Professional Documents
Culture Documents
b.cerebellum -
b.ascending tract
i. the posterior portion of cord that
carries sensory information up to the brain
ii. 31 segments
Motor nerves
Sensory nerves
Autonomic nervous system - regulates
body's internal environment
Sympathetic - prepares body for fight or
flight; used only as needed when scared or
excessively happy
Parasympathetic - controls normal body
functioning for day to day activities, e.g.,
increases muscle tone, maintains
secretions with moist mucous membranes;
maintains heart rate within normal limits;
maintains GI and GU peristalsis
Cranial nerves
These nerves are the vital bridges
between the brain and the rest of the body.
E. Physiology - nervous system coordinates
and controls all activities of the body
4.Management
a.expected outcome: postpone dependence
b.supportive care for findings
c. therapies: speech, physical
d.genetic counseling
5.Nursing interventions
a. foster independence in ADL
b. reinforce the use of assistive devices for
ambulation as needed
c. teach client to
i. maintain good nutrition
ii. get emotional support from support
groups, friends
iii. seek genetic counseling
Amyotrophic lateral sclerosis (ALS, Lou
Gehrig's disease)
Amyotrophic lateral sclerosis (ALS, Lou
Gehrig's disease)
1.Definition
a. progressive atrophy of spinal muscle;
bulbar palsy
b. progressive degeneration of the motor
neurons of the anterior horn cells of the
spinal cord, brainstem, and motor cortex
c. onset in later middle age; more in men
than in women
d. clients with ALS usually die within two to
six years
e. etiology unknown
Upper motor neurons are motor neurons
that originate in of the cerebral cortex or the
brain stem and carry motor information down
to the final common pathway, that is, any
motor neurons that are not directly
responsible for stimulating the target muscle.
Lower motor neurons (LMNs) are the motor
neurons connecting the brainstem and spinal
cord to muscle fibers, bringing the nerve
impulses from the upper motor neurons out to
the muscles
2.Findings
a. usually beginning in the upper body - the
head and arms, the distal portion first
b. mild clumsiness progressing to total
incapacity
c. muscle wasting, atrophy, spasticity
d. speech disorders
e.no change in sensation or autonomic
system
f. death most often from complications:
respiratory failure, urinary or pulmonary
infections for stasis
g.mind usually intact while client has loss of
voluntary and eventually involuntary muscle
functions
c. Visual acuity
d. Thinking and reasoning
Correct answer: A
Infectious Inflammatory Disorders
A. Meningitis
1.Definition/course
a. acute or chronic inflammation of the
meninges
b. average length of illness is four months
2.Types
a. bacterial: mostly contagious; requires
isolation
i. mostly common meningococcal
• the covering of the brain and
spinal cord are involved
• in children 2 to 18 years-old
• in high risk groups
o infants
o adults with weakened or suppressed
immune systems
c. cryptococcal fungal
i. often from bird droppings
ii. organism is found in dirt
iii. common in clients with AIDS
3.Findings
a.severe headache
b.sudden fever
c. altered LOC – decreased
d.photophobia
e.nuchal rigidity – severe pain in the back of
neck when the chin is moved toward the
chest with the client resisting movement
4.Diagnostics
a. history and physical exam
b. positive Kernig's sign: 90-degree flexion
of hip and knee with extension of knee
causes pain
c. positive Brudzinski's sign: flexion of neck
causes flexion of hip and knee
d. lumbar puncture (illustration ) for
characteristics of cerebral spinal fluid -
decreased glucose in bacterial or fungal
infections
e. CT or MRI with and without contrast
f. EEG
Management
a.expected outcomes: to cure the infection
and prevent complications
b.pharmacologic
i. antibiotic therapy depends on the type
of pathogen
ii. preventive therapy for people exposed
to those with meningococcal or
haemophilus influenzae (H flu) meningitis:
rifampin (rifadin)
iii. H flu vaccine
iv. antifungals if fungus
v. anticonvulsants to prevent seizures
c. actions to minimize fever
d.prevention of increased intracranial
pressure or seizures
Nursing interventions
a. care of client with increased ICP
b. seizure precautions
c. administer drugs as ordered
d. provide comfort measures for pain
e. reduce external stimuli and lighting if
photophobia
CARE OF CLIENT WITH INCREASED
INTRACRANIAL PRESSURE
Institute seizure precautions
Administer oxygen as ordered
Monitor for changes in intracranial pressure
Monitor neuro vital signs as ordered
Maintain fluid restriction as ordered
Observe for herniation syndrome
Raise head of bed at 30-45 degrees; avoid
90 degrees since pressure in hip area
increases ICP
Prevent any activities that increase ICP
such as: laughing, straining at stool,
coughing, vomiting, any restrictive clothing
around neck, anxiety, pushing up in bed
with heels, pulling on rails when turning,
neck rotation, flexion or extension
Provide for the care of the unconscious
clients if decreased LOC
SEIZURE PRECAUTIONS
Before seizure
Bed rest with padded side rails
Suction available at the bedside
Oxygen available at bedside
During seizures
Loosen any tight or restrictive clothing.
If clients are falling, gently help them to the
ground and position clients on their side.
Do not place anything in the mouth.
Observe the seizure as it runs its course.
If it lasts longer than 5 minutes, notify
health care provider immediately.
Note the activity and the time it begun and
ended.
Daily life precautions
For children discourage climbing over 10
feet high.
Recommend for clients not to lock
bathroom or shower doors.
If swimming, clients are to have someone
with them who can rescue.
If old enough to drive, clients should be
seizure free for six months. The time may
vary in some states.
Parameningeal infections
Definition
localized collection of exudate in the brain or in
the spinal cord
a recurrent aseptic meningitis
considered noninfectious
Findings
similar to meningitis
headache, fever, stiff neck, altered
consciousness - decreased
Diagnostics
NO lumbar puncture; may cause herniation
computerized tomogram (CT) scan
Management
expected outcomes: to cure infection and
prevent complications
surgical decompression of abscess
symptomatic and preventive treatment as with
meningitis
drugs: antibiotics
Nursing interventions: same as meningitis
except that infectious precautions are not
required
Encephalitis
Definition
acute viral or less commonly bacterial
inflammation, irritation and swelling on the
brain tissue
can occur as epidemics or sporadically
death rate ranges up to 70%
may follow a systemic viral illness such as
chicken pox
Encephalitis
Findings
adult
sudden fever
severe headache
altered LOC – decreased progressing to stupor then
coma with seizure activity
nuchal rigidity
speech or hearing de
change in personality
mild flu-like complaints
infant
vomiting
body stiffness
constant crying that worsens when child picked up
constant full or bulging anterior fontanel
Diagnostics
history and physical exam
CT scan, MRI, EEG
brain biopsy
cerebral spinal fluid – decreased glucose
suggests bacterial or fungal infection
Management
expected outcomes: to cure infection and prevent
infections
uncomplicated cases require supportive and
preventive care
bed or chair rest
support nutritional needs
monitor for fluid balance maintenance
herpes simplex calls for antivirals: vidarabine
(viraA), acyclovir (Zovirax) (illustration )
prevention of increased ICP
antivirals such as acyclovir or ganciclovir
anticonvulsants - prevent seizures
· Nursing interventions
comfort measures for fever
administer drugs as ordered
seizure precautions
care of the client with increased ICP
when needed, ensure isolation and
airborne-droplet precautions
Various Disorders of the Neurologic System
Multiple sclerosis
Definition
demyelination of white matter throughout brain and
spinal cord
third most common cause of disability in clients aged
15 to 60
specific cause unknown
increased incidence in temperate to cool climates
illness improves and worsens unpredictably
Findings depend on the location of the
demyelination
cranial nerve: blurred vision, dysphagia,
diplopia, facial weakness and/or
numbness
motor: weakness, paralysis, spasticity, gait
disturbances
sensory: paresthesias, decreased
proprioception
cerebellar: dysarthria, tremor,
incoordination, ataxia, vertigo
cognitive: decreased short-term memory,
difficulty with new information, word-
finding difficulty, short attention span
urinary retention or incontinence
loss of bowel control
sexual dysfunction
fatigue
Guillain-Barre syndrome
Definition
acquired inflammatory disease
process: demyelinization of peripheral nerves
precipitating factors include prior bacterial or
viral infection within one to two weeks
Findings
muscle weakness: progressive, ascending,
bilateral
leads to paralysis of voluntary muscles
c. Tremors at rest
d. Flaccid muscles
Correct answer: A
CARE OF THE CLIENT ON VENTILATOR
Nutrition
Administer as ordered
IV fluids, meds
Enteral feedings
Evaluate for
balanced fluid intake and output
adequate and balanced nutrition
Hygiene
Provide
a rigorous, scheduled mouth care � prevents
ventilator acquired pneumonia
bed baths and skin care as necessary
eye care if client has decreased LOC
meticulous perineal care to prevent yeast
infections
for the initiation of a bowel regimen with stool
softeners with expected bowel movements at
least every three days
Skin and Muscle Integrity
Prevent the effects of immobility by routine
passive or active range of motion exercises
or get client OOB as tolerated
Minimize decubitus ulcers by avoidance of
rubbing or massaging reddened areas
Reposition client every hour if bed ridden
Safety
Apply bilateral splints as ordered to prevent footdrop
and wristdrop
Provide a safe environment - bed in low position,
side rails up, call light within reach
Initiate seizure precautions if indicated
Sensory Stimulation
Provide appropriate stimulation which means to
schedule groups of tasks to prevent overstimulation
Talk to clients before and during procedures or when
any direct care or when in the room for other
reasons
Explain procedures before beginning them
Encourage family members to talk with
clients about usual family activities
Enhance stimulation by
insertion of hearing aids
a check of glasses for cloudy smeared lens then
clean and put them nearby or on client
a change of lighting in the room to mimic natural
light changes
promotion of the use of electronic battery
devices such as CD � DVD � MP3 players,
radio, television. Have maintenance check for
leakage of currents before use.
Management
expected outcomes: to improve strength
and endurance
pharmacologic
anticholinesterase agents: pyridostigmine
(mestinon), neostigmine (prostigmin)
corticosteroid therapy
immunosuppressants: azathioprine (imuran)
thymectomy
plasma exchange
myasthenic crisis management
crisis usually follows stressor or during dosage
changes usually when being increased
signs: sudden inability to swallow, speak, or
maintain patent airway
cholinergic crisis may follow over dosage of
medication
positive edrophonium (tensilon) test signals
myasthenia
if negative endophronium test, client has not
myasthenic but cholinergic crisis, so treat with
atropine
ventilatory support as indicated
Nursing interventions
electroencephalogram (EEG)
Classifications
Recurrent migraine headache
common migraine
cluster headache
hemiplegic headache
ophthalmoplegic headache
Management of headaches
Expected outcomes: to alleviate pain and treat
underlying cause
Vasoconstriction by pressure or cold
Management of migraine
nonnarcotic analgesics usually when onset
noted: aspirin, acetaminophen (Tylenol),
ibuprofen
narcotic analgesics: codeine, meperidine
(Demerol), morphine
alpha-adrenergic blocking agentblocker:
ergotamine tartrate (Ergostat) without or with
caffeine
steroids: dexamethasone (Decadron)
effects
alternatives for pain relief including
Epidural
usually something lacerates the blood vessels
(arteries) of the middle meninges
since this is arterial bleeding, the risk of death is
greatest
client commonly looses consciousness after injury
then is lucid; then LOC drops quickly with the next
24 hours
Subdural
something has lacerated the blood vessels
(veins) crossing the subdural space
acute: findings surface in 24 to 72 hours after
injury with rapid neurologic deterioration
subacute: findings surface 72 hours to 2
weeks after injury with a slower progression
of deterioration
chronic: gradual clot formation over time,
possibly months with minimal deterioration
Progression of skull fracture injury
Onset: contusions and lacerations of
nerve cells
Neuron death: gradual demyelinization of
affected nerve fibers
Scarring: meninges adheres to injured
area of brain
Complications
Cerebral edema
results in increased intracranial pressure
results directly from cerebral ischemia, anoxia,
and hypercapnia
Diabetes insipidus (DI)
DI results from a decrease release of antidiuretic
hormone (ADH) and body excretes too much fluid
the increase in urinary output results in a low
specific gravity
more common in the initial acute phase of head
injury
Stress ulcer
head injuries activate both the sympathetic and
parasympathetic systems
stimulation of sympathetic system leads to gastric
ischemia from vasoconstriction
stimulation of parasympathetic system leads to
increased release of hydrochloric acid (HCL) into the
stomach
steroid therapy may contribute to the development of
ulcers since steroids increase HCL acid
Syndrome of inappropriate anitdiuretic
hormone (SIADH)
too much ADH is produced
water is excessively retained - hemodilution
urinary output decreases; urine specific granity
increases effect
more common in the chronic phase of care after a
head injury
Seizure disorders
Infection: brain, lungs, urinary system from
immobility
Hyperthermia or hypothermia
Findings of head trauma
Degree of neurological damage varies with
type and location of injury
Restlessness and irritability - initially
Decreased LOC - lethargy, difficulty with
arousal
Headache
Nausea and vomiting - projectile vomiting
indicates increased ICP
Diagnostics
physical
speech
behavioral
occupational
Nursing interventions
Provide care of the client with increased
intracranial pressure
seizure precautions
seizure care
Definition/etiology
is a disorder of cranial nerve seven (facial
nerve)
involves one side only; unilateral
analgesics