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Neuro Study Guide

Disease

Brief
Clinical
pathophysiology manifestation
/Assessment

Diagnostic
tests &
findings

Altered Level
of
Consciousness
(LOC)

Not a disease
process!

 At risk for
alterations in
any body
system!!!

3 “types”
-Neurologic
-Toxic
-Metabolic
Can be caused by
factors such as:
drug overdose
head injury
stroke
alcohol
hepatic/renal
failure
DKA

Increased
Intracranial
Pressure (ICP)

Not a disease
process!
Increased ICP
occurs when one
of the three
factors
(blood,brain,CSF)
increases and the

LOC is a
continuum from
A&O x3 to coma
Restlessness
Anxiety
Slow pupils
Conscious?
Decreased
verbal response
Decreased
motor response
Decreased eye
response
Respiratory
depression

*Earliest signs are
change in LOC,
slowed speech,
delayed response
More signs:
Restlessness
Increased
drowsiness
Confusion

 Full
assessment
 Neuro exam
 Glasgow
coma scale

Medical
management

**Airway is first
priority,
especially if
unconscious
-Find the cause
to find the
treatment

Potential labs:
Blood glucose,
Electrolytes,
Liver function,
BUN, Serum
ammonia,
PT/PTT, Serum
ketone, Blood
alcohol/drug,
ABGs
Diagnostic:
CT, MRI, EEG,
PET/SPECT
**NO lumbar
punctures!!
CT, MRI, PET,
SPECT, cerebral
angiography,
transcranial
doppler,
Evoked

EMERGENCY
Intracranial
monitoring
indicated
Craniotomy,
craniectomy,
Osmotic

Nursing
diagnoses

Interventions

Other notes:

Ineffective Airway
clearance
Risk of injury
Deficient fluid
volume
Impaired oral
mucous
membranes
Risk for impaired
skin integrity
Impaired tissue
integrity of the
cornea
Ineffective
thermo-regulation
Impaired urinary
elimination
Bowel
incontinence
Disturbed sensory
perception
Interrupted family
process

Obtain/ maintain
patent airway
Protect the patient
Maintain fluid balance/
IV fluids as ordered
Tube feedings if
indicated
Mouth care
ROM
Turning/ repositioning
Keep eyes moist and
protected
Heat/cold as necessary
to maintain body
temperature
Bladder scan/ Catheter
Promote bowel
function
Provide sensory
stimulation
Care for the family
SCD hose/ DVT
prevention

Coma:
unconscious,
unrousable,
unresponsive
Locked –In
syndrome:
Inability to move
or respond except
for eye movement
(lesion of Pons)
Akinetic Mutism:
Sometimes opens
eyes but makes
not movement or
sound
Persistent
vegetative state:
devoid of
cognitive function
but has sleepwake cycles

Ineffective airway
clearance
Ineffective
breathing pattern
Ineffective
cerebral tissue
perfusion
Deficient fluid
volume

Maintain patent
airway
Monitor respiratory
status
HOB up to 60
Avoid stimuli that
increases ICP
Hourly I/O during
acute phase

CPP: 70-100 mm
Hg
ICP in ventricles is
0-10 mm Hg, with
a max of 15 mm
Hg

Dx: CBC. etc **recommend rereading the status epilepticus section as well . UA. high PEEP. Usually treated with medication though surgical options do exist in some cases. electrophysiologic monitoring. straining with BM. maintaining BP and O2 status. drug screen. CT scan. Weakness on one side or in one extremity Headache Vomiting Impaired gag and/or corneal reflexes Progression towards stupor and coma Late signs: Coma Fixed pupils Decortication Decerebration Impaired/ absent respirations Cushing’s response: Increased BP Widened pulse pressure Cardiac slowing Cushing’s triad: Bradycardia Hypertension Bradypnea Depends on type of seizure how they present. Is either primary or secondary to metabolic. identify triggers and avoid ***See pages 8-11 on the ch 61-62 notes packet. During a seizure – documentation: Circumstance before the seizure Aura potential studies. fluid restriction. fever control. skull xray Assess: Patient Hx Family Hx diuretics. avoid increases r/t increased abdominal pressure. pad siderails. EEG. place on their side Adherence to medications is important to prevent. CSF drainage. CMB. Details types of seizures. reducing cerebral demands.Neuro Study Guide other two cannot compensate to maintain normal ICP Seizures Uncontrolled electrical discharge in the brain. Risk for infection Impaired skin/ mucous membrane integrity Risk for injury Fear Ineffective individual coping Strict aseptic technique with ICP monitoring Turn/reposition hygiene Do not restrain patient.see note. lumbar puncture. systemic and other causes.

paralysis. unconsciousness. size of pupils and if eyes are open. automatisms. cold/heat. – protect from injury and do not touch during seizure- Characteristics of the seizures Deficient knowledge Teaching about management and referral to counseling Ongoing education and encouragement. quiet room. Medic alert bracelet.Neuro Study Guide Head injury. inability to speak. and movements at the end of seizure as well as if the patient sleeps after. incontinence. cognitive status. etc) Analgesics Acute pain Medication and other nonpharmacological measures(dark. massage. food cravings. duration. type of movements. Family teaching. areas of body involved. CVA are biggest causes of new onset seizures What the patient does – first area affected and how. Nurse then prevents complications and allows patient to rest – bedrails up and padded if needed Headache (HA) Migraine: abnormal metabolism of serotonin – exact mechanism unknown 4 phases of migraine: Prodrome – nondescript symptoms (depression. Detailed Hx Medication Hx Assessment of head and neck Complete neuro exam Abortive medications Prevention techniques (identify triggers. elevate HOB 30) Migraine in particular can occur with hormonal changes related to menstruation .

4-72 hours Recovery – exhaustion. positioning. etc) Deficient knowledge Help identify triggers and provide teaching on lifestyle modifications to prevent or reduce occurrences. may sleep for extended periods Other diagnostics not used unless biologic. turning q 2. toxic. PT consult Tension: Band like pain or like a weight on the head. oncologic cause suspected Non-medication therapies (massage. -initial focus is Thrombolytic therapy within less than 3 hours unless contraindicated Impaired physical mobility ROM. Steady. Hx. exercises. Excruciating pain 15min-3hrs – usually in eye/orbit region but may radiate Ischemic stroke Separated into 5 catagories based on location/origin but basically a blood clot or Numbness/wea kness of face/arm/leg on one side Good health Hx is a must – as well as good assessment of the headache  See questions on page 1891 . complete neuro and physical exam. Provide teaching about medications and to take triptans and ergot derivatives at the first symptoms. constant pressure Cluster: unilateral and come in clusters of 1-8 in a day.Neuro Study Guide Tension – contraction of scalp/neck muscles with physical or emotional stress Cluster – dilation of orbital and nearby extracranial arteries (theory) feeling cold) hours-days before AuraNot in most patients. heat/cold. may have neuro symptoms Headache. ambulation assistance.

lyrica Assistive devices. preventing increase in ICP. and recent intracranial pathology.7. anticoagulant use. encouragement Approach from unaffected side and put objects on that side Special diet (thick liquid and pureed foods). tube feeding if needed. etc) Acute pain Self care deficit Disturbed sensory perception Impaired swallowing Impaired urinary elimination Disturbed thought processes Impaired verbal communication Risk for impaired skin integrity Interrupted family processes Sexual dysfunction Analgesia. therapeutic and facilitating communication. Maintenance of cerebral hemodynamics – mannitol. dysrhythmia. TE echo. swallowing techniques Bladder (and bowel) training. education. interdisciplinary training program Emotional support and understanding. counseling. PCO2 between 30-35. medication adjust . cath if needed Reality orientation. lamictal. cueing. If not candidate for TPAHeparin not usually used but is still an option. speech therapy. carotid ultrasound. MRI/MRA. amitriptyline.Neuro Study Guide plaque causes blockage in the brain causing tissue death Confusion/LOC change Trouble speaking or understanding speech Visual disturbances Difficulty walking and dizziness Sudden severe headache Hemiplegia Sensory loss/agnosia airway patencyCT asap to determine if ischemic or hemorrhagic. social contact Patient and family teaching and inclusion in plan of care. ECG. realistic approach that progress may be slow. and managing complications (UTI. emotional care Communication. and SPECT by INR >1. teaching.

HOB 15-30. coma. keep patient informed and family when possible. Fever. accelerationdeceleration injuries. Managing ICP is key here so review (again) the second topic of this study guide May have surgical intervention Maintaining cerebral homeostasis is key Risk for bleeding Disturbed sensory perception Anxiety -others depending on needs of the patient – see above Airway is #1 – there rest are also similar to stroke Avoid increase in ICP. bleeding from pharyx or ears. MRI. close monitoring of VS and status (Rebleeding) BP carefully maintained and increase in ICP avoided r/t aneurysm precautions. visitors restricted. Surgical intervention when applicable or endovascular procedures. and foreign object penetration. S/S of increased ICP CT. BP stabilized Ineffective cerebral tissue perfusion Depends on injury. cerebral angiography. Provide reassure and support Terms: Concussion Contusion Diffuse Axonal injury? Epidural and subdural hematoma . lumbar puncture (only if ICP not increased) Toxicology screening Hx. antiseizure meds. Prevent/treat rebleeding. aneurysm. CT. subarachnoid All cause bleeding into the brain and increased ICP which can cause brain death Head injury (HI) Skull fracture.Neuro Study Guide Hemorrhagic stroke Depends on cause: Arteriovenous malformations. Neuro exam. SCD. hyponatremia and hyperglycemia treated. laceration and/or torn blood vessels due to impact. Vit K or FFP given. cerebral angiography If bleeding caused by warfarin. pt is on strict bedrest with environment keep as calm and quiet as possible. etc. battle sign. xray. Contusion. Increase in ICP – can cause ischemia The same as intracranial – most common complaint is severe headache Key symptoms: Vomiting Seizures Sudden change in LOC Symptoms relate to the injury and affected area May have nosebleed. MRI. csf drainage May have seizures. intracranial neoplasms. DVT prevention. Also depends on type of injury and if there is brain damage present and/or neurological symptoms and deficits.

deterioration of pt neuro status) Ineffective breathing pattern Ineffective airway clearance CAUTIOUS suctioning. May have partial or complete lesions of either sensory or motor or both Dependent on type and level of injury. bone frags in spinal canal. impaired sensory and/or motor function. kinetic bed. know its signs and symptoms. falls. wound penetrating cord. respiratory therapy – including vent if necessary – O2 given bc hypoxemia increased secondary damage. provide emotional support. touch Turn q2. google for better idea Also. high fiber diet. ROM Disturbed sensory perception Risk for impaired skin integrity Impaired urinary elimination Constipation Acute pain Long term anticoagulation Provide prism glasses. dependent on level of injury. may be unable to speak. hygiene and skin/peri care Intermittent cath. sports Respiratory affected T1-T11 Diaphragm controlled by C4 Review chart 63-7 on pg 1935 & table 63-3 on pg 1936 Autonomic Dysreflexia – know it. bowel program institution Provide comfort measures. coping strategies. frequent assessment. assisted coughing. fragmented or unstable vertebrae. May have respiratory failure. music. swallow Xray. analgesia Most common in young males – MVAs.Neuro Study Guide Spinal Cord injury (SCI) Traumatic damage to any level of the spinal cord. Immobilization and stability devices. teach pt and family and encourage participation. Know that can be caused by ANY stimulus below level of injury Spinal and Neurogenic shock – not well described in book.this study guide doesn’t cover long term management pgs 1943-46 . CT. possibly MRI Full neurological exam IV corticosteroids (methylpredniso ne) first 24-48 hrs. close monitoring of resp status. teach to record I/O and monitor void status Stool softeners. air humidification Impaired bed and physical mobility Frequent positioning and early ambulation. violence. Surgical intervention when indicated (compression.

assistive devices. minimize spasticity and contracture. offer resources Home modifications for independence. coordination difficulties No Cure Individualized treatment based on symptoms Nerve blocks Possible meds: Rebif. the cerebrum. stretching Gait training. Referral to sex counselor. patchy and total blindness. set realistic goals. speech consult. urodynamic studies. adequate fluids and diet including fiber Diet modifications if needed. cerebellum and spinal cord. Neurontin. . structured environment Support. temperature control Identification of the problem. progressive demyelinating disease. alternate communication methods teaching Pt and family teaching. Cylert and Prozac for fatigue Inderal. alternative methods Education and medication Onset ages 20-40 Terms: Spasticity Ataxia During Myasthenic crisis ABGs. depression. and Klonopin for Ataxia Bowel and bladder meds Impaired bed and physical mobility Risk for injury Impaired urinary and bowel elimination Impaired verbal communication Impaired swallowing Disturbed thought processes Ineffective individual coping Impaired home maintenance management Potential for sexual dysfunction Myasthenia Gravis (MG) Auto-immune disease that targets Initial: Diplopia and ptosis. Most patients have relapse and remission – deficits may occur and accumulate over time. Areas. self-cath teaching. service referrals. assistive devices. Avonex. home care. – 50% of RR progress to secondary progressive course with increase in deficits and rare plateaus Primary progressive: Quadriparesis Cognitive dysfunction Visual loss Brain stem syndromes Specific symptoms depend on area of brain affected MRI. monitor for pressure ulcers Void schedule. valium for spasticity Symmetrel. blurry vision. numbness. Copaxone. Betaseron. walking. electrophoresis of CSF. bowel/bladder training.optic nerves chiasm and tracts. pain. Aimed at improving function and Myasthenic Crisis: Exercises. Evoked potential studies. Acetycholinest erase inhibitor test. fatigue. assistive devices. brain stem. Theory – virus triggers autoimmune response. neuropsychological testing Sexual Hx Pt may have: Diplopia.Neuro Study Guide Multiple Sclerosis (MS) Immune mediated. T cells allow infiltrates in that cause demyelination. weakness.cause flu like symptoms-treat with nsaids May take 6 months for improvement Baclofen.

.Neuro Study Guide acetycholine and impairs transmission of impulses across the myoneural junction. IVIG *No Novocaine Plasmapheresis Thymectomy ** Medical Emergencies ** Requires ICU management. diminished reflexes and ascending motor weakness. SCD. Avoidance of triggering factors and infections. Intubation. Hx of viral illness. pyridostigmine. Causes weakness of the voluntary muscles. ROM. corticosteroids. -tensilon given IV to diagnose. IV fluids and Parenteral nutrition. i/o and daily weight are monitored. blindness. Lab tests not useful. EMG Begins with muscle weakness and diminished reflexes of lower extremities and may progress to tetraplegia. gastrostomy management electrolytes. Assessment of muscle strength and respiratory function. Sedatives and tranquilizers avoided. Conservation of energy. targeting antibodies No Cure Anticholinesteras e mediation. 80% also have thymic hyperplasia or thymic tumor. management important. hyporeflexia and paresthesias. Guillain-Barre syndrome Autoimmune Attack on the peripheral nerve myelin. Plasmapheresis and IVIG – continuous ECG monitoring Respiratory Distress Dysphagia Dysarthria Ptosis Diplopia Prominent Muscle Weakness *Airway is priority Nursing Diagnoses depend on symptoms and course of disease. Dysphonia and generalized weakness. Supplemental feedings may be needed for adequate nutrition. Aimed at preventing and managing complications Ineffective breathing pattern Impaired bed and physical mobility Imbalanced nutrition. CSF evaluation. Patient presents with symmetric weakness. Anticoagulation. less than body requirements. Eye care important for prevention of corneal damage. -face weakness and ptosis resolve for 5 minutes MRI. Position Changes. imurian. The result is acute rapid demyelination of peripheral nerves and some cranial nerves producing ascending weakness with dyskinesia. weakness of face and throat muscles. bulbar weakness. NG tube if impaired swallowing. Neuromuscular respiratory failure. Close Monitoring and potential mechanical ventilation which should be discussed on admission. Minimize aspiration by timing meals at peak effect of anticholinesterase medications.

Septic=bacterial infection. Evoked potential studies. Can be blood stream or direct inability to swallow or clear secretions and autonomic dysfunction. Treatment aimed at maintaining muscle tone and preventing or minimizing denervation. eye ointment. Impaired gas exchange. painful sensation in the face behind the ear and in the eye. No Diagnostics Nuchal rigidity=early sign. Analgesic and facial massage when tolerated. cephalosporins). Eye patch. teach relaxation and distraction. CSF studies may demonstrate low glucose/high WBC/high protein. Hypotension managed with fluid. Impaired verbal communication Fear and anxiety. Possible trach. MRI. listening to music. Aseptic=viral infection. speech consult. Bell’s Palsy Meningitis Paralysis of the face caused by unilateral inflammation of cranial nerve VII. dexamethasone. reading. Increased lacrimation. eye shield and use of wrap around glasses during the day to minimize moisture loss. . speech difficulties. Corticosteroids. diversional activities. +brudzinskis sign. Risk for injury r/t seizures. TV. The myelin damage results from the inability to distinguish between two proteins. theories include vascular ischemia. Eye blink system. ABGs and PO2 to identify need for support if increasing ICP compromises brain stem. Exact cause unknown. Protect patient from further injury and infection. encourage visitors. provide information about the condition. Risk for Corneal injury Picture Cards. Possible mechanical Most patients are younger than 45. increase patient sense of control. viral disease. photophobia CT. Actual infection. Decadron. Encourage family participation in care.Neuro Study Guide Caused by antecedent event most often viral infection. autoimmune disease or a combination. surgical exploration if tumor suspected or to decompress nerve if doesn’t resolve. moisturizing drops. unable to eat on affected side. May be a type of pressure paralysis. Acute pain Antibiotics for bacterial (vanco. analgesics. +kernig’s sign. dehydration and shock are treated Hypovolemia.

Muscle spasms. Peripheral neuropathy Most commonly caused by diabetes and poor glycemic control. Rapid fluid replacement but take care to prevent overload. baclofen Surg: decompression of the nerve. Diminished reflexes. Physical assessment and findings. water. lyrica. Phenytoin for seizures. Gabapentin. ventilations. assessing “trigger points” Acute pain. Mental deterioration. CreutzfeldtJakob disease Caused by a prion. MRI. The nurse needs to assist with the care of the anxiety. with fluids. Offer emotional support. EEG. Palliative care. Pain ends as abruptly as it starts and is usually unilateral and described as shooting or stabbing. drinks. Educating diabetics on the .Neuro Study Guide introduction through trauma. dysarthria. radiofrequency thermal coagulation. Monitor BP. brain biopsy No effective treatment. rigidity. Chronic pain. Educating on preventative strategies such as avoiding too hot or too cold foods. and insomnia that often accompanies the chronic pain. gabapentic. Risk for injury. Survival is an average of 22months. percutaneous balloon microcompressio ns. Risk for injury/fall Diabetes education and management. Fever reduction. cognitive impairment. Trigeminal Neuralgia As the brain ages a loop of cerebral artery or vein may compress the nerve root entry point. Pain and sensation Pharm: antizeisure agents. MRI. Depression and anxiety are common side effects and It is important that it is prevented b/c there is no cure. paralysis. CSF. It causes spongiform changes in the brain (degeneration of brain tissue). Offer support to the patient and family. Occurs most often before the age of 35 and is more common in women and people with MS compared to the general population. depression. incoordination. Loss of sensation and muscle atrophy and weakness. Palliative care Ineffective coping Grief Progression of the disease occurs quickly after the onset of specific neurologic symptoms. memory loss. Death is inevitable.

Health HX.. people can be tested for the genetic marker before symptoms occur. Pain medications and rest of the surgical spine to allow the C spine to heal and reduce inflammation.Neuro Study Guide Parasthesia and pain. Parasthesia. Surgical excision Pain. Infection risk if surgery. Neck should be kept Hospital stay is likely to be short. Typically occurs at the C5-C7 interspaces. MRI of the Cspine. Bedrest and pain medications for cervical and lumbar disks. Huntington’s Disease Degenerative Disc Disease Cervical Herniation Premature death of cells in the striatum of the basal ganglia. The same at DDD but with the risk of lesions forming on the spinal cord. motions are devoid of rhythm or purpose. Risk for injury. importance of blood sugar management is key. support for these are important. Skin integrity is at risk d/t bedrest. Presence of genetic markers. Antiparkinson’s medications for rigidity. Could mean a need for further surgery. Teach strategies to manage symptoms. Positive family history. emotional disturbance. Pain. fusion. Infection risk if surgery is undertaken. Abnormal involuntary movement (chorea). If there is a family history. Watch for excruciating pain after surgery. C/M depends on the location in the spine. judgment) and in the cerebellum (the region responsible for coordinated voluntary muscle movement) Herniation of the intervertebral disc with subsequent compression it is preceded by degenerative changes that occur with aging. No cure just treat the symptoms. perception. Self care must be promoted and taught. . CT Neurologic exam. MRI. Increased risk for aspiration pneumonia. Pain management and support. Cells are also lost in the cortex (the region associated with thinking. Dopamine receptor blockers. May be flat bedrest after surgery. intellectual decline. testing of extremities. Surgical excision of the herniated disc. Focus on the palliative and coping Look beyond the disease and focus on the patient’s needs and capabilities. constant writhing. End of life care will be a priority. Often prescribed many pain medications and can have chronic narcotic use resulting in increased need for pain medications. Physical exam. Pain and stiffness of the neck. laminectomy. memory.

penetrating head injury. progressive. -Headache. cognition. -monitor neuro status -admin meds -assess response to treatment -supportive care -monitoring safety -educate patient and family -Wandering -Promoting patient -impaired memory function and -impaired physical independence. and ability for self-care -loss of memory and cognition that disturbs daily life -Trouble understanding visual images and spatial relationships -Problems with words or speaking -Misplacing things and losing the ability to retrace steps -Poor judgment -withdrawn from activities -Medical history including family history -Mental status testing -physical and neurological exam -Blood test to rule out other causes -MRI & CT usually used to rule out other causes of the herniated disk may be necessary. and degenerative brain disorder that is accompanied by profound effects on memory. of tongue piercing. rhinosinusitis. usually worse in the morning -fever -vomiting -focal neurologic deficits -Decrease LOC -seizure -MRI or CT scan -blood cultures -Chest x-ray -EKG Alzheimer’s A chronic. and systemic infections. -Acute confusion -fear -Grieving -Decreased intracranial adaptive capacity -Acute pain -Vision loss -Risk for injury -Vision loss -Prevention such as promptly treating otitis media. mobility -promoting safety -self-neglect -reducing anxiety and -risk of loneness agitation -caregiver role -providing strain socialization -chronic confusion -adequate nutrition -hopelessness -supporting and -powerlessness education patient and family -Seizures are common. -behavioral and psychosocial therapies midline and in a neutral position. -definitive diagnosis can be made only at autopsy . -Control ICP -drain abscess -Antimicrobial therapy -high dose antibiotics -Corticosteroids -Antiseizure meds -goal is to manage symptoms -assessing for underlying depression -pharm to treat symptoms but does not stop the progression. dental infections.Neuro Study Guide Brain Abscess Collection of infectious material within the tissue of the brain. mastoiditis. Can be caused by: -intracranial surgery.

levodopa) -stereotactic procedures -neural transplantation -Deep brain stimulation -Impaired physical mobility -Self-care deficits -Constipation related to medication and reduced activity -imbalanced nutrition -impaired verbal communication ineffective coping -Improving mobility -Enhancing self-care activities -Improving bowel elimination -Improved nutrition -enhancing swallowing -encouraging the use of assistive devices -Improving communication -supporting coping abilities -promoting home and community-based care -neurologic exam -Headache -gait disturbances -MRI along with S/S -palliative and involves eliminating of reducing serious symptoms.Neuro Study Guide -Change in mood or personality Parkinson’s Cerebral metastases -Slowly progressing neurologic movement disorder that eventually leads to disability. -cancer that has metastasized (spread) to the brain from another location in the body Gradual onset and symptoms progress slowly. leading to an imbalance that affects voluntary movement. -Self-care deficit -Imbalanced nutrition -Anxiety -Interrupted family processes -Pain management -improve nutrition -compensation for self-care deficits -relieving anxiety -survival time: *no treatment for brain metastases: 1 month . -decresed level of dopamine resulting from destruction of pigmented neuronal cells in the substatia nigra in the basal ganglia region of the brain. The loss of dopamine results in more excitatory neurotrasmitters than inhibitory neurotransmitters . -Cardinal manifestations: -Tremors -Rigidity -Bradykinesia -Postural instability -PET & SPECT scans -diagnosed clinically from the patients history and the presence of two of the four cardinal manifestations Focuses on controlling symptoms and maintaining functional independence -Pharm therapy: antiparkinsonian meds (ex.

-compensation for self-care deficits Diagnosed on the basis of the signs and symptoms. no clinical or laboratory test NO specific therapy exists for ALS. and quality of life *corticosteroid treatment alone: 2 months *Radiation therapy: 3-6 months. there is a loss of motor neurons in the anterior horns of the spinal cord and the lower -visual impairment -personality changes -altered mentation (memory loss and confusion) -focal weakness -paralysis -aphasia -seizures -localized or shooting pains and weakness and loss of reflexes above the tumor level -neurologic examiniation: assess pain. loss of refexes. -The average survival time is 3-5 years with death due. -intramedullary lesions: within the spinal cord -extramedullaryintradural lesions: within or under the spinal dura -extramedullaryextradural lesions: outside the dural membrane ALS Unknown cause. and the presence of weakness and paralysis -pain longer than 1 month -depends on location of the affected motor neuron -fatigue -Radiation therapy -surgery -Chemotherapy -Corticosteriods -Osmotic diuretics -Antiseizure agents -enhancing family processes -promoting home and community-based care. loss of sensation or motor function. -MRI scans: most common used. The main focus of medical and nursing management is on interventions -ineffective breathing pattern -impaired verbal communication -decisional conflict -Chronic sorrow -Monitor for aspiration may in enteral feeds -maintain or improve function.Neuro Study Guide Spinal tumors Tumor within the spine. well-being. most commonly to respiratory insufficiency. . -x-ray -radionuclide bone scan -CT scans -biopsy -Surgical interventions: primary treatment -partial removal of the tumor -decompression of the spinal cord -chemotherapy -radiation therapy -Provide per and postoperative care -Managing pain -monitoring for complications -Patient and family teaching. Classified by anatomic relation to the spinal cord.

-spinal deformity is a severe problem. fall -Most of these disorders are inherited. Post-Polio symptoms: NO diagnostic test for this** -Progressive muscle and joint weakness and pain -General fatigue and exhaustion with minimal activity -Muscle atrophy -Breathing or swallowing problems -Sleep-related breathing Hx. -progressive muscle weakness.Neuro Study Guide Muscular Dystrophies Post-Polio nuclei of the lower brain stem. use assistive devices Heat/Cold. schedule rest periods. -Electromyography and muscle biopsy may be done -MRI -Neuropsychological testing Incurable muscle disorders characterized by progressive weakening and wasting of the skeletal or voluntary muscles. adequate fluid intake. . and quality of life. Unknown – prior polio infection -Muscle wasting and weakness -abnormal elevation in serum levels of muscle enzymes. -facial twitching -loss of coordination are specific for this disease. wellbeing. -riluzole (Rilutek). physical exam and exclusion of other medical conditions to maintain or improve function. is the only med approved for the treatment of ALS. -elevated muscle enzymes. -focuses on supportive care and prevention of complications -individualized therapeutic exercise program -spinal fusion -Impaired swallowing -Risk for aspiration -anxiety No specific treatment – focus on symptoms Activity intolerance -intense therapy to keep the muscles active and functioning normally -night splints -teaching patient selfcare Chronic pain Risk for ineffective breathing pattern Plan activities to conserve energy. assess pattern for nocturia Risk for injury/falls Use of assistive devices. CPAP if applicable Provide teaching and resources for diet and safe exercise Imbalanced nutrition: more than requirements Disturbed sleep Limit caffeine. cautious use of medications Pulmonary hygiene. -cramps. a glutamate antagonist.

Surgery is preferred treatment Pre-Op: Depends on reason for surgery. bowel and bladder function Post-Op: Knowledge deficit Anxiety Fear Post-Op: Same as above Post-Op: Nursing diagnoses and interventions will be varied based on the type of tumor. catheter. visual assessment. large head dressing until surgeon Ok’s smaller one. reduce pressure) Craniectomyremoving a piece of the skull (usually for pressure relief. assessment of LOC. M/S strength. Post-Op: Large head dressing until surgeon removal prevention. how to communicate on the vent Post Op: Location is everything with tumors – where it grows defines what it affects . FSH and LH. benign and slow growing. Neuro evaluation. May not be coherent due to increased ICP or alterations in LOC. transcranial doppler. limited vision if periorbital swelling is present. growth hormone and ATCH. Hair will be shaved on the access site. possible mechanical ventilation. with the most common type of glioma being an astrocytoma which is also graded Note: I recommend re-reading this section: brief synopsis only included here + the following sections on pre/post surgical care Description: Intracranial Craniotomy – Surgery opening the skull to gain access to structures (Used for: removal of tumor or clot.most benign and managed conservatively Pituitary adenoma: Either cause pressure effects or hormonalusually prolactin. hearing loss.also rarely TSH. and osteoporosis (common with postpolio) management Acoustic neuroma: 8th cranial nerve tumortinnitus. Med surg book Pg 1978 figure 651: common locations of tumors Pre-Op: ***Deficient knowledge of Post-Op expectations/care needs to be addressed BEFORE surgery Provide teaching about Post Op including hair removal. stagger. Manifestations are result of pressure. All are at risk for increased intracranial pressure and varying forms of neurologic presentation. vertigo. control hemorrhage. cerebral angiography. central and ART lines. Angioma: Abnormal clusters of blood vessels – cause hemorrhagic stroke in <40 yo Pre-Op: CT. but can be used for access of specific site) disorders (as sleep apnea) -Decreased tolerance of cold temps Meningioma: Common. corticosteroids (dexamethasone) Mannitol/Lasix. Anxiolytics Pre-Op: Depends on patient disease process and functioning. MRI.Neuro Study Guide Primary Brain tumors Glioma: most common type. Pre-Op: Prophylactic antibiotics and phenytoin.

VS. but can be used for access of specific site) Likely ET tube. hygiene care Aseptic technique with ICP monitoring Monitor I/O. I/O ICP monitoring ABGs CBC/CMB BUN/ Creatinine. LOC.Neuro Study Guide Burr holes: either to facilitate a craniotomy OR as a means of pressure relief (also usually for pressure relief. blood glucose. seizure. signals Turning q 2 hours. electrolyes. interaction. treat hyperthermia aggressively Deep breathing/ Incentive spirometer. phenytoin levels (10-20 mcg/mL) Ineffective cerebral tissue perfusion Risk of imbalanced body temperature Potential for impaired gas exchange Disturbed sensory perception Body image disturbance Impaired communication Risk for impaired skin integrity Risk for infection Risk for fluid and electrolyte imbalance Q15-60min VS/Neuro assessment. Assess: Respiration and oxygenation status. grooming. bleeding/CSF leakage. and urine specific gravity. humidify air Announce presence. HOB flat or 30 degrees. fluid restriction. control cerebral edema and ICP Cover pt appropriately. cool compresses and HOB elevation (30) to decrease periorbital edema Verbalization. cover head with turban (later. Cautiously suction/ help pt cough. a wig) Use of communication boards. IV fluids/diuretics as ordered .

cares.Neuro Study Guide Transsphenoidal surgery Description: Access to the brain (usually the pituitary gland) through the mouth and sinuses Also used for ablation of the pituitary with disseminated breast or prostate cancer Pre-Op: Depends on reason for surgery. sneezing etc) . potential complications. May have increased ICP and altered LOC Post-Op: Swollen/ bruised face Nasal packing – cannot remove blood around until packing removed! Pre-Op: Endocrine workup Rhinologic evaluation Nasopharyngea l culture (surgery contraindicate d with sinus infection) Visual evaluation Neuroradiologic studies Post-Op: Urine specific gravity after EACH urination to monitor for diabetes insipidus and SIADH ICP monitoring CMB CBC Pre-Op: May have corticosteroids. and/or prophylactic antibiotics prescribed before surgery Pre-Op: Same as above Pre-Op: Same as above Post-Op: Same as above Post-Op: Same as above Impaired oral and nasal mucous membranes Mouth rinses every 4 hours – no brushing until incision heals Petrolatum for lips Use of air humidifier Post-Op: Antibiotics Corticosteroids Analgesics -medication for diabetes insipidus if indicated (Desmopressin) **Disturbed sensory perception r/t proximity to optic chiasm Monitor visual fields and acuity frequently -decreasing acuity suggests expanding hematoma ***Deficient knowledge of Post-Op expectations/care needs to be addressed BEFORE surgery HOB at 60 for at least 2 weeks to promote venous drainage from site Teaching: Post Op expectations. Deep breathing. avoidance of increasing ICP (coughing. phenytoin.