NOTES on Neurological System

8/12/2019 NOTES on Neurological System

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NEUROLOGICAL SYSTEM

Lecturer: MS. Louradel M. Ulbata, RN

PHYSIOLOGY OF THE NEUROLOGIC SYSTEMOra!"#at"o! o$ t%e Ner&ou' S('te)A. Ce!tral !er&ou' '('te) *CNS+.1. Brain2. Spinal Cord. Per"-%eral !er&ou' '('te) *PNS+.1. Twelve pairs of cranial nerves2. Thirty-one pairs of spinal nerves

.. Auto!o)"c !er&ou' '('te)a. Sympathetic systemb. Parasympathetic system../. SOMATIC NER0OUS SYSTEMa. Afferent Nervesb. fferent Nerves

CELLS OF THE NER0OUS SYSTEM

A. Neuro!-the f!nctional cell of the nervo!s system.1. Co))o! c%aracter"'t"c'.

a. "esponds or reacts to stim!lib. Cond!cts imp!lsesc. #nfl!ences other ne!rons./. Structurea. Cell bod(-contains the cell n!cle!s which controlscell!lar activity.b. A1o!-cond!cts imp!lses away from the cell bodyc. 2e!dr"te'-receive incomin$ stim!li and transmitthem to the a%on of another ne!ron.

&. Fu!ct"o!3cla''"$"cat"o!.a. A$$ere!t !euro!' *'e!'or(' transmit informationaway from the CNS.

b. E$$ere!t !euro!' *)otor+transmit informationaway from the CNS.

"((B") SAMESe!'or(= A$$ere!t; Motor = E$$ere!t

c. So)at"c '('te)1'. Afferent are sensory ne!rons that transmitimp!lses from the s*eletal m!scles and s*in to theCNS.2'. fferent are motor ne!rons that transmit imp!lsesthat lead to contraction and control of s*eletalm!scle.d. 0"'ceral '('te).1'. Afferent are sensory ne!rons that transmitimp!lses from smooth m!scle and cardiac m!scle tothe CNS.2' fferent are motor ne!rons that transmit imp!lsesto the $lands+ cardiac m!scle+ and smooth m!scle.e. Synapse or synaptic terminals are areas ofchemical transmission of an imp!lse from the a%on of

one ne!ron to the dendrites of another ne!ron.

Fu!ct"o!al Pro-ert"e' o$ Neuro!'

#rritability , ability to respond to stim!li

Cond!ctivity , ability to transmit an imp!lse

NER0E FUNCTION "' NER0ECON2UCTION

ACTION POTENTIAL

Ner&e Cell u!deroe':1. "estin$ (embrane Potential2. Action Potential epolari/ation&. "epolari/ation "estabili/ation

1. RESTING MEMRANE POTENTIAL Sodi!m predominates o!tside the cell+

potassi!m inside the cell.

#nside of the cell is relatively ne$ative with the

presence of potassi!m and lar$e amo!nts ofne$ative ions.2. Act"o! Pote!t"al 3 2e-olar"#at"o!

0hen a cell is stim!lated+ cell membranesbecome permeable to sodi!m ions.

Sodi!m moves inside the cell and potassi!mmoves o!t.

#nside of the cell becomes positively char$ed.

S!dden chan$e in the char$e of the cell fromne$ative to positive is called action potential.

&. REPOLARI4ATION The sodi!m-potassi!m p!mp restores the

ori$inal confi$!ration

This action re!ires ATP

Sodi!m is p!mped o!t of the cell andpotassi!m bac* into the cell.

.S!pportin$ cells provide s!pport+ no!rishment+and protection to the ne!ron.

1. Neur"le))a, protective cells whichs!rro!nd the a%ons in the PNS.

a. Provide for effective re$eneration of PNSnerve fibers.

b. orm the myelin sheath in the PNS.c. No ne!rilemma present in the CNS.

2. Glial cells protective cells in the CNS3responsible for the formation of the myelin.

3. Myelin sheath.a. ense membrane or ins!lator aro!nd the

a%on.b. acilitates f!nction of the ne!ron+c. Contrib!tes to the blood-brain barrier to

protect the central nervo!s system a$ainstharmf!l molec!les.

4. !ode' o$ Ra!&"er- #ntermittent $aps between themyelin sheath that allowcomm!nication between nervefibers.- Si$nals 5!mpin$ from node to nodetravel h!ndreds of times faster thansi$nals travelin$ alon$ the s!rface ofthe a%on.

2. I)-ul'e co!duct"o!.SALTATORY CON2UCTION An action potential e%cites one section of the

nerve membrane and electrical imp!lse then

6S7#PS8 from one node to the ne%t$eneratin$ an action potential.

These node-to-node mode of cond!ction istermed 6 SA9TAT:"; :" 9AP#Nrinary retention>rinary retention(ydriasis(ydriasis $eyes$eyeside ith fright$ide ith fright$

TachycardiaTachycardiaBronchodilateBronchodilate

5ac!lation5ac!lation$shoot$$shoot$

JerophthalmiaJerophthalmia?dry eyes'?dry eyes'

Jerostomia ?dryJerostomia ?drymo!th'mo!th'

CRANIAL NER0ES

are nerves which start directly from thebrainsteminstead of thespinal cord.

:nly the first and the second pair emer$efrom thecerebr!m3 the remainin$ 1 pairsemer$e from the brainstem.

N>(B" NA( >NCT#:N#.##.

###.

#=.=.

=#.=##.

:lfactory:ptic

:c!lomotor

TrochlearTri$eminal):pthalmic(acillary(andib!lar

Abd!censacial

Sense of smell=ision-cond!ctsinformation from theretinaown and o!twardmovement of the eyeP!pillary constriction

and accommodation(!scle of the !ppereyelid ?ability to *eepthe eye open'(ovement of the eye

Corneal refle%Sensory fibers of theface(otor nerves forchewin$ andswallowin$#nward movement ofthe eyeacial e%pressionSense of taste onanterior ton$!e(!scle of the eyelid?ability to close theeye'

=###.

#J.

J.

J#.

J##.

Aco!stic


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1. Pace of speech-rapid+ slow+ haltin$.2. Clarity , sl!rred or distinct.&. Tone , hi$h pitched+ ro!$h.4. =ocab!lary , appropriate choice of words.

e. acial feat!res may s!$$est specific syndromes inchildren.2. mental stat!s m!st ta*e into consideration theclients c!lt!re and ed!cational bac*$ro!nd'.

a.


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=i$oro!s stim!li needed to provo*e aresponse

Co)ato'e Completely !nconscio!s

Cannot be aro!sed by painf!l stim!li

Absence of vol!ntary movement

M- refle%es

GLASGO COMA SCALE *GCS+

ane!rolo$ical scale that aims to $ive areliable+ ob5ective way of recordin$ theconscio!s state of a person

Tests & areas- eye openin$+ verbal responseand motor response

Scores are eval!ated- ran$e from &-1D

No -(R* score

patients with scores of &-H are !s!ally said tobe in a coma.

Tests & areas) E(e O-e!"! *E+ D 9 -o"!t'

0erbal Re'-o!'e *0+ D -o"!t'

Motor Re'-o!'e *M+5 -o"!t'

ASSESSMENT OF SPEECH AN2 LANGUAGE

ysarthria- diffic!lty in artic!lation- lesions of ton$!e F palate

ysphonia- diffic!lty in phonation- lesions of palate F vocal cords

A$nosia - inability to reco$ni/e ob5ects or symbols

by means of senses

A'hasia- inability !se and !nderstand written and

spo*en words

TYPES:1. E'ressie (*otor+ non,l-ent+ or roca/s)

a'hasia0- The ability to create words is

impaired+ b!t comprehension and ability toconcept!ali/e are relatively preserved.. - #t often ca!ses a1ra'hia ?loss of the ability

to write' and impairs oral readin$.2. !ece'tie (sensory+ ,l-ent+ or 2ernice/s)

a'hasia04 Patients cannot comprehend words orreco$ni/e a!ditory+ vis!al+ or tactile symbols.- :ften, aleia?loss of the ability to read

words' is also present.!EMEME!0

EARE)rocas area) E%pressive dysphasia.ernic*es Area) REceptive dysphasia

CRANIAL NER0E ASSESSMENT

I. Cra!"al Ner&e 5 Ol$actor( Chec* first for the patency of the nose

P":B9() ANOSMIA56loss of smell8

II. Cra!"al Ner&e /5 O-t"c Pa-"llede)a

- optic disc swellin$ that is ca!sed byincreased intracranial press!re.

He)"a!o-'"a - is loss of vision in one-half of the normalvis!al field ?!s!ally the ri$ht or left half' of one orboth eyes.

+ I-'"lateral bl"!d!e'': :ptic nerve lesion

/+ "te)-oral He)"a!o-'"a: :ptic chiasm lesion

@+ Ho)o!()ou' He)"a!o-'"a *R"%t or Le$t+::ptic tract lesion

III. CRANIAL NER0E III, I0,0I

CN ### , p!pil constriction F elevation ofeyelid- assess p!pil ?P""9A'- assess for ptosis

CN ###+ #=+ =# , control eye movement- S56 + ! 7I CN 4 controls the

s!perior obli!e m!scle and CN Gcontrols the lateral rect!s m!scle

- Assess sim!ltaneo!sly themovement%eviations)

:pthalmople$ia- inability to move the eye in adirection

iplopia- complaint of do!ble vision

!upil Abnormalities)

Asymmetry of p!pil si/e of K1mm s!$$estsCN ### compression

"lateral d"lat"o! ano%ia

dr!$ ffect

U!"lateral co!'tr"ct"o! sympathetic dysf!nction ?@orner

syndrome'

carotid artery dissection

"lateral co!'tr"ct"o!PinPoint , oPiods F Pontine do

Ar(ll Robert'o! -u-"l- bilateral smallp!pils that constrict when thepatient foc!ses on a near ob5ect ?they

7
http://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Scale_(ratio)http://en.wikipedia.org/wiki/Pupilhttp://en.wikipedia.org/wiki/Neurologyhttp://en.wikipedia.org/wiki/Scale_(ratio)http://en.wikipedia.org/wiki/Pupil


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6accommodate8'+ b!t do notconstrictwhen e%posed to bri$ht li$ht ?they do not6react8 to li$ht'.- formerly *nown as OProstit!tes P!pilsObeca!se of their association with tertiarysyphilis- Prostit!tes P!pils ) "!rostitutesaccommodate but do not react.

A!"'ocor"a K2mm difference in si/e

Ad"e' *To!"c+ -u-"l sl!$$ish response

I0. Cra!"al Ner&e 5tr"e)"!al Sensory portion- assess for sensation of the

facial s*in

(otor portion- assess the m!scles ofmastication

Assess corneal refle%

0. CRANIAL NER0E D Fac"al Sensory portion- prepare salt+ s!$ar+ vine$ar

and !inine. Place each s!bstance in theanterior two thirds of the ton$!e+ rinsin$ themo!th with water

(otor portion- as* the client to ma*e faciale%pressions+ as* to forcef!lly close theeyelids

/acial nerve 0CN VII1 palsy) 'ell2s !alsy0I. Cra!"al Ner&e 0e't"bulococ%lear !er&e

Test patients hearin$ ac!ity

:bserve for nysta$m!s and dist!rbedbalance

0II. Cra!"al Ner&e 5 lo''o-%ar(!eal To$ether with Cranial nerve 1 ,va$!s Assess for $a$ refle%

0atch the soft palate risin$ after instr!ctin$the client to say 6A@8

The posterior one-third of the ton$!e iss!pplied by the $lossopharyn$eal nerve

0III. Cra!"al Ner&e 5 acce''or( Press down the patients sho!lder while he

attempts to shr!$ a$ainst resistance

I;. Cra!"al Ner&e /5 %(-olo''al

- As* patient to protr!de the ton$!eand note for symmetry

- >nilateral cortical lesions ca!ses theprotr!ded ton$!e to deviate towardthe affectedside

SENSORY ASSESSMENT

1. 2ISCRIMINATION- Tests the inte$rative f!nctions of sensation

and memory in the brains parietal lobe- #ncl!des)

a. STEREOGNOSIS- discernment of the form orconfi$!ration of ob5ects feltb. GRAPESTHESIA

- reco$nition of the form of writtensymbol

/. SENSATION ANORMALITIESa. 2YSESTHESIAS- well locali/ed irritatin$ sensations 3 warmth+ cold+

itchin$+ tic*lin$b. PARESTHESIAS

- distortion of sensory stim!li 3 li$ht to!ch maybe interpreted as b!rnin$ or painf!l sensation

c. ANESTHESIA- absence of sense of to!ch

d. HYPERESTHESIA5 patholo$ic over perception of to!ch

e. HYPALGESIA5 red!ced sensation to pai

$. HYPERALGESIA- increased sensation to pain

. ANALGESIA5 absence of pain sensation

%. ASTEREOGNOSIS- loss of sense of three dimensional

discrimination

MOTOR SYSTEM ASSESSMENT Pra%is I ability to perform a motor activity

Apra%ia I inability to perform vol!ntarymovement in the absence of deficits

yspra%ia I diffic!lty performin$ an activity

A. Coord"!at"o!: Cerebellar d"'ea'e

incoordination is worse with eyesclosed

d(')etr"a point-to-point movements are

cl!msy+ !nsteady+inappropriately varyin$ inspeed+ force+ F direction

. GAIT. Ata1"c

- sta$$erin$ and !nsteady

/. SPASTIC GAIT- stiff+ short steps+ toes catch and dra$+ le$sare held to$ether and hips and *ness arefle%ed

@. SCISSORS GAIT- le$s cross while wal*in$ with short+ slowsteps

9. STEPPAGE GAIT- foot and toes lifted hi$h+ heels come downheavily

. A22LING GAIT- a broad-based $ait with a d!c*-li*e waddleto the swin$ phase

. $e't"!at"! a"t5 a $ait in which the patient invol!ntarilymoves with short+ acceleratin$ steps+often on tiptoe+ as in par*insonism.

C. ANORMAL MO0EMENTS. AJINESIA

- red!ced body movement in the absence ofwea*ness or paralysis

/. ATHETOSIS- $ross+ writhin$+ worm-li*e movement ofbody+ face or e%tremities

@. RA2YJINESIA- slow movement

2. POSTURING. 2E85!ICATE RIGI2ITY

Abnormal fle%or response

Characteri/ed by ri$idity+ fle%ion of the arms+clenched fists+ and e%tended le$s

the arms are bent inward toward thebody with the wrists and fin$ers bentand held on the chest

8
http://en.wikipedia.org/wiki/Accommodation_(eye)http://en.wikipedia.org/wiki/Syphilishttp://medical-dictionary.thefreedictionary.com/parkinsonismhttp://en.wikipedia.org/wiki/Accommodation_(eye)http://en.wikipedia.org/wiki/Syphilishttp://medical-dictionary.thefreedictionary.com/parkinsonism


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estr!ctive lesion of 8orticospinal tracts

2. 2ECERERATE RIGI2ITY

Abnormal E%tensor "esponse

Characteri/ed by ri$id e%tension of the armsand le$s+ downward pointin$ of the toes+ andbac*ward archin$ of the head

Typicall ca!sed by deterioration of the

str!ct!res of the nervo!s system+ partic!larlythe !pper brain stem

lesion in diencephalon+ midbrain+pons

metabolic disorders

A''e''"! t%e )otor $u!ct"o! o$ t%e bra"!'te)

1. Test for the Oculoce-%al"c re$le15 doll' e(e- head is moved rapidly from side to side

Normal response- eyes appear to moveopposite to the movement of the head

Abnormal- eyes move in the same direction

with s!spected cervical spine in5!ry

NOTE: o not !se the olls eye test on people with

s!spected cervical spine in5!ry.

2. Test for the Oculo&e't"bular re$le1 Slowly irri$ate the ear with cold water and

warm water

Normal response- COSCold I Opposite ) arm I Same

N('ta)u' 5 #nvol!ntary eye movements!s!ally tri$$ered by inner ear stim!lation

REFLE;ES ASSESSMENT

TO */+ REFLE;ES:

1. SUPERFICIAL *CUTANEOUS'- elicited by s!perficial or c!taneo!sstim!lation- stim!l!s is prod!ced by stro*in$ a sensory/one with an ob5ect that will not ca!sedama$e

2. 2EEP TEN2ON REFLE; *MUSCLE STRETCH+- refle% m!scle contraction res!lts fromrapidly stretchin$ the m!scle- prod!ced rapidly by stri*in$ a m!sclestendon of insertion sharply with as!dden+ brief blow !sin$ a refle%hammer

SUPERFICIAL *CUTANEOUS+ REFLE;ES. A2OMINAL REFLE;

- scratchin$ the s*in on an abdominal!adrant normally contracts the abdominalm!scle in that !adrant.

2. CORNEAL REFLE;- $entle stro*in$ of cornea with a wisp of

cotton ca!ses refle% blin*in$ &. PHARYNGEAL 3 GAG REFLE;

- $entle stim!lation with a ton$!e blade atthe bac* of the throat and pharyn%normally prod!ce $a$$in$.

4. CREMASTERIC REFLE;- stro*in$ the inner thi$h of a malenormally elevates the ipsilateral testicle.

2EEP TEN2ON REFLE; *MUSCLE STRETCH+1. AN79 "7 ?plantar fle%ion of the foot'

- prod!ced by tappin$ the Achilles tendon2. 7N "7 ?le$ e%tension'

- prod!ced by tappin$ the !adriceps femoristendon 5!st below the patella

&. B#CPS "7 ?forearm fle%ion'- prod!ced by tappin$ the biceps brachiitendon

4. T"#CPS "7 ?forearm e%tension'- is prod!ced by tappin$ the triceps brachiitendon at the elbow

2ee- Te!do! Re$le1e': Grad"!

Grade 2TR Re'-o!'e

4M =ery bris*+ hyperactive+ withclon!s

& Bris*er than avera$e+ sli$htlyhyperrefle%ic

2 Avera$e+ e%pected response3normal

1 Somewhat diminished+ low

normal No response+ absent

PATHOLOGICAL REFLE;ES- do not normally occ!r- presence indicates ne!rolo$ic do

. CLONUS-"hythmic :scillation

2. AINSJI REFLE;- stro*e the lateral aspect of the soles doin$an inverted?M'-:"S#9J#:N of the Bi$ toe withfannin$ o!t of the little toes

2IAGNOSTIC E;AMINATION

1. LUMAR PUNCTURE- N9 #S #NS"T BT0N 94-9D- B9:0 T@ 9=9 : T@ SP#NA9

C:"

" L3 4 L5 ill +eep the spinal cord alive.

Co)-l"cat"o!': @AAC@

@;P:TNS#:N

(N#NBA"AC@N:# @(AT:(A

NORMAL CSF CHARACTERISTICS) P"SS>" ) G-1& mm@$

APPA"ANC ) clear F colorless

"BC ) none

0BC ) -D cellsmm

Protein) very little


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T(-e':

Te!'"o!-characteri/ed by sensation of ti$htnessaro!nd head and may have specific locali/ed painf!lareas3 areas ca!sed by s!stained contraction ofm!scles and head and nec*3 precipitated by stressand an%iety

M"ra"!e *)ore co))o! "! =o)e!+-rec!rrin$ vasc!lar headache often initiated bytri$$erin$ event and accompanied by ne!rolo$icdysf!nction3 or increase release of sensorys!bstances ?e.$. serotonin'3 tri$$ers incl!de stress+fl!ct!atin$ $l!cose levels+ fati$!e+ hormones+ bri$htli$hts

Clu'ter *co))o! "! )e!+-typically awa*ens client with !nilateral pain aro!ndeye accompanied by rhinorrhea+ lacrimation+ fl!shin$3attac*s occ!r in cl!sters of 1-H days for wee*s

HEA2ACHE

1. Tension headache-EQ3 noise+ stressRs!stainedcontraction of m!scles

2. Sin!s @eadache=ir!s+ aller$en+ bacteria+ temp

Nerves in sin!ses swell

@eadache

e.$. brain free/e d!e to swallowin$ of colds!bstances rapidly

&. @an$-over headacheAlcohol bloc*s hormonal mechanisms

ehydration

4. 0ine headache#ncreases histaminetyramine

ilate blood vessels

Press!re on nerves

D. (i$raine headache) 1)4 ho!sehold0omen &% more than men) &days a wee*(ay be ca!sed by)

9i$htNoise

#rre$!lar eatin$ and sleepChocolate

Stron$ smellPean!t b!tter

lectrical imp!lse altered and tri$$ers tri$eminal

nerve

Tri$eminal nerveIvasodilation and nerve irritation

G. Cl!ster @eadache%cr!ciatin$ painG % more in men+ & min to 2 ho!rs

Nerves irritated

Pain si$nals

Tension @eadacheMa!ae)e!t:

Pharmacolo$ical1.Aspirin6 Ibuprofen-s!ppress prosta$landin thatdilates and sensiti/es nerve fibers2.Acetaminophen-tension headache3 wor*s in CNSto red!ce pain witho!t effect on prosta$landin ?safefor $astritis'&.7riptans-anti-mi$raine3 activates serotoninreceptors decreasin$ inflammation of blood vessels4.'oto,?p!rified bot!lin!m bacteria'-small dosa$es allow it to be locali/ed3 paralysesm!scles locally and is not absorbed into the bloodstream ?may ca!se nerve paralysis if $iven in lar$edoses'D. #ndomethacin-for cl!ster headaches3 with pain*illersNonpharmacolo$ical)

1. Biofeedbac*2. Ac!p!nct!re&. (assa$e4. ;o$aD. @erbal remedies

SYNCOPE3FAINTING

T"ANS#NT 9:SS : C:NSC#:>SNSS

#NAU>AT B"A#N P">S#:N

MANAGEMENT: AN"":>N#N


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Mo!roe5Jell"e H(-ot%e'"':7he s+ull is a CL*S(% C*N7AIN(Rand contains a fi,ed volume8

An increase in any one of thecomponents causes a change inthe volume of the other

Nor)al Co)-e!'ator( Ada-tat"o!':

#nitial)o #ncreased CS absorption

o isplacement of CS into the spinal

s!barachnoid spaceRspace betweenarachnoid and pia mater'

o Collapse of the cerebral veins and d!ral

sin!ses:ther mechanisms)

o istensibility of the d!ra

o #ncreased veno!s o!tflow

o ecreased CS prod!ction

o Constriction and vasodilation

o

Sli$ht compression of brain tiss!e

Su'ta"!ed "!crea'e' a''oc"ated ="t%:a. Cerebral edemab. @ead tra!mac.T!morsd. Abscessese. Stro*ef. #nflammation$. @emorrha$e

Factor' t%at I!crea'e ICPW@ypercapnea+ hypo%emiaWCerebral vasodilatin$ a$entsW=alsalva mane!ver3 co!$hin$ or snee/in$WBody positionin$?prone+ nec* fle%ion+ e%treme hip fle%ion'W#sometric m!scle contractionWmotional !pset3 no%io!s stim!liWAro!sal from sleepWCl!sterin$ of activitiesWPain and a$itation

A. Cerebral edema.1. =aso$enic edema occ!rs when there is an

increase in the vol!me of brain tiss!e ca!sedby increase in the permeability of the walls ofthe cerebral vessels. Protein-rich fl!id lea*sinto the e%tra cell!lar space. (ost often theca!se of ##CP in ad!lts.

2. Cytoto%ic ?cell!lar' edema occ!rs as a res!lt ofhypo%ia. This res!lts in abnormal acc!m!lation offl!id within the cell ?intracell!lar' and a decreaseof e%tra cell!lar fl!id.

B. Cerebral arteries dilate with a decrease in thedelivery of o%y$enated blood.

1. #ncrease in PC:2 and acc!m!lation of lactic acidprecipitates an acidotic state.

2. An acidotic state increases cerebral vasc!lardilatation which+ in t!rn+ increases cerebralvasc!lar blood flow and increases intracranialpress!re.

C. "e$ardless of the ca!se+ ##CP will res!lt inpro$ressive ne!ro deterioration3 the specificdeficiencies seen are determined by the area ofcompression of brain tiss!e.

. #n infants where the cranial s!t!re lines are open+increased #CP will ca!se f!rther separation of the

s!t!re lines and increased the circ!mference ofthe head.

Sc%e)at"c 2"ara)Cranial ins!lt

Tiss!e edema

#ncreased #CP

Compression of blood vessels

ecreased cerebral blood flow

ecreased o%y$en with brain cell death

dema aro!nd necrotic tiss!e

#ncreased #CP with brainstem and respiratory center

compression

Carbon dio%ide acc!m!lation

=asodilation

#ncreased #CP

AT@

Pat%o-%('"olo(:press!re res!lts to lac* of o%y$en and blood s!pply

MANIFESTATIONS:

. HEA2ACHE- TNS#:N :N #NT"AC"AN#A9=SS9S

NURSIN9 CAR()

7P @:B 9=AT

P:ST) N: T"N9NB"P#99A"; C@AN


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- >NCA9 @"N#AT#:NNURSIN9 CAR()

(:N#T:" =S @:>"9;

"" #N 1 >99 (#N

. FALLING PULSE RATE- "9J CT : "#S#N< BP

NURSIN9 CAR()

(:N#T:" =S @:>"9;

P>9S #N 1 >99 (#N

. PAPILLE2EMA- d!e to the compression of optic disc- >NCA9 @"N#AT#:N

NURSIN9 CAR()P>P#99A"; C@C7S ) U>A9#T;F "ACT#:N T: 9#" :N (:T:"

CNT"SNURSIN9 CAR()

"C:" @(#PA"S#S

CN CJS

C@C7 "9JS

. SEI4URE- #NT"AC"AN#A9- ST#(>9AT#:N T: B"A#N

NURSIN9 CAR()

CA"";:>T S#X>"

P"CA>T#:N. LOSS OF SPHINCTER CONTROL- C"B"A9 P"SS>"- #NT"" 0#T@ SP@#NCT"

#N@#B#T:"; C:NT":9

NURSIN9 CAR()

"C:" # F :

C@C7 #STNT#:N

#NC:NT#NNC

CAT@T"#X

K. TEMPERATURE 0ARIATIONS- A(AS- (TAB:9#C C@ANC#NAT#:NS/. ULGING OF FONTANELS

- (C@AN#CA9 P"SS>"NURSIN9 CAR()

"P:"T CS 9A7A


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NURSING ALERT 7 I$ t%e cl"e!t ="t% IICPde&elo-' %(-o&ole)"c '%ocB, do !ot -lacecl"e!t "! Tre!dele!bur' -o'"t"o!, ele&ate t%elo=er e1tre)"t"e' to e!%a!ce &e!ou' retur!.

&. Chan$e clients position slowly and$ently3 avoid 5er*y movements.

4. (aintain fl!id restriction.D. val!ate inta*e and o!tp!t.a. #n response to di!retics.b. As correlated with chan$es in daily

wei$ht.c. or complications of diabetes insipid!s.G. (aintain inta*e evenly over twenty-fo!r

ho!r time period.. Sedatives and narcotics can depress

respiration and mas* symptomsindicatin$ increasin$ #CP.

H. Client sho!ld avoid stren!o!s co!$hin$+=alsalvas mane!ver+ and isometricm!scle e%ercises.

E. #n infants+ meas!re frontal occipitalcirc!mference to eval!ate increase in

si/e of the head.1. Control hyperthermia as indicated.

? INCR(AS( IN*@ R(IR(&(N7*/ '*%; 7ISSU(SB'RAIN7ISSU( IS :I9:L; SUSC(!7I'L( 7* :;!*IA

NURSING MANAGEMENT: (A#NTA#N "::( T(P

#NC"AS 9>#S & (9A;

ANT#P;"T#CS

C:(:"T (AS>"S

(:N#T:" =S

#C BAS CA"S+ P#CT>"S+ S9AT B:A"S

SEI4URESSe"#ure'-alteration in conscio!sness+ sensory and motorWParo%ysmal motor+ sensory+ or co$nitivemanifestations of spontaneo!s abnormal dischar$esfrom ne!rons in cerebral corte%W(ay involve all or part of brain conscio!sness+a!tonomic f!nction+ motor f!nction and sensation

E-"le-'(

13


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) any disorder characteri/ed by rec!rrent sei/!res

T#:9:"#N< PT#T (A9

Tonic-clonic sei/!resPreceded by a!ra+ s!dden loss of conscio!sness7onic phase) ri$id m!scles+ incontinence ?as

m!scle contracts+ bladder rela%'Clonic phase) altered contraction+ rela%ation+ eyesroll bac*+ froths at mo!th!ostEictal phase) !nconscio!s and !nresponsive tostim!li

Statu' E-"le-t"cu'1. Contin!o!s sei/!re activity+ $enerally tonic-clonictype2. Client at ris* to develop hypo%ia+ acidosis+hypo$lycemia+ hyperthermia+ e%ha!stion&. 9ife threatenin$ medical emer$ency re!irin$immediate treatment)

a. stablish and maintain airwayb. ia/epam ?=ali!m' and 9ora/epam ?Ativan'intraveno!sly atc.DQ e%trose #=d. Phenytoin ?ilantin' #=-increase sei/!rethresholde. Pentobarbital-lessen nervo!s irritation

Med"cat"o!':a. (ana$e b!t do not c!re sei/!resb. "aise sei/!re thresholdc. Carbame/epine F 9amotri$ine

- associated with Stevens-ohnsonsyndrome ?SS' or to%ic epidermal

necrolysis ?TN'.- very dan$ero!s s*in reactions- These problems start o!t as s*inrashes b!t can pro$ress to permanentdisfi$!rement or even loss of life.

d.Phenytoin- most common S is


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W#neffective airway clearance) limit s!ctionin$ to L1-1D seconds+ hypero%y$enateW"is* for aspirationW"is* for impaired s*in inte$rity) preventive meas!res+contin!al inspectionW#mpaired physical mobility) maintain f!nctionality of

5oints+ physical therapyW"is* for #mbalanced N!trition) 9ess than bodyre!irementsWAn%iety ?of family'

NEUROLOGICAL 2ISOR2ERS

=8 %(9(N(RA7IV( %IS(AS(S- P"(AT>" SNSCNC : C99S- Par*insons disease- @!ntin$tons Chorea- A9S- Al/heimers

@8 AU7*I&&UN( %IS(AS(- (!ltiple Sclerosis- (ncontrolled contin!al m!sc!larcontractions ?dystonia'

0al*in$ diffic!lty+ st!mblin$+ fallin$

/. Co!"t"&e: Co$nitive f!nction is !s!ally affected with

dementia!s!ally occ!rrin$.

#mpaired 5!d$ment and memory

Slowin$ of tho!$ht processes to controlm!scle.

@. P'(c%"atr"c S()-to)'A. epressionb. Psychotic symptoms

- el!sions- @all!cinations

- ParanoiaMa!ae)e!t::

NO treat)e!t t%at %alt' or re&er'e'8

Med"cat"o!' to reduced c%orea:a' 2o-a)"!e rece-tor blocBer'

- improve the chorea in manypatients- Thiothi%ene @ydrochloride ?Navane'- @aloperidol ecanoate ?@aldol'

b' R"lu#ole *R"luteB+- showed to red!ce chorea

c.' A!t"de-re''a!t'- for patients with emotionaldist!rbances+ partic!larly depression.

d.' A!t"-'(c%ot"c )ed"cat"o!'E 0in lo doses1for patients withpsychotic symptoms.

Nur'"! 2"a!o'e' : "is* for in5!ry

"is* for Aspiration

#mbalanced N!trition) 9ess than bodyre!irements

#mpaired S*in #nte$rity

#mpaired =erbal Comm!nication

ist!rbed tho!$ht processes

Nur'"! Care :Focu' o!:1. (obility2. Personal hy$iene&. Comm!nication4. N!tritionD. liminationG. Ge!et"c cou!'el"!

I0. AL4HEIMERS d"'ea'e A pro$ressive ne!rolo$ic disorder that affects

the brain res!ltin$ in co$nitive impairmentsCAUSES:

>n*nown

Potential factors- Amyloid pla!es in thebrain+ :%idative stress+ ne!rochemicaldeficiencies

=ery common3 ris* increases with a$e

Brain chan$es)

pla!es

tan$led ne!rons blood vessel de$eneration

chemical chan$es

A-to'sy is the *ost e,initie

Te! =ar!"! '"!' o$ Al#%e")er' d"'ea'e (emory loss

iffic!lty performin$ familiar tas*s

Problems with lan$!a$e

isorientation to time and place

Poor or decreased 5!d$ment

Problems with abstract thin*in$

(isplacin$ thin$s

Chan$es in mood or behavior

Chan$es in personality

9oss of initiative

16
http://en.wikipedia.org/wiki/Neurodegenerative_diseasehttp://en.wikipedia.org/wiki/Genetic_disorderhttp://en.wikipedia.org/wiki/Cognitivehttp://en.wikipedia.org/wiki/Dementiahttp://www.neurologychannel.com/dystonia/index.shtmlhttp://www.mentalhealthchannel.net/schizophrenia/symptoms.shtml#delhttp://www.mentalhealthchannel.net/schizophrenia/symptoms.shtml#hallhttp://en.wikipedia.org/wiki/Neurodegenerative_diseasehttp://en.wikipedia.org/wiki/Genetic_disorderhttp://en.wikipedia.org/wiki/Cognitivehttp://en.wikipedia.org/wiki/Dementiahttp://www.neurologychannel.com/dystonia/index.shtmlhttp://www.mentalhealthchannel.net/schizophrenia/symptoms.shtml#delhttp://www.mentalhealthchannel.net/schizophrenia/symptoms.shtml#hall


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9 STAGES OF Al#%e")er' 2ISEASE

Stae Kor$etf!lness

K(ild memory lapses

KShort attention span

Kecrease interest in personal affairs

Ks!btle behavior chan$esStae /

Kshort term memory 9apses Khesitant speech

Kco!$abulat"o!to hide memory problems Kmisplace item

Krepetitive behaviorStae @

Kisoriented to person+place+time

K=a!der' KApra%ia-impairment in the ability to perform

p!rposef!l acts or to manip!late ob5ectsStae 9

KTerminal Sta$e

Ksevere physical and mental deterioriation

KNo reco$nition of selfothers

Kcompletely dependent

Kincontinent

KAphasia

Kyspha$ia

Med"cal Ma!ae)e!t (edication to treat symptoms

(emory)Co!e1, Ar"ce-t A$itation) (ellaril+ @aldol

S!pplements

olic Acid F =itamin B12

9ow fat diet NSA#S

Nur'"! 2"a!o'"' A9T" T@:>se of standard preca!tions with blood and

body fl!ids

S!pport and assistance to client and family

AUTOIMMUNE 2ISEASES

I. MULTIPLE SCLEROSIS

An a!to-imm!ne mediated pro$ressivede)(el"!at"! d"'ea'e o$ t%e CNS

The myelin sheath is destroyed and replacedby sclerotic tiss!e ?sclerosis'

Periods of e1acerbat"o!' a!d re)"''"o!' CA>S- !n*nown

(!ltiple factors- viral infection+ environmentalfactors+$eo$raphic location and 1enetic

'reis'osition

#ncidence is hi$hest in (ou! adult' */K D9K+Qonset between 2 , D

Affects $e)ale'more than males ?&Sfeminine title1

(ore common in te)-erate cl")ate'

PATHOPHYSIOLOGY Sensiti/ed T cells will enter the brain and

promote antibody prod!ction that dama$esthe myelin sheath

Pla!es of sclerotic tiss!es appear on thedemyelinated a%ons interr!ptin$ the ne!ronaltransmission

Ma!"$e'tat"o!'1. ati$!e- initial manifestation2.O-t"c !er&e "!&ol&e)e!t) bl!rred vision+ ha/iness&.ra"! 'te) "!&ol&e)e!t) nysta$m!s+ dysarthria?scannin$ speech'3 co$nitive dysf!nction+ verti$o+deafness4. 0ea*ness+ n!mbness in le$s+ spastic paresis+bladder and bowel dysf!nction

17


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D.Cerebellar "!&ol&e)e!t) nysta$m!s+ ata%ia+hypotoniaG. Blindness

CHARCOTS TRIA2 57 NYSTAGMUSINTENTIONAL TREMORSCANNING SPEECH

TREATMENT:1. No c!re3 medical treatment is

directed toward treatment of thedisease process and symptoms.

2. (edications to decrease edema andinflammation of the nerve site.

a. Anti-inflammatory.b. Antispasmodic.c. #mm!nos!ppressive.d. Anticholiner$ic and choliner$ic.e. #nterferons.

Nur'"! I!ter&e!t"o!:


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2. #ncreased secretions ?saliva+bronchial'.

&. "estlessness and apprehension.4. Tensilon test to differentiate crisis.&. 2"a!o't"c'.a. Clinical manifestations.b. lectromyo$raphy-shows a decreasin$response of m!scles to stim!li.

c. TENSILON te't- edrophoni!mchloride ?Tensilon' administered andclient with myasthenia will showsi$nificant improvement lastin$ Dmin!tes

Treat)e!t:1. Anticholinesterase ?choliner$ic'

medicationsa. to improve imp!lse

transmission ?(estinon'2. Steroids

a. to s!ppress imm!ne system?steroids+ Cyto%an'

&. Plasmapheresisa. >sed to remove antibodies

4. #mm!nos!ppressive therapy.D. S!r$ical removal of the thym!s

?thymectomy'.

Nur'"! I!ter&e!t"o!:? Client $enerally hospitali/ed for ac!temyasthenic crisis or for respiratoryinfection'.


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2. (aintain respiratoryf!nction3 may re!iremechanical ventilation.

Nur'"! I!ter&e!t"o!:


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1. He)"-le"a, loss of vol!ntary movement+dama$e to the ri$ht side of the brain willres!lt in left-sided wea*ness and paralysis

2. A-%a'"a, defect in !sin$ and interpretin$ thesymbols of lan$!a$e+ may incl!de written+printed or spo*en words+ may be partial orcomplete.

&. Problem of ne!rom!sc!lar control ofrespiration.

4. Problem of ne!rom!sc!lar control overswallowin$ and co!$h refle%.

D. #nitially may be incontinent.G. A!o'"a- a percept!al defect that ca!ses a

dist!rbance in interpretin$ sensoryinformation+ client may not be able toreco$ni/e previo!sly familiar ob5ects.

. motional lability.H. #mpairment of 5!d$ment and memory.E. @ypotonia ?flaccidity' for days to wee*s

followed by hypertonia ?spasticity'.1. =is!al defects homonymo!s hemianopsia+ the

loss of vision in one half of the vis!al field.11. Percept!al defects.

12. Apra%ia inability to carry o!t learnedmovements.

Nur'"! 2"a!o'"':

- #neffective Airway Clearance related tone!rolo$ical deficits inability to co!$h.- Altered Tiss!e Perf!sion related to interr!ptedcerebral vasc!lar blood s!pply.- #mpaired =erbal Comm!nications related tovis!al and speech impairment.- Potential for #n5!ry related to sei/!res andne!rolo$ical deficits.

- Alteration #n N!trition)9ess Than Body "e!irements relateddiffic!lty in swallowin$ and potential for

aspiration.- #mpaired Physical (obility related to severewea*ness and paralysis.- 7nowled$e eficit related to pro$nosis.@. 2"a!o't"c'a. Clinical manifestations elicited in the

ne!rolo$ical e%am.b. Cerebral arterio$ram.c. 9!mbar p!nct!red. CAT and brain scan.Treat)e!t=8 !rophylactic8a. Aspirin.b. Persantinec. Antihypertensives.@8 &edical a. (edications to decrease cerebral edema.1. :smotic di!retics2. Corticosteroids ?de%amethasone'.b. (edical meas!rements to maintain

homeostasis.>8 Surgical8a. Carotid endarterectomy.b. Cerebral revasc!lari/ation.

U!"lateral Nelect3 Nelect S(!dro)e,- ne!ropsycholo$icalcondition in which+ afterdama$e to one hemisphere of the brain+ adeficit in attention to and awareness of oneside of space is observed.- is very commonly seencontralateralto thedama$ed hemisphere

Nur'"! I!ter&e!t"o!


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d. "estrict fl!id inta*e as indicated.e. Assess respiratory parameters

indicative of fl!id overload ?rales+dyspnea+ etc.'

&. (aintain and promote normalelimination.

a. Avoid !rinary catheter if possible3 ifcatheter is necessary+ remove assoon as possible.

b. :ffer bedpan or !rinal every twoho!rs3 help establish a sched!le.

c. Prevent constipation- increase b!l* inthe diet+ stool softeners+ etc.

d. Provide privacy and decreaseemotional tra!ma related toincontinence.

4. Prevent problems of s*in brea*downthro!$h proper positionin$ and $oods*in hy$iene.

D. (aintain psycholo$ical homeostasisa. Client is very an%io!s d!e to the flac*

of !nderstandin$ of what hashappened to himher and the inability

to comm!nicate.b. Spea* slowly+ clearly+ and e%plain

what has happened.c. Assess clients comm!nication

abilities and identify methods topromote comm!nication.


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1. Ris+ factors#etiology.a. Con$enital deformities of the

vessel.b. Atherosclerosis res!ltin$ in

wea*ness of the vessel wall.c. @ypertension3 head tra!ma

may enhance the problem.d. (ost often occ!rs in middle

life.2. Clinical manifestations.

a. A "!pt!re may be preceded by)a. Severe headache.b. #ntermittent na!sea.c. "!pt!re fre!ently occ!rs witho!twarnin$.

1. Severe headache.2. Sei/!res.&. N!chal ri$idity4. @emiparesis.D. 9oss of conscio!sness.G. :verall symptoms depends on the

site and amo!nt of bleedin$3 overall

pro$nosis is poor.>8 %iagnostics8a. 9!mbar p!nct!re+ revealin$

blood in the spinal fl!id.b. Cerebral an$io$ram.c. CAT scan.

Treat)e!t1. :smotic di!retics.2. Antihypertensive medications.&. S!r$ical intervention-li$ation or 6clippin$8 of

the ane!rysm.

Nur'"! I!ter&e!t"o!


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WSevere+ headache+ sei/!res+ vomitin$+ hemiparesis+fi%ed+ dilated ipsilateral p!pils

>8 Intracerebral :ematomaWContained well-defined blood clot3 !s!ally at frontaland temporal lobes

Cou-5Co!trecou- "!8ur(-dama$e to the site ofimpact ?co!p' and dama$e on the opposite side ofthe in5!ry ?contreco!p'.

Ma!ae)e!t) Craniotomy

C. Cerebral edema and #ncreased #CP

SBull $ractureWbrea* in contin!ity of s*!ll !s!ally res!ltin$ in braintra!maa.L"!ear) d!ra remains intact3 s!bd!ral or epid!ralhematoma may occ!r !nderneathb. Co))"!uted a!d de-re''ed 'Bull $racture':increase ris* for direct in5!ry to brain tiss!e fromcont!sion ?br!ise' and bone fra$ment) ris* for

infectionc. a'"lar) involves base of s*!ll ?softer' and !s!allyinvolves e%tension of ad5acent fract!res

A''e'')e!t:WR%"!orr%ea) thro!$h noseWOtorr%ea) thro!$hW(ay appear on %-ray

WHe)ot()-a!u)) blood behind tympanic membrane?p!rple or dar* color'Normal) pearly $rayWattle''"!) blood over mastoid processWRaccoo!e(e') bilateral periorbital ecchymosisW


25/33

&. #ncomplete.a. Central cord syndrome-center of cord isdama$ed+ res!lts primarily in impairmentin !pper e%tremities.b. %amage to one side of the cord 0'ronESeJuard syndrome'-motor f!nction andposition sense may be present on one side+temperat!re and sensation may be loston the opposite side.c.Anterior cord damage-disr!ption of bloodflow res!lts in a mi%ed loss of sensory andmotor f!nction below the level of in5!ry.

C. S-"!al Cord S%ocB *are$le1"a'-occ!rspredominantly in complete cord lesions. Beca!se ofthe loss of comm!nication with the hi$her centers ofcontrol+ the m!scles below the level of in5!ry willbecome flaccid and all f!nctional control will cease.

1. Spinal cord in5!ry interr!pts the sympathetic nerveimp!lse transmission+ the parasympathetic imp!lsesare not co!nter chec*ed and vasodilation occ!rs3 thisres!lts in hypovolemia and hypotension.

2. There is loss of the hypothalam!s to control bodytemperat!re by vasoconstriction and dilation.&. Condition may persist for several wee*s andreverse spontaneo!sly+ resol!tion of spinal shoc* willbe evident by the ret!rn of refle%es.4. Spasticity will occ!r as recovery pro$resses.Spastic movements may be precipitated by emotionand c!taneo!s stim!lation.

2. Neuroe!"c '%ocB.

1. ominance of the parasympathetic nervo!ssystem res!lts in loss in vasomotor tone andincreased va$al tone leadin$ to hypotension andbradycardia.2. s*in stays warm and dry d!e to loss of sympatheticresponse of vasoconstriction.&. Condition may mas* symptoms of hemorrha$e inthe tra!ma client.

E. Auto!o)"c d('re$le1"a *A2+occ!rs in clients withan in5!ry at T-G or hi$her.

1. A no%io!s stim!li below the level of in5!ry tri$$ersthe sympathetic nervo!s system which ca!ses arelease of catecholamines res!ltin$ in bnypertension.2. Spinal in5!ry bloc*s the normal transmission ofsensory imp!lses and the imp!lses cannot reach thebrain+ b!t they rebo!nd and stim!late the sympatheticnervo!s system.&. there is an e%a$$erated response to the sensorystim!li+ most common stim!li ca!sin$ the responseare a f!ll bladder+ fecal impaction+ and s*instim!lation.4. Severe hypertension+ po!ndin$ headache+bradycardia+ restlessness+ s*in fl!shed and warm arenot !ncommon body responses.D. Treatment is directed identifyin$ and removin$

no%io!s stim!li.

. Bladder dysf!nction will occ!r as a res!lt of thein5!ry. Normal bladder control is dependent on boththe sensory and motor pathways+ and the lowermotor ne!rons bein$ intact.

1. Re$le1 !euroe!"c bladder?spastic+a!tonomo!s'occ!rs in clients with cord lesions abovethe level of lower l!mbar and ca!dal area of thespine. The lower motor ne!ron pathway remainsintact below the level of the in5!ry.

a.There is loss of vol!ntary m!scle control+and dependin$ on the level of the in5!ry+there is loss or decreased sensation.b. Bladder will retain a vol!me of !rine+ thenrefle%ive invol!ntary voidin$ will occ!r.c. Bladder empties a!tonomically in responseto stretchin$ of the detr!sor m!scles.

2. No!re$le1"c !euroe!"c bladder *$lacc"d+occ!rsin clients will cord lesions at the lower l!mbar andca!dal area of the spine. The lower motor ne!ronsare dama$ed.

a. The sensory f!nction may remain!nimpaired+ there is loss of bladder toneand vol!ntary control.b. Bladder retains a vol!me of !rine+becomes distended and overflows.c. There is no bladder m!scle contraction or

forcef!l emptyin$.


26/33

- Alteration in limination+ bowel andBladder related to level of in5!ry.- #mpaired Physical (obility related tolevel of in5!ry.- ist!rbance in Body #ma$e related todependency on others andchan$e in body f!nction.- Self Care eficit related to anticipatedlosses.-


27/33

re$ard to developmentof ne!ro$enic shoc*and hemorrha$e.

b' =a$al stim!lation+hypothermia+ andhypo%ia mayprecipitate spinalshoc*.

c' evelopment ofspasticity of m!sclesbelow the level ofin5!ry indicatesresol!tion of spinalshoc*.

&. Assess for developmental of a!tonomicdysrefle%ia+ if it occ!rs)

a' levate the head of the bed ?if possible'.b' Assess for so!rces of stim!li-distended

bladder+ fecal impaction+ or constipation.c' "elieve the stim!li and fre!ently

dysrefle%ia will s!bside.d' (aintain cardiovasc!lar s!pport d!rin$

period of hypertension.

4. val!ate cardiovasc!lar responses when ors!ctionin$.D. #f t!rnin$ on a circ!lar electric bed+ eval!ate forpost!ral hypotension.G. Antiembolism stoc*in$s or elastic wraps to thele$s to facilitate veno!s ret!rn. ?9ac* of m!scletone and loss of sympathetic tone in theperipheral vessels res!lts in a decrease inveno!s tone and in veno!s ret!rn predisposin$the client to the development of deep veinthrombosis'.

Goal: to )a"!ta"! adeuate $lu"d a!d!utr"t"o!al 'tatu'.

1. !rin$ the first forty-ei$ht ho!rs+eval!ate


28/33

- Provide pin care.- ns!re wt is han$in$ freely.- T!rn to sides 2@- Assess insertion site for infection.- (assa$e the occip!t.

2. @alo TractionA. Avoid p!ttin$ powder inside the vest.B. T!rn the pt as a !nit+ do not !se the halo

vest to lift the pt.C. Assess for ti$htness of the vest by

ens!rin$ that 1 fin$er can be placed !nder the5ac*et.

. @ave the correct-si/e wrench available atall times for emer$ency.

. Provide pin care.

CNS INFECTIONS

I. Me!"!"t"'W#nflammation of pia matter+ arachnoid ands!barachnoid spaceWSpreads rapidly thro!$h CNS beca!se of circ!lationof CS aro!nd brain and spinal cordW(ay be bacterial+ viral+ f!n$al+ parasitic in ori$inW#nfection enters CNS tho!$h invasive proced!re orthro!$h bloodstream+ secondary to another infectionin body

acter"al Me!"!"t"'

Ca!sative or$anism)Neisseria menin$itides+ Streptococc!s pne!monia+@aemophil!s infl!en/a+ scherichia coli

Ma!"$e'tat"o!'a. ever+ chillsb. @eadache+ bac* and abdominal painc. Na!sea and vomitin$d. Me!"!eal "rr"tat"o!:

N!chal ri$idity ?stiff nec*'-early si$n] :pisthotonosPositive 7erni$s si$nPositive Br!d/ins*is si$n-when the patientsnec* is fle%ed+ fle%ion of the *nees and hips isprod!cedPhotophobia ,e%treme sensitivity to li$ht

e. Me!"!ococcal )e!"!"t"') rapidly spreadin$petechial rash of s*in and m!co!s membranef. I!crea'ed ICP) decreased 9:C+ papilledema ,edema of optic disc d!e to increased #CP

0"ral Me!"!"t"'W9ess severe+ beni$n co!rse with short d!ration+intense headache with malaise+ na!sea+ vomitin$+lethar$y+ si$ns of menin$eal irritation

E!ce-%al"t"'1. Ac!te inflammation of parenchyma of brain orspinal cord2. >s!ally ca!sed by vir!s

Med"cat"o!'1. (enin$itis) immediate treatment of effectiveantibodies for -21 days accordin$ to c!lt!re res!lts3de%amethasone to s!ppress inflammation

ilantinR#ncrease sei/!re threshold

Healt% Pro)ot"o!1. =accinations for menin$ococcal+ pne!mococcal+haemophil!s menin$itis2. Prophylactic rifampins for persons e%posed tomenin$ococcal menin$itis&. (os!ito control4. Prompt dia$nosisD. Asepsis care for clients with open head in5!ry orne!ros!r$ery

NEUROPATHIES

I. Tr"e)"!al Neural"a

A Cranial nerve disorder affectin$ the sensorybranches of the tri$eminal ?cranial nerve ='.

A''e'')e!t1. "is* factorsetiolo$y.

a. :nset $enerally between 2 and 4 years ofa$e.

b. #ncreasin$ fre!ency with a$in$.

2. Clinical manifestations.a. Abr!pt onset of paro%ysmal pain in the lower and

!pper 5aw+ chee*+ and lips.1' Tearin$ of the eyes and fre!ent blin*in$.2' acial twitchin$ and $rimacin$.&' Pain !s!ally brief3 ends as abr!ptly as it

be$ins.b. "ec!rrence of pain is !npredictable.c. Pain is initiated by c!taneo!s stim!lation of theaffected nerve area.

1' Chewin$.2' 0ashin$ the face.&' %tremes of temperat!re-either on the face or

in food.4' Br!shin$ teeth.

&. ia$nostics.a. clinical manifestations.b. Test to r!le o!t other ne!rolo$ic dysf!nctions.Treat)e!t1. (edical mana$ement of pain.a. #9ANT#N.b. T


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Potential for Self @arm related to inability to copewith pain.

-rsin1 Priority0 D-e to the seere 'ain o, theconition+ clients are s-sce'ti


30/33

1. Nysta$m!s.2. iplopia.&. ecrease in vis!al ac!ity.4. =is!al field deficits.f. @ead tilt- child may tilt the head d!e to

dama$e to e%tra oc!lar m!scles3 may be firstindication of a decrease in vis!al ac!ity.

$. Behavioral chan$es.1' :bvio!s personality chan$es.2' ecreasin$ level of conscio!sness.&' ecreasin$ activity+ increased sleep

periods in the infant.h. ecrease in m!scle stren$th or loss of

specific areas of movement.i. Chan$es in vital si$ns indicative of increasin$

#CP.5. Sei/!res ?focal or $enerali/ed'.*. Cranial enlar$ement in the infant !nder

ei$hteen months old.l. Papilledema ?edema of the optic disc'.m. i//iness and verti$o.NURSING 2IAGNOSES: Brain T!mor

#n5!ry) @i$h "is* related to $ait disorders+ verti$o+vis!al dist!rbances+ orcompressiondisplacement of brain tiss!e.

An%iety related to implications of condition and!ncertain f!t!re.Self-care eficit related to inability to perform

A9s secondary to sensory-motor impairment.Altered amily Processesrelated to the nat!re ofthe condition+ role dist!rbances+ and !ncertainf!t!re.

&. ia$nostics.a. Clinical manifestations e%hibited in the

ne!rolo$ical e%am.b.


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c. Perinatal.1' Premat!rity.2' Tra!ma d!rin$ delivery.&' @yperbilir!binemia.

d. Postnatal.1' Cerebral tra!ma.2' C=A&' #nfection.

2. Clinical manifestations.a' elayed achievement of

developmental milestones.b' Ne!romotor dysf!nction in

motor performances.c' #ncreased or decreased

resistance to passivemovement.

d' Abnormal post!re.e' Presence of infantile refle%es

?tonic nec* refle%+ e%a$$eratedmoro'.

f' Associated disabilities incl!de)1. (ental retardation3

appro%imately 1& of thechildren affected are ofnormal or s!periorintelli$ence.

2. Sei/!res&. Attention-deficit problems.4. =ision and hearin$

sensory impairments&. ia$nostics.

a. Ne!rolo$icale%amination andcontrib!tin$ history.

b. ia$nostics tests to

r!le o!t otherne!rolo$icaldysf!nction.

c. re!ently diffic!lt todia$nose in earlymonths3 conditionmay not be evident!ntil child attempts towal*.

Treatment?


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Treat)e!t3Ma!ae)e!t1. i!retics2. S!r$ery&. Protect from in5!ry from altered 9:C andimmobility

SPINA IFI2A

Spina Bifida , refers to a malformation of the spine inwhich the posterior portion of the laminae of thevertebrae fails to close. #ts the most commondevelopmental defect of the Central Nervo!s System.(:ST C:((:N T;PS

1. SP#NA B##A :CC>9TA+ in which thedefect is only in the vertebrae. The spinalcord and menin$es are normal.

2. (N#N


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enhanced the !ality of life for most childrenwho received treatment for the defect.

CLINICAL PROLEMS COMMONLYASSOCIATE2 ITH MENINGOMYELOCELEA. Neurolo"c Proble)'.1. Arnold-Chiari malformation

a'. associated malformation involvin$ thebrain stem and cerebell!m

b'. ca!ses bloc*-flow-CS thr! the ventriclesand leads to fail!re n the reabsorptionmechanism of CSc'. Prod!ces si$nificant hydrocephal!s inappro%imately 2& of children witmenin$omyelocele

2. 9oss of motor control and sensation below thelevel of the lesion..Mob"l"t( a!d Ort%o-ed"c Proble)'

1. Contract!res2. Cl!bfeet&. Scoliosis4. Amb!lation and ability to be !pri$ht.

C. Urolo"c Proble)'- sacral nerves innervate thebladder.

2. o=el Proble)', poor innervation of the analsphincter and bowel m!sc!lat!re.E.SB"! Proble)', areas of decreased sensation

have a tendency to brea* down.

F. 2"etar( Proble)', children become overwei$htbeca!se of activity limitations.

ietary control to prevent obesity.G. 2e&elo-)e!tal Proble)', avera$e intellect!alability despite hydrocephal!s.2IAGNOSTICS, prenatal screenin$ for ne!ral t!bedefects. A blood test may reveal hi$h levels ofmaternal AP , ser!m alphafetoprotein indicatin$ a

brea* in the ne!ral t!be that is allowin$ too m!ch ofthis protein to seep into amniotic fl!id ands!bse!ently into the mothers blood. The res!ltsm!st be confirmed by !ltraso!nd and amniocentesis+altho!$h these tests cant determine the severity ofthe defect.

TREATMENT AN2 NURSING INTER0ENTIONS)

- epends on the e%tent of the ne!rolo$ic deficit+level of the lesion+ and any complication she mayhave , most commonly hydrocephal!s and >T#.5 I! car"! $or a !e=bor! o$ '-"!a b"$"da, t%e!ur'e' )a8or co!cer! "' -re&e!t"! "!$ect"o!.

a. Scree!"! - indentation or t!ft of hair may be theonly visible si$n of mild forms of spina bifida.#n more severe cases - the defect is obvio!s) aportion of the spinal cord protr!des from the infantsbac*. Tiss!es and nerves are either completelye%posed or covered by a thin membrane of s*in.Co&er t%e -rotrud"! 'ac, whether open or closed

, ri$ht away with a non adherent+ sterile $a!/edressin$ soa*ed with sterile saline. 7eepin$ it moistwill help prevent infection before referrin$ her to ane!ros!r$eon. S!r$ery to repair the sac with intacttiss!e and s*in $rafts within the ne%t 4H to 2 hrs.

?others within 24 hrs.'

e$ore 'urer() N!rses do complete physicale%amination - Since m!sc!los*eletal problems s!chas dislocated hips and cl!bfeet fre!ently accompanymyelomenin$ocele , pay partic!lar attention to thelower e%tremities.

baby stays in this position d!rin$ feedin$s. o ran$eof motion e%ercises $ently every ho!r to preventpress!re sores.

Ur"!e a!d $ece'- that remain for any len$th of timein the babys diaper increase the ris* of infection. Soinstead of diaperin$ simply place one !nderneath her.

A foley cathether is inserted before s!r$ery.

To $urt%er -rotect aa"!'t "!$ect"o!, start acontin!o!s #= inf!sion of

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NOTES on Neurological System

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