• Infectious Disease

• Meningitis
• Brain abscess
• Encephalitis
• Neoplastic disease

IMPLEMENTATION PHASE
Increased Intracranial pressure
Altered level of consciousness
Seizures
Autonomic dysreflexia/hyperreflexia
Spinal shock
Cognitive impairment
Bowel incontinence
Impaired physical mobility
Impaired swallowing
Disturbed sensory perception

INCREASED INTRACRANIAL PRESSURE

Intracranial pressure more than 15 mmHg
Brunner: Normal ICP 10-20 mmHg
Causes:
Stroke
Head injury
Inflammatory lesions
Brain tumor
Surgical complications
Intracranial Components
80% Brain tissue
10% CSF
Key to Success! 10% Cerebral blood
Confidence
Test taking strategies The Monro-Kellie Hypothesis
Ample test preparation and study habits The skull is a closed vault. Any increase in
Review of frequent board examination topics one component will increase ICP.
Focus on your GOALS
Above all- PRAYERS Any increase or alteration in these structures
will cause increased ICP
Neurology Course Outline An increased ICP diminishes the functioning
Brief review of Anatomy and Physiology of various cranial areas vital centers.
Application of the Nursing process in the Increased Intracranial pressure
approach of neurologic problems:
ASSESSMENT – relevant techniques and lab Pathophysiology
procedures Compensatory mechanisms:
DIAGNOSIS 1. Increased CSF absorption
PLANNING 2. Blood shunting
IMPLEMENTATION 3. Decreased CSF production
EVALUATION
• Trauma and related accidents Decompensatory mechanisms:
• Traumatic brain injury 1. Decreased cerebral perfusion
• Spinal cord injury 2. Decreased PO2 leading to brain hypoxia
• Cerebrovascular Accidents 3. Cerebral edema
• Neurology Course Outline 4. Brain herniation
• Degenerative disorders- Demyelinating
• Multiple sclerosis Decreased cerebral blood flow
• Guillain-Barre’ syndrome
• Degenerative disorders- Non- Vasomotor reflexes are stimulated initiallyà
demyelinating slow bounding pulses
• Alzheimer’s disease Increased concentration of carbon dioxide
• Parkinson’s disease will cause VASODILATION à increased flowà
• Neurology Course Outline increased ICP
• Motor dysfunction- CNS
• Epilepsy Cerebral Edema
• Motor dysfunction- cranial nerve Abnormal accumulation of fluid in the
• Bell’s palsy intracellular space, extracellular space or
• Trigeminal neuralgia both.
• Motor dysfunction- peripheral
• Myasthenia gravis Herniation
Results from an excessive increase in ICP
when the pressure builds up and the brain
tissue presses down on the brain stem
Cerebral response to increased ICP
Steady perfusion up to 40 mmHg
Cushing’s response
Vasomotor center triggers rise in BP to
increase ICP
Sympathetic response is increased BP but
the heart rate is SLOW
Respiration becomes SLOW
Increased Intracranial pressure
CLINICAL MANIFESTATIONS
Early manifestations:
Changes in the LOC- usually the earliest
Pupillary changes- fixed, slowed response
Headache
vomiting
Increased Intracranial pressure
late manifestations:
Cushing reflex- systolic hypertension,
bradycardia and wide pulse pressure
bradypnea
Hyperthermia
Abnormal posturing
Increased Intracranial pressure
Nursing interventions:
Maintain patent airway
1. Elevate the head of the bed 15-30
degrees- to promote venous drainage
2. assists in administering 100% oxygen
or controlled hyperventilation- to reduce the
CO2 blood levelsàconstricts blood
vesselsàreduces edema
Increased Intracranial pressure
Nursing interventions
3. Administer prescribed medications-
usually
Mannitol- to produce negative fluid balance
corticosteroid- to reduce edema
anticonvulsants-p to prevent seizures
Increased Intracranial pressure
Nursing interventions
4. Reduce environmental stimuli
5. Avoid activities that can increase ICP like
valsalva, coughing, shivering, and vigorous
suctioning
Increased Intracranial pressure
Nursing interventions
6. Keep head on a neutral position. AVOID-
extreme flexion, valsalva
7. monitor for secondary complications
Diabetes insipidus- output of >200 mL/hr
SIADH
Altered level of consciousness
It is a function and symptom of multiple
pathophysiologic phenomena
Causes: head injury, toxicity and metabolic
derangement
Disruption in the neuronal transmission
results to improper function
Altered level of consciousness
Assessment
Orientation to time, place and person
Motor function
Decerebrate
Decorticate
Sensory function
Altered level of consciousness
Patient is not oriented
Patient does not follow command
Patient needs persistent stimuli to be awake
COMA= clinical state of unconsciousness
where patient is NOT aware of self and
environment
Altered level of consciousness
Etiologic Factors
Head injury
Stroke
Drug overdose
Alcoholic intoxication
Diabetic ketoacidosis
Hepatic failure
Altered level of consciousness
Behavioral changes initially
Pupils are slowly reactive
Then , patient becomes unresponsive and
pupils become fixed dilated
Glasgow Coma Scale is utilized
Altered level of consciousness
Nursing Intervention
1. Maintain patent airway
Elevate the head of the bed to 30 degrees
Suctioning
2. Protect the patient
Pad side rails
Prevent injury from equipments, restraints
and etc.
Altered level of consciousness
Nursing Intervention
3. Maintain fluid and nutritional balance
Input an output monitoring
IVF therapy
Feeding through NGT
4. Provide mouth care
Cleansing and rinsing of mouth
Petrolatum on the lips
Altered level of consciousness
Nursing Intervention
5. Maintain skin integrity
Regular turning every 2 hours
30 degrees bed elevation
Maintain correct body alignment by using
trochanter rolls, foot board
6. Preserve corneal integrity
Use of artificial tears every 2 hours
Altered level of consciousness
Nursing Intervention
7. Achieve thermoregulation
Minimum amount of beddings
Rectal or tympanic temperature
Administer acetaminophen as prescribed
8. Prevent urinary retention
Use of intermittent catheterization
Altered level of consciousness
Nursing Intervention
9. Promote bowel function
High fiber diet
Stool softeners and suppository
10. Provide sensory stimulation
Touch and communication
Frequent reorientation
SEIZURES
Episodes of abnormal motor, sensory,
autonomic activity resulting from sudden
excessive discharge from cerebral neurons
A part or all of the brain may be involved
SEIZURES
PATHOPHYSIOLOGY
An electrical disturbance in the nerve cells in
one brain sectionà EMITS ELECTRICAL
IMPULSES excessively
SEIZURES
ETIOLOGIC FACTORS
Idiopathic
Fever
Head injury
CNS infection
Metabolic and toxic conditions
SEIZURES
Nursing Interventions
During seizure
1. remove harmful objects from the
patient’s surrounding
2. ease the client to the floor
3. protect the head with pillows
4. Observe and note for the duration,
parts of body affected, behaviors before
and after the seizure
5. loosen constrictive clothing
6. DO NOT restrain, or attempt to place
tongue blade or insert oral airway
Nursing Interventions
POST seizure
1. place patient to the side to drain
secretions and prevent aspiration
2. help re-orient the patient if confused
3. provide care if patient became
incontinent during the seizure attack
4. stress importance of medication
regimen
AUTONOMIC
DYSREFLEXIA/HYPERREFLEXIA
Seen commonly in spinal cord injury above
T6
An exaggerated response by the autonomic
system resulting from various stimuli most
commonly distended bladder, impacted
feces, pain, skin irritation
Autonomic Dysreflexia/hyperreflexia
Clinical MANIFESTATIONS
1. Hypertension
2. Bradycardia
3. severe pounding headache
4. diaphoresis
5. nausea and nasal congestion
Autonomic Dysreflexia/hyperreflexia
NURSING INTERVENTIONS
1. Elevate the head of the bed
immediately
2. Check for bladder distention and empty
bladder with urinary catheter
3. Check for Fecal impaction and other
triggering factors like skin irritation, pressure
ulcer
4. Administer antihypertensive medications-
usually hydralazine
Spinal Shock
Pathophysiology
The sudden depression of reflex activity in
the spinal cord below the level of injury
The muscles below the lesion are flaccid, the
skin without sensation and the reflexes are
absent including bowel and bladder functions
Spinal Shock
Nursing Interventions
1. Assist in chest physical therapy
2. Manage potential complication- DVT
Cognitive Impairment
Nursing Interventions
Assist or encourage the patient to use
eyeglass, hearing aid or assistive devices
Reorient the patient by calling his name
frequently
Provide background information as to date,
time, place, environment
Cognitive Impairment
Nursing Interventions
4. Use large signs as visual cues
5. Post patient's photo on the door
6. Encourage family members to bring
personal articles and place them in the same
area
Bowel and Bladder incontinence
Establish a regular pattern for bowel care
Place the patient on potty every other day
Use of stool softeners
Maintain a dietary intake. Avoid foods that
can cause excessive gas production
Impaired Swallowing
Elevate the head of the be 90 degrees during
meals and 30 minutes after
Serve foods that are soft and small sized
Keep suction equipment on bedside
Consult with rehabilitation team as to
assistive devices that can be utilized
CONGENITAL DISORDERS:
HYDROCEPHALUS
Excessive CSF accumulation in the brain’s
ventricular system
In infants, head enlarges
In children and adults- brain compression
Non-communicating hydrocephalus results
from CSF outflow obstruction
Communicating hydrocephalus results from
faulty absorption or increased CSF
production
ASSESSMENT
1. irritability
2. change in LOC
3. infants- enlargement of the head, thin
scalp skin
4. sunset eyes
DIAGNOSTIC TESTS
1. Skull x-ray
2. ventriculography

NURSING INTERVENTION
1. monitor neurologic status
2. teach parents to watch for signs of shunt
malfunction, and periodic surgery to
lengthen the shunt as child grows
CONGENITAL DISORDER- Spinal cord defects
1. Spina bifida occulta- incomplete closure of
one or more vertebrae without protrusion of
the spinal cord or meninges
2. Spina bifida with meningocele- a sac
contains meninges and CSF
3. Spina bifida with meningomyelocele- a sac
contains spinal cord substance, meninges
and CSF
CONGENITAL DISORDER: Spinal cord defects
Causes
1. environmental factors
2. radiation
3. folic acid deficiency in a pregnant woman
4. possibly genetic
ASSESSMENT
1. a dimple or tuft of hair in the vertebral
area
2. external sac
DIAGNOSIS
1. Spinal x-ray
2. myelography
NURSING INTERVENTION
1. cover the defect with sterile dressing
moistened with sterile saline
2. position the patient on prone or side to
protect the fragile sac
3. place a diaper under the infant and
change it often
4. avoid the use of lotion
5. avoid frequent handling
6. Measure the child’s head circumference
daily
7. check anal reflex
8. support family members
9. prepare the parents for the possible
outcome of eh defect
10. Post-operative care
Position on abdomen
Check post-operative dressings
Place infant’s hips in abduction and feet in
neutral position
Monitor intake and output
Check for urine retention
Asess infant frequently as he recovers from
the surgery
TRAUMATIC BRAIN INJURY
1. CONCUSSION
Involves jarring of head without tissue injury
Temporary loss of neurologic function lasting
fore a few minutes to hours
Traumatic brain injury
2. CONTUSION
Involves structural damage
The patient becomes unconscious for hours
Traumatic brain injury
3. Diffuse Axonal injury
Involves widespread damage to the neurons
Patient has decerebrate and decorticate
posture
Traumatic brain injury
4. Intracranial hemorrhage
Epidural Hematoma- blood collects in the
epidural space between skull and dura
mater. Usually due to laceration of the
middle meningeal artery
Symptoms develop rapidly
Traumatic brain injury
4. Intracranial hemorrhage
Subdural hematoma- a collection of blood
between the dura and the arachnoid mater
caused by trauma. This is usually due to tear
of dural sinuses or dural venous vessels
Symptoms usually develop slowly
Traumatic brain injury
4. Intracranial hemorrhage
Intracerebral Hemorrhage and hematoma-
bleeding into the substance of the brain
resulting from trauma, hypertensive rupture
of aneurysm, coagulopahties, vascular
abnormalities
Symptoms develop insidiously,
beginning with severe headache and
neurologic deficits
Traumatic brain injury
MANIFESTATIONS
1. Altered LOC
2. CSF otorrhea
3. CSF rhinorrhea
4. Racoon eyes and battle sign
HALO SIGN- blood stain surrounded by a
yellowish stain
Traumatic brain injury
NURSING MANAGEMENT
1. Monitor for declining LOC- use of
Glasgow
2. Maintain patent airway
Elevate bed, suction prn, monitor ABG
Traumatic brain injury
3. Monitor F and E balance
Daily weights
IVF therapy
Monitor possible development of DI and
SIADH
4. Provide adequate nutrition
5. Prevent injury
Use padded side rails
Minimize environmental stimuli
Assess bladder
Consider the use of intermittent
catheter
6. Maintain skin integrity
Prolonged immobility will likely cause
skin breakdown
Turn patient every 2 hours
Provide skin care every 4 hours
Avoid friction and shear forces
7. Monitor potential complications
Increased ICP
Post-traumatic seizures
Impaired ventilation
Spinal cord injury
The most frequent vertebrae – C5-C7, T12 Aphasia
and L1 Dysphagia
Concussion HEMIPARESIS on the OPPOSITE side- more
Contusion severe on the face and arm than on the legs
Compression Localization
Transection Anterior cerebral artery:
Spinal cord injury Weakness
Numbness on the opposite side
Clinical manifestations Personality changes
1. Paraplegia Impaired motor and sensory function
2. quadriplegia Localization
3. spinal shock Posterior cerebral artery:
Spinal cord injury Visual field defects
DIAGNOSTIC TEST Sensory impairment
Spinal x-ray Coma
CT scan Less likely paralysis
MRI
Spinal cord injury CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
EMERGENCY MANAGEMENT There is disruption of the cerebral blood flow
A-B-C due to obstruction by embolus or thrombus
Immobilization RISKS FACTORS
Immediate transfer to tertiary facility Non-modifiable
Spinal cord injury Advanced age
Gender
NURSING INTERVENTION race
1. Promote adequate breathing and airway Modifiable
clearance Hypertension
2. Improve mobility and proper body Cardio disease
alignment Obesity
3. Promote adaptation to sensory and Smoking
perceptual alterations Diabetes mellitus
4. Maintain skin integrity hypercholesterolemia
5. Maintain urinary elimination Pathophysiology of ischemic stroke
6. Improve bowel function Disruption of blood supply
7. Provide Comfort measures Anaerobic metabolism ensues
8. Monitor and manage complications Decreased ATP production leads to impaired
Thromboplebhitis membrane function
Orthostatic hypotension Cellular injury and death can occur
Spinal shock
Autonomic dysreflexia DIAGNOSTIC test
Spinal cord injury 1. CT scan
9. Assists with surgical reduction and 2. MRI
stabilization of cervical vertebral column 3. Angiography

CEREBROVASCULAR ACCIDENTS CLINICAL MANIFESTATIONS

An umbrella term that refers to any 1. Numbness or weakness
functional abnormality of the CNS 2. confusion or change of LOC
related to disrupted blood supply 3. motor and speech difficulties
CEREBROVASCULAR ACCIDENTS 4. Visual disturbance
Can be divided into two major 5. Severe headache
categories Motor Loss
1. Ischemic stroke- caused by thrombus Hemiplegia
and embolus Hemiparesis
2. Hemorrhagic stroke- caused Communication loss
commonly by hypertensive bleeding Dysarthria= difficulty in speaking
Aphasia= Loss of speech
The stroke continuum Apraxia= inability to perform a previously
1. TIA- transient ischemic attack, temporary learned action
neurologic loss less than 24 hours Perceptual disturbances
duration Hemianopsia
2. Reversible Neurologic deficits Sensory loss
3. Stroke in evolution paresthesia
4. Completed stroke
NURSING INTERVENTIONS: ACUTE
General manifestations Ensure patent airway
Localization Keep patient on LATERAL position
Middle cerebral artery: Monitor VS and GCS, pupil size
IVF is ordered but given with caution as not Usually due to rupture of intracranial
to increase ICP aneurysm, AV malformation, Subarachnoid
NGT inserted hemorrhage
Medications: Steroids, Mannitol (to decrease Sudden and severe headache
edema), Diazepam Same neurologic deficits as ischemic stroke
Loss of consciousness
NURSING INTERVENTIONS: Hospital Meningeal irritation
1. Improve Mobility and prevent joint Visual disturbances
deformities
Correctly position patient to prevent DIAGNOSTIC TESTS
contractures 1. CT scan
Place pillow under axilla 2. MRI
Hand is placed in slight supination- “C” 3. Lumbar puncture (only if with no increased
Change position every 2 hours ICP)
2. Enhance self-care
Carry out activities on the unaffected side NURSING INTERVENTIONS
Prevent unilateral neglect- place some items 1. Optimize cerebral tissue perfusion
on the affected side!!! 2. relieve Sensory deprivation and anxiety
Keep environment organized 3. Monitor and manage potential
Use large mirror complications
3. Manage sensory-perceptual difficulties
Approach patient on the Unaffected side MULTIPLE SCLEROSIS
Encourage to turn the head to the affected  An auto-immune mediated
side to compensate for visual loss progressive demyelinating
4. Manage dysphagia disease of the CNS
Place food on the UNAFFECTED side  The myelin sheath is destroyed
Provide smaller bolus of food and replaced by sclerotic tissue
Manage tube feedings if prescribed (sclerosis)
5. Help patient attain bowel and bladder  MULTIPLE SCLEROSIS
control  CAUSE- unknown
Intermittent catheterization is done in the  Multiple factors- viral infection,
acute stage environmental factors, geographic
Offer bedpan on a regular schedule location and genetic predisposition
High fiber diet and prescribed fluid intake  Common in WOMEN ages 20-40
6. Improve thought processes  MULTIPLE SCLEROSIS
Support patient and capitalize on the PATHOPHYSIOLOGY
remaining strengths  Sensitized T cells will enter the brain
7. Improve communication and promote antibody production that
Anticipate the needs of the patient damages the myelin sheath
Offer support  Plaques of sclerotic tissues appear on
Provide time to complete the sentence the demyelinated axons interrupting
Provide a written copy of scheduled activities the neuronal transmission
Use of communication board  MULTIPLE SCLEROSIS
Give one instruction at a time  The most common areas affected are
8. Maintain skin integrity  Optic nerves and chiasm
Use of specialty bed  Cerebrum
Regular turning and positioning  Cerebellum
Keep skin dry and massage NON-reddened  Spinal cord
areas  MULTIPLE SCLEROSIS
Provide adequate nutrition CLINICAL MANIFESTATIONS
9. Promote continuing care  1. visual problems such as
Referral to other health care providers diplopia, blurred vision and
10. Improve family coping nystagmus
11. Help patient cope with sexual  2. motor dysfunction-
dysfunction mono/qudradiplegia
 3. Fatigue, sensory impairment
MEDICAL MANAGEMENT  4. Mental changes like mood swings,
Pharmacologic: depression
Aspirin  5. spasticity, ataxia
Diazepam to prevent seizures  MULTIPLE SCLEROSIS
Thrombolytics DIAGNOSTIC TESTS
Stool softeners  1. MRI- primary diagnostic study
Antihypertensives  2. CSF Immunoglobulin G
Analgesics, Muscle relaxants, STEROIDS  MULTIPLE SCLEROSIS
NURSING INTERVENTIONS
Normal brain metabolism is impaired by 1. Promote physical mobility
interruption of blood supply, compression  Exercise
and increased ICP  Schedule activity and rest periods
  Warm packs over the spastic area
 Swimming and cycling are very useful
2. Prevent injuries
 Wide stance walking
 Use of walking aids
 Wheelchair
3. Enhance bladder and bowel control
 Set a voiding schedule
 Intermittent bladder catheterization
 Use of condom catheter
 Adequate fluids, dietary fibers and
bowel training program
4. Manage speech and swallowing
difficulties
 Careful feeding, proper positioning,
suction machine availability
 Speech therapist
5. Improve Sensory and Cognitive
function
 Vision- use eye patch for diplopia
 Obtain large printed reading materials
 Offer emotional support
 Involve the family in the care
6. Strengthen coping mechanism
 Alleviate the stress
 Referral to the appropriate agencies
7. improve self-care abilities
 Modify activities according to physical
strength
 Provide assistive devices
8. promote sexual functioning
 Refer to sexual counselor
MEDICAL MANAGEMENT
Pharmacotherapy
 Interferons
 Immunomodulators
 Corticosteroids
 BACLOFEN for muscle spasms
 NSAIDS for pain
 Antidepressants
GUILLIAN-BARRE’ SYNDROME
 An auto-immune attack of the
peripheral nerve myelin
 Acute, rapid segmental
demyelination of peripheral
nerves and some cranial nerves
 POTENTIALLY FATAL!
 Guillian-Barre’ Syndrome
 CAUSE: post-infectious
polyneuritis of unknown origin
commonly follows viral infection
 PATHOPHYSIOLOGY
 Cell-mediated immune
attack to the myelin sheath
of the peripheral nerves
 Infectious agent may elicit
antibody production that
can also destroy the myelin
sheath of the PERIPHERAL
NERVES!!
 Because this syndrome causes
inflammation and degenerative
changes in the posterior and
anterior nerve roots, MOTOR and
SENSORY losses occur
SIMULTANEOUSLY!
CLINICAL MANIFESTATIONS
 1. Ascending weakness and
paralysis: Leg affected first
 2. diminished reflexes of the lower
extremities
 3. paresthesia
 4. potential respiratory failure
LABORATORY EXAMINATION
1. CSF protein level is INCREASED
but the WBC remains normal in
the CSF
2. EMG and nerve conduction
velocity studies
NURSING INTERVENTIONS
1. Maintain respiratory function
 Chest physiotherapy and
incentive spirometry
 Mechanical ventilator
 Guillian-Barre’ Syndrome
2. Enhance physical mobility
 Support paralyzed extremities
 Provide passive range of motion
exercise
 Prevent DVT and pulmonary
embolism
 Padding over bony prominences
3. Provide adequate nutrition
 IVF
 Parenteral nutrition
 Assess frequently return of gag
reflex
4. Improve communication
 Use other means of
communication
5. Decrease fear and anxiety
 Provide Referrals
 Answer questions
 Provide diversional activities
6. Monitor and manage complications
 DVT, Urinary retention,
pulmonary embolism,
respiratory failure
MEDICAL MANAGEMENT
 ICU admission
 Mechanical Ventilation
 TPN and IVF
 PLASMAPHERESIS
 IV IMMUNOGLOBULIN
ALZHEIMER’S disease
 A progressive neurologic disorder
that affects the brain resulting in
cognitive impairments
CAUSES:
 Unknown
 Potential factors- Amyloid plaques
in the brain, Oxidative stress,
neurochemical deficiencies
CLINCAL MANIFESTATIONS
 1. Forgetfulness
 2. Recent memory loss
 3. Difficulty learning
 4. Deterioration in personal hygiene
 5. Inability to concentrate
LATE CLINICAL MANIFESTATIONS
 6. Difficulty in abstract thinking
 7. Difficulty communicating
 8. Severe deterioration in memory,
language and motor function
 9. repetitive action- perseveration
 10. personality changes
DIAGNOSTIC TEST
 Neurologic examination
 PET scan
 EEG, CT and MRI
 Other tests to rule out Vit B
deficiencies and hypothyroidism
 Biopsy is the most definitive
DRUG THERAPY
 1. drugs to treat behavioral
symptoms- antipsychotics
 2. anxiolytics
 3. Donepezil
 4. Tacrine
Nursing Interventions
 1. Support patient’s abilities
 2. Provide emotional support
 ALZHEIMER’S disease
3. Establish an effective
communication system with the patient
and family
 Use short simple sentences,
words and gestures
 Maintain a calm and consistent
approach
 Attempt to analyze behavior for
meaning
4. protect the patient from injury
 Provide a safe and structured
environment
 Requests a family member to
accompany client if he wanders
around
 Keep bed in low position
 Provide adequate lightning
 Assign consistent caregivers
5. Encourage exercise to maintain
mobility
PARKINSON’s Disease
 A slowly progressing neurologic
movement disorder
 The degenerative idiopathic form
is the most common form
CAUSATIVE FACTORS: unknown
 Potential factors: genetics,
atherosclerosis, free radical
stress, viral infection, head
trauma and environmental factors
Pathophysiology
 Decreased levels of dopamine due to
destruction of pigmented neuronal
cells in the substantia nigra in the
basal ganglia
 Clinical symptoms do not appear until
60% of the neurons have disappeared
CLINICAL MANIFESTATIONS
 1. Tremor- resting, pill-rolling
 2. Rigidity- cog-wheel, lead-pipe
 3. Bradykinesia- abnormally slow
movement
 4. Dementia, depression, sleep
disturbances and hallucinations
 5. excessive sweating, paroxysmal
flushing, orthostatic hypotension
Medical management
 1. Anti-parkinsonian drugs- Levodopa,
Carbidopa
 2. Anti-cholinergic therapy
 3. Antiviral therapy- Amantadine
 4. Dopamine Agonists- bromocriptine
and Pergolide, Ropirinole anmd
Pramipexole
 5. MAOI
 6. Anti-depressants
 7. Antihistamine
NURSING INTERVENTIONS
 1. Improve mobility
 2. Enhance Self- care activities
 3. Improve bowel elimination
 4. Improve nutrition
 5. Enhance swallowing
 6. Encourage the use of assistive
devices
 7. improve communication
 8. Support coping abilities
EPILEPSY
 A group of syndromes characterized
by recurring seizures

CAUSES
1. idiopathic 6. brain tumors
2. Birth trauma 7. head Injury
3. perinatal infection 8. metabolic
disorders
4. infectious disease 9. CVA
5. ingestion of toxins
EPILEPSY
 Recurring seizures may be classified
as GENERALIZED or PARTIAL SEIZURES
 Generalized Seizures- cause a
generalized electrical abnormality
within the brain
 Partial seizures- these seizures arise
from a localized part of the brain and
cause specific symptoms
GENERALIZED SEIZURES
 1. General Tonic-Clonic seizure-
(Grand mal) characterized by loss of
consciousness and alternating
movements of the extremities
 2. Absence Seizure (Petit mal)-
common in children, begins with a
brief change in the LOC, indicated by
blinking, rolling of eyes and blank
stares
 3. Myoclonic seizure- characterized by
brief, involuntary muscular jerks of
body extremities
  4. Akinetic seizure- general loss of
postural tone and a temporary loss of
consciousness- a drop attack
PARTIAL SEIZURES
 1. Simple partial seizure- typically
limited to one cerebral hemisphere
 2. Complex partial seizure- begins with
an aura, then with impaired
consciousness, with purposeless
behaviors like lip-smacking, chewing
movements
DIAGNOSTIC TESTS
 1. EEG
 2. CT
 3. MRI
 4. LP
 5. Angiography
Medical treatment
 1. Anticonvulsants- most commonly
phenytoin, phenobarbital and
carbamazepine
 Ethosuximide and valproic acid for
absence seizure
 2. surgery
Nursing Intervention
 1. Care of patients during seizure
 2. care of patients after seizures
 3. patient teaching
TRIGEMINAL NEURALGIA
 Also called Tic Douloureux
 Painful disorder that affects one or
more branches of the fifth cranial
nerve
CAUSES: repetitive pulsation of an artery as
it exits the pons is the usual cause
ASSESSMENT
 1. Pain history
 2. Searing or burning jabs of pain
lasting from 1-15 minutes in an area
innervated by the trigeminal nerve
DIAGNOSTIC TESTS
Skull x-ray or CT scan
NURSING INTERVENTIONS
 1. provide emotional support
 2. encourage to express feelings
 3. provide adequate nutrition in small
frequent meals at room temperature
 Myasthenia gravis
 A sporadic, but progressive
weakness and abnormal
fatigability of striated muscles
which are exacerbated by exercise
and repetitive movements
MYASTHENIA GRAVIS

BELL’S PALSY ETIOLOGY

 Autoimmune disease
CAUSES  Thymoma
 1. infection Women suffer at an earlier age and are more
 2. hemorrhage affected
 3. tumor
 4. local traumatic injury Pathophysiology:
 1. Acetylcholine receptor antibodies
MANIFESTATIONS interfere with impulse transmission
 1. Unilateral facial weakness  2. Follows an unpredictable course of
 2. Mouth drooping periodic exacerbations and remissions
 3. Distorted taste perception  Myasthenia gravis
 4. Smooth forehead  CAUSE: autoimmune disorder that
 5. Inability to close eyelid on the impairs transmission of nerve
affected side impulses
 6. Incomplete eye closure
 7. excessive tearing when attempting ASSESSMENT FINDINGS
to close the eyes 1. Gradually progressive skeletal muscle
 8. Inability to raise eyebrows, puff out weakness and fatigue
the cheek 2. Weakness that worsens during the day
3. Ptosis, diplopia and weak eye
Diagnostic tests closure
 EMG 4. Blank, mask-like facies
5. Difficulty chewing and swallowing
Medical management 6. Respiratory difficulty
 1. Prednisone  Myasthenia gravis
 2. Artificial tears
DIAGNOSTIC TESTS
Nursing Interventions  1. EMG
 1. Apply moist heat to reduce pain  2. TENSILON TEST (Edrophonium)
 2. Massage the face to maintain  3. CT scan
muscle tone  4. Serum anti-AchReceptor antibodies
 3. Give frequent mouth care  Myasthenia gravis
 4. protect the eye with an eye patch.
Eyelid can be taped at night MEDICAL THERAPY
 5. instruct to chew on unaffected side
  Anticholinesterase drugs-
pyridostigmine and neostigmine
 Corticosteroids
 Immunosuppresants
 Plasmapheresis
 Thymectomy
 Myasthenia gravis
NURSING INTERVENTIONS
 1. Administer prescribed medication
as scheduled
 2. Prevent problems with chewing and
swallowing
 3. Promote respiratory function
 4. Encourage adjustments in lifestyle
to prevent fatigue
 5.maximize functional abilities
 6. Prepare for complications like
myasthenic crisis and cholinergic crisis
 7. prevent problems associated with
impaired vision resulting from ptosis of
eyelids
 8. provide client teaching
 9. promote client and family coping
CNS INFECTIONS
MENINGITIS
 Infection or inflammation of the
meninges covering the brain and
spinal cord.
 Caused by bacterial, viral and fungal
agents
NURSING INTERVENTIONS
 1. Frequent monitoring of neurologic
status
 2. Monitor intake and output
 3. Administer antibiotics
 4. Administer mild laxative to prevent
constipation
 5. maintain quiet environment
Neoplastic diseases
 A brain tumor is a localized
intracranial lesion that occupies space
within the skull
 Primary brain tumors originate from
cells and structures within the brain.
 Neoplastic disease
 The cause of brain tumors is unknown
 The only risk factor accepted is
radiation exposure to ionization rays
 Neoplastic disease
CLINICAL MANIFESTATIONS
 1. increased ICP
 Vomiting
 Headache. Especially early in
the morning
 Vomiting
 Visual disturbances
 2. Localized symptoms
 Hemiparesis
 Seizures
 Mental status changes

BRAIN ABSCESS DIAGNOSTIC TESTS

 A free or encapsulated collection of  1. CT scan
pus in the brain parenchyma  2. MRI
 Causes: usually secondary to another  3. PET
infection like- sinusitis, meningitis,  4. EEG
dental abscess, mastoiditis,
bacteremia and trauma MEDICAL MANAGEMENT
ENCEPHALITIS  Surgery
 Intense inflammation of the brain  Chemotherapy
tisssue with lymphocytic infiltration,  Radiotherapy
cerebral edema, degeneration of brain
cells and diffuse nerve cell destruction NURSING INTERVENTIONS
 CNS infections  1. promote self-care independence
 2. improve nutrition
ASSESSMENT FINDINGS  3. relieve anxiety
 Meningitis  4. enhance family processes
 1. fever, headache, vomiting  5. provide pre-operative and post-
 2. positive meningeal sings operative care
 6. manage pain
 Brain abscess
 1. headache, N/V, seizures, changes in
LOC
 2. Focal neurologic deficits


DIAGNOSTIC TESTS
 1. CT scan
 2. MRI
 3. EEG

MEDICAL TREAMENT
 1. Antibiotics
 2. Surgical drainage
 3. Drugs to reduce increased ICP