Neuro Content

Pupils
• Equal and react normally
• Reacts to light slowly or briskly
• Dilated pupil = compressed cranial nerve
• Bilateral dilated, fixed pupils = ominous!!
• Pinpoint pupils – pons damage or drugs
 GCS
• Eyes open – spontaneous, to name, to
pain, etc

• Best Verbal response – appropiate,

oriented…..confused, incomprehensible

• Best motor – follows commands, only to

pain, etc
 Brief Neuro Check
• LOC
• Pupils
• Grips
• MAE
• Speech
• VS
 Cranial Nerves
• 12
• Some mixed or some purely sensory or
purely motor
– Names
– Functions
– assessment
• Cranial Nerves - Introduction
Increased Intracranial Pressure
• Definition/Pathophysiology – pressure exerted
by three components in the brain – brain, CSF,
and blood
• Assessment – nl 0-15 mm Hg
– Signs and symptoms – assoc with Decreased CPP
– Deficits – possible brainstem compression and
herniation
– Changes in LOC, posturing, headache, vomiting
– Remove CSF, mannitol,
Fig. 57-1
 Intracranial Pressure (cont’d)
• Cerebral blood flow
– Autoregulation of cerebral blood flow
– Pressure changes
– Factors affecting cerebral blood flow
Fig. 57-2
Increased Intracranial Pressure
• Cerebral edema
– Vasogenic cerebral edema
– Cytotoxic cerebral edema
– Interstitial cerebral edema
• Mechanisms of increased
intracranial pressure
Fig. 57-3
 Increased
Intracranial Pressure (cont’d)
• Clinical manifestations
– Change in level of consciousness
– Changes in vital signs
– Ocular signs
– Decrease in motor function
– Headache
– Vomiting
Fig. 57-5
 Increased
Intracranial Pressure (cont’d)
• Complications
• Diagnostic studies
• Measurement of ICP
– Indications for ICP monitoring
– Methods of measuring ICP
– CSF drainage
 Increased
Intracranial Pressure (cont’d)
• Collaborative care
– Drug therapy
– Hyperventilation therapy
– Nutritional therapy
 Nursing Management
Increased Intracranial Pressure
• Nursing assessment
– Glasgow Coma Scale
– Neurologic assessment
• Nursing diagnoses
• Planning
Fig. 57-11
Fig. 57-12
 Nursing Management
Increased Intracranial Pressure (cont’d)
• Nursing implementation
– Acute intervention
• Respiratory function
• Fluid and electrolyte balance
• Monitoring intracranial pressure
• Body position
• Protection from injury
• Psychologic considerations
• Evaluation
 Head Injury
• Types of head injuries
– Scalp lacerations
– Skull fractures
– Minor head trauma
– Major head trauma
• Pathophysiology
 Head Injury
• Types of head injuries
– Scalp lacerations
– Skull fractures
– Minor head trauma
– Major head trauma
• Pathophysiology
Fig. 57-13
Fig. 57-14
 Head Injury (cont’d)
• Complications
– Epidural hematoma
– Subdural hematoma
– Intracerebral hematoma
• Diagnostic studies and
collaborative care
Fig. 57-15
Fig. 57-16
 Nursing Management
Head Injury
• Nursing assessment
• Nursing diagnoses
• Planning
• Nursing implementation
– Health promotion
– Acute intervention
– Ambulatory and home care
• Evaluation
 Brain Tumors
• Types
• Clinical manifestations
• Complications
• Diagnostic studies
• Collaborative care
– Surgical therapy
– Radiation therapy and radiosurgery
– Chemotherapy
Fig. 57-17
Fig. 57-18
Inflammatory Conditions
of the Brain
 Bacterial Meningitis
• Etiology and pathophysiology
• Clinical manifestations
• Complications
• Diagnostic studies
• Collaborative care

Viral Meningitis
 Headaches (anyone have
one?)
• Migraines

• Clusters

• Tension
 Trigeminal Neuralgia
• Tic Douloureaux
• Intermittent INTENSE pain
• “Triggers”
• Surgeries only reduce pain
• Monitor nutrition
 Chapter 61

Nursing Management
Peripheral Nerve and Spinal Cord
Problems

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
 Trigeminal Neuralgia
• Etiology and pathophysiology
• Clinical manifestations
• Diagnostic studies
• Collaborative care
– Drug therapy
– Conservative therapy
– Surgical therapy
 Chapter 61

Nursing Management
Peripheral Nerve and Spinal Cord
Problems

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 61-1
 Bell’s Palsy
• Facial Palsy
• Inflammatory /
Unilateral
• Cannot close eye,
smile, grimace,
whistle, or
wrinkle forehead
 Multiple Sclerosis

• Chronic Neurological disease

• Pathophysiology
• Symptoms
• Labs/ radiology tests
• Treatments
• Nursing considerations
 Parkinson’s Disease
• Chronic neurological disease
• Pathophysiology
• Symptoms
• Labs/ radiology tests
• Treatment
• Nursing considerations
• “parkinsonism”
 Guillian-Barre
• Definition
• Signs and Symptoms
• Medical Treatment
• Nursing Considerations
 Myasthenia Gravis
• Definition/Pathophysiology
• Signs and Symptoms
• Treatment
• Nursing Considerations

• Myasthenic/Cholinergic Crisis
 Seizure Disorders
• Definition/Pathophysiology
• Types of Seizures
– Partial
– Generalized
• Treatment/Nursing Considerations

• Status Epilepticus
• Aura
 Circulation to the brain
• Carotid arteries
• Vertebral arteries
• Circle of willis
• Perfusion deficit r/t symptoms
 TIA
• Transient Ischemic Attack
• “Mini-strokes” / “Silent strokes”
• Carotid Dopplers
• Echocardiogram for mural thrombi
 TIA
• Most common symptoms
– Contralateral weakness of lower face, fingers,
hands, arms and legs
– Transient dysphagia
– Some sensory impairment

• Nursing considerations
 Carotid Endarterectomy
• Performed on stenotic sites
• Nursing Care IMPORTANT 1st 24
hours
• Hourly checks; positioning
• Horner’s syndrome
 CVA
• 3rd Leading Cause of Death
• Thrombus / Embolus / Hemorrhage
• Circle of Willis
• Ischemia vs. hemorrhagic
• Clinical Warning Signs
• “stroke belt”
 CVA – risk factors
• HTN • Cocaine/drug abuse
• CVD • Obesity
• DM • Increased cholesterol,
• Stress triglycerides, LDL
• BCP • Age
• Gender
 Right brain vs. Left Brain
• Right brain CVA • Left brain CVA
– Left side paralysis – Right paralysis
– Left neglect – Impaired speech/language
– Spatial-perceptual deficit (left=language
– Deny problem – Right/left discrimination
– Impulsive – Slow performance
– Short attn span – Aware of deficits
– Impaired judgement – Impaired comprehension r/t
– language, math
Impaired time concept
 Terminology/management
• Aphasia - expressive, receptive, global
• Apraxia
• Neglect
• Dysphagia
• Impulsive
• Dysarthria
• Ataxia
• Homonymous hemianopsia
• Hemiplegia vs hemiparesis
 Management
• Surgery – selective based on age, area
affected, cause of CVA
• Medications: look at source of CVA
rt-PA
Anti-coagulants / Anti-platelets
Calcium Channel Blockers
antihypertensives
Anti-convulsants
Steroids
 Spinal Cord Injury
• Anatomy
– Vertebral column
• Vertebrae
– Disks
• “cushions”
– Spinal Cord
• Brain stem----L2
• Meningeal layers
– Dura mater
– Arachnoid
– Pia mater
 Spinal cord injury
• Anatomy
– Gray matter – control motor/sensory function
– White matter
• Myelinated
• Tracts that convey info between brain and spinal
cord
– Blood supply
• Vertebral arteries
• Spinal artery
 Spinal Cord Injury
• Etiology and pathophysiology
– Initial injury
• Spinal and neurogenic shock
 Spinal Cord Injury (cont’d)
• Classification of spinal cord injury
– Mechanisms of injury
– Level of injury
– Degree of injury
• Central cord syndrome
• Anterior cord syndrome
• Brown-Séquard syndrome
• Posterior cord syndrome
• Conus medullaris syndrome and cauda equina syndrome
– American Spinal Injury Association (ASIA) Impairment
Scale
Fig. 61-5
Fig. 61-6
 Spinal Cord Function
• Reflexive – stimulus received/ response
initiated at level of spinal cord

• Relay – stimulus enters spinal cord and

travels up to brain to relay information…
processed…response sent back through
descending tracts
 Major Spinal Cord Tracts
• Spinothalamic – ascending – pain, temp
• Corticospinal – descending – voluntary
motor movement
• Spinocerebellar – ascending-coordination
of muscle movements
• Posterior columns – ascending – touch,
pressure, vibration, position
Major Effects of Spinal Cord Injury
• Respiratory
– Phrenic Nerve (above level of C5)
– Intercostal/abdominal muscle impairment
• Spinal Shock
– Flaccidity
– Days to months
Major Effects of spinal cord injuries
• Autonomic dysreflexia
– Dangerous – requires immediate attention
– Exaggerated response of autonomic nervous
system
– Parasympathetic system/regulatory
mechanisms – fail below level of injury
– Vagus nerve stimulation
 Major effects of spinal cord injury
• Spasticity
• Impaired sensory and motor function
• Bowel and bladder dysfunction
• Temperature regulation
• Sexual dysfunction
• Skin integrity
 Medical Treatment
• Medications – corticosteroids, anti-
spasmodics, anti-infectives
• Traction – cervical immobility
– Roto bed, stryker frame
– Halo traction
 Assessment
• Airway – always first priority
• VS
• LOC, posture, spontaneous movement
• Spasticity
• Sensory perception
• proprioception
 Nursing issues
• Risk for injury
• Risk for disuse syndrome
• Bowel and bladder programming
• Risk for infection
• Ineffective thermoregulation
• Ineffective coping
• Self-care deficit
• Ineffective breathing pattern
Fig. 61-7
Fig. 61-8
Fig. 61-9
 Spinal Cord Injury (cont’d)
• Clinical manifestations
– Respiratory system
– Cardiovascular system
– Urinary system
– Gastrointestinal system
– Integumentary system
– Thermoregulation
– Metabolic needs
– Peripheral vascular problems
 Spinal Cord Injury (cont’d)
• Diagnostic studies
• Collaborative care
– Nonoperative stabilization
– Surgical therapy
– Drug therapy
 Nursing Management:
Spinal Cord Injury (cont’d)
– Acute intervention
• Immobilization
• Respiratory dysfunction
• Cardiovascular instability
• Fluid and nutritional maintenance
• Bladder and bowel management
• Temperature control
• Stress ulcers
• Sensory deprivation
• Reflexes
• Autonomic dysreflexia
Fig. 61-10
Fig. 61-11
 Nursing Management
Spinal Cord Injury (cont’d)
– Rehabilitation and home care
• Respiratory rehabilitation
• Neurogenic bladder
• Neurogenic bowel
• Neurogenic skin
• Sexuality
• Grief and depression
• Evaluation
 Spinal Cord Tumors
• Etiology and pathophysiology
• Clinical manifestations
• Nursing management: Spinal
cord tumors