Professional Documents
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PROBLEMS RELATED TO
NEUROLOGICAL SYSTEM
♦ Behavioral changes
♦ Loss of consciousness
♦ Memory loss
♦ Headache
Neurological Examination
♦ Memory
– Recent – ability to recall immediate events
– Remote – ability to remember past events
♦ Speech
– Aphasia – impairment of language function
– Dysarthria – indistinctness of word articulation
or enunciation resulting from inference with
peripheral speech mechanisms
Neurological Examination
♦ Motor
– Decerebrate rigidity – arms stiffly extended and
abducted with hyperpronation of arms
– Decorticate rigidity – arms, wrisht and fingers
are flexed; arms are adducted; in both, legs
fully extended and internally rotated with
plantar flexion of feet
– Paresis – impaired strength or power
– Paralysis – loss of strength
Neurological Examination
– Brudzinski sign
• Forward flexion of pt’s head by examiner; abn =
flexion of ankle knee or thigh
– Cremasteric = stroke medial surface of upper
thigh = elevation of scrotum and testicle
Diagnostic Procedures or Tests
♦ Cerebral angiography,
pneumoencephalography, ventriculography
contrast studies
– Cerebral Angiography – visualization of brain’s
vascular system by injection contrast dye into
the circulation blood
– Pneumoencephalography – visualization of
ventricles and subarachnoid spaces by
withdrawal of CSF and injection of air or
oxygen into subarachnoidal space through
lumbar puncture
Diagnostic Procedures or Tests
♦ Unconsciousness
– State of depressed cerebral function in which
reaction to stimuli is lost and any response, if
present is on the reflex level
– Causes
• A Alcohol
• E Epilepsy
• I Insulin
• O Opiates
• U Urates
Unconsciousness
– Causes
• T Trauma
• I Infection
• P Psychological
• P Poison
• S Shock
– Basic mechanism – interruption of oxygen
supply and glucose supply
Unconsciousness
– Objectives of care:
• A. assess for and maintain patent airway
• B. monitor VS and neurological status
• C. maintain integrity of skin
– Bedsores class:
– Grade 1 – erythema
– 2 – dermis
– 3 – subcutaneous
– 4 – muscle
– 5 – joints and body cavities
Unconsciousness
♦ Nursing Assessment
– A. swelling of optic disk
– B. headache, vomiting projectile
– C. decreasing level of consciousness
– D. pupillary signs – ipsilateral pupil – affected is
dilated
– E. blood pressure – increased systolic and decreased
diastolic (widening pulse pressure)
– F. decreased PR and RR
– G. respiration – cheyne-stokes
– H. temperature regulation – increased temperature
Increased intracranial pressure
♦ Nursing management:
– A. positioning – HOB elevated 15-30o
– B. activites: no coughing, sneezing or straining at stool
valsalva maneuver
– C. avoid hip, waist, neck flexion; avoid rotation of head
especialy to right
– D. space out nursing activities
– E. perform suctioning only PRN
Increased intracranial pressure
♦ Seizures (Convulsions)
– Brief cerebral storms associated with sudden
excessive and disorderly electrical discharges
from the brain.
– Nursing observations:
• A. Aura – symptoms that occur during the prodome
of seizure (numbness, dizziness, yawning, smells).
Seizures
• B. During
– Never leave alone
– If standing, lower to floor to prevent injury
– Loosen constrictive clothing
– Do not restrain
– Do not pry jaw open to place padded tongue
blade
– Pad side rails; no pillows
• C. Postictal phase – normally groggy and
confused; deep sleep also follows
Common Neurological Disorders
♦ Etiology:
– A. Thrombosis – most common cause of cerebral
infarct (atherosclerosis)
– B. Embolism – increased incidence after 40 years
Common Neurological Disorders
♦ Intracerebral hemorrhage
– Within brain substance most common cause –
rupture of arteriosclerotic hypertensive vessels
– most common cause of death in CVA
– Middle cerebral artery – most common site
♦ Nursing Assesment:
– A. mental confusion, drowsiness, headache, transient
loss of speech, TIA, hemiplegia or paresthesias to
paralysis
– B. typical headache, vomiting, seizures, coma, nuchal
rigidity, fever, hpn, confusion disorientation
– C. Focal symptoms – weakness, paralysis, sensory loss,
language disorders, reflex changes
– D. Fatal – increased temperature, PR and RR; increased
depth of coma and collapse of vasomotor and heat
regulating centers
Intracerebral Hemorrhage
♦ Nursing management:
– A. Decrease salt diet, oxygen therapy
– B. intubation and mechanical ventilation
– C. GI decomopression, NGT
– D. Semi-fowler’s position
– E. Antacid, anticoagulants, antihpn
– F. Anticonvulsants
Intracerebral Hemorrhage
– G. intracranial surgery
• Craniectomy – portion of cranium is permanently
removed to relieve pressure on brain structures to
provide space for expansion
• Craniotomy – surgical opening into skull
– Position – not in operative site
– Superatentorial – HOB elevated at 30o
– Infratentorial – flat without head elevation to
prevent pressure on brain stem structures
Neurologic Degenerative Diseases
♦ Parkinson’s disease
– Degeneration and destruction of nerve cells of
the basal ganglia throughout the brain (loss of
dopamine – neurotransmitter with
anticholinergic effect)
– Incidence: men and women (50-60 y/o)
– Cause: unknown
– Signs and symptoms: cogwheel rigidity; pill
rolling or resting tremor; masklike appearance
of face; slow monotonous speech
Parkinson’s Disease
– Nursing management:
• Levo-dopa to increase dopamine
• Sinemet to prevent breakdown of dopamine
Neurologic Degenerative Diseases
♦ Multiple Sclerosis
– Multiple patches of demyelination or nerve
degeneration throughout the brain and spinal
cord
– Cause: unknown
– Incidence: women
– Signs and symptoms: Charcot’s triad –
nystagmus, intention tremor, scanning speech,
muscular and gait incoordination
Multiple Sclerosis
– Nursing management:
• Baclofen – to decrease spasms
• Symptomatic
Neurologic Degenerative Diseases
♦ Myasthenia Gravis
– Decreased secretion of acetylcholine or
increase in cholinesterase at the myoneural
junction leading to transmission failure
– Etiology: autoimmunity
– Incidence: young adults (women)
Myasthenia Gravis
– Signs and Symptoms:
• Muscular weakness
• Fatigue
• Ptosis
• Weight loss
• Muscle atrophy