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Chapter 78 Nervous System Disorders

Chapter 78 Nervous System Disorders. Neurology. Neurology Medical specialty related to the nervous system Neurologists Neurosurgeons Neuroscience nurses. Diagnostic Tests. Visualization procedures CT scan, MRI

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Chapter 78 Nervous System Disorders

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  1. Chapter 78Nervous System Disorders

  2. Neurology • Neurology • Medical specialty related to the nervous system • Neurologists • Neurosurgeons • Neuroscience nurses

  3. Diagnostic Tests • Visualization procedures • CT scan, MRI • Positron emission tomography-glucose containing glucose between 80-150 for test and hold metformin24-48 hours or kidney function assessed- • Cerebral angiography and arteriography-baseline neurologic assessment- encourage fluids after- check site for bleeding • Myelography, brain scan • Lumbar puncture • Electroencephalography-tv monitoring/ sleep or not? • Videotelemetry monitoring

  4. Nursing Process • Data collection see in practice page 1257 • Planning and implementation • Assisting with ADL • Providing exercise • Providing comfort with special devices • Neuro chair help move the client in various positions • Evaluation

  5. Question Which of these is a key component of a neurological assessment? a. Signs of increased intracranial pressure and eye signs b. Signs of heightened hearing c. Loss of the sensation of touch d. Loss of appetite e. Loss of hearing

  6. Answer a. Signs of increased intracranial pressure and eye signs Other key components of a neurological assessment include: • Neurologic nursing history, including history given by family and Neurologic status • Speech patterns, Level of consciousness (LOC), changes in LOC • Gross evaluation of muscle tone/strength • Overview of balance, coordination, and protective reflexes and of sensory function • Function of selected cranial nerves

  7. Craniocerebral Disorders • Symptomatic headache • Cephalgia (headache) • Most common symptom of a neurologic disorder • Migraine headache (vascular headache)-know symptoms • Medical interventions • Abortive therapy, symptomatic relief, preventative therapy • Cluster headache-tear formation common

  8. Seizure Disorders • Seizure • Convulsion • Ictal phase and postictal phase –nursing considerations page 1260-61 • Seizure disorders • Repeated episodes of seizures • Epilepsy • Status epilepticus

  9. Classification of Seizures • Partial or focal seizures • Partial simple, complex partial (psychomotor) • Primary general • Tonic-clonic (grand mal) • Absence (petit mal) • Tonic • Clonic • Atonic • Myoclonic • Status epilepticus

  10. Nursing Considerations During a Seizure • To protect and observe • Observe for respiratory depression and have emergency airway equipment readily available. • Necessary equipment • Oral airway • Suction setup • Setup of piggyback port on an open IV • Rectal or tympanic temperature probe

  11. Cerebrovascular Accident • A stroke, a brain attack, or a central vascular accident • May cause complete or partial paralysis or death • Underlying cause • Involves atherosclerosis of the cerebral blood vessels

  12. Nerve Disorders • Neuralgia • Pain in a nerve • Trigeminal neuralgia • Root of the trigeminal nerve becomes painful even with the slightest touch • Bell’s palsy • Temporary, partial, one-sided facial paralysis how is it different than a stroke facial drooping • Shingles (herpes zoster)airborne and contact isolation • Acute viral inflammation of a nerve

  13. Question Is the following statement true or false? When caring for a client with cardiovascular accident(CVA) and hemiplegia, the client should be encouraged to use the trapeze bar on the bed.

  14. Answer True Frequent position changes help to prevent disorders caused by immobility–disuse disorders. Use of trapeze bar allows the client to assist with position changes and to reduce the shearing forces that can lead to skin breakdown. Mobility will prevent respiratory complications and will help the client to maintain self-esteem. Splints or high-top sneakers aid in maintaining normal anatomical alignment of the joints.

  15. Spinal Cord Disorders • Categories • Congenital defects of the spinal cord • Spinal cord tumor • Trauma to the spinal cord • Transection • Complete • Partial or incomplete transection • Spinal cord is the communication system between the brain and the body

  16. Spinal Cord Disorders (cont’d) • Level of injury • Paraplegia, quadriplegia • Effects of injury • Spinal shock, respiratory arrest • Sensory deficits, movement disabilities • Complications due to impaired circulation, immobility, respiratory complications, gastric distention, bowel and bladder incontinence • Phantom pain

  17. Autonomic Dysreflexia • Autonomic dysreflexia or autonomic hyperreflexia • Seen in clients with injury to the upper spinal cord • Signs and symptoms • Elevated blood pressure, sudden, throbbing headache, chills, pallor, goose flesh, nausea, sudden perspiration, increased heart rate • Treatment • Elimination of the triggering stimulus

  18. Paralysis in Female Clients • Menses usually resume within 3 months following the injury. • The use of tampons is dangerous. • The use of birth control pills is not recommended. • The use of intrauterine devices (IUDs) is not recommended. • Labor and childbirth may be dangerous.

  19. Emergency Treatment and Diagnostic Tests • The head, neck, and spine must be stabilized with the person lying flat on a firm surface. • Never lift the person with a known or suspected spinal cord injury by the head, shoulder, or feet. • A victim of trauma should never be moved without proper precautions. • Treatment for shock and hemorrhage may be necessary. • Medical priority: X-ray examination • Injections should be given above the level of the injury because circulation is impaired and the drug is delayed and skin breakdown is likely • Foot droop prevention wear high top tennis shoes

  20. Medical and Surgical Treatment • Skeletal traction • Spinal fusion • Rehabilitation • Surgery • To remove a portion of vertebral bone pressing on the spinal cord • To stabilize the vertebrae

  21. Nursing Considerations • Observe the client. • Check for minute changes. • Rehabilitation • Encourage the client. • Provide realistic feedback.

  22. Degenerative Disorders • Multiple sclerosis (MS) • Myelin sheath covering the nerves is destroyed. • Clinical progression • Relapsing-remitting (RRMS) • Secondary-progressive (SPMS) • Primary-progressive (PPMS) • Progressive-relapsing (PRMS)

  23. Degenerative Disorders (cont’d) • Parkinson’s disease • Chronic, progressive disease affecting the dopamine-producing cells of the brain • Myasthenia gravis (MG) • Chronic autoimmune disorder characterized by episodes of weakness in the voluntary muscles • Emotional upset and infections can precipitate a crisis- check out the in practice page 1270

  24. Question Which of these medications are given to a client with Parkinson's disease? a. Neostigmine methylsulfate b. Zolmitriptan c. MAO B inhibitors d. Beta-blockers e. Phenytoin

  25. Answer c. MAO B inhibitors Medications given to a client with Parkinson’s disease include: • Levodopa (L-dopa, Dopar, Larodopa) replenishes missing dopamine and helps reduce tremors and rigidity • Levodopa plus carbidopa (Sinemet) • Dopamine agonists • MAO B inhibitors • Anticholinergics • Glutamate (NMDA) blocking drugs

  26. Degenerative Disorders (cont’d) • Huntington’s disease (HD) or Huntington’s chorea • Chronic, progressive, hereditary condition in which brain cells in the basal ganglia prematurely die • Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease-always progresses to respiratory dysfuction and death within 5 years of onset • Rapidly progressive, fatal neurologic disorder resulting in destruction of motor neurons of the cortex, brain stem, and spinal cord

  27. Inflammatory Disease • Brain abscess • Meningitis • Signs of meningeal irritation – select all that apply • Kernig’s sign, Brudzinski’s sign –Know page 1272 • Encephalitis • Guillain-Barré syndrome- the nurse must keep in mind that this client has an excellent chance of total or nearly total recovery • Acute transverse myelitis

  28. Head Trauma • Increased intracranial pressure- 4-13 mmHG inpractice page 1274 • Herniation of the brain • Concussion no structural abnomality, laceration, and contusion • Skull fractures • Hematoma, epidural hematoma • Intracranial hematoma • Subdural hematoma- caused by torn vein • Penetrating head injuries

  29. Head Trauma (cont’d) • The Glasgow coma scale (GCS) • Medical and surgical treatment • Methods to limit swelling and damage caused by ICP • Osmotic diuretics may be given. • Immediate neurosurgery • Burr holes or intraventricular catheter to relieve cICP by draining CSF or blood

  30. Blood patch

  31. Neoplasms • Only a small percentage of brain tumors are malignant. • Signs and symptoms • Diagnostic tests • Treatment • Craniotomy • Nursing considerations • Providing preoperative care • Providing postoperative care

  32. Triad’s • Cushing: HTN, Bradycardia, wide pulse pressure :ICP • Beck’s: distended neck veins, distant heart sounds , Hypotension: pericardial tamponade • Adult • Infant • Glasgow coma scale • See handout

  33. NIH stroke scale • Helps makes a differentiation between TIA and stroke and assist with evaluation after administration of clot busters and hemolytic therapy. • Ischemic stroke: brain attack causing a blockage of blood to the brain that can lead to damage of the brain. • Thrombolytic therapy is the injection of medication tissue plasminogen activator tPA that breaks up a blood clot • Nearly half of patient’s receive therapy are able to care for themselves in 3 months

  34. contiued • Complications; bleeding, death higher in those >80 • Strokes types: • Ischemic stroke caused by an interruption of blood flow to the brain-80% • Hemorrhagic stroke is caused by bleeding inside the brain • TIA ( aka mini stroke); Transient ischemic attack warning stroke difference is time. Last less than 5 minutes usually and resolution of symptoms within 24 hours

  35. FAST • Face drooping • Arm weakness • Speech difficulties • Time to call 911 • tPA administer with in 4.5 hours of the last time someone recognized the patient as being normal or baseline for them.

  36. NCLEX ready • Posturing: • Decorticate- pathway between brain and spinal cord • Decerebrate=upper brain stem • Reflex+ 0-no response,1 weaker than norm, 2 normal,3 stronger • 4+hyperactive • Babinski • PERRLA

  37. NCLEX • DASH diet: high in fruits and vegs moderate in low fat dairy products and low in animal protein • Dietary approach to stop HTN • ICP- hob 30-40 • Avoid strain • Avoid hypercapnia=vasodilation =increase ICP • Any hea= check for glucose • Raccoon eyes/battle signs=mastoid bone

  38. End of Presentation

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