The document discusses various neurological disorders and conditions, including their anatomy, symptoms, assessment, and treatment. It covers disorders of the central nervous system like increased intracranial pressure and seizures. It also discusses various degenerative diseases like multiple sclerosis, Parkinson's disease, Alzheimer's disease and others. Other conditions covered include cerebrovascular accidents, meningitis, Guillain-Barré syndrome, and spinal cord injuries.

1. Medical Surgical Nursing A Care of the Patient With a Neurological Disorder

2. Anatomy and Physiology Central nervous system (CNS) Brain Spinal cord Peripheral nervous system Somatic (voluntary) Autonomic (involuntary)

3. Anatomy and Physiology Neurons Transmitter cells Carry messages to and from brain and spinal cord Glial cells Support and protect neurons Produce cerebral spinal fluid

4. Anatomy and Physiology CNS: brain Cerebrum – lobe functions Diencephalon – thalamus, hypothalamus Cerebellum – balance, coordination Brain stem – midbrain, pons, medulla oblongata

5. Anatomy and Physiology PNS: Somatic (voluntary) 31 pairs of spinal nerves 12 pair of cranial nerves

6. Anatomy and Physiology PNS: Autonomic (involuntary) Controls: Smooth Muscles Cardiac Muscles Glands Check and balance system: Sympathetic nervous system Parasympathetic nervous system

7. Neurological Assessment History Headaches Loss of function Visual acuity Seizures Numbness Pain Personality change Mood swing Fatigue

8. Neuro Assessment Mental Status Orientation Mood and behavior General knowledge Short term memory Long term memory

9. Neuro Assessment Level of consciousness Glasgow Coma Scale Eye opening Verbal response Motor response

10. Neuro Assessment Language and Speech Aphasia Sensory Expressive Global

11. Cranial Nerves I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Acoustic IX. Glossopharyngeal X. Vagus XI. Spinal Accessory XII. Hypoglossal

12. Neuro Assessment Motor Function Paralysis Paresis Flaccid Spastic

13. Neuro Assessment Sensory and Perceptual Status Pain Touch Temperature Proprioception Unilateral neglect Hemianopia

14. Neuro Assessment Blood and urine ABG Lumbar puncture Imaging EEG EMG Carotid Duplex

15. Neurological Problems Headache Vascular – migraine, cluster, hypertensive Tension – stress Traction-inflammatory – infection, occlusion vessels

16. Neurological Problems Increased Intracranial Pressure (IIP) Occurs slowly or rapidly May lead to brain stem herniation and death

17. Assessment of IIP Subjective Diplopia Personality change Thought processes change Headache Nausea

18. Assessment of IIP Objective Decreasing LOC Hyperthermia Weakness Vomiting Seizures Papilledema Posturing Wide pulse pressure Bradycardia Altered respirations Pupils fixed & dilated

19. Assessment of IIP Diagnostic tests: CT scan, MRI Close observation Craig’s screw

20. Medical Management of IIP Craniotomy Craniectomy Tumor removal Drainage of ventricles Drainage of hematoma Intubation

21. Medical Management of IIP Medications Osmotic diuretics - Mannitol Corticosteroids - Decadron Anticonvulsants - Dilantin Internal monitoring

22. Nursing Care of the Patient With IIP Elevate HOB Neck in neutral position Avoid flexion hips, waist and neck Avoid isometric activity or Valsalva Restrict fluids Foley Suctioning O2 Hypothermia blanket

23. Neurological Disorders- Seizures Seizures Disorderly neuron discharges in brain Transitory Different types affect body differently Involuntary movement usually

24. Seizures Generalized: Tonic-clonic – grand mal Absence - Petit mal Myoclonic Atonic or akinetic Localized: (Focal) Partial (Jacksonian) Psychomotor

25. Seizures Causes: Hypoglycemia Infection Electrolyte imbalance Trauma IIP Toxins

26. Seizure Medications Dilantin (Phenytoin) Phenobarbital Mysoline Tridione Valium (Diazepam) Depakene Clonopin Mesantoin Neurontin Lamictal Felbatol Cerebyx

27. Seizure Medications Nursing: Medications Continue meds Medic alert ID Avoid alcohol, avoid driving, get adequate rest If on Dilantin, instruct on oral hygiene

28. Seizures: Nursing Care Protect Lower to the floor; pad side rails; pillow under head; don’t restrain No bite block or padded tongue blade Allow for post-ictal rest Prevent aspiration (airway) Turn side; loosen clothing around neck Document everything

29. Degenerative Neuro Diseases Multiple Sclerosis Parkinson’s Disease Alzheimer’s Disease Myasthenia Gravis Amyotrophic Lateral Sclerosis (ALS) Huntington’s Disease (chorea)

30. Multiple Sclerosis Common degenerative neurological disease. Myelin sheath is destroyed. Symptoms vary. Relapsing/remitting. Usually ages 20-40.

31. Multiple Sclerosis - Symptoms Subjective: Shakiness, difficulty walking Fatigue, muscle weakness Numbness, tingling Tinnitus Visual problems Difficulty chewing and speaking Incontinent; impotent

32. Multiple Sclerosis - Symptoms Objective: Ataxia Changes in behavior & emotions Nystagmus Spasticity, tremors, dysphagia, facial palsy, speech impaired, fatigue Incontinence Impaired judgment

33. Multiple Sclerosis - Tests CSF CT scan MRI

34. Multiple Sclerosis-Treatment Meds: Anti inflammatory ACTH, Solu Medrol, Prednisone Immuno Modifiers Avonex, Betaseron, Capoxone Muscle Relaxants Valium

35. Multiple Sclerosis-Nursing Interventions Nutrition Skin Care Activity Control of environment Emotional support Patient teaching

36. Parkinson’s Disease Unknown cause Lack of dopamine. Parkinsonism: encephalitis, toxic chemicals, meds, drugs

37. Parkinson’s Symptoms include: Muscular tremors and rigidity Emotional instability Judgment defects Heat intolerance Mask-like facial appearance Dysphagia and drooling

38. Parkinson’s Testing No specific test to diagnose Parkinson’s Diagnosis based on symptoms

39. Parkinson’s – Medical Treatment Medications Sinemet, Symmetrol, Levodopa or Cogentin Less effective over time Surgery Experimental

40. Parkinson’s – Nursing Care Prevent injury (fall or aspiration) Prevent urinary retention and constipation Patient teaching about medication Patient and family support

41. Alzheimer’s Unknown cause, but genetic link Very common; risk increases with age Brain changes: plaques tangled neurons blood vessel degeneration chemical changes

42. Alzheimer’s - Symptoms 1st– memory lapses, difficult word finding, decreased attention span 2nd – increased memory problems, disoriented to time, loses things, confabulates 3rd – total disorientation, apraxia, wanders 4th – severe impairment

43. Alzheimer’s - Testing No definitive test Family history Diagnosis: autopsy

44. Alzheimer’s – Medical Management Medication to treat symptoms Memory:Cognex, Aricept Agitation: Mellaril, Haldol Supplements Folic Acid & Vitamin B12 Low fat diet NSAIDS

45. Alzheimer’s – Nursing Care 2 key points for all care: Prevent overstimulation Provide structured, orderly environment Other concerns Communication Family support and education

46. Myasthenia Gravis Autoimmune disorder Myoneural junction problem Symptoms: ptosis, diplopia, weakness, dysarthria, dysphagia, difficulty sitting up, respiratory distress

47. Myasthenia Gravis - Treatment Medication to improve impulse transmission (Mestinon) to suppress immune system (steroids, Cytoxan) Plasmapheresis Respiratory support Safety

48. Amyotrophic Lateral Sclerosis ALS – Lou Gehrig’s disease Motor neurons in brain stem and spinal cord degenerate Brain’s messages don’t reach the muscles Symptoms – weakness, dysarthria, dysphagia No loss of cognitive function No cure, death occurs in 2-6 years

49. Huntington’s Disease Chorea Genetic Onset at age 35-45 Excessive involuntary movements Death in 10-20 years No cure

50. Huntington’s Disease Nursing interventions are palliative Give meds Provide for safety Provide adequate diet Emotional support Genetic counseling

51. Cerebrovascular Accident (CVA) Ischemia of brain tissue Hemorrhage Thrombus Embolus 3 rd leading cause of death in the US All ages, but usually elderly

52. CVA – Contributing Factors Atherosclerosis Heart disease Kidney disease Hypertension Obesity High cholesterol Cigarette smoking Stress Sedentary Diabetes Oral contraceptives Cocaine

53. Cerebral Thrombosis Most common cause of CVA Most often: Atheroclerosis ↓ Thrombus ↓ CVA

54. Cerebral Embolism 2nd most common cause of CVA Most often: Heart disease ↓ Thrombus ↓ Embolus ↓ CVA

55. Cerebral Hemorrhage 3rd most common cause of CVA Most often: Hypertension ↓ Ruptured cerebral blood vessel ↓ CVA

56. Transient Ischemic Attack Cerebrovascular insufficiency Causes – same as CVA Warning sign of impending CVA

57. CVA - Assessment Motor changes Opposite side Balance, coordination, gait, proprioception Glasgow Coma Scale

58. CVA Assessment Sensory Changes Aphasia =can’t speak or write Agnosia =can’t recognize familiar objects/people Apraxia =can’t perform purposeful acts or use objects properly Neglect Syndrome Visual problems, including hemianopsia

59. CVA Assessment Cognitive changes denial impaired memory, judgment can’t concentrate disoriented slow and cautious versus impulsive depressed, anxious versus euphoric angers quickly versus constantly smiling

60. CVA - Testing CT or MRI Cerebral angiogram CBC, PT, PTT, electrolytes

61. CVA – Medical Management Thrombolytic (“clot buster”) Anticoagulants Antiplatelet drugs Aneurysm repair Carotid endarterectomy

62. CVA-Nursing Care Assess LOC IV, NG, Foley, Vent. Nutrition Encourage perform ADLs Bladder and bowel training ROM Teaching and emotional support

63. Trigeminal Neuralgia Tic Douloureux Trigeminal nerve – degeneration, pressure Facial pain Medication, surgery Avoid triggers

64. Bell’s Palsy Facial nerve inflammation Unilateral weakness of facial muscles Steroids, Zovirax, warm moist cloth, massage, facial exercises

65. Infection and Inflammation Meningitis Encephalitis Brain abscess Guillain-Barré Neurosyphilis Poliomyelitis Herpes zoster AIDS

66. Guillain-Barré - Polyneuritis Peripheral nerve disease Prior infection; autoimmune response Weakness and paralysis, begins in extremities and works up Respiratory failure may occur

67. Meningitis Acute infection of the meninges Viral or bacterial Severe headache, irritable, fever, delirium, N/V, neck stiffness Kernig’s sign Brudzinski’s sign

68. Meningitis-Medical Management Diagnosed by LP Medications Respiratory isolation Cool, dark quiet room Maintain hydration Prevent injury

69. Acquired Immunodeficiency Syndrome - AIDS AIDS dementia complex Infection of CNS Dementia Treatment depends on infection Treat symptoms, maintain safety

70. Spinal Cord Trauma Complete cord injury – all voluntary movement below level of trauma is lost Autonomic hyperreflexia stimulus sympathetic nervous system response