Shalom H.

Jaco BSN

MEDICAL SURGICAL
Overview of the Structures & Functions of Nervous System Central NS PNS ANS Brain & spinal cord 31 spinal & cranial sympathetic NS Parasypathatic NS Somatic NS C- 8 T- 12 L- 5 S- 5 C- 1 ANS (or adrenergic of parasympatholitic response) SNS involved in fight or aggression response Release of norepinephrine (adrenaline – cathecolamine) Adrenal medulla (potent vasoconstrictor) Increases body activities Except GIT – decrease GITmotility * Why GIT is not increased = GIT is not important! Increase blood flow to skeletal muscles, brain & heart. Effects of SNS (anti-cholinergic/adrenergic) 1. Dilate pupil – to aware of surroundings - medriasis 2. Dry mouth VS = Increase 3. BP & HR= increased bronchioles dilated to take more oxygen 4. RR increased 5. Constipation & urinary retention

I. Adrenergic Agents – Epinephrine (adrenaline) SE: SNS effect II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’) Blocks release of norepinephrine. Decrease body activities except GIT (diarrhea) Ex. Propanolol, Metopanolol SE: B – broncho spasm (bronchoconstriction) E – elicits a decrease in myocardial contraction T – treats HPN A – AV conduction slows down Given to angina & MI – beta-blockers to rest heart Anti HPN agents: 1. Beta blockers (-lol) 2. Ace inhibitors (-pril) ex ENALAPRIL, CAPTOPRIL 3. Calcium antagonist ex CALCIBLOC or NEFEDIPINE Peripheral nervous system: cholinergic/ vagal or sympatholitic response Involved in fly or withdrawal response Release of acetylcholine (ACTH) Decrease all bodily activities except GIT (diarrhea) I Cholinergic agents ex 1. Mestinon Antidote – anti cholinergic agents Atropine Sulfate – S/E – SNS Effect of PNS: (cholinergic) 1. Meiosis – contraction of pupils 2. Increase salivation 3. BP & HR decreased 4. RR decrease – broncho constriction 5. Diarrhea – increased GI motility 6. Urinary frequency

S/E- of anti-hpn drugs: 1. orthostatic hpn 2. transient headache & dizziness. -Mgt. Rise slowly. Assist in ambulation. CNS (brain & spinal cord) I. Cells – A. neurons Properties and characteristics a. Excitability – ability of neuron to be affected in external environment. b. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another

Sensory 2.Expressive – brocca’s aphasia – unable to speak . Supports neurons. Controls motor activity b. Any increase in one component will increase ICP. Controls personality development c. OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulse transmission.blood MONROE KELLY HYPOTHESIS: The skull is a closed vault. Toxins that can pass in BBB: 1. Most brain tumors are found at astrocyte. 2. Where brain tumors are found. Normal ICP: 0-15mmHg Brain mass 1. cant regenerate (ex.c.) Temporal – . resp (lung cells). Site of development of sense of umor e. Astrocyte – maintains integrity of blood brain barrier (BBB). GIT cells.Corpus collusum Rt cerebral hemisphere.brain mass 10% . Lt cerebral hemisphere Function: 1. Astrocyte 2. Permanent cells – retina. GUT B. II.)ALZHEIMER’S DISEASE– atrophy of brain tissue due to a deficiency of acetylcholine. engulfs bacteria. Ammonia-liver cirrhosis. No myelin sheath – degenerates neurons Damage to myelin sheath – demyellenating disorders DEMYELLENATING DSE 1. Types: 1. Compositions of Cord & Spinal cord 80% . S&Sx: A – amnesia – loss of memory A – apraxia – unable to determine function & purpose of object A – agnosia – unable to recognize familiar object A – aphasia – .CSF 10% . Microglia – stationary cells. kernicterus/hyperbilirubenia. Cerebrum – largest Connects R & L cerebral hemisphere . brain. Permanent cells – once destroyed.) Neuroglia – attached to neurons. Integrative Lobes 1. Where primitive reflexes are inhibited d.jaundice. 2.Receptive – wernickes aphasia – unable to understand spoken words Common to Alzheimer – receptive aphasia Drug of choice – ARICEPT (taken at bedtime) & COGNEX. Bilirubin. pancreas cells cell of liver. hepatitis. Mgt: Supportive & palliative. 4. Labile – once destroyed cant regenerate . engulfs cellular debris. osteocytes) Regenerative capacity A. Carbon Monoxide – seizure & parkinsons. Motor 3. 3. retina. kidney cells C.Epidermal cells. brain. heart. 4. Ketones –DM. Stable – capable of regeneration BUT limited time only ex salivary gland. 3. osteocytes can’t regenerate. Brocca’s area – speech center Damage .expressive aphasia 2. 3. heart. BBB – semi permeable / selective -Toxic substance that destroys astrocyte & destroy BBB.) Frontal a. Oligodendria Astrocytoma – 90 – 95% brain tumor from astrocyte.

a.controls visceral fx Function: .a. Hearing b. BRAIN STEM. vomiting. 11. appetite/ satiety center.) Occipital . heat & cold 4.based on Monroe Kellie Hypothesis Skull is a closed container. hiccups/ singutus Vasomotor center. touch.) Alternate pronation & supination Palm up & down . (+) To alternate pronation & supination or damage to cerebellum – dymentrium Composition of brain . Decrease acetylcholine – Myasthenia Gravis & Alzheimer’s Increased neurotransmitter = psychiatric disorder Increase dopamine – schizo Increase acetylcholine – bipolar MID BRAIN – relay station for sight & hearing Controls size & reaction of pupil 2 – 3 mm Controls hearing acuity CN 3 – 4 Isocoria – normal size (equal) Anisocoria – uneven size – damage to mid brain PERRLA – normal reaction DIENCEPHALON.Pain.) Insula/island of reil/ Central lobe. Wernickes area – gen interpretative or knowing Gnostic area Damage – receptive aphasia 3. Pons – or pneumotaxic center – controls respiration Cranial 5 – 8 CNS MEDULLA OBLONGATA. gait. shock absorber Obstruction of flow of CSF = increase ICP Hydrocephalus – posteriorly due to closure of posterior fontanel CVA – partial/ total obstruction of blood supply . libido.) Rhinencephalon/ Limbec .vision 5. CN 9. swallowing.) R – Romberg’s test. sleep & wakefulness.) Parietal lobe – appreciation & discrimation of sensory imp . spinal decuissation termination.Controls posture. Any alteration in 1 of 3 intracranial components = increase in ICP Normal ICP – 0 – 15 mmHg Foramen Magnum C1 – atlas C2 – axis (+) Projectile vomiting = increase ICP Observe for 24 . emotional responses. controls pituitary function. b. respiratory rate. 12 CEREBELLUM – lesser brain .) Finger to nose test – (+) To FTNT – dymetria – inability to stop a movement at a desired point c. Short term memory c.activities of internal organ 6.Normal anatomical position 5 – 10 min (+) Romberg’s test – (+) ataxia or unsteady gait or drunken like movement with loss of balance. thirst. pressure.controls heart rate. 10.48 hrs CSF – cushions the brain.needs 2 RNs to assist . equilibrium Cerebellar Tests: a.Smell. long-term memory Basal Ganglia – areas of gray matte located deep within a cerebral hemisphere Extra pyramidal tract Releases dopamineControls gross voluntary unit Decrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse. balance.between brain Thalamus – acts as a relay station for sensation Hypothalamus – (thermoregulating center of temp.

) Possible seizure. Assist in mechanical ventilation 1. Limit fluid intake 1.) Localized abscess 4.) Uncal herniation – unilateral dilation of pupil. encephalitis B.) Change or decrease LOC – Restlessness to confusion Wide pulse pressure: Increased ICP .000 – 3. shock .500 ml/day (FORCE FLUID means:Increase fluid intake/day – 2.not for inc ICP.200 – 1.same) 2.INCREASED ICP – increase ICP is due to increase in 1 of the Intra Cranial components. (Bilateral dilation of pupil – tentorial herniation. Monitor VS & I&O 3. max 15 seconds.) d.) Inflammatory conditions .) Maintain patent a/w & adequate ventilation a.) Headache Projectile vomiting Papilledima (edema of optic disk – outer surface of retina) Decorticate (abnormal flexion) = Damage to cortico spinal tract / Decerebrate (abnormal extension) = Damage to upper brain stem-pons/ c.) Cerebral edema 6. Predisposing factors: 1. Maintain quiet & comfy environment . Elevate head of bed 30 – 45 degrees angle neck in neutral position unless contra indicated to promote venous drainage 4.000 ml/day). Suction upon removal of suction cap. Nursing priority: 1. S&Sx change in VS = always late symptoms Earliest Sx: a.) Tumor 3.increase ICP Hypoxia – inadequate tissue oxygenation Late symptoms of hypoxia – B – bradycardia E – extreme restlessness D – dyspnea C – cyanosis Early symptoms – R – restlessness A – agitation T – tachycardia Increase CO2 retention/ hypercarbia – cerebral vasodilatation = increase ICP Most powerful respiratory stimulant increase in CO2 Hyperventilate decrease CO2 – excrete CO2 Respiratory Distress Syndrome (RDS) – decrease Oxygen Suctioning – 10-15 seconds. RR is decreased (Cheyne-Stokes = bet period of apnea or hyperpnea with periods of apnea) 4. Prevent increase ICP by: a.) Hydrocephalus 7. Widening pulse pressure Normal adult BP 120/80 120 – 80 = 40 (normal pulse pressure) Increase ICP = BP 140/80 = 140 – 80= 60 PP (wide) 3.) Head injury 2. Ambu bag – pump upon inspiration c. 5.Meningitis. Temp increase Increased ICP: Increase BP Shock – decrease BP – Decrease HR Increase HR CUSHINGS EFFECT Decrease RR Increase RR Increase Temp Decrease temp b.Stupor to coma Late sign – change in V/S 1. Maintain patent a/w 2. Prevent complications of immobility 6. Hypoxia – cerebral edema .Disorientation to lethargy Narrow pp: Cardiac disorder. diastole.) Hemorrhage (stroke) 5. BP increase (systolic increase. Prevention of hypoxia – (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention).

Instruct patient to avoid the ff: -Valsalva maneuver or bearing down.5 – 5. spinach. (+) “U” wave in ECG tracing Nursing Mgt: 1. If given at 7am. Put bp cuff on arm=hand spasm. Administer meds as ordered: 1.5 meg/L) S&Sx 1.Lasix (Furosemide) Nursing Mgt: Lasix Same as Mannitol except .Excessive cough – antitussive Dextrometorpham -Excessive vomiting – anti emetic (Plasil – Phil only)/ Phenergan . Administer via side drip 4. report if < 30cc out put 3. K chloride Potassium Rich food: ABC’s of K Vegetables Fruits A .Lifting of heavy objects . avoid straining of stool (give laxatives/ stool softener Dulcolax/ Duphalac) .5 – 11mg/100ml) or Tetany: S&Sx weakness Paresthesia (+) Trousseau sign – pathognomonic – or carpopedal spasm. Food appropriate for toddler – spaghetti! Not milk – increase bronchial secretions Don’t give grapes – may choke S/E of Lasix: 1. Avoid clustering of nursing activities 7. Siderails up d. Max effect – 6 hrs due (7am – 1pm) S/E of Lasix Hypokalemia (normal K-3.asparagus A – apple B – broccoli (highest) B – banana – green C – carrots C – cantalope/ melon O – orange (highest) –for digitalis toxicity also. (+) Chevostek’s sign Arrhythmia Laryngospasm Administer – Ca gluconate – IV slowly Ca gluconate toxicity: Sx – seizure – administer Mg SO4 Mg SO4 toxcicity– administer Ca gluconate B – BP decrease U – urine output decrease R – RR decrease P – patellar reflexes absent . Monitor BP – SE of hypotension 2. Monitor I&O every hr. Avoid use of restraints – lead to fractures c.) Hypocalcemia (Normal level Ca = 8.) Osmotic diuretic – Mannitol.) Hypokalemia 2./Osmitrol promotes cerebral diuresis by decompressing brain tissue Nursing considerations: Mannitol 1. carrots yellow vegetables & fruits.b. chesa Iron – raisins. Pt will urinate at 7:15 Immediate effect of Lasix within 15 minutes. Vit A – squash.) Loop diuretic .) Administer K supplements – ex Kalium Durule. Weakness & fatigue 2.Bending & stooping e. Constipation 3.Lasix is given via IV push (expect urine after 10-15mins) should be in the morning. Regulate fast drip – to prevent formation of crystals or precipitate 2.

Early signs – Adult: thirst and agitation / Child: tachycardia Mgt: force fluid Administer isotonic fluid sol 4. 5. Apply warm moist pack? Least priority Rationale: Wont need to pass larynx due to larynx is inflamed. gen body malaise.) Mild analgesic – codeine SO4. For headache. organ meat) (Not good if pt taking MAO) b.6 – 1. Gout y arthritis kidney stones. a/w c. Acute gout drug of choice. Nsg Mgt of Gouty Arthritis a.) Cheese (not sardines. Need tracheostomy onlyMagic 2’s of drug monitoring Drug N range D – digoxin .) Force fluid c.urate crystals in joint.) Anti consultants – Dilantin (Phenytoin) Question: Increase ICP what is the immediate nsg action? a.) Administer meds – Allopurinol/ Zyloprim – inhibits synthesis of uric acid – drug of choice for gout Colchicene – excretes uric acid. Assist in tracheotomy – permanent (Answer) d.2 meq/L A – aminophylline 10 – 19 mg/100ml 20 D – Dilantin 10 -19 mg/100 ml A – acetaminophen 10 – 30 mg/100ml Toxicity Classification Indication 2 cardiac glycosides CHF 2 antimanic bipolar bronchodilator COPD 20 anticonvulsant seizures narcotic analgesic osteoarthritis 200 Digitalis – increase cardiac contraction = increase CO .5 meq/L L .3. anchovies. Administer Mannitol as ordered b. ET can’t pass. Cool moist skin Mgt: 1.) Force fluid 2. poor skin turgor.) Corticosteroids . Restrict fluid d. Avoid use of restraints Nsg Priority – ABC & safety Pt suffering from epiglotitis.) Hyperglycemia – increase blood sugar level P – polyuria P – polyphagia P – polydipsia Nsg Mgt: a. Tophi. Assist in ET – temp.) Meds – narcotic analgesic Morphine SO4 SE of Morphine SO4 toxicity Respiratory depression (check RR 1st) Antidote for morphine SO4 toxicity –Narcan (NALOXONE) Naloxone toxicity – tremors Increase ICP meds: 3. Elevate head 30 – 45 degrees c. Kidney stones – renal colic (pain).lithium .) Hyperurecemia – increase serum uric acid. What is nsg priority? a. Administer steroids – least priority b.renal colic (pain) Cool moist skin Sx joint pain & swelling usually at great toe.Dexamethsone – decrease cerebral edema (Decadrone) 4. Monitor FBS (N=80 – 120 mg/dl) 5.5 – 1.) Hyponatremia – Normal Na level = 135 – 145 meg/L S/Sx – Hypotension Signs of Dehydration: dry skin.

Digivine a. Beer/ wine c. Mixed with plain NSS or . n/v GIT c.9 NaCl to prevent formation of crystals or precipitate Do sandwich method Give NSS then Dilantin.) Anorexia b. don’t giveDigoxin) Digitalis toxicity – antidote .ataxia N – nystagmus – abnormal movement of eyeballs A – acetaminophen/ Tylenol – non-opoid analgesic & antipyretic – febrile pts Acetaminophen toxicity : 1. Organ meat/ box cereals – anti parkinsonian MAOI – antidepressant m AR plan n AR dil can lead to CVA or hypertensive crisis p AR nate 3 – 4 weeks . Monitor liver enzymes SGPT (ALT) – Serum Glutamic Piruvate Tyranase SGOT. S/Sx : Aminophylline toxicity: 1. agitation. b. Photophobia f.before MAOI will take effect Anti Parkinsonian agents – Vit B6 Pyridoxine reverses effect of Levodopa D – dilatin (Phenytoin) – anti convulsant/seizure Nursing Mgt: 1.Nursing Mgt 1. avoided only if pt is given MAOI b. then NSS! 2. Tachycardia 2.) Dehydration – force fluid.) n/s c. Confusion e. Instruct the pt to avoid alcohol – bec alcohol + dilantin can lead to severe CNS depression Dilantin toxicity: S/Sx: G – gingival hyperplasia – swollen gums i. Monitor BUN (10 – 20) Crea (. Cheese/butter– food rich in tyramine. Hyperactivity – restlessness. Oral hygiene – soft toothbrush ii. serotonine.) Hypothyroidism (CRETINISM– the only endocrine disorder that can lead to mental retardation) A – aminophyline (theophylline) – dilates bronchioles. maintain Na intake 4 – 10g daily e. Take bp before giving aminophylline. Massage gums H – hairy tongue A .) L – lithium (lithane) decrease levels of norepinephrine. Tachycardia I – irritability . Diarrhea d. Digoxin is metabolized in liver not in kidney. Check PR. tremors Question: Avoid giving food with Aminophylline a. Changes in color perception – yellow spots (Ok to give to pts with renal failure.) Diarrhea d. Hepato toxicity 2. acetylcholine Antimanic agent Lithium toxicity S/Sx a. HR (if HR below 60bpm. Hot chocolate & tea – caffeine – CNS stimulant tachycardia d. Anorexia -initial sx.8-1) Acetaminophen toxicity can lead to hypoglycemia T – tremors.Serum Glutamic Acetate Tyranase 3.

Pill rolling tremors of extremities – early sign 2. Carbidopa (Sinemet). Bradykinesia – slow movement 3. Haloperidol (Haldol).don’t take food Vit B6 (Pyridoxine) cereals. Arteriosclerosis 4. Mood labilety – always depressed – suicide Nsg priority: Promote safety 9. Narrow angled closure glaucoma 2. Phenothiazide . Nardil) Nsg Mgt when giving anti-parkinsonian 1.anti psychotic d. SE – 1. progressive disease of CNS char by degeneration of dopamine producing cells in substancia nigra at mid brain & basal ganglia Palliative. Supportive Function of dopamine: controls gross voluntary motors. Question: The following are symptoms of hypoglycemia except: a. Diaphoresis PARKINSONS DSE (parkinsonism) . Suction. Amantadine Hcl (Symmetrel) Mechanism of action Increase levels of dopa – relieving tremors & bradykinesia S/E of anti parkinsonian Anorexia n/v Confusion Orthostatic hypotension Hallucination Arrhythmia Contraindication: 1.suicidal 2. organ meats. Shuffling – most common c. Reserpine (serpasil) anti HPN. Mask like facial expression with decrease blinking eyes 6. Encephalitis High doses of the ff: a.) Anti parkinsonian agents Levodopa (L-Dopa). Instruct pt. Prepare suctioning apparatus. Poisoning (lead & carbon monoxide).) breast cancer b. Nightmares b.anti psychotic SE of anti psychotic drugs – Extra Pyramidal Symptom Over meds of anti psychotic drugs – neuroleptic malignant syndrome char by tremors (severe) S/Sx: Parkinsonism – 1. Inform pt – urine/ stool may be darkened 3. Pt taking MAOI (Parnate.Cause B6 reverses therapeutic effects of levodopa . Monotone speech 7. Predisposing Factors: 1. Diaphoresis Antidote for acetaminophen toxicity – Acetylcesteine = causes outporing of secretions. Antidote for lead = Calcium EDTA 2.chronic.) depression . green leafy veg . Difficulty rising from sitting position 8. Take with meals – to decrease GIT irritation 2.R – restlessness E – extreme fatigue D – depression (nightmares) . Marplan. Stooped posture b. Propulsive gait 5. Methyldopa (aldomet) . Autonomic signs: Increase sweating Increase lacrimation Seborrhea (increase sebaceous gland) Constipation Decrease sexual activity Nsg Mgt 1. Over fatigue 4.promote safety c. Increase salivation – drooling type 10. Rigidity (cogwheel type) a. Extreme thirst – hyperglycemia symptoms c. Hypoxia 3. Weakness d.

Diplopia/ double vision c.) Assist in surgery – Sterotaxic Thalamotomy Complications in sterotaxic thalmotomy.SNS 3.Turn pt every 2h Turn pt every 1 h – elderly 3.) Meds . 15 – 35 yo cause – unknown Predisposing factor: 1. Ig A – body secretions – saliva.) Subarachnoid hemorrhage 2. MRI – reveals site & extent of demyelination 3. heat. Visual disturbances a.) Increase fluid in take. Theres spasm & paralysis at spinal cord. Monitor RR. Tingling c.) Antihistamine – Diphenhydramine Hcl (Benadryl) – take at bedtime S/E: adult– drowsiness. Introduce electricity at the back.) Dopamine agonist Bromotriptine Hcl (Parlodel) – respiratory depression. Mood swings – euphoria (sense of elation ) 4. Decrease sexual ability Dx – MS 1.) Maintain good nutrition CHON – in am CHON – in pm – to induce sleep – due Tryptopan – Amino Acid 5. Nsg Mgt MS Supportive mgt 1. CSF analysis thru lumbar puncture . Impaired cerebellar function Triad Sx of MS I – intentional tremors N – nystagmus – abnormal rotation of eyes Charcots triad A – Ataxia & Scanning speech 6. tears.) aneurism 3. colostrums. Child – hyperactivity CNS excitement for kids. Remission & exacerbation Common – women. S/E . Lhermitte’s response is (+).– avoid driving & operating heavy equipt. pain. Short acting.) Assist in passive ROM exercises to prevent contractures 4.Reveals increase CHON & IgG 2.) Maintain siderails 2. 2.) Anti cholinergic agents – relieves tremors Artane mech – inhibits acetylcholine Cogentin action .) Prevent complications of immobility . Weakness b. Urinary retention or incontinence 7. Impaired sensation to touch. Spasiticity –“ tigas” c.) encephalitis MULTIPLE SCLEROSIS (MS) Chronic intermittent disorder of CNS – white patches of demyelenation in brain & spinal cord. cold a.Give INH (Isoniazide-Isonicotene acid hydrazide. Autoimmune – (supportive & palliative treatment only) Normal Resident Antibodies: Ig G – can pass placenta – passive immunity. Blurring of vision b. Numbness b. pressure. 4. Constipation 8. Impaired motor function: a. Take at bedtime. sweat Ig M – acute inflammation Ig E – allergic reactions IgD – chronic inflammation S & Sx of MS: (everything down) 1.) SE-Peripheral neuritis. Scotomas (blind spots) – initial sx 2. high fiber diet to prevent constipation 6. Paralysis –major problem 5. Paresthesia 3. Slow growing virus 2. Nsg Mgt – Parkinson 1.1.

) 4. Maintain siderails 3. Siderails 4. Vit C MYASTHENIA GRAVIS (MG) – disturbance in transmission of impulses from nerve to muscle cell at neuro muscular junction. Tensilon test (Edrophonium Hcl) – temporarily strengthens muscles for 5 – 10 mins. Monitor VS. Prevent complications of immobility 5. Cranberry. Common in Women.Increase acetylcholine s/e – PNS b. biofeedback. Stress 3. Orange juice. Give stress reducing activity. Decrease vital lung capacity. Prepare at bedside tracheostomy set Extreme muscle weakness during activity especially in the morning. Give ACTH – steroids b. unknown cause or idiopathic Autoimmune – release of cholenesterase – enzyme Cholinesterase destroys ACH (acetylcholine) = Decrease acetylcholine Descending muscle weakness (Ascending muscle weakness – Guillain Barre Syndrome) Nsg priority: 1) a/w 2) aspiration 3) immobility S/ Sx: 1. 5/5.a.) 6. Deep breathing exercises. Interferone – to alter immune response d.every 1 hr. Give diuretics Urinary incontinence – give Prophantheline bromide (probanthene) Antispasmodic anti cholinergic 8.) 7. Adult-every 2 hrs. yoga techniques.) 2. Maintain patent a/w & adequate vent by: a. 20 – 40 yo.) 3.PNS Ptosis – drooping of upper lid ( initial sign) Check Palpebral fissure – opening of upper & lower lids = to know if (+) of MG. 5. Encourage fluid intake & increase fiber diet – to prevent constipation 6. Nsg Mgt 1. Under medication 2. Immunosuppresants 2. Prevent complications of immobility.) Dx test 1. Infection B S&Sx 1. 2. Provide acid-ash diet – to acidify urine & prevent bacteria multiplication Grape. 9. muscle strength or motor grading scale (4/5.) Corticosteroids – to suppress immune resp Decadron (dexamethasone) Monitor for 2 types of Crisis: Myastinic crisis A cause – 1.) 5. etc) 3.cholinergic. PNS effect. . Unable to see – Ptosis & diplopia Cholinergic crisis Cause: 1 over meds S/Sx . Provide catheterization die urinary retention 7. Diplopia – double vision Mask like facial expression Dysphagia – risk for aspiration! Weakening of laryngeal muscles – hoarseness of voice Resp muscle weakness – lead respiratory arrest. I&O neuro check. Short term. Baclopen (Lioresol) or Dantrolene Na (Dantrene) To decrease muscle spasticity c. Acute exacerbation ACTH – adenocorticotopic Steroids – to reduce edema at the site of demyelination to prevent paralysis Spinal Cord Injury Administer drug to prevent paralysis due to edema a.) Monitor pulmonary function test.) Assist in mechanical vent – attach to ventilator b.) Cholinergics or anticholinesterase agents Mestinon (Pyridostigmine) Neostignine (prostigmin) – Long term . NGT feeding Administer meds – a. Assist passive ROMexercises – promote proper body alignment 4. Elderly.

Siderails 4. idiopathic Auto immune r/t antecedent viral infection Immunizations S&Sx Initial : 1.Toxic effect – cinchonism Quinidine toxicity S/E – anorexia.. Increase lacrimation Constipation Dx most important: CSF analysis thru lumbar puncture reveals increase in : IgG & CHON (same with MS) Nsg Mgt 1. Assist in passive ROM exercises 6. 4. Assist in plasmaparesis (MG. increase salivation. .) Bretyllium c. Prevent compl – immobility 5. Adm meds (GBS) as ordered: – 1. Assist in surgical proc – thymectomy.unable to swallow. 6. GBS – Guillain Barre Syndrome Disorder of CNS Bilateral symmetrical polyneuritis Ascending paralysis Cause – unknown. Give with meals. I&O neuro check. adm anti-cholinergic Atropine SO4 SNS – dry mouth 7. Anti cholinergic – atropine SO4 2. MENINGITIS – inflammation of meningitis & spinal cord . Arachmoid matter 3. Dysphagia. Anti arrhythmic agents a. GBS) 9. INFL CONDITONS OF BRAIN Meninges – 3-fold membrane – cover brain & spinal cord Fx: Protection & support Nourishment Blood supply 3 layers 1. Maintain patent a/w & adequate vent a. 2. Duramater sub dural space 2. Corticosteroids – to suppress immune response 3. headache. Site for lumbar puncture. Clumsiness Ascending muscle weakness – lead to paralysis Dysphagia Decrease or diminished DTR (deep tendon reflexes) Paralysis Alternate HPN to hypotension – lead to arrhythmia . vertigo. Monitor vs.2. Unable to breath C Mgt – adm cholinergic agents Mgt. Prevent complication – respiratory arrest Prepare tracheostomy set at bedside. Assist in plasmaparesis – filter blood 9. Prevent comp – arrhythmias. n/v.) Quinines/Quinidine – anti malarial agent. Removal of thymus gland.complication Autonomic changes – increase sweating. Assist in mechanical vent b. 3. ECG tracing due to arrhythmia 3. Thymus secretes auto immune antibody.) Lidocaine /Xylocaine –SE confusion = VTach b. Monitor pulmonary function test 2. 3. 8. Institute NGT feeding – due dysphagia 7. visual disturbances 8. respiratory arrest Prepare tracheostomy set at bedside. Pia matter sub arachnoid space where CSF flows L3 & L4. 5.

wbc.due to increased corticosteroid in body. Adm meds a.due to bone marrow depression. CSF analysis: a. increase CHON & WBC Content of CSF: Chon. Nsg Mgt for lumbar puncture – invasive 1. GIT irritation – take with food 2. Super infection – alteration in normal bacterial flora N flora throat – streptococcus N flora intestine – e coli Sx of superinfection of penicillin = diarrhea b. Flat on bed – 12 – 24 h to prevent spinal headache & leak of CSF 2. Complete blood count CBC – reveals increase WBC Mgt: 1. bowel – promote comfort 3. Empty bladder. nephrotoxcicity 3. Allergic reaction 4. Lumbar puncture – lumbar/ spinal tap – use of hallow spinal needle – sub arachnoid space L3 & L4 or L4 & L5 Aspirate CSF for lumbar puncture.rigid arching of back Pathognomonic sign – (+) Kernig’s & Brudzinski sign Leg pain neck pain Dx: 1. Arch back – to clearly visualize L3. Strict resp isolation 24h after start of antibiotic therapy A – Cushing’s synd – reverse isolation . . discoloration & leakage to tissue 4. Force fluid 3. glucose b. Consent / explain procedure to pt RN – dx procedure (lab) MD – operation procedure 2.) Mild analgesic 2. Hepatotoxicity.Etiology – Meningococcus Pneumococcus Hemophilous influenza – child Streptococcus – adult meningitis MOT – direct transmission via droplet nuclei S&Sx Stiff neck or nuchal rigidity (initial sign) Headache Projectile vomiting – due to increase ICP Photophobia Fever chills.) Broad-spectrum antibiotic penicillin S/E 1. increase CSF opening pressure N 50 – 160 mmHg d. Assess for movement & sensation of extremeties Result 1. L4 Nsg Ngt post lumbar 1. (+) Culture microorganism 2. anorexia Gen body malaise Wt loss Decorticate/decerebration – abnormal posturing Possible seizure Sx of meningeal irritation – nuchal rigidity or stiffness Opisthotonus. Decrease glucose Confirms meningitis c. Check punctured site for drainage. D – Post liver transplant – reverse isolation – takes steroids lifetime. C – Cancer anytype – reverse isolation – immunocompromised. B – Aplastic anemia – reverse isolation .) Antipyretic c.

paresis or plegia (monoplegia – 1 extreme) Increase ICP 2. Comfy & dark room – due to photophobia & seizure Prevent complications of immobility Maintain F & E balance Monitor vs. 7. apoplexy Partial or complete disruption in the brains blood supply 2 largest & common artery in stroke Middle cerebral artery Internal carotid artery Common to male – 2 – 3x high risk Predisposing factor: 1. Prevent seizure. 5. TIA. CEREBRO VASCULAR ACCIDENT – stroke. tinnitus. Sedentary lifestyle 3. visual & speech disturbances. Where to bring 2 yo post meningitis .) Cheyne-Stokes Resp . valvular heart dse . 8. diaphoresis & mild restlessness S/Sx: cerebral embolism Headache.post repair myelomeningocele . artherosclerosis. DM. I&O . CHON-for tissue repair.) Compartment syndrome – compression of nerves/ arteries Risk factors of CVA: HPN.E – Prolonged use steroids – reverse isolation F – Meningitis – strict respiratory isolation – safe after 24h of antibiotic therapy G – Asthma – not to be isolated 3.Post heart surgery – mitral valve replacement Lifestyle: 1.) Hemorrhage 3. neuro check Provide client health teaching & discharge plan a. hearing loss or nerve deafness. Hyperlipidemia – genetic 4. Rehab for neurological deficit.Promote lipolysis (breakdown of lipids/fats) – artherosclerosis – HPN .stroke 5.warning signs of impending stroke attacks Headache (initial sx). SOB Tachycardia.Audiologist due to damage to hearing. Small freq feeding b. confusion & decrease in LOC Femur fracture – complications: fat embolism – most feared complication w/in 24hrs Yellow bone marrow – produces fat cells at meduallary cavity of long bone Red bone marrow – provides WBC.Mini pill – has large amt of progestin . Nutrition – increase cal & CHO. Embolism – dislodged clot – pulmo embolism S/Sx: pulmo embolism Sudden sharp chest pain Unexplained dyspnea. Prolonged use of oral contraceptives . Thrombosis – clot (attached) 2. platelets. brain attack or cerebral thrombosis. numbness. Emotional & physical stress 8. 2 – 5 things at the same time c.) Headache b. Deadline driven person b. Obesity S & Sx 1. Smoking – nicotine – potent vasoconstrictor 2. Can lead to mental retardation or a delay in psychomotor development. RBC found at epiphisis 2. palpitations.Urologist -Damage to sacral area – spina bifida – controls urination 9. disorientation. Guilty when not dong anything 6. 4. Type A personality a. 6. Diet – increase saturated fats 7. MI.Macro pill – has large amt estrogen . Stroke in evolution – progression of S & Sx of stroke 3. Prevent complication hydrocephalus. Complete stroke – resolution of stroke a. dizziness/ vertigo.

Delay in psychomotor development .Assist mechanical ventilation . . monitor PT prothrombin time if prolonged. neuro check 5. Coumadin –Long term. SE-Urticaria. decrease Na & saturated fats Complications: Subarachnoid hemorrhage Rehab for focal neurological deficit – physical therapy 1. n/v d.(+) To hemianopsia – approach on unaffected side 9. Avoidance modifiable lifestyle . Dysarthria – inability to vocalize. Not paper and pen. Phlegia 2. Passive ROM exercise q4h 8. ulcer.Administer O2 2. Monitor vs. Streptokinase Urokinase Tissue plasminogen activating Monitor bleeding time Anticoagulants – Heparin & Coumadin” sabay” Coumadin will take effect after 3 days Heparin – monitor PTT partial thromboplastin time if prolonged – bleeding give Protamine SO4. pruritus-caused by foreign subs. Alternative means of communication . Egg crate mattress or H2O bed c. NGT feeding – if pt can’t swallow 7. CT Scan – reveals brain lesion 2.antidote. 4. Prevent compl of immobility by: a.distal Nsg Mgt 1. Aphasia 4. Tiring for pt.Non-verbal cues . Elevate head of bed 30-45 degrees angle. Maintain patent a/w & adequate vent . Sand bag or foot board. Homoninous hemianopsia – loss of half of field of vision Left sided hemianopsia – approach Right side of pt – the unaffected side Dx 1.) Focal & neurological deficit 1. smoking 2.Avoid caffeine.) (+) Kernig’s & Brudzinski – sx of hemorrhagic stroke g.Diet. Avoid valsalva maneuver. Antiplatelet – PASA – aspirin paraanemo aspirin. and unknown headache. Agraphia diff writing 5.prevent foot drop 6. articulate words 3. Mental retardation 2.) Increase BP f.) Force fluid – to excrete dye is nephrotoxic 2.c. Meds Osmotic diuretics – Mannitol Loop diuretics – Lasix/ Furosemide Corticosteroids – dextamethazone Mild analgesic Thrombolytic/ fibrolitic agents – tunaw clot.) Anorexia. Cerebral arteriography – site & extent of mal occlusion Invasive procedure due to inject dye Allergy test All – graphy – invasive due to iodine dye Post 1. Turn client q2h Elderly q1h To prevent decubitus ulcer To prevent hypostatic pneumonia – after prolonged immobility.bleeding give Vit K – Aquamephyton.Magic slate.. Health Teaching 1. Dietary modification . Restrict fluids – prevent cerebral edema 3.antidote.) Check peripheral pulses . b. Alesia – diff reading 6. don’t give to dengue.) Dysphagia e. I&O.

Avoid restraints 4.) Psychomotor/ focal motor .disorder of the CNS char.Twitching of mouth . Contractions-CLONIC Post ictal sleep -state of lethargy or drowsiness . dec O2.1st convulsive attack Epilepsy – 2nd and with history of seizure Predisposing Factor Head injury due birth trauma Toxicity of carbon monoxide Brain tumor Genetics Nutritional & metabolic deficit Physical stress Sudden withdrawal to anticonvulsants will bring about status epilepticus Status epilepticus – drug of choice: Diazepam & glucose S & Sx I. glucose Dx-Convulsion. if untreated.) Jacksonian seizure or focal seizure – tingling/jerky movement of index finger/thumb & spreads to shoulder & sideof the body with janksonian march b.) Grand mal / tonic clonic seizures With or without aura – warning symptoms of impending seizure attack. Avoid precipitating stimulus – bright glaring lights & noises 8. auditory sensory experience Epileptic cry – fall Loss of consciousness 3 – 5 min Tonic clonic contractions Direct symmetrical extension of extremities-TONIC. Can you outgrow febrile seizure? Febrile seizure Normal if < 5 yo Pathologic if > 5 yo Difference between: Seizure.get health history! 1. Auditory – schitzo – paranoid type 2. lead to hyperprexia – coma – death Seizure: inc electrical firing in brain=increased metabolic activity in brain=brain using glucose and O2=dec glucose. Tx:Diazepam (drug of choice).seizure -Automatism – stereotype repetitive & non-purposive behavior . Remove blunt/sharp objects 2. . Visual – korsakoffs psychosis – chronic alcoholism 3.Clouding of consciousness – not in control with environment . Dilantin (Phenytoin) –( toxicity level – 20 ) 1 . visual. 7. Turn head to side to prevent aspiration 6. Status epilecticus – continuous.Epigastric pain. tactile. abnormal motor activity.CONVULSIVE Disorder (CONVULSIONS). Loosen clothing 3. alteration in sensation & perception & change in behavior.associated with olfactory. Generalized Seizure – a.Loss of consciousness – 5 – 10 secs (quick & short) II. Localized/partial seizure a. EEG electroencephalography Hyperactivity brain waves Nsg Mgt Priority – Airway & safety 1. Tactile – addict – substance abuse III. Administer meds a. by paroxysmal seizures with or without loss of consciousness. Maintain patent a/w & promote safety Before seizure: 1.unresponding sleep after tonic clonic b.Blank stare .) Petimal seizure – (same as daydreaming!) or absent seizure. CT scan – brain lesion 2.Mild hallucinatory sensory experience HALLUCINATIONS 1. uninterrupted seizure activity. Maintain siderails 5.Decrease blinking eye . Tongue guard or mouth piece to prevent biting of tongue-BEFORE SEIZURE ONLY! Can use spoon at home.

answer d. Alert – not all pt are alert & oriented to time & place b. Aware Different types of pain stimulation Don’t prick 1.) Levels of orientation 3. Complications: Subarachnoid hemorrhage and encephalitis Question: 1 yo grand mal – immediate nursing action = a/w & safety a. decrease body reflex 4. Mouthpiece – 1 yr old – little teeth only b. Suction apparatus ready at bedside 3. Awake. GCS . Give pillow – safety (answer) d.) Cerebral test – Romhberg.) Sensory assessment 6. Deep sternal stimulation/ pressure 3x– fist knuckle With response – light coma Without response – deep coma 2. Conscious (conscious) – awake – levels of wakefulness 2. sleepy. (Tegretol) Carbamasene.Duration of post ictal sleep. the higher chance of having status epilepticus! 4.) CN assessment 4.SE Ginguial hyperplasia H-hairy tongue A-ataxia N-nystagmus A-acetaminophen. Pressure on great toe – 3x . Assist in surgical procedure. Comprehensive neuro exam 2.given also to Trigeminal Neuralgia.Glasgow coma scale – obj measurement of LOC or quick neuro check 3 components of ECS M – motor 6 V – verbal resp 5 E – eye opening 4 15 15 – 14 – conscious 13 – 11 – lethargy 10 – 8 – stupor 7 – coma 3 – deep coma – lowest score Survey of mental status & speech (Comprehensice Neuro Exam) 1. Cortical resection 5.) Motor assessment 5. Prepare suction Neurological assessment: 1.Don’t give alcohol – lead to CNS depression b.febrile pt Mix with NSS .Type of seizure . Coma (Comatose) light – (+) all forms of painful stimulations Deep – (-) to painful stimulation Question: Describe a conscious pt ? a. Adm o2 inhalation – post! c.) LOC & test of memory 2. finger to nose 7. Stupor (stuporous) – awakened by vigorous stimulation Pt has gen body weakness. Phenobarbital (Luminal). The longer the duration of post ictal sleep. Post seizure: Administer O2.) DTR 8. Monitor onset & duration . Lethargy (lethargic) – drowsy. Institute seizure & safety precaution. obtunded 3. SE: arrythmia c. Coherent c.) Autonomics Levels of consciousness (LOC) – 1.SE: hallucinations 2.

Test of peripheral vision/ visual field Superiority Bitemporally Inferiorly Nasally Common Disorders – see page 85-87 for more info on glaucoma.Increase IOP . a.20 ft Numerator – distance to snellens chart Denominator – distance the person can see the letters OD – Rt eye 20/20 20/200 – blindness – cant read E – biggest OS – left eye 20/20 OU – both eye 20/20 2. c.Diposmia – distorted sense of smell . d. Macular degeneration – black spots III. Agraphesthesia – cant identify numbers or letters written on palm with a blunt object. cigarette tar .) Short term memory – What did you eat for breakfast? Damage to temporal lobe – (+) antero grade amnesia b.) Long term memory (+) Retrograde amnesia – damage to limbic system 6. alcohol. IV. Orbital pressure – pressure on orbits only – below eye Corneal reflex/ blinking reflex Wisp of cotton – used to illicit blinking reflex among conscious patients Instill 1-drop saline solution – unconscious pt if (-) response pt is in deep coma 5. CN assessment: I– II – III – IV – V– VI – VII – VIII – IX – X– XI– XII – Olfactory Optic Oculomotor Trocheal Trigeminal Abducens Facial Acustic/auditory Glassopharyngeal Vagus Spinal accessory Hypoglossal s m m b s b b m m longest CN s m smallest CN b largest CN I. b.Hyposmia – decrease sensitivity to smell . Retinal detachment – curtain veil – like vision & floaters 4. bar soap. etc. Glaucoma – Normal 12 – 21 mmHg pressure . 1. VI – tested simultaneously Innervates the movementt of extrinsic ocular muscle 6 cardinal gaze EOM Rt eye IO LR SR 3 – 4 EOM IV – sup oblique VI – lateral rectus Normal response – PERRLA (isocoria – equal pupil) Anisocoria – unequal pupil SO MR O S E N left eye . cologne irritating to mucosa – use coffee.can identify numbers or letters written on palm with a blunt object. Cataract – opacity of lens .Anosmia – absence of sense of smell Either of 3 might indicate head injury – damage to cribriform plate of ethmoid bone where olfactory cells are located or indicate inflammation condition – sinusitis II optic. 4. Levels of orientation Time Place Person Graphesthesia.test of visual acuity – Snellens chart – central or distance vision Snellens E chart – used for illiterate chart N 20/20 vision distance by w/c person can see letters. “Blurring or hazy vision” 3. Test of memory – considered educational background a.3.Loss of peripheral vision – “tunnel vision” 2.Loss of central vision. Olfactory – don’t use ammonia. vinegar.

5 – 2 mm V – Trigeminal – Largest – consists of . teeth & cornea reflex Unconscious – instill drop of saline solution Motor – controls muscles of chewing/ muscles of mastication Trigeminal neuralgia – diff chewing & swallowing – extreme food temp is not recommended Question: Trigeminal neuralgia. toast.chest . salad. stirrup or melleus. raisins b. mucus membrane.Inertia Test for acoustic nerve: Repeat words uttered IX – Glossopharyngeal – controls taste – posterior 1/3 of tongue X – Vagus – controls gag reflex Test 9 – 10 Pt say ah – check uvula – should be midline Damage cerebral hemisphere is L or R Gag reflex – place tongue depression post part of tongue  Don’t touch uvula XI – Spinal Accessory . Raising of eyelid – Ptosis Controls pupil size 2 -3 cm or 1. Potato. put pressure. raise eyebrow Damage – Bells palsy – facial paralysis Cause – bells palsy pedia – R/T forcep delivery Temporary only Most evident clinical sign of facial symmetry: Nasolabial folds VIII Acoustic/ vestibule cochlear (controls hearing) – controls balance (kenesthesia or position sense) Movement & orientation of body in space Organ of Corti – for hearing – true sense organ of hearing Outer – tympanic membrane. mandibular Sensory – controls sensation of the face. Cereals c. vertigo) 1. Mid otitis media Eustachean ear Inner ear. Gelatin.) Severe vertigo due.) Pregnant – check up – ultrasound reveals fetus is carried by amniotic fluid .Archimedes 3. sensory hearing loss (research parts! & dse) Remove vestibule – meniere’s dse – disease inner ear Archimedes law – buoyancy (pregnancy – fetus) Daltons law – partial pressure of gases Inertia – law of motion (dizziness. pinna. staples. maxillary. Pt should resist pressure. Paresis or phlegia XII – Hypoglossal – controls movement of tongue – say “ah”. incus.meniere dse. -Put applicator with sugar to tip to tongue. RN should give a.controls muscles of facial expression. smile frown.Diffusion – Dalton’s law 2.Movement of air in & out of lungs is carried by what principle? .Push tongue against cheek . -Start of taste insensitivity: Age group – 40 yrs old Motor.controls sternocleidomastoid (neck) & trapezius (shoulders and back) Shrug shoulders. butter.) Pt with multiple stab wound . anvil. Assess tongue position=midline L or R deviation . 2. potato – all correct but d.ophthalmic. gelatin – salad easier to chew VI Facial: Sensory – controls taste – ant 2/3 of tongue test cotton applicator put sugar. Hot milk. cerumen Middle – hammer. oricle (impacted cerumen).Oculomotor 1.Short frenulum lingue – Tongue tied – “bulol” .

Sign up to vote on this title
UsefulNot useful

Master Your Semester with Scribd & The New York Times

Special offer: Get 4 months of Scribd and The New York Times for just $1.87 per week!

Master Your Semester with a Special Offer from Scribd & The New York Times