Professional Documents
Culture Documents
Medical-Surgical Nursing
Enrichment Class
NERVOUS SYSTEM
DISORDERS
PRE-TEST
1.
A.
B.
C.
D.
Brain
Cerebrum- right and left hemispheres
- governs sensory and motor activity
- divided into 4 lobes (frontal, parietal,
temporal and occipital)
Cerebral cortex- outer gray area
Basal ganglia
- cell bodies in white matter
- smooth voluntary movements
Frontal
- primary motor area; voluntary eye movement
- Brocas area
- access to past info, behavior, judgment, reasoning, affective
response
Parietal
- sensation, texture, size, spatial relationships , body position
awareness
Temporal
- auditory center, complicated memory patterns, Wernickes
area
Occipital primary visual center
Diencephalon
- thalamus- relays sensory impulses to the
cortex- part of the RAS
- hypothalamus- regulates ANS, sleep and
wake cycles, appetite, body temperature,
emotions, pituitary secretions and emotions
Limbic system: hunger, aggression, sexual
and emotional arousal
RAS: stimulates wakefulness
Cerebellum
- coordinates smooth muscle movement;
posture, equilibrium and muscle tone
Brain Stem
Pons- contains respiratory center
Midbrain- motor coordination; visual and auditory
relay center
Medulla oblongata
- contains all afferent and efferent tracts
- regulates vomiting, cardiac, vasomotor and
respiratory function
Spinal cord
- carries sensory to, and motor information
from, the brain
- inner portion of gray matter
dorsal and ventral horns
- outer portion of white matter
ascending and descending nerve tracts
Cerebrospinal fluid
- secreted in ventricles, circulates in
subarachnoid space then reabsorbed
- protective cushion and assists in exchange
of wastes and nutrients
- normal pressure- 50-175mm H2O
- normal volume- 125-150ml
Blood supply
- internal carotids, vertebral arteries, circle of
Willis
Internal carotid arteries
-
CIRCLE OF WILLIS
Diagnostic Tests
1. X-Ray (skull and spine)
2. Computerized Tomography (CT
Scan)
3. Electroencephalography (EEG)
4. Electromyography and Nerve
Conduction
Velocity studies
(EMG-NCV)
Diagnostic Tests
5. Cerebral Arteriogram
- assess patency of the cerebral arteries
- femoral artery, monitor for hemorrhage
6. Lumbar Puncture (tap)
- L3-L4; spinal headache and hypotension
- contraindicated in a patient with increased ICPbrain herniation
7. Magnetic Resonance Imaging (MRI)
- remove electrical devices and prosthesis
Neurologic Assessment
Neurologic Assessment
Decorticate posturing
Decerebrate posturing
Cranial nerves
Cranial nerves
Vagus (CNX)
Neurological Assessment
Assessment of Reflexes
Babinski reflex
Corneal reflex- loss of blink reflex; CN V
Gag reflex- loss of gag reflex; CN IX and X
Assessment of meningeal irritation
Brudzinskis sign- flexion of the head causes flexion
of the both thighs to the hip and knee flexion
Kernigs sign- flexion of the thigh and knee to right
angles and when extended causes spasm and
pain of hamstring
Question:
Two days after admission a stroke client has
a steady rise in temperature accompanied by
slow pulse and labile respiration. What do
these symptoms likely suggest?
A. absorption of the clot
B. injury to the vital centers in the brainstem
C. development of pneumonia
D. bacterial infection of the CNS
Increased Intracranial
Pressure
Increase in one content will increase pressure
Increased Intracranial
Pressure
Nursing management
Control HPN
Restrict fluid intake- if IV, slow infusion
pharmacotherapy
diuretics (mannitol, furosemide)
dexamethasone
anticonvulsants (diazepam, phenytoin,
phenobarbital)
Sample Question
Sample Questions
Seizures
Abnormal electrical activity
Effects altered loc
motor, sensory and autonomic dysfunction
Types
Grand mal (tonic-clonic)
Petit mal (absence or little sickness)
Jacksonian/ Focal
Febrile
Status epilepticus
Epilepsy
Seizures
Three Phases
- Prodromal phase: produces an aura
(sensory signals) - flash of light, mood or
behavior changes, sudden sensation of
smell or taste; cry
- Ictal phase: seizure itself
- Postictal phase: after the seizure;
amnesia, confusion, inability to be
aroused, sleepiness
Nursing management
Health education :
avoid alcohol
active lifestyle with adequate rest
avoid hazardous activities
Cerebrovascular Accidents
Stroke
Destruction of brain cells due to sudden
decrease in cerebral blood flow (cerebral
infarct)
Cerebral anoxia lasting more than 610minutes causes cerebral infarction with
irreversible damage
TIA: temporary interruption of blood supply
to the brain; symptoms disappear in 124hours; warning signal that a CVA can
occur
Cerebrovascular
Accidents
Maybe an ischemic or hemorrhagic
Causes :
thrombosis
embolism
hypertension
subarachnoid hemorrhage
Manifestations include :
Increased ICP
Symptoms will depend upon what lobe was
affected
Frontal (speech, motor movementhemiplegia, facial drooping, judgment,
personality, thinking and cognition)
Parietal- sensory
Temporal- hearing, speech
Occipital- visual
Nursing Management
CVA Treatment
Rehabilitation
HEAD TRAUMA
CONSIDERATIONS:
1. obtain thorough hx
2. monitor VS & check for additional injuries
3. check LOC & pupil reaction & observe closely.
4. note for increasing ICP, increasing headache,
vomiting, signs of ear bleed, or CSF leak
5. wake patient up at intervals during the night
6. With serious head injury:
- establish & maintain patent airway
- is CSF leaks from the nose:
- NO nasal airway >>> intubate
- avoid nose blowing
Parkinsons Disease
Pathology of Parkinsons
Disease
MANIFESTATIONS
Mask-like facies
drooling of saliva
dysphagia
Shuffling and propulsive gait
Stooped posture
no sensory deficits
diagnostic test : clinical observation
Nursing Management
Myasthenia Gravis
Autoimmune disorder
Myoneural junction problem
Acetylcholine- skeletal muscle contraction
Theories
Imbalance of acetylcholine and acetylcholinesterase
Formation of autoantibodies that destroy
acetylcholine receptors (thymus gland)
Signs
Muscle weakness (including dysphagia and
dyspnea)
Easy fatigability
Ptosis and diplopia
Impaired speech
Mask-like facies with snarl smile
Drooling
Progressive respiratory difficulty
Diagnostic test
Tensilon Test (Edrophonium Chloride Test)
short acting acetylcholine (5-20mins)
Nursing management
Aspiration precautions
accident preventions
medications should be timely given
Cholinergic drugs (neostigmine,
pyridostigmine)
adequate ventilation
adequate rest periods
avoid exposures to infections
Sample Question
a.
b.
c.
d.
Sample question
a.
b.
c.
d.
MULTIPLE SCLEROSIS
Autoimmune; characterized by exacerbations
and remissions (aggravated by fatigue and
emotional disturbances)
Demyelinating disease of the CNS inflammation and destruction of the myelin
sheath > sclerotic plaque (scar tissue) >
irritation of nerves and slowing down of
impulses
MULTIPLE SCLEROSIS
signs
diplopia, scotoma, blindness (optic
nerve)
muscle spasms, weakness and
numbness, fatigue
dysphagia
Nursing management
prednisone
dexamethasone
corticotropin
Sample Questions
a.
b.
c.
d.
Autoimmune: Guillain-Barr
Syndrome
An autoimmune attack of the peripheral nerve
Clinical Manifestations
muscle weakness
diminished reflexes of the lower extremities
quadriplegia
neuromuscular respiratory failure
paresthesias of the hand and feet
blindness
inability to swallow or clear secretions
instability of the cardiovascular system
Infectious: Meningitis
Diagnostic exam:
Lumbar puncture
CSF pressure
cloudy or milky white (clear- viral)
protein level
glucose concentration (normal in viral)
(+) Gram stain, C & S (except in viral)
CBC leukocytosis
CT Scan / skull X-ray to rule out underlying cause
Cultures of blood, urine, nose & throat secretions
Infectious: Meningitis
Initial Manifestations:
Headache, fever
Classical Manifestations:
nuchal rigidity, (+) Kernigs sign, (+) Brudzinskis sign,
photophobia
Others:
- rash; skin lesions (ranging from petechial rash with
purpuric lesions to large areas of ecchymosis)
- disorientation and memory impairment
- behavioral manifestations
- seizures (sec. to focal areas of cortical irritability )
- increased ICP (sec. to accumulation of purulent exudates);
as manifested by decrease LOC and focal motor deficits)
Infectious: Meningitis
Prevention: vaccination
Nursing Management:
- Neurologic status and VS continually
assessed
- Protect client from injury (seizure or
altered LOC)
- Preventing complications
- Instituting droplet precaution until 24 hrs.
after the initiation
Infectious: Meningitis
Medications:
Early administration of antibiotic
( penicillin e.g. ampicillin and piperacillin;
cephalosporin e.g. ceftriaxone sodium and
cefotaxime sodium,)
( Vancomycin HCL)
anti-fungal = (Amphotericin B)
Adjunctive therapy (Dexamethasone)
Seizures are controlled with phenytoin (Dilantin)
Trigeminal Neuralgia
(Tic Douloureux)
Clinical manifestations:
Pain felt on skin (more severe over lip, chin,
nostrils, in the teeth)
Paroxysms are aroused by stimulation of
affected nerve endings (washing the face,
shaving, brushing teeth, eating, drinking)
Drafts of cold air and direct pressure against
the nerve may cause pain
Trigeminal Neuralgia
(Tic Douloureux)
Nursing management
Assist patient to recognize the factors that
trigger facial pain- use cotton pads and room
temperature water
Rinse mouth if toohbrushing causes pain
Take food and fluids at room temperature , chew
on unaffected side, ingest soft foods
Perform personal hygiene during pain free
interval
Medical management
Anticonvulsive agents
carbamazepine (Tegretol)
phenytoin (Dilantin)
Surgery:
microvascular decompression of the
trigeminal nerve
Bells Palsy
Clinical manifestations
- distortion of the face
- increased lacrimation
- painful sensations : face, behind the ear, in the eye
- diminished blink reflex
- speech difficulties
- may be unable to swallow
1.
2.
3.
4.
1.
2.
3.
4.
A.
B.
C.
D.