Neuro Study Guide

Disease Brief Clinical Diagnostic Medical Nursing Interventions Other notes:

pathophysiology manifestation tests & management diagnoses
/Assessment findings
Altered Level Not a disease LOC is a  At risk for Ineffective Airway Obtain/ maintain Coma:
of process! continuum from alterations in **Airway is first clearance patent airway unconscious,
Consciousness A&O x3 to coma any body priority, Risk of injury Protect the patient unrousable,
(LOC) 3 “types” system!!! especially if Deficient fluid Maintain fluid balance/ unresponsive
-Neurologic Restlessness unconscious volume IV fluids as ordered Locked –In
-Toxic Anxiety  Full Impaired oral Tube feedings if syndrome:
-Metabolic Slow pupils assessment -Find the cause mucous indicated Inability to move
Conscious?  Neuro exam to find the membranes Mouth care or respond except
Can be caused by Decreased  Glasgow treatment Risk for impaired ROM for eye movement
factors such as: verbal response coma scale skin integrity Turning/ repositioning (lesion of Pons)
drug overdose Decreased Impaired tissue Keep eyes moist and Akinetic Mutism:
head injury motor response Potential labs: integrity of the protected Sometimes opens
stroke Decreased eye Blood glucose, cornea Heat/cold as necessary eyes but makes
alcohol response Electrolytes, Ineffective to maintain body not movement or
hepatic/renal Respiratory Liver function, thermo-regulation temperature sound
failure depression BUN, Serum Impaired urinary Bladder scan/ Catheter Persistent
DKA ammonia, elimination Promote bowel vegetative state:
PT/PTT, Serum Bowel function devoid of
ketone, Blood incontinence Provide sensory cognitive function
alcohol/drug, Disturbed sensory stimulation but has sleep-
ABGs perception Care for the family wake cycles
Interrupted family SCD hose/ DVT
Diagnostic: process prevention
CT, MRI, EEG,
PET/SPECT
Increased Not a disease *Earliest signs are **NO lumbar EMERGENCY Ineffective airway Maintain patent CPP: 70-100 mm
Intracranial process! change in LOC, punctures!! clearance airway Hg
slowed speech, Intracranial Ineffective Monitor respiratory
Pressure (ICP)
Increased ICP delayed response CT, MRI, PET, monitoring breathing pattern status ICP in ventricles is
occurs when one More signs: SPECT, cerebral indicated Ineffective HOB up to 60 0-10 mm Hg, with
Restlessness
of the three angiography, cerebral tissue Avoid stimuli that a max of 15 mm
Increased
factors drowsiness
transcranial Craniotomy, perfusion increases ICP Hg
(blood,brain,CSF) Confusion doppler, craniectomy, Deficient fluid Hourly I/O during
increases and the Evoked Osmotic volume acute phase
 Neuro Study Guide

other two cannot Weakness on one potential diuretics, fluid Risk for infection Strict aseptic
compensate to side or in one studies, restriction, CSF Impaired skin/ technique with ICP
maintain normal extremity electrophysio- drainage, fever mucous monitoring
ICP Headache logic control, membrane Turn/reposition -
Vomiting
monitoring. maintaining BP integrity hygiene
Impaired gag
and/or corneal
and O2 status,
reflexes reducing cerebral
Progression demands, avoid
towards stupor increases r/t
and coma increased
Late signs: abdominal
Coma pressure,
Fixed pupils straining with
Decortication BM, high PEEP.
Decerebration
Impaired/ absent
respirations
Cushing’s
response:
Increased BP
Widened pulse
pressure
Cardiac slowing
Cushing’s triad:
Bradycardia
Hypertension
Bradypnea

Seizures Uncontrolled Dx: ***See pages 8-11

electrical Depends on CBC, CMB, UA, Usually treated Risk for injury Do not restrain on the ch 61-62
discharge in the type of seizure drug screen, with medication patient, pad siderails, notes packet.
brain. how they lumbar though surgical place on their side Details types of
Is either primary present- see puncture, CT options do exist Fear Adherence to seizures, etc
or secondary to note. scan, EEG, skull in some cases. medications is
metabolic, xray important to prevent, **recommend re-
systemic and During a seizure identify triggers and reading the status
other causes. – documentation: Assess: avoid epilepticus section
Circumstance Patient Hx Ineffective as well
before the seizure Family Hx individual coping
Aura
 Neuro Study Guide

Head injury, CVA What the patient Characteristics Teaching about

are biggest causes does – first area of the seizures management and
of new onset affected and how, Deficient referral to counseling
seizures type of knowledge
movements,
Ongoing education
areas of body
involved, size of
and encouragement.
pupils and if eyes Medic alert bracelet.
are open, Family teaching.
automatisms,
incontinence,
duration,
unconsciousness,
paralysis, inability
to speak,
cognitive status,
and movements
at the end of
seizure as well as
if the patient
sleeps after. –
protect from
injury and do not
touch during
seizure-

Nurse then
prevents
complications and
allows patient to
rest – bedrails up
and padded if
needed

Headache (HA) Migraine: 4 phases of Detailed Hx Abortive Acute pain Medication and other Migraine in
abnormal migraine: Medication Hx medications nonpharmacological particular can
metabolism of Prodrome – Assessment of Prevention measures(dark, quiet occur with
serotonin – exact nondescript head and neck techniques room, cold/heat, hormonal changes
mechanism symptoms Complete (identify triggers, massage, elevate HOB related to
unknown (depression, neuro exam etc) 30) menstruation
food cravings, Analgesics
 Neuro Study Guide

Tension – feeling cold) Other Non-medication Deficient Help identify triggers Good health Hx is
contraction of hours-days diagnostics not therapies knowledge and provide teaching a must – as well as
scalp/neck before used unless (massage, on lifestyle good assessment
muscles with Aura- biologic, toxic, heat/cold, etc) modifications to of the headache
physical or Not in most oncologic prevent or reduce  See
emotional stress patients, may cause occurrences. Provide questions
have neuro suspected teaching about on page
Cluster – dilation symptoms medications and to 1891
of orbital and Headache- 4-72 take triptans and
nearby hours ergot derivatives at
extracranial Recovery – the first symptoms.
arteries (theory) exhaustion, may
sleep for
extended
periods

Tension:
Band like pain
or like a weight
on the head.
Steady, constant
pressure

Cluster:
unilateral and
come in clusters
of 1-8 in a day.
Excruciating
pain 15min-3hrs
– usually in
eye/orbit region
but may radiate

Ischemic Separated into 5 Numbness/wea Hx, complete Thrombolytic Impaired physical ROM, positioning,
stroke catagories based kness of neuro and therapy within mobility turning q 2,
on location/origin face/arm/leg on physical exam, less than 3 hours ambulation
but basically a one side -initial focus is unless assistance, exercises,
blood clot or contraindicated PT consult
 Neuro Study Guide

plaque causes Confusion/LOC airway by INR >1.7, Acute pain Analgesia,

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

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

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

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

Potential for Identification of the

sexual dysfunction problem, Referral to
sex counselor,
alternative methods
Myasthenia Auto-immune Initial: Acetycholinest Aimed at Myasthenic Crisis: Education and During
Gravis (MG) disease that Diplopia and erase inhibitor improving medication Myasthenic crisis
targets ptosis, test. function and ABGs,
 Neuro Study Guide

acetycholine and weakness of -tensilon given targeting Respiratory management electrolytes, i/o
impairs face and throat IV to diagnose. antibodies Distress important. and daily weight
transmission of muscles. -face weakness No Cure Dysphagia are monitored.
impulses across Dysphonia and and ptosis Anticholinesteras Dysarthria Conservation of
the myoneural generalized resolve for 5 e mediation, Ptosis energy. NG tube if
junction. weakness. minutes pyridostigmine, Diplopia impaired
Causes weakness corticosteroids, Prominent Muscle Minimize aspiration swallowing.
of the voluntary MRI, EMG imurian, IVIG Weakness by timing meals at
muscles. *No Novocaine *Airway is priority peak effect of Sedatives and
80% also have Plasmapheresis anticholinesterase tranquilizers
thymic Thymectomy Nursing Diagnoses medications. avoided.
hyperplasia or depend on
thymic tumor. symptoms and Supplemental
course of disease. feedings may be
Aimed at needed for adequate
preventing and nutrition.
managing
complications Eye care important for
prevention of corneal
damage.

Avoidance of
triggering factors and
infections.
Guillain-Barre Autoimmune Begins with Patient ** Medical Ineffective Close Monitoring and
syndrome Attack on the muscle presents with Emergencies ** breathing pattern potential mechanical
peripheral nerve weakness and symmetric ventilation which
myelin. The result diminished weakness, Requires ICU should be discussed
is acute rapid reflexes of diminished management. on admission.
demyelination of lower reflexes and Assessment of Impaired bed and ROM, SCD, Position
peripheral nerves extremities and ascending muscle strength physical mobility Changes,
and some cranial may progress to motor and respiratory Anticoagulation.
nerves producing tetraplegia, weakness. function. Imbalanced IV fluids and
ascending Neuromuscular Hx of viral Intubation. nutrition, less Parenteral nutrition,
weakness with respiratory illness. Plasmapheresis than body gastrostomy
dyskinesia, failure, bulbar Lab tests not and IVIG – requirements. management
hyporeflexia and weakness, useful. continuous ECG
paresthesias. blindness, CSF evaluation. monitoring
 Neuro Study Guide

inability to Evoked Hypotension Impaired verbal Picture Cards, Eye

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

introduction with fluids. ventilations. Monitor

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

Parasthesia and testing of support for these are importance of

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

of the herniated midline and in a

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

-Change in
mood or
personality

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

-visual -Radiation -enhancing family *corticosteroid

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

nuclei of the -progressive are specific for to maintain or -Impaired

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

disorders (as prevention, and

sleep apnea) osteoporosis
-Decreased (common with post-
tolerance of polio) management
cold temps
Primary Brain Glioma: Meningioma: Acoustic Pituitary Angioma: Nursing diagnoses and Med surg book
tumors most common Common, neuroma: adenoma: Abnormal clusters interventions will be Pg 1978 figure 65-
type, with the benign and slow 8th cranial Either cause of blood vessels – varied based on the 1: common
Note: I most common growing. nerve tumor- pressure effects cause type of tumor. All are locations of
type of glioma Manifestations tinnitus, or hormonal- hemorrhagic at risk for increased tumors
recommend
being an are result of hearing loss, usually prolactin, stroke in <40 yo intracranial pressure
re-reading this
astrocytoma pressure. vertigo, growth hormone and varying forms of Location is
section: brief which is also Surgery is stagger- most and ATCH- also neurologic everything with
synopsis only graded preferred benign and rarely TSH, FSH presentation. tumors – where it
included here treatment managed and LH. grows defines
+ the following conservatively what it affects
sections on
pre/post
surgical care
Intracranial Description: Pre-Op: Pre-Op: Pre-Op: Pre-Op: Pre-Op: ***Deficient
Surgery Craniotomy – Depends on CT, MRI, Prophylactic Depends on knowledge of
opening the skull reason for cerebral antibiotics and patient disease Provide teaching Post-Op
to gain access to surgery. May angiography, phenytoin, process and about Post Op expectations/care
structures (Used not be coherent transcranial corticosteroids functioning. including hair needs to be
for: removal of due to increased doppler. (dexamethasone) removal, catheter, addressed BEFORE
tumor or clot, ICP or Mannitol/Lasix, Knowledge deficit possible mechanical surgery
control alterations in Neuro Anxiolytics Anxiety ventilation, central
hemorrhage, LOC. evaluation, Fear and ART lines, large
reduce pressure) Hair will be assessment of Post-Op: head dressing until
Craniectomy- shaved on the LOC, visual Same as above surgeon Ok’s smaller
removing a piece access site. assessment, one, limited vision if
of the skull M/S strength, periorbital swelling is
(usually for Post-Op: bowel and present, how to
pressure relief, Large head bladder communicate on the
but can be used dressing until function vent
for access of surgeon
specific site) removal Post-Op: Post-Op: Post Op:
 Neuro Study Guide

Burr holes: either Likely ET tube.

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

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