Unit 4 Neurological Disorders
Terms
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- WHAT 2 THINGS MAKE UP THE CENTRAL NERVOUS SYSTEM?
-
1.BRAIN
2.SPINAL CORD - WHAT IS THE BASIC CELL OF THE NERVOUS SYSTEM AND IS MADE UP OF A DENDRITE, CELL BODY, AND AN AXON?
- NEURON
- THE CONTROL CENTER OF THE NERVOUS SYSTEM.
- BRAIN
- LARGEST AREA OF THE BRAIN AND IS DIVIDED INTO A RIGHT AND LEFT HEMISPHERE.
- CEREBRUM
- WHAT IS THE LEFT HEMISPHERE RESPONSIBLE FOR?
- SPEECH,PROBLEM SOLVING,REASONING, AND CALCULATIONS
- WHAT IS THE RIGHT HEMISPHERE RESPONSIBLE FOR?
- VISUAL-SPATIAL INFORMATIONS SUCH AS ART, MUSIC, AND THE SURROUNDING PHYSICAL ENVIRONMENT.
- CONTAINS THE THALAMUS AND HYPOTHALMUS
- DIENCEPHALON
- RELAYS ALL SENSORY INFORMATION INTO THE CORTEX
- THALAMUS
- REGULATES TEMP., FLUID BALANCE, THIRST, APPETITE, EMOTIONS, AND THE SLEEP WAKE CYCLE
- HYPOTHALAMUS
- CONSISTS OF THE MIDBRAIN, PONS, AND MEDULLA OBLONGATA
- BRAIN STEM
- CENTER FOR AUDITORY AND VISUAL REFLEXES
- MIDBRAIN
- CONTROLS RESPIRATION
- PONS
- CONTROLS HEART RATE, BLOOD PRESSURE, RESPIRATIONS, COUGHING, SWALLOWING, AND VOMITING.
- MEDULLA OBLONGATA
- CONNECTED TO THE MIDBRAIN, PONS, AND MEDULLA, AND COORDIANTES INVOLUNTARY MUSCLE ACTIVITY AND FINE MOTOR MOVEMENTS AS WELL AS BALANCE AND POSTURE.
- CEREBELLUM
- CLEAR, COLORLESS LIQUID THAT PROTECTS THE BRAIN AND SPINAL CORD FROM TRUAMA AND IS COMPRISED OF WATER, GLUCOSE, PROTEIN, AND SODIUM CHLORIDE
- CEREBROSPINAL FLUID
- CONTROLS VOLUNTARY MORTOR CONTROL ON THE OPPOSITE SIDE OF THE BODY AND DETERMINES EMOTIONS, MOTIVATION, COMPLEX THINKING, JUDGEMENT, AND PERONALITY. (BROCA'S AREA PORMOTES SPEAKING ABILITY.
- FRONTAL LOBE
- INTERPRETS SENSATIONS AND DETERMINES RIGHT FROM LEFT AND WHERE THE BODY IS IN RELATION TO THE ENVIRONMENT.
- PARIETAL LOBE
- PROCESSES TAST, SMELL, AND HEARING STIMULI; ALSO IMPORTANT IN LONG TERM MEMORY (WERNICKE'S AREA PROMOTES UNDERSTANDING OF SPOKEN AND WRITTEN WORD)
- TEMPORAL LOBE
- PROCESSES VISUAL STIMULI
- OCCIPITAL LOBE
- EXTENDS FROM THE BRAIN DOWN TO L2, SURROUNDED AND PROTECTED BY VERTEBRAL COLUMN.
- SPINAL CORD
- INJURY BELOW L2 DOES NOT RESULT IN PARALYSIS B/C...
- NOT PART OF THE SPINAL CORD
- H-SHAPED AND CONSISTS OF GRAY MATTER SURROUNDED BY WHITE MATTER
- CORD
- VERTEBRAL COLUMN CONSISTS OF...
-
7 CERVICAL
12 THORACIC
5 LUMBAR
5 SACRAL
4 FUSED VERTEBRAE = COCCYX - LINKS THE CNS TO THE REST OF THE BODY...
- PERIPHERAL NERVOUS SYSTEM
- MAKES UP THE PNS...
-
SPINAL NERVES
CRANIAL NERVES
GANGLIA - PNS IS DIVIDED INTO WHAT 2 SYSTEMS
-
SOMATIC SYSTEM
AUTONOMIC SYSTEM - CONNECTS SKIN AND MUSCLES TO THE CNS
- SOMATIC SYSTEM
- CONTROLS VISCERAL ORGANS AND SOME GLANDS
- AUTONOMIC NERVOUS SYSTEM
- HOW MANY PAIRS OF SPINAL NERVES ARE THERE...
- 31 PAIRS
- NAME LOCATION AND NUMBER OF PAIRS IN EACH LOCATION (SPINAL NERVES)
-
CERVICAL: 8 PAIRS (C1-C8)
THORACIC: 12 PAIRS (T1-T12)
LUMBAR: 5 PAIRS (L1-L5)
SACRAL: 5 PAIRS (S1-S5) - AREA OF SKIN SUPPLIED BY A SINGLE SPINAL NERVE, AND ARE USEFUL FOR LOCATING PAIN SITES AND NEUROLOGIC LESIONS
- DERMATOMES
- COME FROM BRAIN STEM ITSELF; CONVEYS INFO DIRECTLY TO THE BRAIN
- CRANIAL NERVES
- SMELL
- CRANIAL NERVE I: OLFACTORY
- VISION
- CRANIAL NERVE II: OPTIC
-
PUPIL CONSTRICION
EYEBALL MOVEMENT
RAISING OF UPPER EYELID - CRANIAL NERVE III: OCULOMOTOR
- EYEBALL MOVEMENT
- CRANIAL NERVE IV: TROCHLEAR
-
SENSATION OF THE SCALP,NOSE,MOUTH, AND CORNEA
CHEWING - CRANIAL NERVE V: TRIGEMINAL
- LATERAL MOVEMENT OF THE EYEBALL
- CRANIAL NERVE VI: ABDUCENS
-
MVMT. OF FACIAL MUSCLES
SECRETIONS FROM LACRIMAL AND SALIVARY GLANDS
TASTE IN ANTERIOR TWO THIRDS OF TONGUE - CRANIAL NERVE VII: FACIAL
- SENSE OF HEARING AND EQUILIBRIUM
- CRANIAL NERVE VIII: VESTIBULOCOCHLEAR
-
TASTE IN POSTERIOR ONE THIRD OF TONGUE
SENSATION OF PHARYNX AND TONGUE
GAG REFLEX
SWALLOWING
SECRETIONS OF PAROTID GLAND - CRANIAL NERVE IX: GLOSSOPHARYNGEAL
-
SWALLOWING
CONTROLS PARASYMPATHETIC NERVOUS SYSTEM ACTIVITIES(HR, RESP RATE, DIGESTION)
SENSATION IN PHARYNX AND LARYNX - CRANIAL NERVE X: VAGUS
- NECH AND SHOULDER MVMT'S
- CRANIAL NERVE XI: ACCESSORY
- TONGUE MOVEMENT
- CRANIAL NERVE XII: HYPOGLOSSAL
- HOW MANY PAIRS OF CRANIAL NERVES?
- 12 PAIRS
- RESPONSIBLE FOR MAINTAINING THE BODY'S INTERNAL HOMEOSTASIS
- AUTONOMIC NERVOUS SYSTEM
- 2 SYSTEMS OF ANS:
-
SYMPATHETIC NERVOUS SYSTEM
PARASYMPATHETIC NERVOUS SYSTEM - FIGHT OR FLIGHT
- SYMPATHETIC NERVOUS SYSTEM
- OPERATES DURING NONSTRESSFUL SITUATIONS
- PARASYMPATHETIC NERVOUS SYSTEM
- HELPS NERVE IMPULSES CROSS THE SYNAPSE OR STOPS IT
- NEUROTRANSMITTER (EX: ACETYLCHOLINE)
- EPINEPHRINE
-
BRONCHODILATOR, VASOPRESSOR
INCREASES BP, STIMULATION OF HEART, DILATION OF BRONCHIOLES
SE: RESTLESSNESS, PALP., - NOREPINEPHRINE
-
CARDIAC STIMULATION,
VASOPRESSOR
VASOCONSTRICTION, DILATION OF CORONARY ARTERIES, INCREASES BLOOD PRESSURE
SE:OCCASIONAL BRADYCARDIA, HA - ACETYLCHOLINE
-
ADRENERGIC
GLAUCOMA
SE: HA - DOPAMINE
-
ADRENERGIC
INCREASES CARDIAC OUTPUT
SHOCK;INCREASED PERFUSION;HYPOTENSION
SE: HA, PALP,TACHY, HTN, ECTOPIC BEATS,ANGINA,WIDE QRS COMPLEX, N/V/D - CAUSATIVE FACTORS INVOLVED IN NEURO DISORDERS:
-
-GENETIC & DEV. DISORDERS
-INFECTION & INFLAMMATION
-BENIGN & MALIG. TUMORS
-METABOLIC & ENDOCRINE DISORDERS
-VASCULAR DISORDERS
-DEGENERATIVE PROCESSES
-TRAUMA - PREVENTION OF NEURO INJURIES
-
-PREVENT HEAD & SPINAL INJURIES
-OBSERVE SAFETY PRECAUTIONS WHEN SWIMMING & DIVING
-WEAR SEAT BELTS
-AVOID RECREATIONAL DRUG USE & EXCESSIVE ALCOHOL
-PROMOTE IMMUNIZATION (MMR CAN CAUSE NEURO PROBS)
-PREVENT OR CONTROL HTN TO PREVENT CVA
-PROMOTE LOW-FAT DIET TO PREVENT ATHEROSCLEROSIS & CVA - EVALUATION OF NEURO STATUS
-
HEALTH HISTORY
NEURO ASSESSMENT
DIAGNOSTIC TESTS - EEG (ELECTROENCEPHALOGRAM)
- -CAN DETERMINE THE TYPE OF SEIZURE AND LOCATE THE SEIZURE FOCUS
- EEG NURSING CARE
-
-EXPLAIN PROCEDURE TO CLIENT
-TELL THEM TO WITHHOLD TRANQUILIZER AND DEPRESSANT MEDS 24-48H BEFORE AND CAFFEINE,BUT NOT NPO
-SHAMPOO HAIR NIGHT BEFORE AND SHORTEN SLEEP PERIOD - EEG CLIENT AND FAMILY TEACHING
-
-TEST LASTS FROM 1-2H
-TEST IS PAINLESS, DONE WHILE LYING ON STRETCHER OR SITTING IN RECLINER
-ELECTRODES ARE APPLIED TO SCALP WITH A THICK PASTE
-AFTER TEST NURSE WILL HELP REMOVE PASTE FROM HAIR - EEG NORMAL VALUES:
- NORMAL FREQUENCY, AMPLITUDE, AND CHARACTERISTICS OF BRAIN WAVES
- LUMBAR PUNCTURE
-
PT TEACHING: NEEDLE WILL BE PLACED IN SUBARACHNOID SPACE OF SPINAL CORD, TO MEASURE PRESSURE OF THAT SPACE AND COLLECT CSF
-CLARIFY INFO ABOUT PROCEDURE
-EXPLAIN IMPORTANCE OF NOT MOVING DURING
-EMPTY BOWEL AND BLADDER BEFORE HAND
-NOT NPO
-BAND-AID WILL COVER WHERE NEEDLE INSERTED
-REMAIN FLAT IN BED 4-24H AFTER PROCEDURE (AOBP)
-IF HA OR BACK ACHE OCCUR, ASK FOR PAIN MED
NORMAL VALUES: CLEAR CSF, PRESSURE < 20CM, NO ORGANISMS, VERY LITTLE PROTEIN
NURSING: MONITOR VS AND NEUROLOGIC SIGNS
MONITOR PUNCTURE SITE FOR LEAKAGE OF CSF OR HEMATOMA FORMATION
ENCOURAGE FLUID INTAKE
GIVE PAIN MEDS AS PRESCRIBED - MYELOGRAM
-
PT. TEACHING:
-ASSESS FOR ALLERGIES TO SHELLFISH OR IODINATED CONTRAST DYE
-DO NOT EAT OR DRINK FOR SEVERAL HOURS BEFORE TEST
-EMPTY BOWEL AND BLADDER BEFORE
-WILL BE PLACED ON TILTING TABLE SO DYE CAN CIRCULATE IN SPINAL COLUMN
-DYE INJECTED THROUGH LP, MAY FEEL WARMTH OR BURNING SENSATION, TELL DR. IF PAIN
-DO NOT MOVE UNLESS DOCTOR ORDERS DIFFERENT POSITION
-IMMEDIATELY REPORT FEVER, STIFF NECK, OR SEIZURES.
NORMAL VALUES:
-NORMAL SPINAL CANAL
NURSING:
-MONITOR VS AND ASSESS NEURO STATUS Q1-4H FOR 24H
-INCREASE FLUIDS 2400-3000 ML IN 24H (MAY REDUCE HA)
-MAKE SURE PT. VOIDS WITHIN 8H AFTER
-GIVE PAIN MEDS AND N/V AS NEEDED
-IF WATER SOLUBLE DYE USED, ELEVATE HOB 45 DEGREES FOR 8-12H - CEREBRAL ANGIOGRAPHY
-
PT.TEACHING:
-ASSESS FOR ALLERGIES TO SHELLFISH OR IODINE
-EXPLAIN PROCEDURE
-WARMTH UPON INJECTION
-ASSESS ANTICOAGULANT THERAPY
-NPO 2-8H PRIOR
-NEURO ASSESSMENT PRIOR
-REMOVE VALUABLES/DENTURES
-VOID PRIOR
NORMAL VALUES:
NORMAL ARTERIAL VASCULATURE
NURSING:
-MONITOR VS
-NEURO CHECKS
-ASSESS SITE FOR BLEEDING
-BR 6-24H
-WATCH FOR DELAYED REACTION TO DYE
-GIVE MILD PAIN MED IF NEEDED
-NOTIFY DR.IF PAIN SEVERE - BRAIN SCAN (PET SCAN)
-
R.A. CHEMICAL ADMINISTERED TO PT.
PT TEACHING:
-EXPLAIN PROCEDURE
-CONSENT
-POSS. 2 IV LINES INSERTED
-NPO 4H PRIOR
-NO ALCOHOL,CAFFEINE, OR TOBACCO 24H PRIOR
-DIABETIC TAKE PRETEST MED 3-4H BEFORE
-NO SEDATIVES OR TRANQUILIZERS PRIOR
-EMPTY BLADDER BEFORE TEST
NORMAL VALUES:
NORMAL PATTERNS OF TISSUE METABOLISM
NURSING:
-TELL PT. TO CHANGE POSITION SLOWLY TO AVOID POSTURAL HYPOTENSION
-ENCOURAGE TO DRINK FLUIDS AND URINATE FREQUENTLY TO AID IN REMOVAL OF RADIOACTIVE ISOTOPES FROM BLADDER - ELECTROMYOGRAPHY
-
NEEDLE ELECTRODES INSERTED INTO MUSCLES
PT. TEACHING:
-EXPLAIN PROCEDURE
-CONSENT
-RESTRICT STIMULANTS 2-3H PRIOR, NOT NPO
-PREMED NOT USUALLY GIVEN
-USUALLY NOT PAINFUL
NORMAL VALUES:
NO EVIDENCE OF NEUROMUSCULAR ABNORMALITIES
NURSING:
-OBSERVE NEEDLE SITE FOR HEMATOMA OR INFLAMMATION
-GIVE PAIN MED IF NEEDED. - COMMON NEURO PT. CARE PROBLEMS:
-
-INEFFECTIVE AIRWAY
-IMPAIRED MOBILITY
-SELF-CARE DEFICIT
-DYSPHAGIA (DIFF. SWALLOWING)
-INCONTINENCE
-PAIN
-CONFUSION
-APHASIA (W/O SPEECH)
-SEXUAL DYSFUNCTION
-PSYCHOSOCIAL CONCERNS
-INEFFECTIVE FAMILY COPING - INCREASED INTRACRANIAL PRESSURE
-
DEF: WHEN PRESSURE OF ONE OF THE THREE CRANIAL COMPARTMENTS (BRAIN,BLOOD,OR CSF) INCREASES CAUSING THE OTHER TWO TO DECREASE.
PATHO:TUMOR,BLEEDING,SWELLING,SOME MEDS
S/S:
-ALTERED LOC
-HA
-VOMITING (PROJECTILE, NO NAUSEA
-PAPILLEDEMA (EDEMA OF OPTIC NERVE
-CHANGE IN VS (T/BP UP, P/R DOWN & IRREGULAR (CHEYNE-STOKES)
-UNEQUAL PUPIL & ABNORMAL RESPONSE TO LIGHT
-POSTURING
PRECIPITATING FACTORS:(IMPENDING CERBRAL DISASTER)
-CHANGE IN LOC
-CHANGE IN LIMB MOTION
-CHANGE IN PUPIL SIZE
-CHANGE IN VS
MEDICAL MNGMT:
-BLOOD GLUCOSE
-ABGS
-TOXICOLOGY SCREENING
-CREAT. & BUN
-LFT'S
-CBC W/ DIFF
-CT
-CEREBRAL ANGIOGRAPHY
-LUMBAR PUNCTURE
-PHARMACOLOGY
-ICP MONITORING
-FLUID RESTRICTION
-KEEP HOB ELEVATED
-AVOID VALSALVA MANEUVER
-MECHANICAL VENTILATION
NURSING MGMT:
-ASSESS CHANGE LOC OR MEMORY, OCCUR? FAST OR SLOW
-PRESENCE OF HA, N/V
-VISUAL CHANGES
-RINGIN IN EARS
-PAST MEDICAL HISTORY
-VS
-MEMORY LAPSES
-G.C.S.
-PERRLA
-STRENGTH
-NOTE N/V
-NOT COLOR/AMT OF DRAINAGE FROM EARS/NOSE - ISOTONIC IV FLUIDS
- NS OR LR B/C CAN REDUCE CEREBRAL EDEMA WHILE OTHER IV FLUIDS INCREASE IT
- OSMOTIC DIURETICS
-
MANNITOL OR LASIX
DRAWS WATER OUT OF EDEMATOUS BRAIN TISSUE TO BE EXCRETED BY THE KIDNEYS - CORTICOSTEROIDS
- REDUCES INFLAMMATION AND CEREBRAL EDEMA BUT CAUSES IRRITATION AND POSSIBLY GASTRIC ULCERS
- ANTICONVULSANTS
-
PHENYTOIN(DILANTIN),DIAZEPAM(VALIUM),OR PHENOBARBITAL
MAY TREAT OR PREVENT SEIZURE ACTIVITY ASSOCIATED WITH A HEAD INJURY - APAP
-
ACETAMINOPHEN
ANTIPYRETIC TO TREAT HYPERTHERMIA WITH CAN RAISE CEREBRAL METABOLISM AND INCREASE ICP - BARBITUATES
- PLACES CLIENT IN A COMA, REDUCING CEREBRAL METABOLISM, ALLOWING THE BRAIN TIME TO HEAL WITHOUT PERMANENT DAMAGE.
- WHEN A PROBE IS ENTERED INTO THE VERTRICAL OF THE SKULL TO CONSTANTLY MONITOR INTRACRANIAL PRESSURE
- ICP MONITORING
- REMOVING A BONE FLAP FROM THE SKULL TO ALLOW ROOM FOR BRAIN TO EXPAND, REMOVE A BLOOD CLOT OR EVACUATE A HEMATOMA, OR ALSO RELIEVE THE PRESSURE OF A BRAIN TUMOR.
- CRANIOTOMY
- OTHER WAYS TO MONITOR ICP:
-
-RESTRICT FLUIDS TO PREVENT OVERLOAD
-AVOID VALSALVA MANUEVER
-MECHANICAL VENTILATION - MENINGITIS
-
DEF: INFLAMMATION OF THE MENINGES OF THE BRAIN AND SPINAL CORD
PATHO:INFLAMMATION INCREASES PRODUCTION OF CSF LEADING TO CEREBRAL EDEMA AND IICP.
PRECIP:ORGANISMS ENTER THE BRAIN BY WAY OF: THE BLOODSTREAM, RESPIRATORY TRACT, OR PENETRATING WOUNDS OF THE SKULL OR CRANIAL SURGERY.
S/S: CLASSIC SYMPTOM: NUCHAL RIGIDITY. HA,IRRITABILITY, FEVER, BRUDZINKSKI'S SIGN, KERNIG'S SIGN
COMPLICATIONS: SEIZURES, SEPSIS, CRANIAL NERVE DYSFUNCTION, CEREBRAL INFARC, COMA, AND DEATH
MEDICAL MGMT:
-ANALYSIS OF CSF WITH C/S
(+ APPEARS MILKY)
-ANTIBIOTICS (IMMEDIATELY)
-ANTICONVULSANTS
-ANTIPYRETICS
-ANALGESICS
NURSING:
-DECREASE ICP
-PREVENT SEIZURES
-PROMOTE SAFETY & COMFORT - WHEN NECK IS FLEXED, THE KNEES AND HIPS FLEX
- BRUDZINSKI'S SIGN
- INABILITY TO EXTEND THE LEGH WHEN THE HIP IS FLEXED AT A 90 DEGREE ANGLE
- KERNIG'S SIGN
- ENCEPALITIS
-
DEF: ACUTE INFLAMMATION OF BRAIN AND SPINAL CORD ALMOST ALWAYS CAUSED BY A VIRUS
S/S:HA, FEVER, EXTREME RESTLESSNESS, LETHARY, CONFUSION, VISUAL DISTURBANCES, DELIRIUM
MEDICAL MGMT:
-ANTIVIRAL AGENTS, TX SX
NURSING MGMT:
-VS
-ORIENTATION, LOC, MEMORY, AND RESPONSE TO STIMULI
-ASSESS FOR DIZZINESS, DIPLOPIA, DROOPING EYELIDS, PUPIL CHANGES, AND HEARING DIFF. DUE TO CRANIAL NERVE DAMAGE
-ASSESS FOR BRUDZ. AND KERN. SIGNS
-OBSERVE FOR ANY SEIZURE ACTIVITY, RESTLESSNESS, AND/OR AGITATION
-INSPECT SKIN FOR PRESENCE OF PETECHIAL RASH OVER THE BODY - GUILLAIN-BARRE SYNDROME
-
DEF: AN ACUTE, PROGRESSIVE INFLAMMATION OF THE PNS.
PATHO: ANTIBODIES ATTACK THE MYELIN SHEATH COVERING THE PERIPHERAL NERVES CAUSING IMPULSES TO BE POORLY CONDUCTED
S/S: BILATERAL WEAKNESS, NUMBNESS, AND TINGLING IN THE LEGS WHICH OVER 24-72H PROGRESSES TO PARALYSIS (STARTS AT FEET AND MOVES UP)
-PRECIP: RECENT VIRAL INFECTION, INCREASED LEVEL OF PROTEIN IN CSF
COMPLICATIONS:(MOST SERIOUS = RESPIRATORY FAILURE)
-SKIN BREAKDOWN
-DVT
MEDICAL MGMT:
-PLASMAPHERESIS
-INTRAVENOUS IMMUNE GLOBULIN
-ABX GIVEN FOR UTI & URI
-ANTICOAGULANTS GIVEN TO PREVENT DVT AND PE
NURSING MGMT:
-PROMOTE SAFETY
-PREVENT COMPLICATION OF IMMOBILITY
-PROMOTE ADEQUATE HYDRATION, NURTRITION, AND RESPIRATORY FXN - POLIOMYELITIS
-
DEF:VIRAL INFECTION THAT ATTACKS CNS
-PREVENTABLE BY VACCINE (INJECTABLE BETTER)
TX: SYMPTOMATIC,
-CONSERVE ENERGY & MAINTAIN MOBILITY - BRAIN ABSCESS
-
DEF: COLLECTION OF PURULENT MATERIAL WITHIN THE BRAIN
PATHO: MICROORGANISMS IN THE BRAIN TISSUE CAUSE LOCAL INFLAMMATION
S/S: IICP, HA, FEVER, CHILLS,(AS ABSCESS EXPANDS = N/V, DROWSINESS, CONFUSION, WEAKNESS ON ONE SIDE, & SEIZURES)
PRECIP:
-INFECTION OF MIDDLE EAR OR NASAL SINUSES
-HEAD INJURY
-INTRACRANIAL SURGERY
-BACTERIAL ENDOCARDITIS
-OSTEOMYELITIS
-LUNG, PELVIC, OR SKIN INFECTION (STREP, STAPH, & PNEUMOCOCCI ARE OFTEN UNDERLYING CAUSES)
MEDICAL MGMT:
-START ABX ASAP
-POSS. SURGERY TO DRAIN OR REMOVE
-SYMPTOMS TREATED AS THEY GO
COMPLICATIONS AND NURSING SAME AS ENCEPHALITIS
(MAY CAUSE BRAIN DAMAGE IF NOT TREATED) - INVOLVES AND OPENING B/W THE OUTSIDE ENVIRONMENT AND THE BRAIN
-
OPEN HEAD INJURY
(THESE CLIENTS AT GREATER RISK FOR MENINGITIS) - USUALLY RESULTS FROM AN ACCERLERATION-DECELERATION INJURY (COUP-CONTRECOUP PHENOMENON)-BRUISES BRAIN AT 2 POINTS
- CLOSED HEAD INJURY
- ACCUMULATION OF BLOOD IN THE EPIDURAL, SUBDURAL OR SUBARACHNOID SPACES, OR W/IN THE CEREBRAL LOBES
-
HEMATOMA
-CLASSIFIED BY THEIR LOCATION -
-ARTERIAL BLEEDING
-ON TOP OF DURA
-RAPIDLY CAUSES ICP
-SEPERATES DURA FROM CRANIUM
-DESTRUCTION OF BRAIN TISSUE FAST - EPIDURAL HEMATOMA
-
-BELOW DURA
-VENOUS BLEEDING (SLOW)
-CLOT FORMS
-USUALLY ABSORBED BACK IN TO BODY AND PT. RECOVERS
-IF LARGE CAN BE ASPIRATED BY DOING A CRANIOTOMY - SUBDURAL HEMATOMA
-
-SLOW BLEED
-ACTUALLY IN CEREBRAL TISSU
-GRADUALLY REABSORBED - INTRACEREBRAL HEMATOMA
- BONE FRAGMENT MAY BE PUSHED IN TO THE BRAIN; USUALLY CAUSED BY A POWERFUL BLOW TO THE SKULL.
- DEPRESSED SKULL FX
- CARE OF HEAD INJURY
-
ASSESS:
-LOC, PUPILS, VS, N/V (VOMITING WITH NO NAUSEA = VERY BAD), LOSS OF SENSATION, SLURRED SPEECH
DX: X-RAY, ANGIOGRAM, EEG, CT
TX: CONSERVATIVE AT 1ST. SURGERY IF NEEDED
NURSING:H.E.A.D.S.
-HOB SEMI-FOWLERS
-EVALUATE ICP/NEURO CHECKS
-AIRWAY
-DRAINAGE (EAR/NOSE)
-SAFETY:(SEIZURE PREC., RESTRICT FLUID, NO SEDATIVES OR NARC (BE CAUTIOUS IF ORDERED), MAINTAIN TEMP., AVOID VALSALVA MANEUVER - BRAIN TUMOR
-
DEF: ABNORMAL GROWTHS WITHIN CRANIUM
PATHO: INVADE, DISPLACE, AND DESTROY BRAIN TISSUE
S/S: HA, VOMITING W/O NAUSEA, VISUAL PROBS, PERSONALITY CHANGES, DISTURBANCES IN JUDGEMENT, MEMORY, COORDINATION, & SPEECH
PRECIP: CAUSE UNKNOWN, BUT EXPOSURE TO CERTAIN CHEMICALS AND RADIATION INCREASES THE INCIDENCE.
MEDICAL MGMT:
-SURGERY
-STEROSTACTIC SURGERY
-RADIATION
-CHEMO
NURSING:
-PREOP
-BASELINE NEURO ASSESS.
POST-OP NSG:
*MONITOR:
-RESP. STATUS Q 1-2H, AIRWAY PATENCY
-O2 SATS
-POSITION ON NON-OP SITE
-COOL CLOTH OVER EYES
-REDUCE NOISE/BRIGHT LIGHTS
-NON-NARC ANAL. OR CODEINE
-REPORT CSF LEAK (EARS, NOSE, OR WOUND)
-USE INTERVENTIONS TO PREVENT INFECTION EX: STERILE DSG CHANGES.
-MONITOR FOR SEIZURES - MIGRAINE HEADACHES
-
-CONSTRICTION & THEN DILATION OF CERBRAL ARTERIES
-MAY HAVE AURA OR SCOTOMA-SPOTS BEFORE EYES
S/S: N/V, SENSITIVITY TO LIGHT
TX:
-IMITREX, ERGOTAMINE DERIVATIVE
-REST IN DARKENED RM
-COLD COMPRESS
-IDENTIFY TRIGGERS: STRESS, WINE, CHOCOLATE, CHEESE... - CEREBROVASCULAR ACCIDENT (STROKE)
-
DEF:BRAIN ATTACK, DECREASED BLOOD SUPPLY TO A LOCAL AREA OF THE BRAIN
PATHO: TIA-BRIEF EPISODE OF REVERSIBLE NEUROLOGIC DEFICITS
S/S:
-DIZZINESS
-VISUAL LOSS IN ONE EYE
-ONE SIDED NUMBNESS OR WEAKNESS OF FINGERS, ARMS, OR LEGS, APHASIA
-PRECIP: HTN, ATHEROSCLEROSIS, CARDIAC DISEASE, HIGH CHOLESTEROL, OBESITY, DM, SMOKING, EXCESSIVE ALCOHOL, DRUG USE (COCAINE), ORAL CONTRACEPTIVES, OVER 65 YRS. OLD, AFRICAN AMER., MALES (SLIGHTLY HIGHER RISK)
COMPLICATIONS:
-MOTOR DEFICITS
-SPEECH DEFICITS
-VISUAL DEFICITS
-SENSORY-PERCEPTUAL DEFICITS
-COGNITIVE/BEHAVIORAL CHANGES
-URINARY/GASTRO PROBS
DX:CT,MRI,PET,CEREBRAL ANGIOGRAM, EEG, DOPPLER ULTRASOUND, OCCAS. LP
TX:
-ANTIPLATELETS
-THROMBOLYTICS
-ANTICOAGULANTS
-ANTIHYPERTENSIVES
-EMOBLUS REMOVAL - NURSING CARE FOR CVA
-
PHASE ONE: (ACUTE CARE)
-FREQ. VS & NEURO CHECKS
-MAINTAIN PATENT AIRWAY
-DECREASE ICP
-PRESERVE JOINT & MUSCLE FXN
-PREVENT COMPLICATIONS
PHASE TWO (REHAB):
-STREGTHEN MUSCLES & MAKE ADAPTATIONS FOR ADL'S
PHASE THREE (DISCHARGE & REFERRAL):
-CONT. REHAB & PT/OT AS OUTPATIENT -
DEF: WHEN SEIZURES OCCUR IN A CHRONIC PATTERN
PATHO: WHEN UNSTABLE NEURONS CONTINUE TO SEND ELECTRICAL IMPULSES TO THE CEREBRAL CORTEX - EPILEPSY
- START IN ONE AREA OF THE CEREBRAL CORTEX
-
PARTIAL SEIZURES
2TYPES:
SIMPLE
COMPLEX -
CAUSE UNCONTROLLED JERKING MVMTS OF A FINGER, HAND, FOOT, LEG, OR THE FACE, LASTS 20-30 SEC, AND CLIENT DOES NOT LOSE CONSCIOUSNESS.
SYMPTOMS: FLASHING LIGHTS, TINGLING, HALLUCINATIONS - SIMPLE PARTIAL SEIZURE
-
-PSYCHOMOTOR SEIZURE
-NONPURPOSEFUL ACTIONS: LIP SMACKING, AIMLESS WALKING, OR PICKING AT CLOTHING (AUTOMATISMS)
-LAST LESS THAN A MINUTE
-CLIENT HAS ALTERED LOC
-CONFUSED, MAY NOT REMEMBER SEIZURE
-AURA MAY BE WARNING SIGN - COMPLEX PARTIAL SEIZURE
- SEIZURE THAT INVOLVE BOTH HEMISPHERES OF THE BRAIN AND RESULT IN LOSS OF CONSCIOUSNESS.
- GENERALIZED SEIZURES
- ABSENCE SEIZURES
-
-PETIT MAL SEIZURE
-MORE COMMON IN CHILDREN
-BRIEF CHANGE IN CONSCIOUSNESS
-LASTS ON 5-10 SEC. - TONIC CLONIC SEIZURES
-
-GRAND MAL SEIZURE
-MOST COMMON DISORDER IN ADULTS AND CHILDREN
-EXPERIENCE:
AURA
EPLIPTIC CRY
TONIC PHASE
CLONIC PHASE
POSTICTAL PHASE - WHEN THE BODY BECOMES RIDGID WITH AREMS AND LEGS EXTENDED, JAW CLENCHED, EYES ROLL BACK, BREATHING STOPS BRIEFLY
- TONIC CONTRACTION
- MVMTS ARE JERKY AS MUSCLES ALTERNATELY CONTRACT AND RELAX, TONGUE/CHEEK BITING, FROTHING FROM MOUTH, URINARY/BOWEL INCONT. COMMON.
- CLONIC CONTRACTION
- UNCONSCIOUS FOR UP TO 30 MIN, UPON WAKING-CONFUSED AND DISORIENTED, EXPER. HA, MUSCLE ACHES, AND FATIGUE, USUALLY SLEEP FOR HOURS AFTERWARD.
- POSTICAL PHASE (POST SEIZURE)
- STATUS EPILEPTICUS
-
-UNRELENTING CONVULSIONS
-PT. DOES NOT REGAIN CONSCIOUSNESS
-CAN HARM THE BRAIN'S NERVE CELL AND LEAD TO PERM. DAMAGE
-CONSIDERED A LIFE THREATENING EMERGENCY
-CAN BE TRIGGERED BY ABRUPT DC'ING OF ANTICONVULSANTS - TX OF EPILEPSY
-
-EEG
-ANTICONVULSANTS
-SURGERY (REMOVING EFFECTED TISSUE WITH PT. AWAKE) - NURSING CARE OF EPILEPSY
-
-SEIZURE PRECAUTIONS:
PUT IN ROOM CLOST TO NURSES
PAD SIDE RAILS
-DURING SEIZURE:
1ST GET HELP
MAINTAIN AIRWAY
PROTECT HEAD
DON'T RESTRAIN
-ASSESS:
ONSET
DURATION
BEHAVIOR A/P
TYPE OF MVMTS
LOSS OF CONSCIOUSNESS
INCONTINENCE
SEIZURE AWARENESS
-DURING POSTICTAL PHASE:
ASSESS FOR INJURY
VS
PROMOTE REST
-LONG-TERM SUPPORT:
EDUCATION (SAFETY, MEDS)
AVOIDANCE OF TRIGGERS
MEDIC ALERT BRACELET
NO DRIVING
IDENTIFICATION OF AURA (TEACH TO GET IN SAFE PLACE IF OCCURS) - HUNTINGTON'S DIEASE
-
DEF: PROGRESSIVE, INHERITED NEUROLOGICAL DISEASE (TYPICALLY EFFECTED B/W AGES 40-50)
-S/S:CHOREA(CONSTANT, JERKY, UNCRONTROLLED MVMTS OF THE BODY), DEMENTIA, EMACIATION & EXHAUSTION
DX: SYMPTOMS AND FAMILY HISTORY
TX:
-NO SPECIFIC TEST FOR THIS DISEASE
-ANTIDEPRESSANTS
-ANTIPSYCHOTICS
-DOPAMINE BLOCKERS - TRIGEMINAL NEURALGIA
-
DEF: SEVERE, ONE-SIDED FACIAL PAIN LASTING A FEW SECONDS TO A FEW MINUTES, AFFECTS CRANIAL NERVE V
S/S:
-NEURALGIA (EXCRUTIATING PAIN
-FACIAL MUSCLE CONTRACTION
UNKNOWN ETIOLOGY
TX:
-DILANTIN OR TEGRETOL(ANTICONVULSANT)
-LOCAL NERVE BLOCK
-SURGICAL INTERRUPTION OF NERVE IMPULSE TRANSMISSION (RHIZOTOMY)
NURSING CARE:(N.E.U.R.A.L.G.I.A.)
-NATURE OF PAIN
-EYE CARE
-UNEFFECTED SIDE-CHEW ON
-ROOM TEMP.
-ASSESS NATURE OF PAIN
-LUKEWARM FOOD
-hyGiene-ORAL
-INCREASE PROTEIN/CALORIES, SOFT DIET
-AVOID TOUCHING CLIENT (LET PT WASH THAT SIDE OF THEIR FACE) - BELL'S PALSY
-
DEF: FACIAL PARALYSIS (ASSOC. WITH THE HERPES SIMPLEX VIRUS)
-CRANIAL NERVE VII
S/S: AFFECTS ONE SIDE OF FACE, NUMBNESS, PARTIAL OR TOTAL PARALYSIS
TX:
-STEROIDS (CORTICOSTEROIDS)
-ANTIVIRAL DRUGS
-ANALGESICS
NSG:
-PROMOTE + SELF IMAGE
-MEDS
-EYE DROPS
-OPTHTHALMIC OINT. & EYE PATCH AT NIGHT
-EVALUATE ABILITY TO EAT
-WARM, MOIST HEAT - SPINAL CORD INJURY
-
MOST OCCUR IN CERVICAL AND LUMBAR REGIONS
PATHO:
-HYPERFLEXION-MVA
-HYPEREXTENSION-WHIPLASH
-COMPRESSION-DIVING, SKIING, SPORTS INJURY - GOALS OF SPINAL CORD INJURY
-
-STABILIZE VS
-PREVENT FURTHER CORD DAMAGE
-REPAIR DAMAGE TO SPINAL CORD
-PREVENT COMPLICATIONS
-MAINTAIN AS MUCH FUNCTION AS POSS.
-PROMOTE REHABILITATION - NURSING CARE SCI
-
-PREVENT FURTHER CORD DAMAGE
-ASSESS RESP. FUNCTION
-MAINTAIN URINARY/BOWEL FXN
-PREVENT THROMBUS
-MAINTAIN CARDIOVASCULAR STABILITY
-HELP MAINTAIN ONGOING NEURO. ASSESSMENTS
-ENCOURAGE ADEQUATE FLUID & NUTRITION
-PREVENT SKIN BREAKDOWN
-PROVIDE EMOTIONAL SUPPORT
-LOGROLL THESES PT'S
-REMEMBER PARALYSIS OCCURS BELOW LEVEL OF INJURY - SPINAL SHOCK
-
DEF: TEMPORARY LOSS OF REFLEX ACTIVITY BELOW LEVEL OF SPINAL CORD INJURY
-CESSATION OF MOTOR, SENSORY, AUTONOMIC & REFLEX IMPULSES
-BRADYCARDIA
-HYPOTENSION
-LOSS OF SWEATING & TEMP CONTROL
-BOWEL/BLADDER DYSFUNCTION
-FLACCID PARALYSIS
-POIKILOTHERMIA_(CLIENT ASSUMES TEMP. OF ENVIRONMENT)
-LAST FROM 1-6 WKS
-UNTIL RESOLVED PT. NEEDS MEDICAL SUPPORT - HERNIATED INTERVERTEBRAL DISK
-
DEF: WHEN THE NUCLEUS PULPOSUS PROTRUDES THROUGHA WEAKENED OR TORN ANNULUS FIBROSUS.
LUMBAR/SACRAL S/S:
-PAIN IN LOWER BACK RADIATING DOWN ONE LEG; HX OF FEELING SOMETHING "GIVE WAY"
CERVICAL S/S:
-PAIN IN NECK & SHOULDER RADIATING DOWN ONE ARM
DX:
-MYELOGRAPHY: R/O TUMORS & LOCATE HERNIATION
-CT/MRI: SHOW SITE OF HERNIATION
MEDS:
-NSAIDS (ASA, MOTRIN, NAPROSYN)
-NON-NARCOTIC ANALGESICS (VICODIN)ACUTE PAIN
-MUSCLE RELAXANTS
-TENS (RELIEVES UNCONTROLLED PAIN - TX H.I.D.
-
-CHIROPRACTIC
-BR W/ FIRM MATTRESS
-PELVIC OR HEAD TRACTION
-HEAT/COLD
-MILD EXERCISE TO STREGTHEN ABD
-BACK BRACE
-PT
-SURGERY:
DISKECTOMY
LAMINECTOMY
SPINAL FUSION
CHEMONUCLEOLYSIS
-SURGERY DEPENDS ON THE LOC/SIZE OF RUPTURED DISK
-P SUCCESSFUL SURGERY MOST CAN RETURN TO JOBS IN ABOUT 6 WKS. - REMOVAL OF THE HERNIATED DIS OR DISK FRAGMENTS
- DISKECTOMY
- REMOVAL OF THE VERTEBRAL LAMINA TO RELIEVE PRESSURE ON THE NERVES. (MOST COMMON)
- LAMINECTOMY
- INSERTION OF BONE GRAFT (FROM ILIAC CREST) B/W THE VERTEBRAE.
- SPINAL FUSION
- INJECTION OF THE ENZYME CHYMOPAPAIN INTO THE NUCLEUS PULPOSUS TO SHRINK OR DISSOLVE THE PROTRUDING HERNIATION
- CHEMONUCLEOLYSIS
- PARKINSON'S DISEASE
-
DEF: CHRONIC, PROGRESSIVE, DEGENERATIVE NEURO DISEASE THAT ALTERS MOTOR COORDINATION (CAUSE UNKNOWN)
PATHO: DEFICIENCY OF DOPAMINE
S/S:
-TREMOR
-RIGIDITY
-BRADYKINESIA
SLOWED, VOLUNTARY MVMT
SLURRED SPEECH
MASKLIKE, EXPRESSIONLESS
DX: BASED ON SYMPTOMS
MEDS:
-LEVODOPA
-CARBIDOPA
-DOPAMINE AGONIST
-MAOI'S
-ANTICHOLINERGICS: ARTANE, CONGENTIN
-ANTIDEPRESSANTS
SURGERY:
-PALLIDOTOMY
-STEREOTAXIC THALAMOTOMY - PART OF THE GLOBUS PALLIDUS IS DESTROYED TO CONTROL RIGIDITY AND TREMORS
- PALLIDOTOMY
- DESTROYS PART OF THE THALAMUS TO REDUCE TREMORS
- STEREOTAXIC THALAMOTOMY
- MULTIPLE SCLEROIS
-
DEF: CHRONIC, DEGENERATICE DISEASE THAT DAMAGES THE MYELIN SHEATH SURROUNDING THE AXONS OF THE CNS.
-MARKED BY PERIODS OF REMISSION AND EXACERBATION
-ONSET 20-40YRS OF AGE
-EXACT CAUSE UNKNOWN
SYPTOMS: FATIGUE IS COMMON BUT OFTEN IGNORED, DIPLOPIA,WEAKNESS, TINGLING, & NUMBNESS IN EXTREMITIES
DX:
-BASED ON PT'S HX, PX EXAM & SX
-CSF ANALYSIS=ELEV. WBC'S
-MRI DETECTS PLAQUE LESIONS
-EEG SHOW SLOWED BRAIN ACTIV.
GOAL OF TX: KEEP CLIENT FXNING AS LONG AS POSS.
-TX:
BETA-INTERFERON
ADRENOCORTICOTROPIC HORMONE, STEROIDS
IMMUNOSUPPRESSANTS - NSG INTERVENTIONS TO HELP MS PT. COPE WITH:
-
-IMMOBILITY
-FATIGUE
-INCONTINENCE
-VISUAL PROBLEMS
-SPEECH DISORDERS
-SEXUAL IMPOTENCE
-MUSCLE SPASTICITY - ALZHEIMER'S DISEASE
-
DEF: PROGRESSIVE, IRREVERSIBLE DETERIORATION OF THE BRAIN (MOST COMMON)
-CAUSES ATROPHY OF PORTIONS OF FRONTAL & TEMPORAL LOBES
-SLOW ONSET, EVENTUALLY FATAL
PATHO:
-LOSS OF NERVE CELLS
-REDUCED BRAIN SIZE
-PRESENCE OF NEUROFIBRILLARY TANGLES
-NEURITIC PLAQUES(AMYLOID CAUSES PLAQUE FORMATION)
FIRST SIGN: MEMORY LOSS
NSG: HELP CLIENT MAINTAIN THE HIGHEST QUALITY OF LIFE
GOALS:
-PROMOTE PERFORMANCE ADL'S
-PROTECT FROM INJURY
-PRESERVE DIGNITY -
AMYOTROPHIC LATERAL SCLEROSIS
(LOU-GEHRIG'S DISEASE) -
DEF: RAPIDLY PROGRESSIVE, FATAL NEUROLOGICAL DISEASE
-DEGENERATION OF MOTOR NEURONS-MUSCLE ATROPHY
-CLIENT REMAINS FULLY ALERT
-FATAL, NO TX OR CURE
-CAUSE UNKNOWN
-MEN, AGES 40-70S\
COMPLICATIONS:
-MUSCLE WEAKNESS
-FASCICULATIONS(INVOLUNTARY CONTRACTIONS)
-MUSCLE WASTING
-BRAIN STEM INVOLVEMENT (SPEECH/SWALLOWING DIFF.)
-BREATHING PROBS
DX:
-SYPMTOMS
-EMG-CONFIRMS MUSC. WEAK
-MUSCLE BIOPSY-SHOW LOSS OF MUSCLE FIBER
DEATH: USUALLY FROM ASPIRATION PNEUMONIA OR RESP. FAILURE
MEDS:RILUTEK(RILUZOLE)ONLY ONE THAT SEEM TO SLOW DESTRUCTION OF MOTOR NEURONS
ASSESS:
-PT'S LEVEL OF OPTIMAL PX ACTIVITY
-SPECIFIC PROBLEMS RELATED TO PARALYSIS
NSG INTERVENTIONS:
-PROVIDING PX COMFORT & EMOTIONAL SUPPORT
-PROMOTING MAX. INDEPENDENCE - MYASTHENIA GRAVIS
-
DEF: CHRONIC, AUTOIMMUNE DISORDER AFFECTING ACETYCHOLINE RECEPTORS & AFFECTING WOMEN B/W AGES OF 20-30.(CAUSES EXTREME MUSCLE WEAKNESS AND FATIGUE)
S/S: AGGRAVATED BY ACTIVITY, RELIEVED BY REST
-EYELID PTOSIS, DIPLOPIA, SLURRED SPEECH, NASAL VOICE, DIFFICULTY CHEWING & SWALLOWING, FATIGUE
-PROGRESSIVE DIFF. PERFORMING FINE MOTOR SKILLS
-RISK OF ASPIRATION & RESP INSUFFICIENCY
DX: TENSILON INJECTION IMPROVES CONDITION FOR ONLY 5 MIN
TX:
-ANTICHOLINESTERASE DRUGS(WATCH OUT FOR CRISIS)
-PLASMAPHERESIS
-SURGICAL REMOVAL OF THYMUS
NSG INTERVENTION:
-SAME AS MS OR PD
-MONITOR FOR MYASTHENIC CRISIS & CHOLINERGIC CRISIS
DEATH: USUALLY DUE TO RESP. FAILURE
-