Nervous System

DEAN JANE L. OLID

Neuron
Central Nervous
System
Brain
Cerebrum
Cerebellum
Brain stem
Midbrain
Pons
Medulla oblongata
Spinal cord
 Nervous System

1. Central Nervous System

 Brain
 Spinal Cord

2. Peripheral Nervous System

 Cranial Nerves

 Spinal Nerves
 •BRAIN

The Brain is divided into 3 major areas:

1. Cerebrum

2. Brain Stem

3. Cerebellum
External surface of the brain
 BRAIN- 1. Cerebrum
 The largest part of the brain.
 Composed of:
 2 hemispheres- the right and left, and the basal
ganglia.
 The hemisphere is connected by corpus callosum,
a band of fibers.
 Each hemisphere is divided into 4 lobes.
Structure of the Brain
1.
The 4 Lobes
Frontal Lobe of the CEREBRUM
 Largest lobe
 location: front of the skull.
 contains the primary motor cortex and
responsible for functions related to motor
activity.
 The left frontal lobe contains Broca’s area
(control the ability to produce spoken words)
 The frontal lobe controls higher intellectual
function, awareness of self, and
autonomic responses related to emotions.
2. Parietal
 Sensory lobe
 location: near the crown of the head.
 Contains the primary sensory cortex.
 One of its major function is to process sensory
input such as position sense, touch, shape, and
consistency of objects.
3. Temporal
 Location: around the temples.
 Contains the primary auditory cortex.

 Wernicke’s area is located on left temporal

lobe.
 Contains the interpretative area where auditory, visual and
somatic input are integrated into thought and memory
 Lobes-cont.

4. Occipital
 Location: lower back of the head
 Contains the primary visual cortex

 Function: responsible for visual

interpretation.
 THE 4 LOBES
 Frontal- motor
/controls higher
intellectual function,
awareness of self, and
autonomic responses
related to emotions.
 Parietal- sensory
 Temporal-auditory
(Wernicke’s); Contains
the interpretative area
where auditory, visual
and somatic input are
integrated into thought
and memory
 Occipital-visual
 BRAIN- DIENCEPHALON
 Lies on the top of the brain-stem
 contains the thalamus, hypothalamus, epithalamus, and
subthalamus.
 Thalamus
 Lies on the either side of the third ventricle
 “Relay station” for all sensation except smell.
 All memory, sensation and pain impulses pass through this
section.
 Hypothalamus
 Located anterior and inferior to the thalamus.
 Has a variety of function and plays an important role in
maintaining homeostasis.
 regulation of body temperature, hunger and thirst;
formation of autonomic nervous system responses; and
storage and secretion of hormones from the pituitary
gland.
 Epithalamus
 Contains pineal gland.
 Subthalamus
 Part of the extrapyramidal system of the autonomic nervous
system and the basal ganglia.
 The Basal Ganglia
 Are masses of nuclei located deep in the
cerebral hemispheres.
 responsible for fine motor movements,
including those of the hands and lower
extremities.
 Several motor disorders are associated with
basal ganglia damage including
Huntington’s chorea and Parkinson’s
disease.
 BRAIN-2. Brain Stem
 Consist of the midbrain, pons, and medulla
oblongata.
 Midbrain

-connects the pons and the cerebellum with the

cerebral hemisphere, it contains sensory and
motor pathways
-center for auditory and visual reflexes
 Pons

-connects the two halves of the cerebrum

- involved in the integration of movements in the
right and left sides of the body, and the
transmission of motor information from the higher
brain areas and the spinal cord to the cerebellum.
 medulla oblongata - involved in the respiration,
circulation, gastrointestinal functioning, coughing,
sneezing, and swallowing.
 BRAIN-3. Cerebellum
 Location: base of the brain.
 Responsible for coordination, balance

and posture.
 Damage to the cerebellum can result in

ataxia, a condition characterized by

drunken-like movements, severe
tremors, and loss of balance.
 Structures Protecting the Brain
 The brain is contained in the rigid skull,
which protects it from injury.
 The meninges (fibrous connective

tissues that cover the brain and the

spinal cord) provide protection, support
and nourishment to the brain and the
spinal cord.
 Layers of the meninges:

1.dura mater
2.arachnoid
3.pia mater.
 CSF
 CSF - provide a cushion, provide
nutrition, maintain normal ICP, remove
metabolic waste.
 Composition – colorless, odorless fluid
containing glucose, electrolytes, oxygen,
water, small amount of carbon monoxide and
few leukocytes.
 Produced in the choroid plexus of the
ventricles.
 •Spinal Cord
 Approximately 45 cm long (18 inches) long.
 Acts as a passageway for condition
of sensory information from the
periphery of the body to the
brain (via afferent nerve fibers).
 Serve as the connection between the brain
and the periphery.
 Mediates the reflexes.
 Spinal Cord

cervical - C1-4
brachial plexus - C5-8, T1
intercostal - T2-T12
lumbar - L1-L4
sacral - L4-L5, S1-S3
pudendal - S4
 BLOOD SUPPLY TO THE CNS
 1/3 of the cardiac output
 From 2 vertebral artery and one internal
carotid arteries
 Circle of willis
Peripheral Nervous System –
Cranial Nerves & Spinal Nerves
 •Cranial Nerves
 I—Olfactory nerve
 II—Optic nerve
 12 pairs  III—Oculomotor nerve
 emerge from the  IV—Trochlear nerve
undersurface of the brain.  V—Trigeminal nerve
 Cranial nerve conducts  VI—Abducens nerve
impulses (motor and VII—Facial nerve
sensory information)  VIIIAcoustic/Vestibuloc
between the brain and ochlear
various structures of the  IX—Glossopharyngeal
head, neck, thoracic nerve
cavity and abdominal  X—Vagus nerve
cavity.  XI—Accessory nerve
 XII—Hypoglossal nerve
 Cranial Nerves
Cranial Nerves Function Assessment
I. Olfactory Sensory: Assess nose for Smell.
smell reception and Have the client close eyes

interpretation and properly identify

common aromatic substance
held under the nose; test one
nostril at a time. (ex. coffee,
toothpaste, orange)

Assess eyes for Visual Acuity

II. Optic Sensory: and Peripheral Vision.
visual acuity and visual Vision and visual field tested
fields with an eye chart and by
testing point at which person
sees an object (finger)
moving into visual fields;
inside of the eye is viewed
with ophthalmoscope to
observe blood vessels.
Cranial Nerves Function Assessment
III. Oculomotor Motor: Assess eyes for
raise eyelids, most Extraocular Movement.
extraocular movements The CN III, CN IV,

and CN VI nerves are

tested together since
they control muscles
that provide eye
movement. Test the
movement of the eyes
in the six cardinal
fields of gaze.
Assess eyes for
Parasympathetic:
Pupillary Constriction
pupillary constriction, and Accommodation.
change lens shape To test pupillary

reaction and
accommodation, shine
a light into the eye to
note whether the iris
Cranial Nerves Function Assessment
constricts, making the
pupil smaller.
Accommodation is

tested by observing
pupillary constriction
when the client changes
gaze from a distant
object to a near object.
IV. Trochlear Motor: Assess eyes for
downward, inward eye Extraocular Movement
movement.
Assess face for
Motor: jaw opening and Movement and
V. Trigeminal
clenching, chewing and Sensation
mastication Test motor function by

Sensory: sensation to having the client clench

cornea, iris, lacrimal his/her teeth, then
glands, conjunctiva palate the temporal and
eyelids, forehead, nose, masseter muscles.
nasal and mouth To test light sensation,

mucosa, teeth, tongue, have the client close his/

Cranial Nerves Function Assessment
her eyes, then wipe a
cotton wisp lightly over
the anterior scalp,
paranasal sinuses, and
jaw.
To test deep sensation,

use alternating blunt and

sharp ends of a paper clip
over the client’s forehead
and paranasal sinus.
VI. Abducens Motor: lateral eye
movement
Inspect the face both at
VII. Facial Motor: movement of
facial expression rest and during
muscles except jaw, conversation.
close eyes, labial Have the client raise the

speech sounds. eyebrows, frown, close

the eyes tightly and show
the teeth,
Cranial Nerves Function Assessment
Smile and puff out the
cheeks.
Sensory: taste- Assess mouth for Taste
anterior two third of Instruct the client to stick

tongue, sensation to out the tongue and leave it

Pharynx out during the testing
Parasympathetic: process. Use a cotton
secretion of saliva applicator to place
and tears. quantities of salt, sugar,
and lemon to client’s
tongue.
VIII. Acoustic Sensory: hearing and Hearing initially can be
equilibrium. screened while taking the
history.
Cranial Nerves Function Assessment
IX. Glossopharyngeal Motor: Assess mouth for Gag
voluntary muscle for Reflex and Movement
swallowing and of Soft Palate.
phonation. Evaluate CN IX and

CN X together for
movement and gag
reflex.
Parasympathetic:
Instruct the client to
secretion of salivary
gland, carotid reflex say “ah”; there should
be bilateral equal
upward movement of
the soft palate and
uvula; gagging will
occur; and speech
Motor: voluntary should be smooth.
muscle of phonation
X. Vagus Assess mouth for Gag
and swallowing
Reflex and Movement
Sensory: sensation of Soft Palate
behind ear and part of
Cranial Nerves Function Assessment
external ear canal.
Parasympathetic:
secretion of digestive
enzymes; peristalsis;
carotid reflex;
involuntary action
of the heart, lungs
and digestive tract.
XI. Spinal accessory Motor: turn head, Assess shoulder and
shrug shoulders, neck muscles for
some actions for Strength and Movement
phonation Have the client shrug

his/her shoulders
upward against your
hands.
Have the client turn

his/her head to the side

against your hand,
repeat on the other side.
Cranial Nerves Function Assessment
XII. Hypoglossal Motor: Assess mouth for Tongue
tongue movement for Movement, Symmetry,
speech sound Strength, and Absence of
articulation and Tumors
swallowing  client protrudes tongue.

Note symmetry, atrophy, and

absence of tumors.
Then ask the client to move

tongue toward nose, chin,

and side to side.
Strength of the tongue can

be tested by pressing it
against your gloved index
finger.
  Spinal nerves
•Spinal Nerves
 31 pairs
 8 cervical, 12 thoracic, 5 lumbar
 5 sacral, 1 coccygeal
 Two roots
 Dorsal and ventral-Each spinal nerve has a ventral root
(motor) and a dorsal root (sensory).

 Dermatome distribution
 The dorsal roots contains sensory fibers that relay
information from sensory receptors to the spinal
cord
 The ventral root contains motor fibers that relay
information from the spinal cord to the body’s
glands and muscles.
Dermatome distribution
 Autonomic Nervous System
 Regulates the activities of the internal
organs (heart, lungs, blood vessels,
digestive organs, and glands)
 Responsible for maintenance and
restoration of internal homeostasis.

2 Components of ANS
1. Sympathetic Nervous System
2. Parasympathetic Nervous System
 Sympathetic Nervous System
 Expenditure of energy
 Catecholamines:

Epinephrine; norepinephrine; dopamine

 “Fight or flight” response.
 Pupil dilates

 Increased HR

 Increased BP

 Increased RR

 Constipation

 Dry mouth

 Urinary retention
 Parasympathetic Nervous
System
 conserving energy.
 Acetylcholine

 Pupil constricts

 Decreased HR

 Decreased BP

 Decreased RR

 Diarrhea

 Increased salivation

 Urinary frequency
 Assessment
The Neurologic Examination
 General Assessment for Neurological
Disorders
Health History
Health History
 Past Health History
 Injuries and surgeries
 Use of alcohol, medications, and illicit drugs
 Onset of symptoms.
 Duration of current complain
 Recent trauma
 The disorders involving neurologic system
impairment are headache, dizziness or
vertigo, seizures, change in consciousness,
altered sensation and visual disturbances.
 Physical Examination

 The brain and spinal cord cannot be

examined directly as other system of the
body.
 V/S - abnormal respiration
 breathing pattern
 Pupillary reaction/pupillary changes
 Eye movement & reflex response
 Change in balance
 Neurological Assessment
 recognition of change
 helps assess the patient’s ability to engage
in self-care activities.
 Neurologic assessment is divided to into 5
components:
 Cerebral function
 Cranial nerves
 Motor system
 Sensory system
 Reflexes
 1. Cerebral Function
 Mental status: observe patient’s
appearance, behavior, dressing,
grooming and personal hygiene.
 Posture, gestures, movements, facial
expression, motor activity, the patient’s
manner of speech and LOC are also
assessed.
 Level of Consciousness (LOC) – awareness
of self and environment and level of arousal
(alert, lethargic, obtunded, stuporous,
coma).
Altered Level of Consciousness (LOC)- can result from
destruction of the brain stem or its reticular formation of
ascending nerves, or from other structural, metabolic, or
psychogenic disturbances.

 Confusion  Impaired ability to think clearly

 Disturbed ability to perceive, respond to, and
remember current stimuli
 Disorientation
 Functional in activities of daily living (ADLs)

 Motor restlessness
 Delirium
 Increased disorientation
 Transient hallucinations
 Delusions possible
 Requires some assistance with ADLs
 Altered Arousal/Level of Consciousness
(LOC) cont.
 Obtundation  Decreased alertness
 Psychomotor retardation
 Requires complete assistance with ADLs

 Stupor  Arousable but not alert

 Severe disorientation
 Little or no spontaneous activity

 Coma  Unarousable
 Unresponsive to external stimuli or internal
needs
 Determination commonly documented using
Glasgow Coma Scale score
 Altered Movement
 Involves certain neurotransmitters (ex.
dopamine)
Hyperkinesia- excessive movement
Hypokinesia- decreased movement
 Marked by paresis- partial loss of motor function

and muscle power; commonly described as

weakness; can result from destruction of upper
& lower motor neurons
 2. Cranial Nerve Function

 Assess cranial nerve function.

 3. Motor System Function
Assess muscle size (inspect and palpate) tone, and strength; assess
symmetry differences between right and left side; balance and
coordination.

 Altered Muscle Tone

 Hypotonia- severely reduced degree of
tension or resistance to movement in a
muscle
 Hypertonia- marked increase in a muscle
tension and decreased ability of a muscle
to stretch
 Sensory Function
Test for:
 superficial tactile sensation superficial
and deep pressure pain
 thermal sensitivity

 sensitivity to vibration

 point localization.

Reflexes
 Evaluate deep and superficial reflexes
(biceps, triceps, patellar, ankle
reflexes) and abnormal reflexes
(Babinski’s reflex).
Diagnostic Tests
Diagnostic Procedure
Computed Tomography Scanning
Visualize sections of the spinal
cord as well as intracranial
contents
The injection of a water-soluble
iodinated contrast into the
subarachnoid space through
lumbar puncture helps
noninvasive and painless
 has a high degree of sensitivity
for detecting lesions.
Use of xray beams cross section
Use : to identify intracranial
tumor, hemorrhage, cerebral
atrophy, calcification, edema,
infarction, congenital abnormality.
Nursing Interventions
 teaching the client about the
need to lie quietly
throughout the procedure.
 Relaxation technique maybe
helpful for clients with
claustrophobia.
 Assess for iodine/shellfish
allergy.
 Secure patent IV line.
 NPO if with contrast medium,
for 4 hrs.
 Monitor for allergic reaction:
flushing, nausea and
vomiting.
Magnetic Resonance Imaging
Diagnostic Procedure
Magnetic Resonance Imaging
Uses a powerful magnetic field
to obtain images of different
areas of the body.
Can be performed with or
without a contrast agent and can
identify a cerebral abnormality
earlier and more clearly than
other diagnostic tests.
Useful in diagnosis of multiple
sclerosis and can describe the
activity and the extent of disease
in the brain and spinal cord.
Cerebral Angiography
Is an x-ray study of the cerebral
circulation with a contrast agent
injected into a selected artery
(femoral)
Visualize aneurysm
Nursing Interventions
Obtain history of metal
implants. Remove all metal
objects.
Inform the client that the
procedure last for 30 to 90 mins.
Patient preparation should include
teaching relaxation technique.
Inform the client that a narrow,
tunnel like machine will enclose
him/her during the procedure.
Sedation may be needed for
claustrophobic client.
Obtain a signed consent.
Hydrate the client, clear liquids
are usually permitted.
Instruct the client to void before
the procedure.
Diagnostic Procedure Nursing Interventions
Instruct the patient to remain
immobile during the test.
Tell the client to expect a brief

feeling of warmth in the face,

behind the eyes or in the jaw,
teeth, tongue, and lips, and a
metallic taste when the contrast is
injected.
After the procedure check LOC,

and injection site should be

observed.
Myelography
Explain the procedure.
Contrast agent are injected into
Obtain a signed consent.
spinal subarachnoid space to
permit visualization of spinal cord. Withhold oral intake 4-6 hours

Shows any distortion of the before the test.

spinal cord or spinal dural sac After the procedure:

caused by tumors, cysts, For pantopaque myelogram (oil-

based) pt lies flat for 6-24 hours.

Diagnostic Procedure
herniated vertebral disks or other
lesions.
Electroencephalography
Graphic record of the electrical
activity generated in the brain.
EEG is a useful test for
diagnosing and evaluating seizure
disorders, coma, or organic brain
syndrome.
A sleep EEG may be recorded
after sedation because some
abnormal brain waves are seen
only when the patient is asleep.
Nursing Interventions
Formetrizamide myelogram
(water-based), HOB is elevated at
30 degrees for at least 8 hours.
Encourage fluid intake
Explain the procedure, assure the
client he/she will not receive
electrical shock.
The nurse needs to check
doctor’s order regarding the
administration of antiseizure
medication prior to testing.
Withhold tranquillizer and
stimulants for 24 to 48 hours.
Inform the client that the
standard EEG takes 45 to 60
minutes and 12 hours for sleep
EEG.
 Electroencephalography

Measurement of
the electrical activity
Of the brain
done during:
•Relax
•Hyperventilate
•Sleeping
•Flickering lights
 Lumbar puncture
•Insertion of needle in the
sub arachnoid space
•Assess the csf
 Lumbar Puncture
Lumbar Puncture
 Is carried out by inserting
a needle into the lumbar
subarachnoid space to
withdraw CSF for
diagnostic or therapeutic
purposes.
 The needle is usually
inserted between L4 and
L5.
 Maintain position, usually
lateral horizontal with knees
to chest, chin on chest.
 Obtain signed consent.
 Explain the procedure.
 Observe for complication
following the procedure.
 Keeping the patient in
prone position overnight
may reduce the incidence
of headache.
Electromyography
Obtain
by inserting
needle electrodes into the
skeletal muscles.
Measure changes in the
electrical potential of the
muscles and the nerves
leading to them.
Useful in determining
neuromuscular disorders
and myopathies.
Nursing Interventions
Explain the procedure.
The patient is warned to
expect a sensation similar
to that of an
intramuscular injection
and the muscle examined
may ache for a short time
after the procedure.
Electromyogram
Pneumoencephalography Nursing Interventions
Special contrast study of the
ventricular and cisternal
system using air as contrast
medium.
Permits accurate localization
of brain lesions by spinal or
cisternal puncture with x-ray
examination.
Secure written consent.
Sedate as ordered. GA may
be used.
Inform the client that the
procedure takes 2 hours.
Inform the client that he/she
may experience discomfort,
N/V, after the procedure.
After the procedure keep the
client flat in bed for 24 to 48
hours.
Monitor VS and neurologic
checks.
 Common Health
Problem of the
Neonate and Infant
 Nervous System
Developmental Disorders
Cranial
 Hydrocephalus

Spinal Cord
 Meningocele
 Hydrocephalus
 Is an excess of cerebrospinal fluid in the
ventricles and subarachnoid spaces of the
brain.
 Reasons for excess:
 over production of fluid by the choroid plexus in
the 1st or 2nd ventricle
 obstruction of the passageway of fluid
somewhere between the point of origin and the
point of absorption
 interference with the absorption of fluid from
the subarachnoid space.
 Classifications:
1. congenital
2. acquired.
 The cause of congenital hydrocephalus
is unknown.
 Incidence: 3 to 4 per 1000 live births.
 In older child infections such as
meningitis and encephalitis may leave
adhesion that lead to obstruction.

Nursing
Enlarged head
Assessment
 Prominent scalp vein.
 Enlarged or full fontanels
 Separated suture line
 Increased head circumference
 Sunset eyes
 Shrill cry
 Hyperactive reflexes
 Signs of increased ICP
 Decreased pulse

 Increased temperature

 Decreased respiration

 Increased BP
 Diagnostic Test
 sonogram, CT scan, MRI.
 Skull x-ray film will reveal the

separating sutures and thinning

of the skull bones.
 Transillumination will reveal skull

filled with fluid rather than solid brain

substance.
 Nursing Goals and Interventions
 Assess neurologic status closely.
 measure and plot occipital-frontal baseline
measurement, then measure head circumference
once a day.
 Check for fontanelle for bulging and sutures
for widening.
 assist with head ultrasound and Transillumination.
 Maintain skin integrity: change position frequently.
 Clean skin creases after feeding or vomiting.
 Postoperatively, position head off operative site.
 Watch for signs of infection.
 Myelomeningocele
 The spinal cord and the meninges
protrude through the vertebrae.
 This result in lower motor neuron damage.
 The child will have flaccidity and lack

of sensation of the lower extremities

and loss of bowel and bladder control.
 Hydrocephalus accompanies
myelomeningocele in as many as 80% of
infant due to lack of subarachnoid
membrane.
 Diagnostic Test
 Neural tube defects can be
discovered during intrauterine life by
sonography, fetoscopy,
amniocentesis, or analysis of AFP in
maternal serum.
 When infants are detected having
myelomeningocele, they may born by
cesarean birth to avoid pressure and
injury to the spinal cord.
 Nursing Assessment
 Saclike cyst containing meninges,
spinal cord, and nerve roots in
thoracic and/or lumbar area.
 Myelomeningocele directly connects
to subarachnoid space so
hydrocephalus often associated.
 No response or varying response to
sensation below level of sac.
 May have constant dribbling of urine.

 Retention of stool.
 Nursing Goals and Interventions
 Prevent trauma and infection.
 Position on abdomen or on side and

restrain.
 Meticulously clean buttocks and

genitals after each voiding and

defecation.
 May put protective covering over sac.

 Observe sac for oozing of fluid or pus.

 Crede bladder (apply downward
pressure on bladder with thumbs,
moving urine toward the urethra) as
ordered to prevent urinary stasis.
 Assess amount of sensation and
movement below defect.
 Observe for complications.

 Obtain occipital-frontal circumference

baseline measurement, then measure
head circumference once a day (to
detect hydrocephalus).
 Check fontanelle for bulging.
Common Health
Problems of the
Child and
Adolescent
Cerebral Palsy
Reye’s Syndrome
 Cerebral Palsy
 Group of nonprogressive disorders of upper motor
neuron impairment that result in motor
dysfunction.
 A child may also have speech or ocular difficulty,
seizures, cognitive challenges, or hyperactivity.
 Exact cause is unknown, but the disorder is
associated with low birth weight, prebirth, or birth
injury.
 Occurs in approximately 2 in 1000 live births,
occurring most frequently in very-low-birth-weight
infants
 It apparently occurs when brain anoxia leads to cell
destruction of the motor tracts.
 Types of Cerebral Palsy
 Spastic Type
 Spasticity is excessive tone in the voluntary
muscles (loss of upper motor neurons)
 The child with spastic CP has hypertonic
muscle, abnormal clonus, exaggeration of
deep tendon reflexes, abnormal reflexes
such as tonic neck reflex.
 Spastic movement may affect both
extremities on one side (hemiplegia), all four
extremities (quadriplegia), or primarily the
lower extremities (paraplegia)
 Dyskinetic or Athetoid Type
 Involves abnormal involuntary movement.
 Athetoid means “wormlike”.
 The child is limp and flaccid.
 The child makes slow, writhing motions. This
may involve all four extremities, plus the
face, neck, and tongue.
 The child drools and speech is difficult to
understand.
 Ataxic Type
 Children with ataxic involvement have an
awkward, wide-base gait.
 On neurologic examination, they are unable
to perform finger-to-nose test or perform
rapid, repetitive movements (tests of cerebral
function).
 Mixed Type
 Symptoms of both spasticity and athenoid
movements are present together.
 Nursing Assessment
 Diagnosis is based on history and
physical assessment.
 On history, an episode of possible

anoxia during prenatal life or at birth

is documented.
 Neurologic exam in infant is difficult.

In all forms of CP may have sensory

alteration.
 Reye’s Syndrome
 Is acute encephalitis with accompanying
fatty infiltration of the liver, heart, lungs,
pancreas, and skeletal muscle.
 1 to 18 years of age regardless of gender.
 The cause is unknown, but it generally occurs
after a viral infection such as varicella or
influenza if the child is treated with salicylate.
 Avoiding the use of aspirin during viral
infection has led to almost total prevention of
the syndrome.
 Nursing Assessment
 Children: Lethargic, vomiting, agitation, anorexia,
confusion, and combativeness.
 Laboratory diagnosis of Reye's syndrome is
confirmed by:
 Elevated Liver Enzyme Levels
 Elevated Serum Ammonia
 Normal Direct Bilirubin
 Delayed Prothrombin Time and Partial Thromboplastin Time
 Decreased Blood Glucose
 Elevated BUN
 Elevated Serum Amylase
 Elevated Short-chain Fatty Acid
 Elevated WBC Count
Common Health
Problems of the
Young Adult
 NEUROMUSCULAR DISORDERS

Multiple
Sclerosis
Myasthenia Gravis
 MS is:
Multiple Sclerosis
 chronic, degenerative disease of the central
nervous system that is characterized by
demyelination of the nerve fibers of the brain
and spinal cord.
 Gen. characterized by exacerbations and remisions
(relapsing-remitting type0
 Although the cause of MS is unknown, it appears
to be related to autoimmune disorder and viral
infections.
 commonly appears during adulthood (ages 20 to
40).
 W>M
 Areas of the CNS most commonly affected
brainstem, cerebrum, cerebellum, optic nerves, and
the spinal cord.
Process of Demylination
 Pathophysiology
MS
Causes
Unknown
Viral infection
Autoimmune disease

Multiple foci of dmyelination in the white matter

(brainstem, spinal cord, optic nerves, cerebrum)
Then later the gray matter.

Destruction of the myelin sheath

(SCHWANN’S CELLS)

INTERRUPTION/DISTORTION OF IMPULSE
(SLOWED/BLOCKED)
 Assessment
 Sign and symptoms of MS is characterized by
remissions and exacerbation of symptoms.
 Symptoms vary depending on the area of the CNS
involved, but generally include:
 Visual disturbances (diplopia, partial or total loss of
vision, nystagmus)
 Scanning speech (slow, monotonous, slurred)
 Tremors
 Weakness/numbness of the extremities
 Fatigue
 Increased susceptibility to URTI
 Dysphagia
 Ataxic gait
 Diagnostic Test
 Lumbar Puncture-total CSF protein is normal; IgG
(gamma globulin is elevated- IgG reflects
hyperactivity of the immune system due to chronic
demyelinaton)
 EEG-abnormalities in brain waves
 CT scan/ MRI reveals multifocal white

matter lesion
 Myelogram

 Skull x-ray
 Nursing Diagnoses for MS:
 Risks: Ineffective breathing pattern; airway
clearance; impaired—swallowing, physical
mobility, skin integrity; altered nutrition;
urinary incontinence; constipation
Interventions for MS:
There is no specific treatment for MS.
Treatment includes:
 physical therapy- to assist with motor dysfunction, such as problem
with balance, stregnth, and motor coordination.
 speech therapy- to manage dysarthria
 drug therapy

 Glucocorticoids (Prednisone, Dexamethasone, Corticotropin)-

to reduce edema of the myelin sheet; sppeds recovery from
attack
 Muscle relaxant (Baclofen)- to treat spasticity

 Amantadine, Ritalin, or antidepressants –to manage fatigue

 Low-dose TCAs- to manage sensory symptoms such as

pains, numbness, burning, and tingling
sensationsAntihistamines with vision therapy & exercises to
minimize vertigo
 Nursing Responsibilities/ Considerations for MS:
 Provide regular activity, rest, and
relaxation.
 Assist with physical therapy: muscle
stretching, relaxation and coordination
exercise, walking exercise.
 Encourage well balanced, high fiber diet.
 Force fluids to prevent constipation.
 Avoid hot baths.
 Provide skin care to prevent skin
breakdown.
 Nursing Responsibilities/ Considerations for
MS cont.:
 Patient and family teaching to promote
emotional stability
Help patient establish daily routine, and help family
understand patient’s changes in personality and physical
capabilities.
Inform the pt that exacerbations are unpredictable,
necessitating physical & emotional adjustments in
lifestyle
- eye patch
- Speech therapy
- Medicate and watch for adverse effects
 Evaluate
 Respiration; nutrition; ADLs; skin; bowel
elimination; urinary incontinence

Myasthenia Gravis
progressive neuromuscular disorder that results in the
failure to transmit nerve impulses at the MYONEURAL
JUNCTION causing extreme weakness
 Failure of transmission is due to decreased
acetylcholine
 Women > Men; 3 times more common in w
 Young adults 20-30
 secretion and increased cholinesterase at the nerve
ending.
 Autoimmune disease.
 Characterized by progressive weakness and abnormal
fatigability of the skeletal muscles.
 Commonly affects muscles innervated by the cranial nerves
(face, lips, tongue, neck, and throat)
 Exacerbated by exercise & repetitive movement
 Occurs along with thymic abnormalities in 75% of pts
 Pathophysiology:
 Transmission of nurve impulses at the
neuromuscular junction FAILS.
 Antireceptor antibodies block, weaken, or
reduce the number of acetylcholyne Ach
receptors available at each neuromuscular
juction,thereby impairing the muscle
depolarization necessary for movement
 Myasthenia Gravis
Cause:
 Autoimmune response leading to

ineffective acetylcholine release and

inadequate muscle fiber response to Ach.
Complications:
 Aspiration

 Pneumonia

 Respiratory distress
 Assessment
 S&S
 Skeletal muscle
weakness, fatigue
 Weak eye
closure,ptosis, diplopia,
 “snarl smile” (smiles
slowly)
 Masklike facial
expression; Impaired
speech; drooling
 Weakened respiratory
muscles
 Muscle are usually strongest
in the morning but become
progressively weaker during
the day and following an
exercise.
 Rationale/ Pathophysiologic
Basis
 due to impaired neuromuscular
transmission
 due to impaired neuromuscular
transmission to the cranial
nerves supplying the eye
muscles
 Impaired transmission of the
cranial nerves innervating the
facial muscles
 Due to impaired
neuromuscular transmission to
the diaphragm due to loss of
ACh receptors in the
appropriate junctions
 Myasthenia Gravis

Skeletal muscle weakness

 Diagnostic Test
 Tensilon Test (Edrophonium Chloride Test)
Tensilon Test (Edrophonium Chloride Test)
 Short acting cholinergic is administered.

 Reveals Increased muscle strength is

observed (+ Tensilon Test) within 30-60 secs
after IV injectio of edrophonium (tensilon) or
Neostigmine (Prostigmin), lasting up to 30
mins.

Single fiber electromyography with neural

stimulation at the specific muscle fiber-
progressive decrease in muscle fiber
contraction
Chest x-ray- reveals thymoma in 15% of pts
 Treatment of Myasthenia Gravis

 Anticholinesterase drugs, such as neostigmine and

pyridostigmine- to counteract fatigue and muscle
weaknes and allow for about 80% of normal muscle
 Immunosuppresive therapy with corticosteroids,
azathioprine (Imuran) – to decrease the immune
response toward Ach receptors at the neuromuscular
junction
 IgG during acute relapses- to suppress the immune
system
 Thymectomy- to remove thymomas
 Tracheostomy, suctioning to remove secretions
 Nursing Goals and Interventions
 Establish neurologic and respiratory baselines
 Assess swallowing / gag reflex before feeding the client.
 Plan exercise, meals, patient care & activities to make the
most of energy peaks. Ex.,administer medications 20-30
minutes before meal to facilitate chewing or swallowing.
 Start meal with cold beverage.
 Administer medication at precise time to prevent relapses.
 Protect the client from falls.
 Provide adequate ventilation.
 Avoid exposure to infection, stree, strenous exercise, and
needless exposure to the sun r cold.
 Frequent rest periods.
 Be prepared to give atropine for anticholinesterase overdose
or toxicity
 Avoid aminoglycoside antibiotics, which can exacerbate
myasthenia gravis
 Aerosol, pesticides/cleaners should
also be avoided,
 Avoid alcohol, tonic water, and
cigarette smoke.
 Pharmacotherapy

 Cholinergics (Anticholinesterase)
 Neostigmine (Postigmin)
 Pyridostigmin (Mestinon)

 Ambenomium (Mytelase)

 Glucocorticoids
 Antacids
 Common Health
Problem of the
Middle-aged Adult
 CRANIAL NERVE DISORDER: Trigeminal Neuralgia
(Tic Douloureux)
 Neurologic disorder affecting the 5th
cranial nerve. Possible fifth cranial
nerve root compression
 Manifested by excruciating, recurrent

paroxysms of sharp, stabbing facial

pain along the trigeminal nerve.
Areas innervated by the three branches of the
trigeminal nerve
 Management
Narcotic analgesics; anticonvulsants
 Tegretol

 Dilantin

 Alcohol injection of the nerve

 Avoid extremes of heat and cold.
 Correction of dental malocclusion
 Surgical Management
 Surgical division of the trigeminal nerve
(neurectomy)
 Nursing Management
 Assessment
 Complete history
 Affected area; oral cavity
 Record weight and ability to eat food
 Diagnosis, Planning, and Interventions
 Acute pain
 Evaluate:
 Pain; client cooperation
 CRANIAL NERVE DISORDER:
Bell’s Palsy
Definition: Disease of the cranial nerve VII (facial nerve that produces
unilateral or bilateral facial weakness or paralysis
 Resolves spontaneously in 80& of pts, with complete recovery in 18 weeks
 Recover may be delayed in the elderly
 If recovery is partal, contractures may developed on the paralyzed side of
the face.
Causes:
 Hemorrhage
 Herpes simplex or herpes zoster
 Infection
 Local trauma
 Meningitis
 Tumor
 Viral disease
 Bell’s Palsy
 Pathophysiology:
 An inflammatory reaction occurs around cranial
nerve VII, usually at the internal auditory
meatus, where the nerves leave bony tissue
 The inflammatory reaction produces a
conduction block that inhibits appropriate neural
stimulation to the muscle by the motor fibers of
the facial nerve, resulting in the characteristic
unilateral or bilateral facial weakness.
Pathophysiologic Chanes/ S & S:
 Unilateral facial weakness
 Drooping mouth & drooling saliva
 Lost of taste
 Smooth forehead appearance
 Impaired ability to close the eye on the weak
side
 Bell’s phenomenon-Upward rolling of the eyes
when attempting to close them
 Excessive tearing
 Ringing in the ear
Complications of Bell’s Palsy
 Corneal abrasion

 Infection (masked by steroid use)

 Poor functional recovery

Diagnostic Tests:
-based on clinical presentation
MRI-rules out tumor
Electromyography- 10 days after the onset
of S/S
 Treatment
 Analgesics- to relieve pain
 Steroids- to reduce facial nerve edema &
improve edema & improve nerve
conduction & bld flow
 Possible electrotheraphy
 Surgery for persistent paralysis
 Nursing Considerations
 Watch for adverse effects of steroids use
 Apply moist heat to the affected side of the face-to reduce pain

 Help the pt maintain muscle tone:

-massaging the face with a gentle upward motion 2-3xdaily x 5-10mins

Exercise by grimacing in front in front of a mirror
 Protect eyes, have pt cover eye w/ an eye patch

 Prevent excessive wt loss:

-have him chew on unaffected side of his mouth

-provide a soft, nutritionally balanced diet, eliminating hot foods &
fluids
-apply a facial sling to improve lip alignment
 Provide frequent & complete mouth care

 Offer psychological support

Common Health
Problems of the
Older Adult
 CEREBRO-VASCULAR DISORDER:Stroke/Cerebrovascular
Accident (CVA)
Definition: Disruption of the Blood
Supply to the Brain-
-sudden loss of neurologic funtion
Note: Middle Cerebral Artery is
commonly affected.
The second most
frequently affected is the
internal carotid artery.
Classification:
1. ischemic (a thrombus or
embolus blocks circulation
2. hemorrhagic (a blood vessel
ruptures)
Risk factors:
 Increased alcohol intake or
cocaine
 Cardiac disease
 Cigarrette smoking
 DM
 Familial hyperlipidemia
 Family history of stroke
 Hx of TIA
 HPN
 Obesity,sedentary lifestyle
 Sickle cell disease
 Use of hormonal contraceptives
 Causes of Stroke:
Ischemic
 Thrombosis- occluded bld flow caused by thrombosis of the
cerebral arteries supplying the brain or the intracranial vessels
 The most frequent cause of CVA

 The most common cause of cerebral thrombosis is

atherosclerosis; usually affecting elderly persons.

 Tends to occur during sleep or soon after arising.

 This may tend to occur among clients with DM, and

hypertension.
 Embolism- from thrombus outside the brain, such as in
the heart, aorta, or common carotid artery.
 The second most common cause of CVA.

 Most commonly affecting younger people.

 Most frequently caused by Rheumatic Heart Disease and MI.

 Symptoms occur at any time and progress rapidly.

 Causes of Stroke: Hemorrhagic Stroke

 Hemorrhage- Hemorrhagic Stroke

 Impaired cerebral perfusion from hemorrhage
causes infarction, & the bld itself as a space-
occupying mass, exerting pressure on the brain
tissues
 Hemorrhage from an intracranial artery or vein,
such as HPN, ruptured aneurysm, trauma,
hemorrhagic disorder, or septic embolism.
 Transient Ischemic Attacks

 Refers to transient cerebral ischemia with

temporary episodes of neurologic dysfunction.
 Manifestation include contralateral weakness of

the lower portion of the face, fingers, hands,

arms, and legs; dysphagia, and sensory
impairment.
 Stoke in evolution refers to development of a

neurologic deficit over several hours to days

 Pathophysiologic Changes in CVA:-specific manifestations
are determined by the cerebral artery affected, the brain tissue supply by that
of that vessel, and the adequacy of the collateral circulation

 Aphasia, dysphasia; visual fields deficits; and

hemiparesis of affected side (more severe in face &
arms)- resulting from thrombosis or hemorrhage of
middle cerebral artery
 Weakness, paralysis, numbness; sensory changes;
altered LOC; bruits over carotid artery; and headache
caused by thrombosis or hemorrhage of carotid artery
 Weakness, paralysis, numbness around lips & mouth;
visual field deficits, diplopia, nystagmus; poor
coordination, dizziness, dysphagia, slurred speech;
amnesia, and ataxia resulting from thrombosis or
hemorrhage of vertebrobasilar artery.
 Confusion, weakness, numbness; urinary
incontenece; impaired motor & sensory
functions; and personality changes caused by
thrombosis or hemorrhage of anterior cerebral
artery.
 Visual field deficits; sensory impairments;
dyslexia; cortical blindness and coma resulting
from thrombosis or hemorrhage of posterior
cerebral artery.
 Assessment of CVA:
check for:
 S&S of increased ICP.
 Perceptual defects

 Aphasia

 Unstable respiration

 Severe headache

 Diagnostic procedure results

 Unilateral neglect
 Diagnostic Findings:
 CT scan- identifies an ischemic stroke within the
first 72 hours of symptom onset or evidence of a
hemorrhagic stroke (lesions >1 cm immediately)
 MRI-assists in identifying areas of ischemia or
infarction and cerebral swelling
 Others: angiography, carotid duplex scan,EEG
 Complications:
 Hemiplegia –
weakness/paralysis of half the
body
 Cognitive impairement-
Aphasia – maybe expressive or
receptive; the partial or tota
inability to
produce & understand speech
 Apraxia – can move but cannot
do the purpose; inability to
perform complex
movements
 Sensory impairement-Visual
changes – homonymous
hemianopsia; Agnosia – loss of
sense of smell
 Dysarthria - difficulty in
speech articulation due to lack
of muscle control
 Kinesthesia – loss of sensation
(of bodily movement)
 Incontinence – maybe
fecal/urine; inability to control
urination or defecation
 Shoulder pain
 Contractures
 Fluid imbalances
 Cerebral edema
 Aspiration
 Altered LOC
 Infections such as pneumonia
 Nursing Considerations:CVA
 Maintain a patent airway and oxygenation:
If the pt is unconscious; vomiting- lateral position to prevent aspiration of
saliva

 Check v/s & neurologic status:

Monitor BP, LOC, pupillary changes, motor and sensory functions, speech,
skin, color, temp.
Monitor pt for s/s of increased ICP and nuchal rigidity or flaccidity

 Watch for s/s of pulmonary emboli:

chest pain, shortness of breath, dusky color, tachycardia, fever, and
change in sensorium

 If the pt is unresponsive, monitor ABG as ordered

 Monitor F & E balance:

Monitor I and O.
Administer IVF as ordered
Offer bedpan /urinal
 .
 Nursing Considerations:CVA
 Ensure adequate nutrition:
Check for gag reflex before offering small oral feedings of semisolod
food
Teach the client to chew on the unaffected side.
If oral feeding is not possible,TPN, NGT feeding, gastrostomy feeding.

 Turn the patient frequently, at least q 2 hrs to prevent

pneumonia.
 Perform ROM exercises for affected & unaffected sides.
 Massage if not contraindicated.
 Provide meticulous eye care- Instill meds as ordered; patch the
affected eye if the pt can’t close eyelid.
 Nursing Considerations:CVA
 Compensate for perceptual difficulties.
 Care of the client with Hemianopsia.
 Approach from the unaffected side.
 Place articles on the unaffected side.

 Promote communication
 Care for the client with aphasia.
 Say one word at time.
 Give simple commands.
 Allow the client to verbalize, no matter how long it takes him

Give medications as ordered- Tell the pt to watch out

for side effects. (ex. Aspirin-GI bleeding
 Assist with rehab
 Teach the pt to comb hair, to dress, & to wash
 Obtain assistive devices ( through the aid of PT/OT)
such as walkers, hand bars by the toilet, and ramps as
needed
 Be aware that the pt has a unilateral neglect, in which
he fails to recognize that he ha a paralized side- show
him how to protect his body from harm
 Emphasize importance of regular ff-up visits
 Parkinson’s Disease
 Slowly progressive degenerative disorder
of basal ganglia function that results in
variable combinations of tremor, rigidity,
and bradykinesia
 Onset usually after age 40

 men>women
Parkinson’s Disease: deficient in
dopamine
 Causes:
Exact cause unknown
 Possible causes:
 Dopamine deficiency, which prevents affected
brain cells from performing their nomal inhibitory
function in the CNS
 Exposure to toxins( manganese dust or carbon
monoxide)
 Repeated trauma to the brain
 Stroke
 Brain tumors
 Pathophysiology:
 Dopamine neurons degenerate, causing loss of
available dopamine
 Dopamine deficiency prevents
 Affected brain cells from performing their normal
inhibitory function
 Excess excitatory Ach occurs at the synapses
 Nondopamineric receptors are also involvd
 Motor neurons are depressed
Pathophysiologic changes/ S&S:
 Muscle rigidity, akinesia, and insidious tremor beginning in the
fingers (UNILATERAL PILL_ROLL TREMOR) secondary to loss of
inhibitory dopamine activity at the synapse- increase during stres or
anxiety; decreases with purposeful movement & sleep
 Muscle rigidity with resistance to passive
 Mask-like appearance
 Gait disturbance-lacks normal parallel motion;
may be retropulsive or propulsive
 Oily skin- secondary to inappropriate
regulation of androgen production by
hypothalmic-pituitary axis
Pathophysiologic changes/ S&S:
 Dysphagia, dysarthria; excessive sweating;
decreased GI motility and genitourinary
smooth muscle-from impaired autonomic
transmission
 Voice changes
 Small handwriting
 Poor judgement, endogenous depression,
dementia- from impaired dopamine
metabolism, and neurotransmitter dysfunction
 Common Health
Problem that occur
Across the Life
Span
 SEIZURE DISORDER
 Sudden explosive and disorderly discharge of cerebral
neurons
 abnormal and excessive discharge of neurons in the
brain
 Types of seizures:
grand mal
petit mal
febrile seizures
status epilepticus
 Petit mal
 No aura
 10-20 seconds
 Common to children as well as adult
 Little tonic-clonic movements
 Cessation of ongoing physical activities
 Jacksonian
 With aura
 With organic lesion
 Group of muscle affectation
 Psychomotor Seizure
 With aura
 With psychiatric involvement
 Characterized with mental clouding
 Violence, antisocial acts
 Febrile Seizure
 Related to temperature
 Present among children
 Status epilepticus
 Prolonged seizure state
 Can occur in any type of sizure
 Rapid successions with no full
consciousness in between
 Brain damage can occur; most life
threatening in tonic-clonic seizures
 Common to clients who are in coma
 Related to medication
 Primary Seizure Disorder (Epilepsy)
 Idiopathic

 No apparent structural changes in the brain

Secondary Epilepsy
 Characterized by structural changes or metabolic

alterations of the neuronal membranes that

caused increased automacity
 Causes of Seizures:
 Idiopathic- two-thirds of all seisure disorders
 Anoxia
 Birth trauma (inadequate supply of O2 supply to the brain, bld
incompatibility, hemorrhage)
 Brain tumors
 Drug or alcohol abuse or rapid withrawal from abused drugs
 Febrile illness
 Genetic predisposition
 Head injury or trauma
 Infectious diseases
 Ingestions of toxins( lead, mercury, or carbon monoxide)
 Metabolic disorders, such as hypoglycemia or hypoparathyroidism
 Perinatal infections
 Pathophysiology:
 Some neurons of the brain may depolarize easily
or hyperexcitable.
 On stimulation, these neurons fires locally or
throughout the cerebrum and spreads electric
current to surrounding cells.
 Cells fire in turn and the impulses cascades to
one side of the brain ( a partial seizure), both
sides of the brain (a generalized seizure), or the
cortical, subcortical, and brain stem areas.
 Pathophysiologic changes:
 Recurring seizures, possibly of more than one type
( hallmark of epilepsy)
 Visual, olfactory, or auditory hallucinations; sweating or
flushing; dream states; anger, or fear reactions resulting
from simple partial seizures
 Altered consciousness , such as amnesia for events
around the time of the seizure, resulting from complex
partial seizures
 Movement and muscle involvement resulting from tonic-
clonic or myoclonic seizures
 Brief changes in LOC without motor involvement due to
absence sizures
 Complications:
 Hypoxia or anoxia from airway occlusion
 Traumatic injury
 Brain damage
 Depression and anxiety
 Diagnostic Tests:
 CT scan or MRI- reveals abnormalities
 EEG- reveals paroxysmal abnormalities
in tonic-clonic seizures, high, fast
voltagespikes are present in all leads
In absence seizures, rounded spike wave complexes
are present
Note: a negative EEG doesn’t rule out epilepsy because
the abnormalities occur intermittently
 Skull x-ray may show evidence of fractures or shifting of
the pineal gland, bony erosion, or separated sutures
 Serum chemistry bld studies may reveal hypoglycemia,
electrolyte imbalances, and elvated liver enzyme &
alcohol level
 Treatment
 Drug Therapy-
 Ex. Phenytoin (Dilantin) carbamazepine (Tegretol), phenobarbital
(Barbita, Luminal) –for generalized tonic clonic seizures and
complex partial seizures
 Valproic acid (Depakene), clonazepam (Klonopin) for absence
seizures
 If drug therapy is inefective, surgery to remove a demonsrated focal
lesion, or to remove the underlying cause (tumor, abscess)
 I.V. diazepam ( valium), lorazepam (Ativan) phenytooin, or
phenobarbital for status epilepticus
 Dextrose- for hypoglycemia
 Thiamine-for chronic alcoholism or withdrawal
 Nursing Considerations

 Patent airway
 Oxygenate as needed
 Raise siderails
 Ensure safety-during seizure:
Avoid restraining the pt
Help the pt to a lying position
Loosen any tight clothing
Clear the area of hard objects
Don’t place anything into the pt’s mouth to prevent lascerating the mouth &
lips or displace teeth
If vomiting occurs, turn the head to provide an open airway
 After the seizure subsides, reorient the patient to time & place; inform him
that he had a seizure
 Companion at bedside
 Meds as ordered
 Increased Intracranial Pressure
ICP- the pressure exerted within the intact skull by the
intracranial volume-about 10% blood,10% CSF, & 80% brain
tissue.
Causes : head injury
CVA
tumors
HPN

Pathophysiology:
^ICP- the brain will compensate by:
limiting bld flow to the head
displaces CSF into the spinal canal
increases absorption or decreases production
If ICP remains high, there will be loss of autoregulatory
mechanism which will lead to passive dilation, increased cerebral
flow, venous congestion. Further increase in ICP will result to
cellular hypoxia and eventually, brain death.
Major Types of Herniation
 Increased Intracranial Pressure
S&S:
 Increased HA

 Nausea &Vomoting

 Cushing’s triad

 Restlessness

 Eye involvement

 Altered LOC

 Sensory dysfunction

 Elimination problem

 Decorticate/decerebrate
 NURSING MANAGEMENT OF INCREASED ICP:

 Determine airway patency

 Elevate HOB
 Check VS/neuro assessment
 Record I&O
 Enema restriction
 Avoid coughing,vomiting, restraints, stress
ulcer,suctioning
 Seizure precaution
 Edema reduction
 Diuretics
 Craniocerebral Trauma (Head Injury)
 Involves injury to the scalp, skull, and/or
brain tissues.
 Types of Brain Injury
 Concussions. Jarring of the brain and its
sudden, forceful contact with the rigid skull.
There is transient period of unconsciousness.
 Contusion (bruising). A structural alteration
characterized by extravasion of blood cells.
 Laceration. Tearing of tissue caused by sharp
fragment or object or shearing force.
 Compression of the Brain. Result from
depressed fracture causing edema and
hemorrhage.
 Assessment
 Sign and symptoms of increased ICP.
 CSF leakage from ears and nose.
 Battle’s sign (hematoma at the mastoid process)
in basilar head trauma.

Management
 Care for the client with increased ICP.
 Monitor drainage from ears and nose.
 Monitor for signs and symptoms of meningitis,
atelectasis, pneumonia, UTI.
 Intracranial Tumors
 Intracranial tumors may be classified
as: gliomas, meningiomas, neuromas,
hemangiomas.
 Gliomas account for about 50% of all

brain tumors.
 Assessment
 Frontal lobe
 Personality disturbance
 Inappropriate affect

 Indifference of bodily functions

 Precental gyrus
 Jacksonian seizures
 Occipital lobe
 Visual disturbances preceeding
convulsions.
 Temporal lobe
 Olfactory, visual or gustatory hallucinations.
 Psychomotor seizures with automatic

behavior.
 Parietal lobe
 Inability to replicate pictures.
 Loss of right-left discrimination
 Management
 Care for the client with increase ICP.
 Surgery

 Supratentorial craniotomy (post-op)

 Semi-fowler’s position
 Infratentorial craniotomy
 Flat position; turn to sides, avoid supine position
for the first 48 hours. Avoid neck flexion.
 Report immediately for presence of yellowish

drainage on the head dressing.

 An increase in urine output may herald onset of

diabetes insipidus.
 Test the urine for glucose and acetone when

steroids are administered.

 Spinal Cord Injury

-complete or partial disruption of

nerve tracts and neurons
Causes : infection
trauma
injury
 Signs and symptoms

 Cervical –respiratory diff, quadriplegia

 Thoracic- paraplegia
 Lumbar – flaccid paralysis
 Sacral – loss of erection, ejaculation
 Nursing Asessment:
 Injury; treatment given at scene
 Neurologic assessment: Document findings
 Vital signs; respiratory status
 Movement and sensation below injury level
 Signs
 Worsening neurologic damage
 Respiratory distress

 Spinal shock
 Nursing Diagnoses:
 Ineffective breathing pattern
 Ineffective airway clearance
 Neuropathic pain
 Impaired physical mobility
 Anxiety
 Risks
 Impaired gas exchange
 Disuse syndrome

 Ineffective coping
 Medical Management
 Cervical collar; cast or brace; traction; turning frame
 IV; stabilization of vital signs
 Corticosteroids
 Surgical intervention
 Surgical Management
 Surgery to
 Remove bone fragments
 Repair dislocated vertebrae
 Stabilize the spine
 Management
 Maintain airway patency
 Immobilize
 Suction PRN
 Position
 Nutrition
 Elimination hygiene
 Drugs
 Evaluation:
 Adequate breathing
 Pain relief
 Mobility using minimal assistive devices
 Reduced complications from inactivity
 Coping with the challenge of rehabilitation
Infectious Neurologic Disorders
 Meningitis
 Brain Abscess

 Herpes Simplex Virus Encephalitis

 Arthropod-Borne Virus Encephalitis

 Fungal Encephalitis

 Creutzfeldt-Jakob and New-Variant

Creutzfeldt-Jakob Disease
 Brain Injuries
 Closed (blunt)  Intracranial
Brain Injury Hemorrhage
 Open Brain Injury  Epidural Hematoma
 Concussion  Subdural
Hematoma
 Contusion  Intracerebral
 Diffuse Axonal Hemorrhage and
Injury Hematoma
Pathophysiology