,
awareness of self,
and autonomic
responses related to
emotions.
 Parietal- sensory
 Temporal-auditory
(Wernicke’s);
Contains the
interpretative area
where auditory,
visual and somatic
input are integrated
into thought and
memory
 Occipital-visual
 BRAIN- DIENCEPHALON
 Lies on the top of the brain-stem
 contains the thalamus, hypothalamus, epithalamus, and
subthalamus.
 Thalamus
 Lies on the either side of the third ventricle
 “Relay station” for all sensation except smell.
 All memory, sensation and pain impulses pass through
this section.
 Hypothalamus
 Located anterior and inferior to the thalamus.
 Has a variety of function and plays an important role in
maintaining homeostasis.
 regulation of body temperature, hunger and
thirst; formation of autonomic nervous system
responses; and storage and secretion of
hormones from the pituitary gland.
 Epithalamus
 Contains pineal gland.
 Subthalamus
 Part of the extrapyramidal system of the autonomic
nervous system and the basal ganglia.
 The Basal Ganglia
 Are masses of nuclei located deep in
the cerebral hemispheres.
 responsible for fine motor
movements, including those of the
hands and lower extremities.
 Several motor disorders are
associated with basal ganglia damage
including Huntington’s chorea and
Parkinson’s disease.
 BRAIN-2. Brain Stem
 Consist of the midbrain, pons, and medulla
oblongata.
 Midbrain

-connects the pons and the cerebellum with

the cerebral hemisphere, it contains sensory
and motor pathways
-center for auditory and visual reflexes
 Pons

-connects the two halves of the cerebrum

- involved in the integration of movements in
the right and left sides of the body, and the
transmission of motor information from the
higher brain areas and the spinal cord to the
cerebellum.
 medulla oblongata - involved in the
respiration, circulation, gastrointestinal
functioning, coughing, sneezing, and
 BRAIN-3. Cerebellum
 Location: base of the brain.

Responsible for coordination,
balance and posture.
 Damage to the cerebellum can result in

ataxia, a condition characterized

by drunken-like movements,
severe tremors, and loss of
balance.
 Structures Protecting the
Brain
 The brain is contained in the rigid
skull, which protects it from injury.
 The meninges (fibrous
connective tissues that cover the
brain and the spinal cord) provide
protection, support and nourishment
to the brain and the spinal cord.
 Layers of the meninges:

1.dura mater
2.arachnoid
3.pia mater.
 CSF
 CSF - provide a cushion, provide
nutrition, maintain normal ICP,
remove metabolic waste.
 Composition – colorless, odorless fluid
containing glucose, electrolytes, oxygen,
water, small amount of carbon
monoxide and few leukocytes.
 Produced in the choroid plexus of the
ventricles.
 •Spinal Cord
 Approximately 45 cm long (18 inches)
long.
 Acts as a passageway for
condition of sensory
information from the
periphery of the body to the
brain (via afferent nerve fibers).
 Serve as the connection between the
brain and the periphery.
 Mediates the reflexes.
 Spinal Cord

cervical - C1-4
brachial plexus - C5-8, T1
intercostal - T2-T12
lumbar - L1-L4
sacral - L4-L5, S1-S3
pudendal - S4
BLOOD SUPPLY TO THE CNS
 1/3 of the cardiac output
 From 2 vertebral artery and one
internal carotid arteries
 Circle of willis
Peripheral Nervous System –
Cranial Nerves & Spinal Nerves
 •Cranial Nerves
 I—Olfactory nerve
 II—Optic nerve
 12 pairs  III—Oculomotor
 emerge from the nerve
undersurface of the  IV—Trochlear nerve
brain.  V—Trigeminal nerve
 Cranial nerve  VI—Abducens nerve
conducts impulses VII—Facial nerve
(motor and sensory  VIIIAcoustic/Vestibul
information) between ocochlear
the brain and various  IX—
structures of the head, Glossopharyngeal
neck, thoracic cavity nerve
and abdominal cavity.  X—Vagus nerve
 XI—Accessory nerve
 XII—Hypoglossal
 Cranial Nerves
Cranial Function Assessment
Nerves
I. Olfactory Sensory: Assess nose for Smell.
smell reception and Have the client close

interpretation eyes and properly identify

common aromatic
substance held under the
nose; test one nostril at a
time. (ex. coffee,
toothpaste, orange)

II. Optic Sensory: Assess eyes for Visual

visual acuity and Acuity and Peripheral
visual fields Vision.
Vision and visual field

tested with an eye chart

and by testing point at
which person sees an
object (finger) moving
into visual fields; inside of
Cranial Nerves Function Assessment
III. Oculomotor Motor: Assess eyes for
raise eyelids, most Extraocular
extraocular Movement.
The CN III, CN IV,
movements
and CN VI nerves
are tested together
since they control
muscles that
provide eye
movement. Test the
movement of the
eyes in the six
cardinal fields of
Parasympathetic: gaze.
pupillary constriction, Assess eyes for
change lens shape Pupillary
Constriction and
Accommodation.
To test pupillary

reaction and
accommodation,
shine a light into
Cranial Function Assessment
Nerves constricts, making
the pupil smaller.
Accommodation is

tested by observing
pupillary constriction
when the client
changes gaze from a
distant object to a
Motor: near object.
IV. Trochlear
downward, inward Assess eyes for
eye movement. Extraocular
Movement
Motor: jaw opening
V. Trigeminal and clenching, Assess face for
chewing and Movement and
mastication Sensation
Test motor function
Sensory: sensation to
cornea, iris, lacrimal by having the client
glands, conjunctiva clench his/her teeth,
eyelids, forehead, then palate the
nose, nasal and temporal and
mouth mucosa, teeth, masseter muscles.
Cranial Function Assessment
Nerves her eyes, then wipe a
cotton wisp lightly
over the anterior
scalp, paranasal
sinuses, and jaw.
To test deep

sensation, use
alternating blunt and
sharp ends of a paper
clip over the client’s
forehead and
VI. Abducens Motor: lateral eye paranasal sinus.
movement
VII. Facial Motor: movement of
facial expression Inspect the face both
muscles except jaw, at rest and during
close eyes, labial conversation.
speech sounds. Have the client raise

the eyebrows, frown,

close the eyes tightly
and show the teeth,
Cranial Nerves Function Assessment
Smile and puff out the
cheeks.
Sensory: taste- Assess mouth for Taste
anterior two third Instruct the client to
of tongue, stick out the tongue
sensation to and leave it out during
Pharynx the testing process.
Parasympathetic: Use a cotton applicator
secretion of saliva to place quantities of
and tears. salt, sugar, and lemon
to client’s tongue.
VIII. Acoustic
Hearing initially can
Sensory: hearing
and equilibrium. be screened while
taking the history.
Cranial Nerves Function Assessment
IX. Motor: Assess mouth for
Glossopharyngeal voluntary muscle Gag Reflex and
for swallowing and Movement of Soft
phonation. Palate.
Evaluate CN IX

and CN X together
for movement and
Parasympathetic: gag reflex.
secretion of
Instruct the client
salivary gland,
to say “ah”; there
carotid reflex
should be bilateral
equal upward
movement of the
soft palate and
uvula; gagging will
Motor: voluntary occur; and speech
muscle of should be smooth.
X. Vagus phonation and
Assess mouth for
swallowing
Gag Reflex and
Sensory: sensation Movement of Soft
behind ear and part Palate
of
Cranial Nerves Function Assessment
external ear canal.
Parasympathetic:
secretion of
digestive enzymes;
peristalsis; carotid
reflex;
involuntary
action of the
XI. Spinal heart, lungs and Assess shoulder and
accessory digestive tract. neck muscles for
Motor: turn head, Strength and
shrug shoulders, Movement
Have the client
some actions for
phonation shrug his/her
shoulders upward
against your hands.
Have the client turn

his/her head to the

side against your
hand, repeat on the
other side.
Cranial Function Assessment
Nerves
XII. Motor: Assess mouth for Tongue
Hypoglossal tongue movement Movement, Symmetry,
for speech sound Strength, and Absence of
articulation and Tumors
swallowing  client protrudes tongue.

Note symmetry, atrophy,

and absence of tumors.
Then ask the client to

move tongue toward

nose, chin, and side to
side.
Strength of the tongue

can be tested by pressing

it against your gloved
index finger.
 
• Spinal
Spinal nerves
Nerves
 31 pairs
 8 cervical, 12 thoracic, 5 lumbar
 5 sacral, 1 coccygeal
 Two roots
 Dorsal and ventral-Each spinal nerve has a ventral
root (motor) and a dorsal root (sensory).

 Dermatome distribution
 The dorsal roots contains sensory fibers that
relay information from sensory receptors to
the spinal cord
 The ventral root contains motor fibers that
relay information from the spinal cord to the
body’s glands and muscles.
Dermatome distribution
 Autonomic Nervous System
 Regulates the activities of the
internal organs (heart, lungs, blood
vessels, digestive organs, and glands)
 Responsible for maintenance and
restoration of internal homeostasis.

2 Components of ANS
1. Sympathetic Nervous System
2. Parasympathetic Nervous System
 Sympathetic Nervous System
 Expenditure of energy
 Catecholamines:

Epinephrine; norepinephrine;
dopamine
 “Fight or flight” response.
 Pupil dilates

 Increased HR

 Increased BP

 Increased RR

 Constipation

 Dry mouth

 Urinary retention
 Parasympathetic Nervous
System
 conserving energy.
 Acetylcholine

 Pupil constricts

 Decreased HR

 Decreased BP

 Decreased RR

 Diarrhea

 Increased salivation

 Urinary frequency
Assessment
The Neurologic
Examination
 General Assessment for
Neurological Disorders
Health History
Health History
 Past Health History
 Injuries and surgeries
 Use of alcohol, medications, and illicit
drugs
 Onset of symptoms.
 Duration of current complain
 Recent trauma
 The disorders involving neurologic
system impairment are headache,
dizziness or vertigo, seizures, change in
consciousness, altered sensation and
 Physical Examination
 The brain and spinal cord cannot be
examined directly as other system of
the body.
 V/S - abnormal respiration
 breathing pattern
 Pupillary reaction/pupillary changes
 Eye movement & reflex response
 Change in balance
 Neurological Assessment
 recognition of change
 helps assess the patient’s ability to
engage in self-care activities.
 Neurologic assessment is divided to
into 5 components:
 Cerebral function
 Cranial nerves
 Motor system
 Sensory system
 Reflexes
 1. Cerebral Function
 Mental status: observe patient’s
appearance, behavior, dressing,
grooming and personal hygiene.
 Posture, gestures, movements, facial
expression, motor activity, the
patient’s manner of speech and LOC
are also assessed.
 Level of Consciousness (LOC) –
awareness of self and environment and
level of arousal (alert, lethargic,
obtunded, stuporous, coma).
 Altered Level of Consciousness (LOC)- can
result from destruction of the brain stem or its
reticular formation of ascending nerves, or from other
structural, metabolic, or psychogenic disturbances.

 Confusion
 Impaired ability to think clearly
 Disturbed ability to perceive, respond
to, and remember current stimuli
 Disorientation
 Functional in activities of daily living
(ADLs)

 Delirium  Motor restlessness

 Increased disorientation
 Transient hallucinations
 Delusions possible
 Requires some assistance with ADLs
Altered Arousal/Level of Consciousness
(LOC) cont.
 Obtundation  Decreased alertness
 Psychomotor retardation
 Requires complete assistance with ADLs

 Stupor  Arousable but not alert

 Severe disorientation
 Little or no spontaneous activity

 Coma  Unarousable
 Unresponsive to external stimuli or
internal needs
 Determination commonly documented
using Glasgow Coma Scale score
 Altered Movement
 Involves certain neurotransmitters (ex.
dopamine)
Hyperkinesia- excessive movement
Hypokinesia- decreased movement
 Marked by paresis- partial loss of motor

function and muscle power; commonly

described as weakness; can result from
destruction of upper & lower motor
neurons
 2. Cranial Nerve Function

 Assess cranial nerve function.

 3. Motor System Function
Assess muscle size (inspect and palpate) tone, and strength;
assess symmetry differences between right and left side;
balance and coordination.

 Altered Muscle Tone

 Hypotonia- severely reduced degree
of tension or resistance to movement
in a muscle
 Hypertonia- marked increase in a
muscle tension and decreased ability
of a muscle to stretch
 Sensory Function
Test for:
 superficial tactile sensation
superficial and deep pressure pain
 thermal sensitivity

 sensitivity to vibration

 point localization.

Reflexes
 Evaluate deep and superficial
reflexes (biceps, triceps, patellar,
ankle reflexes) and abnormal
reflexes (Babinski’s reflex).
Diagnostic Tests
Diagnostic Procedure Nursing Interventions
Computed Tomography
Scanning  teaching the client about
Visualize sections of the the need to lie quietly
spinal cord as well as throughout the
intracranial contents procedure.
The injection of a water-  Relaxation technique
soluble iodinated contrast into maybe helpful for clients
the subarachnoid space with claustrophobia.
through lumbar puncture  Assess for
helps
iodine/shellfish
noninvasive and painless
allergy.
 has a high degree of
 Secure patent IV line.
sensitivity for detecting
lesions.
 NPO if with contrast
medium, for 4 hrs.
Use of xray beams cross
section  Monitor for allergic
Use : to identify intracranial
reaction: flushing, nausea
tumor, hemorrhage, cerebral and vomiting.
atrophy, calcification, edema,
infarction, congenital
Magnetic Resonance Imaging
Diagnostic Procedure Nursing Interventions
Magnetic Resonance
Imaging Obtain history of metal
Uses a powerful magnetic implants. Remove all metal
field to obtain images of objects.
different areas of the body. Inform the client that the
Can be performed with or procedure last for 30 to 90
without a contrast agent and mins.
can identify a cerebral Patient preparation should
abnormality earlier and more include teaching relaxation
clearly than other diagnostic technique.
tests. Inform the client that a
Useful in diagnosis of
narrow, tunnel like machine
multiple sclerosis and can will enclose him/her during the
describe the activity and the procedure.
extent of disease in the brain Sedation may be needed for
and spinal cord. claustrophobic client.

Cerebral Angiography Obtain a signed consent.

Is an x-ray study of the
Hydrate the client, clear
cerebral circulation with a liquids are usually permitted.
contrast agent injected into a
Instruct the client to void
Diagnostic Procedure Nursing Interventions
Instruct the patient to
remain immobile during the
test.
Tell the client to expect a

brief feeling of warmth in the

face, behind the eyes or in the
jaw, teeth, tongue, and lips,
and a metallic taste when the
contrast is injected.
After the procedure check

LOC, and injection site should

be observed.
Myelography
Contrast agent are injected
Explain the procedure.
into spinal subarachnoid
Obtain a signed consent.
space to permit visualization
of spinal cord. Withhold oral intake 4-6

Shows any distortion of the hours before the test.

spinal cord or spinal dural sac After the procedure:

caused by tumors, cysts, For pantopaque myelogram

(oil-based) pt lies flat for 6-24

Diagnostic Procedure Nursing Interventions
herniated vertebral disks or Formetrizamide myelogram
other lesions. (water-based), HOB is
elevated at 30 degrees for at
least 8 hours.
Encourage fluid intake

Electroencephalography
Graphic record of the
Explain the procedure,
electrical activity generated in
assure the client he/she will
the brain.
not receive electrical shock.
EEG is a useful test for
The nurse needs to check
diagnosing and evaluating doctor’s order regarding the
seizure disorders, coma, or administration of antiseizure
organic brain syndrome. medication prior to testing.
A sleep EEG may be
Withhold tranquillizer and
recorded after sedation stimulants for 24 to 48 hours.
because some abnormal brain Inform the client that the
waves are seen only when the standard EEG takes 45 to 60
patient is asleep. minutes and 12 hours for
sleep EEG.
Electroencephalography
Lumbar puncture
 Lumbar Puncture
Lumbar Puncture  Maintain position,
 Is carried out by usually lateral
inserting a needle into horizontal with knees
the lumbar to chest, chin on
subarachnoid space to chest.
withdraw CSF for  Obtain signed

diagnostic or consent.
therapeutic purposes.  Explain the procedure.
 The needle is usually  Observe for
inserted between L4 complication
and L5. following the procedure.
 Keeping the patient in

prone position
Electromyography Nursing Interventions

Obtain Explain the

by inserting
needle electrodes into procedure.
the skeletal muscles. The patient is warned

Measure changes in to expect a sensation

the electrical potential similar to that of an
of the muscles and the intramuscular
nerves leading to injection and the
them. muscle examined may
Useful in determining
ache for a short time
after the procedure.
neuromuscular
disorders and
myopathies.
Electromyogram
Pneumoencephalogra Nursing Interventions
phy

Special contrast study of Secure written consent.

the ventricular and Sedate as ordered. GA
cisternal system using air may be used.
as contrast medium. Inform the client that the
Permits accurate
procedure takes 2 hours.
localization of brain lesions Inform the client that
by spinal or cisternal he/she may experience
puncture with x-ray discomfort, N/V, after the
examination. procedure.
After the procedure keep

the client flat in bed for 24

to 48 hours.
Monitor VS and neurologic
Common Health
Problem of the
Neonate and
Infant
 Nervous System
Developmental Disorders
Cranial
 Hydrocephalus

Spinal Cord
 Meningocele
 Hydrocephalus
 Is an excess of cerebrospinal fluid in
the ventricles and subarachnoid spaces
of the brain.
 Reasons for excess:
 over production of fluid by the choroid
plexus in the 1st or 2nd ventricle
 obstruction of the passageway of fluid
somewhere between the point of origin
and the point of absorption
 interference with the absorption of fluid
from the subarachnoid space.
 Classifications:
1. congenital
2. acquired.
 The cause of congenital
hydrocephalus is unknown.
 Incidence: 3 to 4 per 1000 live
births.
 In older child infections such as
meningitis and encephalitis may
leave adhesion that lead to
obstruction.
 Nursing Assessment
 Enlarged head
 Prominent scalp vein.
 Enlarged or full fontanels
 Separated suture line
 Increased head circumference
 Sunset eyes
 Shrill cry
 Hyperactive reflexes
 Signs of increased ICP
 Decreased pulse

 Increased temperature

 Decreased respiration

 Increased BP
 Diagnostic Test
 sonogram, CT scan, MRI.
 Skull x-ray film will reveal the

separating sutures and

thinning of the skull bones.
 Transillumination will reveal skull

filled with fluid rather than solid

brain substance.
 Nursing Goals and

Interventions
Assess neurologic status closely.
 measure and plot occipital-frontal baseline
measurement, then measure head
circumference once a day.
 Check for fontanelle for bulging and
sutures for widening.
 assist with head ultrasound and
Transillumination.
 Maintain skin integrity: change position
frequently.
 Clean skin creases after feeding or vomiting.
 Postoperatively, position head off operative
site.
 Myelomeningocele
 The spinal cord and the meninges
protrude through the vertebrae.
 This result in lower motor neuron
damage.
 The child will have flaccidity and

lack of sensation of the lower

extremities and loss of bowel and
bladder control.
 Hydrocephalus accompanies
myelomeningocele in as many as 80%
of infant due to lack of subarachnoid
membrane.
 Diagnostic Test
 Neural tube defects can be
discovered during intrauterine
life by sonography, fetoscopy,
amniocentesis, or analysis of AFP
in maternal serum.
 When infants are detected having
myelomeningocele, they may
born by cesarean birth to avoid
pressure and injury to the spinal
cord.
 Nursing Assessment
 Saclike cyst containing
meninges, spinal cord, and nerve
roots in thoracic and/or lumbar
area.
 Myelomeningocele directly
connects to subarachnoid space
so hydrocephalus often
associated.
 No response or varying response
to sensation below level of sac.
 May have constant dribbling of
urine.
 Nursing Goals and
Interventions
 Prevent trauma and infection.
 Position on abdomen or on side

and restrain.
 Meticulously clean buttocks and

genitals after each voiding and

defecation.
 May put protective covering over

sac.
 Observe sac for oozing of fluid or

pus.
 Crede bladder (apply downward
pressure on bladder with
thumbs, moving urine toward the
urethra) as ordered to prevent
urinary stasis.
 Assess amount of sensation and
movement below defect.
 Observe for complications.

 Obtain occipital-frontal
circumference baseline
measurement, then measure
head circumference once a day
(to detect hydrocephalus).

Common Health
Problems of the
Child and
Adolescent
CerebralPalsy
Reye’s Syndrome
 Cerebral Palsy
 Group of nonprogressive disorders of upper
motor neuron impairment that result in motor
dysfunction.
 A child may also have speech or ocular
difficulty, seizures, cognitive challenges, or
hyperactivity.
 Exact cause is unknown, but the disorder is
associated with low birth weight, prebirth, or
birth injury.
 Occurs in approximately 2 in 1000 live births,
occurring most frequently in very-low-birth-
weight infants
 It apparently occurs when brain anoxia leads to
cell destruction of the motor tracts.
 Types of Cerebral Palsy
 Spastic Type
 Spasticity is excessive tone in the
voluntary muscles (loss of upper motor
neurons)
 The child with spastic CP has
hypertonic muscle, abnormal clonus,
exaggeration of deep tendon reflexes,
abnormal reflexes such as tonic neck
reflex.
 Spastic movement may affect both
extremities on one side (hemiplegia),
all four extremities (quadriplegia), or
primarily the lower extremities
(paraplegia)
 Dyskinetic or Athetoid Type
 Involves abnormal involuntary
movement.
 Athetoid means “wormlike”.
 The child is limp and flaccid.
 The child makes slow, writhing motions.
This may involve all four extremities,
plus the face, neck, and tongue.
 The child drools and speech is difficult
to understand.
 Ataxic Type
 Children with ataxic involvement have
an awkward, wide-base gait.
 On neurologic examination, they are
unable to perform finger-to-nose test or
perform rapid, repetitive movements
(tests of cerebral function).
 Mixed Type
 Symptoms of both spasticity and
athenoid movements are present
together.
 Nursing Assessment
 Diagnosis is based on history and
physical assessment.
 On history, an episode of

possible anoxia during prenatal

life or at birth is documented.
 Neurologic exam in infant is

difficult. In all forms of CP may

have sensory alteration.
 Reye’s Syndrome
 Is acute encephalitis with
accompanying fatty infiltration of the
liver, heart, lungs, pancreas, and
skeletal muscle.
 1 to 18 years of age regardless of
gender.
 The cause is unknown, but it generally
occurs after a viral infection such as
varicella or influenza if the child is
treated with salicylate.
 Avoiding the use of aspirin during viral
infection has led to almost total
prevention of the syndrome.
 Nursing Assessment
 Children: Lethargic, vomiting, agitation,
anorexia, confusion, and combativeness.
 Laboratory diagnosis of Reye's syndrome is
confirmed by:
 Elevated Liver Enzyme Levels
 Elevated Serum Ammonia
 Normal Direct Bilirubin
 Delayed Prothrombin Time and Partial
Thromboplastin Time
 Decreased Blood Glucose
 Elevated BUN
 Elevated Serum Amylase
 Elevated Short-chain Fatty Acid
 Elevated WBC Count
Common Health
Problems of the
Young Adult
NEUROMUSCULAR DISORDERS

Multiple
Sclerosis
Myasthenia Gravis
 MS is:
Multiple Sclerosis
 chronic, degenerative disease of the central
nervous system that is characterized by
demyelination of the nerve fibers of the
brain and spinal cord.
 Gen. characterized by exacerbations and
remisions (relapsing-remitting type0
 Although the cause of MS is unknown, it
appears to be related to autoimmune
disorder and viral infections.
 commonly appears during adulthood (ages
20 to 40).
 W>M
 Areas of the CNS most commonly affected
brainstem, cerebrum, cerebellum, optic
nerves, and the spinal cord.
Process of Demylination
Pathophysiology




 Assessment
 Sign and symptoms of MS is characterized
by remissions and exacerbation of
symptoms.
 Symptoms vary depending on the area of
the CNS involved, but generally include:
 Visual disturbances (diplopia, partial or total
loss of vision, nystagmus)
 Scanning speech (slow, monotonous, slurred)
 Tremors
 Weakness/numbness of the extremities
 Fatigue
 Increased susceptibility to URTI
 Dysphagia
 Ataxic gait
 Diagnostic Test
 Lumbar Puncture-total CSF protein is
normal; IgG (gamma globulin is elevated- IgG
reflects hyperactivity of the immune system
due to chronic demyelinaton)
 EEG-abnormalities in brain waves
 CT scan/ MRI reveals multifocal

white matter lesion

 Myelogram

 Skull x-ray
Nursing Diagnoses for MS:
 Risks: Ineffective breathing pattern;
airway clearance; impaired—swallowing,
physical mobility, skin integrity; altered
nutrition; urinary incontinence;
constipation
 Interventions for
MS:
There is no specific treatment for MS.
Treatment includes:
 physical therapy- to assist with motor dysfunction, such as
problem with balance, stregnth, and motor coordination.
 speech therapy- to manage dysarthria
 drug therapy

 Glucocorticoids (Prednisone, Dexamethasone,

Corticotropin)- to reduce edema of the myelin sheet;
sppeds recovery from attack
 Muscle relaxant (Baclofen)- to treat spasticity

 Amantadine, Ritalin, or antidepressants –to manage

fatigue
 Low-dose TCAs- to manage sensory symptoms such
as pains, numbness, burning, and tingling
sensationsAntihistamines with vision therapy &
exercises to minimize vertigo
 Nursing Responsibilities/ Considerations for
MS:
 Provide regular activity, rest, and
relaxation.
 Assist with physical therapy: muscle
stretching, relaxation and
coordination exercise, walking
exercise.
 Encourage well balanced, high fiber
diet.
 Force fluids to prevent constipation.
 Avoid hot baths.
 Provide skin care to prevent skin
breakdown.
 Nursing Responsibilities/
Considerations for MS cont.:
 Patient and family teaching to
promote emotional stability
Help patient establish daily routine, and help
family understand patient’s changes in
personality and physical capabilities.
Inform the pt that exacerbations are
unpredictable, necessitating physical & emotional
adjustments in lifestyle
- eye patch
- Speech therapy
- Medicate and watch for adverse effects
 Evaluate
 Respiration; nutrition; ADLs; skin;
bowel elimination; urinary
incontinence

Myasthenia Gravis
progressive neuromuscular disorder that results in
the failure to transmit nerve impulses at the
MYONEURAL JUNCTION causing extreme weakness
 Failure of transmission is due to decreased
acetylcholine
 Women > Men; 3 times more common in w
 Young adults 20-30
 secretion and increased cholinesterase at the
nerve ending.
 Autoimmune disease.
 Characterized by progressive weakness and
abnormal fatigability of the skeletal muscles.
 Commonly affects muscles innervated by the cranial
nerves (face, lips, tongue, neck, and throat)
 Exacerbated by exercise & repetitive movement
 Occurs along with thymic abnormalities in 75% of pts
 Pathophysiology:
 Transmission of nurve impulses at
the neuromuscular junction FAILS.
 Antireceptor antibodies block,
weaken, or reduce the number of
acetylcholyne Ach receptors
available at each neuromuscular
juction,thereby impairing the muscle
depolarization necessary for
movement
 Myasthenia Gravis
Cause:
 Autoimmune response leading to

ineffective acetylcholine release and

inadequate muscle fiber response to
Ach.
Complications:
 Aspiration

 Pneumonia

 Respiratory distress
 Assessment
 S&S  Rationale/
Pathophysiologic Basis
 Skeletal muscle  due to impaired
weakness, fatigue neuromuscular
transmission
 Weak eye
closure,ptosis,  due to impaired
diplopia, neuromuscular
transmission to the cranial
nerves supplying the eye
 “snarl smile” (smiles muscles
slowly)
 Masklike facial  Impaired transmission of
expression; Impaired the cranial nerves
speech; drooling innervating the facial
muscles
 Weakened
respiratory muscles
 Due to impaired
 Muscle are usually neuromuscular
strongest in the morning transmission to the
but become progressively
weaker during the day diaphragm due to loss of
and following an exercise. ACh receptors in the
Myasthenia Gravis
 Diagnostic Test
 Tensilon Test (Edrophonium Chloride Test)
Tensilon Test (Edrophonium Chloride Test)
 Short acting cholinergic is administered.

 Reveals Increased muscle strength is

observed (+ Tensilon Test) within 30-60
secs after IV injectio of edrophonium
(tensilon) or Neostigmine (Prostigmin),
lasting up to 30 mins.

Single fiber electromyography with neural

stimulation at the specific muscle fiber-
progressive decrease in muscle fiber
contraction
Chest x-ray- reveals thymoma in 15% of
pts
 Treatment of Myasthenia Gravis

 Anticholinesterase drugs, such as neostigmine

and pyridostigmine- to counteract fatigue and
muscle weaknes and allow for about 80% of
normal muscle
 Immunosuppresive therapy with
corticosteroids, azathioprine (Imuran) – to
decrease the immune response toward Ach
receptors at the neuromuscular junction
 IgG during acute relapses- to suppress the
immune system
 Thymectomy- to remove thymomas
 Tracheostomy, suctioning to remove secretions
 Nursing Goals and
 Interventions
Establish neurologic and respiratory baselines
 Assess swallowing / gag reflex before feeding the
client.
 Plan exercise, meals, patient care & activities to
make the most of energy peaks. Ex.,administer
medications 20-30 minutes before meal to facilitate
chewing or swallowing.
 Start meal with cold beverage.
 Administer medication at precise time to prevent
relapses.
 Protect the client from falls.
 Provide adequate ventilation.
 Avoid exposure to infection, stree, strenous exercise,
and needless exposure to the sun r cold.
 Frequent rest periods.
 Be prepared to give atropine for anticholinesterase
overdose or toxicity
 Avoid aminoglycoside antibiotics, which can
exacerbate myasthenia gravis
 Aerosol, pesticides/cleaners
should also be avoided,
 Avoid alcohol, tonic water, and
cigarette smoke.
 Pharmacotherapy

 Cholinergics
(Anticholinesterase)
 Neostigmine (Postigmin)
 Pyridostigmin (Mestinon)

 Ambenomium (Mytelase)

 Glucocorticoids
 Antacids
Common Health
Problem of the
Middle-aged
Adult
 CRANIAL NERVE DISORDER: Trigeminal
Neuralgia
(Tic Douloureux)
 Neurologic disorder affecting the
5th cranial nerve. Possible fifth
cranial nerve root compression
 Manifested by excruciating,

recurrent paroxysms of sharp,

stabbing facial pain along the
trigeminal nerve.
Areas innervated by the three branches
of the trigeminal nerve
 Management
Narcotic analgesics; anticonvulsants
 Tegretol

 Dilantin

 Alcohol injection of the nerve

 Avoid extremes of heat and cold.
 Correction of dental malocclusion
 Surgical Management
 Surgical division of the trigeminal nerve
(neurectomy)
 Nursing Management
 Assessment
 Complete history
 Affected area; oral cavity
 Record weight and ability to eat food
 Diagnosis, Planning, and
Interventions
 Acute pain
 Evaluate:
 Pain; client cooperation
 CRANIAL NERVE DISORDER:
Bell’s Palsy
Definition: Disease of the cranial nerve VII (facial nerve that
produces unilateral or bilateral facial weakness or paralysis
 Resolves spontaneously in 80& of pts, with complete recovery in
18 weeks
 Recover may be delayed in the elderly
 If recovery is partal, contractures may developed on the paralyzed
side of the face.
Causes:
 Hemorrhage
 Herpes simplex or herpes zoster
 Infection
 Local trauma
 Meningitis
 Tumor
 Viral disease
 Bell’s Palsy
 Pathophysiology:
 An inflammatory reaction occurs around
cranial nerve VII, usually at the internal
auditory meatus, where the nerves leave
bony tissue
 The inflammatory reaction produces a
conduction block that inhibits appropriate
neural stimulation to the muscle by the
motor fibers of the facial nerve, resulting
in the characteristic unilateral or bilateral
facial weakness.
 Pathophysiologic Chanes/ S
& S:
 Unilateral facial weakness

 Drooping mouth & drooling saliva

 Lost of taste
 Smooth forehead appearance
 Impaired ability to close the eye on the
weak side
 Bell’s phenomenon-Upward rolling of the
eyes when attempting to close them
 Excessive tearing
 Ringing in the ear
Complications of Bell’s Palsy
 Corneal abrasion

 Infection (masked by steroid use)

 Poor functional recovery

Diagnostic Tests:
-based on clinical presentation
MRI-rules out tumor
Electromyography- 10 days after the
onset of S/S
 Treatment
 Analgesics- to relieve pain
 Steroids- to reduce facial nerve
edema & improve edema & improve
nerve conduction & bld flow
 Possible electrotheraphy
 Surgery for persistent paralysis
 Nursing Considerations
 Watch for adverse effects of steroids use
 Apply moist heat to the affected side of the face-to reduce
pain
 Help the pt maintain muscle tone:

-massaging the face with a gentle upward motion 2-3xdaily x

5-10mins
Exercise by grimacing in front in front of a mirror
 Protect eyes, have pt cover eye w/ an eye patch

 Prevent excessive wt loss:

-have him chew on unaffected side of his mouth

-provide a soft, nutritionally balanced diet, eliminating hot
foods & fluids
-apply a facial sling to improve lip alignment
 Provide frequent & complete mouth care

 Offer psychological support

Common Health
Problems of the
Older Adult
 CEREBRO-VASCULAR
DISORDER:Stroke/Cerebrovascular Accident (CVA)
Definition: Disruption of the Risk factors:
Blood Supply to the  Increased alcohol intake or
Brain-
cocaine
-sudden loss of neurologic  Cardiac disease
funtion
 Cigarrette smoking

 DM
Note: Middle Cerebral Artery
 Familial hyperlipidemia
is commonly affected.
 Family history of stroke
The second most
frequently affected is  Hx of TIA

the internal carotid  HPN

artery.  Obesity,sedentary lifestyle
Classification:  Sickle cell disease
5. ischemic (a thrombus or  Use of hormonal
embolus blocks contraceptives
circulation
6. hemorrhagic (a blood
 Causes of Stroke:
Ischemic
 Thrombosis- occluded bld flow caused by thrombosis
of the cerebral arteries supplying the brain or the
intracranial vessels
 The most frequent cause of CVA

 The most common cause of cerebral thrombosis is

atherosclerosis; usually affecting elderly persons.

 Tends to occur during sleep or soon after arising.

 This may tend to occur among clients with DM, and

hypertension.
 Embolism- from thrombus outside the brain,
such as in the heart, aorta, or common carotid
artery.
 The second most common cause of CVA.

 Most commonly affecting younger people.

 Most frequently caused by Rheumatic Heart Disease

 Causes of Stroke: Hemorrhagic Stroke

 Hemorrhage- Hemorrhagic Stroke

 Impaired cerebral perfusion from
hemorrhage causes infarction, & the bld
itself as a space-occupying mass, exerting
pressure on the brain tissues
 Hemorrhage from an intracranial artery or
vein, such as HPN, ruptured aneurysm,
trauma, hemorrhagic disorder, or septic
embolism.
 Transient Ischemic Attacks

 Refers to transient cerebral ischemia with

temporary episodes of neurologic
dysfunction.
 Manifestation include contralateral

weakness of the lower portion of the face,

fingers, hands, arms, and legs;
dysphagia, and sensory impairment.
 Stoke in evolution refers to development

of a neurologic deficit over several hours

to days
 Pathophysiologic Changes in CVA:-specific
manifestations are determined by the cerebral artery affected, the
brain tissue supply by that of that vessel, and the adequacy of the
collateral circulation
 Aphasia, dysphasia; visual fields deficits;
and hemiparesis of affected side (more severe
in face & arms)- resulting from thrombosis or
hemorrhage of middle cerebral artery
 Weakness, paralysis, numbness; sensory
changes; altered LOC; bruits over carotid artery;
and headache caused by thrombosis or
hemorrhage of carotid artery
 Weakness, paralysis, numbness around lips &
mouth; visual field deficits, diplopia, nystagmus;
poor coordination, dizziness, dysphagia, slurred
speech; amnesia, and ataxia resulting from
thrombosis or hemorrhage of vertebrobasilar
artery.
 Confusion, weakness, numbness; urinary
incontenece; impaired motor & sensory
functions; and personality changes
caused by thrombosis or hemorrhage of
anterior cerebral artery.
 Visual field deficits; sensory impairments;
dyslexia; cortical blindness and coma
resulting from thrombosis or hemorrhage
of posterior cerebral artery.
 Assessment of CVA:
check for:
 S&S of increased ICP.
 Perceptual defects

 Aphasia

 Unstable respiration

 Severe headache

 Diagnostic procedure results

 Unilateral neglect
 Diagnostic Findings:
 CT scan- identifies an ischemic stroke
within the first 72 hours of symptom onset
or evidence of a hemorrhagic stroke
(lesions >1 cm immediately)
 MRI-assists in identifying areas of ischemia
or infarction and cerebral swelling
 Others: angiography, carotid duplex
scan,EEG
 Complications:
 Hemiplegia –  Dysarthria - difficulty in
weakness/paralysis of half speech articulation due to
the body lack of muscle
 Cognitive impairement- control
Aphasia – maybe  Kinesthesia – loss of
expressive or receptive; sensation (of bodily
the partial or tota movement)
inability to produce &
understand speech
 Apraxia – can move but
 Incontinence – maybe
cannot do the purpose; fecal/urine; inability to
inability to perform control urination or
complex movements defecation
 Sensory impairement-
 Shoulder pain
Visual changes –  Contractures
homonymous  Fluid imbalances
hemianopsia; Agnosia –  Cerebral edema
loss of sense of smell  Aspiration
 Altered LOC
 Infections such as
pneumonia
 Nursing Considerations:CVA
 Maintain a patent airway and oxygenation:
If the pt is unconscious; vomiting- lateral position to
prevent aspiration of saliva

 Check v/s & neurologic status:

Monitor BP, LOC, pupillary changes, motor and sensory
functions, speech, skin, color, temp.
Monitor pt for s/s of increased ICP and nuchal rigidity or
flaccidity

 Watch for s/s of pulmonary emboli:

chest pain, shortness of breath, dusky color,
tachycardia, fever, and change in sensorium

 If the pt is unresponsive, monitor ABG as

ordered

 Monitor F & E balance:

Monitor I and O.
Nursing Considerations:CVA
 Ensure adequate nutrition:
Check for gag reflex before offering small oral feedings of
semisolod food
Teach the client to chew on the unaffected side.
If oral feeding is not possible,TPN, NGT feeding, gastrostomy
feeding.

 Turn the patient frequently, at least q 2 hrs to prevent

pneumonia.
 Perform ROM exercises for affected & unaffected sides.
 Massage if not contraindicated.
 Provide meticulous eye care- Instill meds as ordered;
patch the affected eye if the pt can’t close eyelid.
Nursing Considerations:CVA
 Compensate for perceptual difficulties.
 Care of the client with Hemianopsia.
 Approach from the unaffected side.
 Place articles on the unaffected side.

 Promote communication
 Care for the client with aphasia.
 Say one word at time.
 Give simple commands.
 Allow the client to verbalize, no matter how
long it takes him
Give medications as ordered- Tell the pt to
watch out for side effects. (ex. Aspirin-GI
bleeding
 Assist with rehab
 Teach the pt to comb hair, to dress, & to wash
 Obtain assistive devices ( through the aid of
PT/OT) such as walkers, hand bars by the toilet,
and ramps as needed
 Be aware that the pt has a unilateral neglect, in
which he fails to recognize that he ha a paralized
side- show him how to protect his body from
harm
 Emphasize importance of regular ff-up visits
 Parkinson’s Disease
 Slowly progressive degenerative
disorder
of basal ganglia function that results in
variable combinations of tremor,
rigidity, and bradykinesia
 Onset usually after age 40

 men>women
Parkinson’s Disease: deficient
in dopamine
 Causes:
Exact cause unknown
 Possible causes:
 Dopamine deficiency, which prevents
affected brain cells from performing their
nomal inhibitory function in the CNS
 Exposure to toxins( manganese dust or
carbon monoxide)
 Repeated trauma to the brain
 Stroke
 Brain tumors
 Pathophysiology:
 Dopamine neurons degenerate, causing
loss of available dopamine
 Dopamine deficiency prevents
 Affected brain cells from performing their
normal inhibitory function
 Excess excitatory Ach occurs at the
synapses
 Nondopamineric receptors are also involvd
 Motor neurons are depressed
 Pathophysiologic changes/
S&S:
 Muscle rigidity, akinesia, and insidious tremor beginning in
the fingers (UNILATERAL PILL_ROLL TREMOR) secondary to
loss of inhibitory dopamine activity at the synapse- increase
during stres or anxiety; decreases with purposeful
movement & sleep
 Muscle rigidity with resistance to passive
 Mask-like appearance
 Gait disturbance-lacks normal parallel motion;
may be retropulsive or propulsive
 Oily skin- secondary to inappropriate
regulation of androgen production by
hypothalmic-pituitary axis
 Pathophysiologic changes/
S&S:
 Dysphagia, dysarthria; excessive sweating;
decreased GI motility and genitourinary
smooth muscle-from impaired autonomic
transmission
 Voice changes
 Small handwriting
 Poor judgement, endogenous depression,
dementia- from impaired dopamine
metabolism, and neurotransmitter dysfunction
Common Health
Problem that
occur Across the
Life Span
 SEIZURE DISORDER
 Sudden explosive and disorderly discharge of
cerebral neurons
 abnormal and excessive discharge of neurons in
the brain
 Types of seizures:
grand mal
petit mal
febrile seizures
status epilepticus
 Petit mal
 No aura
 10-20 seconds
 Common to children as well as adult
 Little tonic-clonic movements
 Cessation of ongoing physical
activities
 Jacksonian
 With aura
 With organic lesion
 Group of muscle affectation
 Psychomotor Seizure
 With aura
 With psychiatric involvement
 Characterized with mental clouding
 Violence, antisocial acts
 Febrile Seizure
 Related to temperature
 Present among children
 Status epilepticus
 Prolonged seizure state
 Can occur in any type of sizure
 Rapid successions with no full
consciousness in between
 Brain damage can occur; most life
threatening in tonic-clonic seizures
 Common to clients who are in coma
 Related to medication
 Primary Seizure Disorder (Epilepsy)
 Idiopathic

 No apparent structural changes in the

brain
Secondary Epilepsy
 Characterized by structural changes or

metabolic alterations of the neuronal

membranes that caused increased
automacity
 Causes of Seizures:
 Idiopathic- two-thirds of all seisure disorders
 Anoxia
 Birth trauma (inadequate supply of O2 supply to the brain,
bld incompatibility, hemorrhage)
 Brain tumors
 Drug or alcohol abuse or rapid withrawal from abused drugs
 Febrile illness
 Genetic predisposition
 Head injury or trauma
 Infectious diseases
 Ingestions of toxins( lead, mercury, or carbon monoxide)
 Metabolic disorders, such as hypoglycemia or
hypoparathyroidism
 Perinatal infections
 Pathophysiology:
 Some neurons of the brain may depolarize
easily or hyperexcitable.
 On stimulation, these neurons fires locally
or throughout the cerebrum and spreads
electric current to surrounding cells.
 Cells fire in turn and the impulses
cascades to one side of the brain ( a
partial seizure), both sides of the brain (a
generalized seizure), or the cortical,
subcortical, and brain stem areas.
 Pathophysiologic changes:
 Recurring seizures, possibly of more than one
type ( hallmark of epilepsy)
 Visual, olfactory, or auditory hallucinations;
sweating or flushing; dream states; anger, or fear
reactions resulting from simple partial seizures
 Altered consciousness , such as amnesia for
events around the time of the seizure, resulting
from complex partial seizures
 Movement and muscle involvement resulting
from tonic-clonic or myoclonic seizures
 Brief changes in LOC without motor involvement
due to absence sizures
 Complications:
 Hypoxia or anoxia from airway
occlusion
 Traumatic injury
 Brain damage
 Depression and anxiety
 Diagnostic Tests:
 CT scan or MRI- reveals abnormalities
 EEG- reveals paroxysmal abnormalities
in tonic-clonic seizures, high, fast
voltagespikes are present in all leads
In absence seizures, rounded spike wave
complexes are present
Note: a negative EEG doesn’t rule out epilepsy
because the abnormalities occur intermittently
 Skull x-ray may show evidence of fractures or
shifting of the pineal gland, bony erosion, or
separated sutures
 Serum chemistry bld studies may reveal
hypoglycemia, electrolyte imbalances, and
elvated liver enzyme & alcohol level
 Treatment
 Drug Therapy-
 Ex. Phenytoin (Dilantin) carbamazepine (Tegretol),
phenobarbital (Barbita, Luminal) –for generalized tonic
clonic seizures and complex partial seizures
 Valproic acid (Depakene), clonazepam (Klonopin) for
absence seizures
 If drug therapy is inefective, surgery to remove a
demonsrated focal lesion, or to remove the underlying
cause (tumor, abscess)
 I.V. diazepam ( valium), lorazepam (Ativan) phenytooin, or
phenobarbital for status epilepticus
 Dextrose- for hypoglycemia
 Thiamine-for chronic alcoholism or withdrawal
 Nursing Considerations

 Patent airway
 Oxygenate as needed
 Raise siderails
 Ensure safety-during seizure:
Avoid restraining the pt
Help the pt to a lying position
Loosen any tight clothing
Clear the area of hard objects
Don’t place anything into the pt’s mouth to prevent lascerating the
mouth & lips or displace teeth
If vomiting occurs, turn the head to provide an open airway
 After the seizure subsides, reorient the patient to time & place;
inform him that he had a seizure
 Companion at bedside
 Meds as ordered
 Increased Intracranial
Pressure
ICP- the pressure exerted within the intact skull by the
intracranial volume-about 10% blood,10% CSF, & 80% brain
tissue.
Causes : head injury
CVA
tumors
HPN

Pathophysiology:
^ICP- the brain will compensate by:
limiting bld flow to the head
displaces CSF into the spinal canal
increases absorption or decreases production
If ICP remains high, there will be loss of autoregulatory
mechanism which will lead to passive dilation, increased cerebral
flow, venous congestion. Further increase in ICP will result to
cellular hypoxia and eventually, brain death.
Major Types of Herniation
 Increased Intracranial
Pressure
S&S:
 Increased HA

 Nausea &Vomoting

 Cushing’s triad

 Restlessness

 Eye involvement

 Altered LOC

 Sensory dysfunction

 Elimination problem

 Decorticate/decerebrate
NURSING MANAGEMENT OF INCREASED ICP:

 Determine airway patency

 Elevate HOB
 Check VS/neuro assessment
 Record I&O
 Enema restriction
 Avoid coughing,vomiting, restraints, stress
ulcer,suctioning
 Seizure precaution
 Edema reduction
 Diuretics
 Craniocerebral Trauma (Head
 Involves injury toInjury)
the scalp, skull,
and/or brain tissues.
 Types of Brain Injury
 Concussions. Jarring of the brain and its
sudden, forceful contact with the rigid
skull. There is transient period of
unconsciousness.
 Contusion (bruising). A structural
alteration characterized by extravasion of
blood cells.
 Laceration. Tearing of tissue caused by
sharp fragment or object or shearing
force.
 Compression of the Brain. Result from
depressed fracture causing edema and
hemorrhage.
 Assessment
 Sign and symptoms of increased ICP.
 CSF leakage from ears and nose.
 Battle’s sign (hematoma at the mastoid
process) in basilar head trauma.

Management
 Care for the client with increased ICP.
 Monitor drainage from ears and nose.
 Monitor for signs and symptoms of
meningitis, atelectasis, pneumonia, UTI.
 Intracranial Tumors
 Intracranial tumors may be
classified as: gliomas,
meningiomas, neuromas,
hemangiomas.
 Gliomas account for about 50%

of all brain tumors.

 Assessment
 Frontal lobe
 Personality disturbance
 Inappropriate affect

 Indifference of bodily functions

 Precental gyrus
 Jacksonian seizures
 Occipital lobe
 Visual disturbances preceeding
convulsions.
 Temporal lobe
 Olfactory, visual or gustatory
hallucinations.
 Psychomotor seizures with automatic

behavior.
 Parietal lobe
 Inability to replicate pictures.
 Loss of right-left discrimination
 Management
 Care for the client with increase
ICP.
 Surgery

 Supratentorial craniotomy (post-op)

 Semi-fowler’s position
 Infratentorial craniotomy
 Flat position; turn to sides, avoid supine
position for the first 48 hours. Avoid neck
flexion.
 Report immediately for presence of

yellowish drainage on the head dressing.

 An increase in urine output may herald

onset of diabetes insipidus.

 Spinal Cord Injury

-complete or partial disruption of

nerve tracts and neurons
Causes : infection
trauma
injury
 Signs and symptoms

 Cervical –respiratory diff, quadriplegia

 Thoracic- paraplegia
 Lumbar – flaccid paralysis
 Sacral – loss of erection, ejaculation
 Nursing Asessment:
 Injury; treatment given at scene
 Neurologic assessment: Document
findings
 Vital signs; respiratory status
 Movement and sensation below injury
level
 Signs
 Worsening neurologic damage
 Respiratory distress

 Spinal shock
 Nursing Diagnoses:
 Ineffective breathing pattern
 Ineffective airway clearance
 Neuropathic pain
 Impaired physical mobility
 Anxiety
 Risks
 Impaired gas exchange
 Disuse syndrome

 Ineffective coping
 Medical Management
 Cervical collar; cast or brace; traction; turning
frame
 IV; stabilization of vital signs
 Corticosteroids
 Surgical intervention
 Surgical Management
 Surgery to
 Remove bone fragments
 Repair dislocated vertebrae
 Stabilize the spine
 Management
 Maintain airway patency
 Immobilize
 Suction PRN
 Position
 Nutrition
 Elimination hygiene
 Drugs
 Evaluation:
 Adequate breathing
 Pain relief
 Mobility using minimal assistive devices
 Reduced complications from inactivity
 Coping with the challenge of
rehabilitation
 Infectious Neurologic
 Meningitis
Disorders
 Brain Abscess
 Herpes Simplex Virus

Encephalitis
 Arthropod-Borne Virus

Encephalitis
 Fungal Encephalitis

 Creutzfeldt-Jakob and New-

Variant Creutzfeldt-Jakob
 Brain Injuries
 Closed (blunt)  Intracranial
Brain Injury Hemorrhage
 Open Brain  Epidural
Injury Hematoma
 Subdural
 Concussion
Hematoma
 Contusion  Intracerebral
 Diffuse Axonal Hemorrhage and
Injury Hematoma
Pathophysiology