Neurological Disorders Part 2

UNIT 3
ADULT NURSING II
 Objectives
2

By the end of this unit each student she be able to:

1. Define nervous disorders.
2. Describe the aetiology, pathophysiology, and possible
complications of the common nervous disorders.
3. Identify common diagnostic and laboratory tests used in the
evaluation of selective nervous disorders.
4. Discuss the relevant medical and/or surgical management for
nervous disorders.
5. Discuss the nursing interventions (with rationale), nursing
diagnoses and expected outcomes for nervous disorders
6. Discuss the discharge planning for the client
Seizure Disorders
3

EPILEPSY
 Seizure Disorders
4

 A Seizure is a sudden, abnormal electrical discharge

from the brain that result in changes in sensation,
behaviour, movement, perception or consciousness.
 There are two basic types of seizures:
 Epileptic: These seizures have no apparent cause (or
trigger) and occur repeatedly. These seizures are called a
seizure disorder or epilepsy.

 Non-epileptic: These seizures are triggered (provoked) by

a disorder or another condition that irritates the brain. In
children, a fever can trigger a nonepileptic seizure (called a
febrile seizure).
 Seizure Disorders
5

 In Seizure disorders the brain’s electrical activity

is periodically disturbed, resulting in some degree of
temporary brain dysfunction. Seizures may result
when the brain’s electrical activity is disrupted.
 Some seizure disorders are hereditary, but others are
caused by birth defects or environmental hazards, such as lead
poisoning.
 Epilepsy
6

 Epilepsy is a group of syndromes characterized by

unprovoked, recurring seizures with one or more of
the following manifestations
 Loss of consciousness, convulsive movements or other motor
activity, sensory phenomena and behavioural abnormalities.

 The mechanism responsible for such malfunction is

unknown but may be attributed to neuronal
structural impairment, Na+/K+ pump or changes in
neurochemicals. An epileptogenic focus may develop
where cell membranes are more permeable.
 Epilepsy
7

 Pathophysiology and Etiology

 Primary – Idiopathic (genetic, developmental)
 Idiopathic most often begin before the age of 20yrs and rarely
after 30yrs. They are mainly caused by congenital brain defects,
birth injuries, metabolic disorders (anoxia, hypoglycemia,
hypocalcemia).
 When these occur in person over 65 years it can attributed to
conditions that cause neurological changes (CVA, tumors,
infection, trauma, chronic alcoholism and aging process)
 Secondary – Acquired (where the seizures are a symptoms of
another underlying condition)
 After age 20 years, generalized seizures normally have an
identifiable cause.
 Epilepsy
8

Causes of Acquired Seizures:

 Cerebrovascular disease  Metabolic and toxic
 Hypoxemia of any cause, conditions (eg, renal
including vascular failure, hyponatremia,
insufficiency hypocalcemia,
 Fever (childhood) hypoglycemia, pesticide
exposure)
 Head injury
 Brain tumor
 Hypertension
 Drug and alcohol
 Central nervous system withdrawal
infections
 Allergies
 Epilepsy
9

 The OLD International Classification of

Seizures differentiates between two main types:
 PartialSeizures – either focal or local with no loss
of consciousness and affects only one side of the
brain.
 Generalized Seizures – involve electrical discharges
within large areas on both sides of the brain. They
often cause loss of consciousness and can be
convulsive or nonconvulsive.
Epilepsy
10

www.epilepsy.com
 Epilepsy
11

 Partial Seizures
 Simple partial seizures can have:
 motor (frontal lobe-arm movement),
 somatosensory (parietal region-experiencing numbness or
tingling),
 psychic (temporal lobe-aura eg strange smell, noise,
sensation or déjà vu), or
 autonomic symptoms (sweating, pallor, epigastric
sensation, tachycardia) without impairment of
consciousness
 People are completely conscious and aware of their
surroundings. A simple partial seizure may progress to a
complex partial seizure.
12
 Epilepsy
13

 Partial Seizures
 Complex – Complex partial seizures have an impairment
(but not a loss) of consciousness with simple partial
features, automatisms, or impairment of consciousness
only, lasting between 2mins – 15 mins.
 Automatisms – purposeless repetitive activities such as:
 Stare
 Chew or smack the lips involuntarily
 Move the hands, arms, and legs in strange, purposeless ways
 Utter meaningless sounds
 Not understand what other people are saying
 Resist help
 Epilepsy
14

 Generalized seizures
 Tonic-clonic seizures (formally known as ‘grand-mal’) -
muscles contract (the tonic part), then rapidly alternate
between contracting and relaxing (the clonic part).
 Have severe muscle spasms and jerking throughout the body
 Fall down
 Clench their teeth
 Bite their tongue (often occurs)
 Drool or froth at the mouth
 Lose bladder control
 Afterwards may have a headache, are temporarily confused, feel
extremely tired and have anmesia of the event.
 Epilepsy
15

 Generalized seizures
 Absence seizures – Unlike ‘tonic-clonic’, absence seizures do
not cause convulsions or other dramatic symptoms. They have
episodes of staring with fluttering eyelids and sometimes
twitching facial muscles.
 They are completely unaware of their surroundings.
 These episodes last 10 to 30 seconds.
 People abruptly stop what they are doing and resume it just as
abruptly. They experience no after-effects and do not know that a
seizure has occurred.
 Usually begin in childhood, between the ages of 5 and 15 and do
not continue into adulthood.
 Epilepsy
16

 Generalized seizures
 Myoclonic seizures - are characterized by quick jerks of a
muscle or group of muscles or the trunk. The seizures are brief
and do not cause loss of consciousness, but they may occur
repetitively and progress to a tonic-clonic seizure with loss of
consciousness.
 Don’t last more than 1-2 secs.
 Can occur as one or many in a short time.
 These seizures can be mistaken for tics, tremors or clumsiness
(causing persons to fall).
 Begin in childhood but can affect any age.
 No first aid needed
 Epilepsy
17

 Generalized seizures
 Atonic seizures – associated with total lost of muscle tone.
They begin suddenly and without warning. Some atonic
seizures may be fragmentary and lead to dropping of the head
with slackening of the jaw or dropping of a limb.
 There may be total lack of tone, so that the person will fall quickly
to the floor and cannot protect himself or herself against injury.
 Consciousness is impaired during the fall, although the patient
may regain alertness immediately upon striking the floor.
 Atonic seizures are rare and are usually confined to childhood.

 Other seizure types

 Epilepsy
18

 General clinical manifestations:

 Impaired consciousness
 Distributed muscle tone or movement
 Disturbance of behaviour, mood, sensation, or perception
 Disturbance of autonomic functions
 Postictal State – the period of impaired consciousness after a
seizure, may be manifested as sleep, confusion, or fatigue
 Epilepsy
19

 Assessment Findings
 Description by witness

 Neurologic examination

 Diagnostic Test
 EEG - An electroencephalogram is a recording of the brain’s
electrical activity. This helps classify seizure types since different
types of seizures have different wave patterns.

 MRI, CT Scan - to identify lesions that may cause seizures

 Serology; Serum Electrolyte Levels

 Epilepsy
20

 Medical Management

 The aim of medical management is to:

 Prevent injury during seizures
 Eliminate factors that precipitate seizures
 Diagnose and treat the cause of the seizures
 To control seizures to allow a desire lifestyle.
 Epilepsy
21

 Medical Management
 The objective of pharmacotherapy is to achieve seizure control
with minimal side effects.
 Anticonvulsant drugs
 Clonazepam (for generalised seizures) – take PO up to 20mg/day
increasing by 0.5mg over a 3day period.
 Carbamazepine (Tegretol)(for partial and generalised seizures) –
give PO up to 1600mg/day individed dosage or to clinical toxicity.
 Phenytoin (Dilantin) (for partial and generalised seizures) – iv
900mg – 1.5g run at 50mg/min, PO 300mg/day in divided doses.
 Valporic Acid (Depakene, Depakote) (for febrile, partial and
generalised seizures) PO initally 15mg/kg/day, add 5-
10mg/kg/day
 Epilepsy
22
 Precautions
 There are many different types of anticonvulsants. Which one is
effective depends on the type of seizure and the resulting side
effects. The best dose is the smallest dose that stops all seizures
while having the fewest side effects.
 Doctors also measure the level of anticonvulsant in the blood,
because the rate of drug absorption varies among patients.
Therefore accumulation of these drugs within the blood can result
in drug toxicity. Such as Gingival hyperplasia (swollen and tender
gums) can be associated with long-term use of phenytoin
(Dilantin). Serum levels:
 Normal phenytoin (Dilantin) serum levels is 10-20 mcg/mL
 Between 10 and 20 - Occasional mild nystagmus
 Between 20 and 30 - Nystagmus
 Between 30 and 40 - Ataxia, slurred speech, nausea, and vomiting
 Between 40 and 50 - Lethargy and confusion
 Higher than 50 - Coma and seizures
 Epilepsy
23

 Precautions
 Common medication side effects may include fatigue,
dizziness, or weight gain.
 After seizures are controlled, people take the anticonvulsant
until they have been seizure-free for at least 2 years. Then, the
dose of the drug may be decreased gradually, and the drug
eventually stopped. If a seizure recurs after the anticonvulsant
is stopped, people may have to take an anticonvulsant
indefinitely.
 Patients with epilepsy are at risk for status epilepticus from
having their medication regimen interrupted or abruptly stop.
 Epilepsy
24

 Surgical Management
 Seizures caused by brain tumor, brain abscess, and other
disorders
 Stimulation of the Vagus Nerve
 Electrical stimulation of the 10th cranial nerve (vagus nerve)
can reduce the number of partial seizures by more than one
half in some people. This treatment is used when seizures
continue despite use of anticonvulsants and when surgery is
not a possibility. It reduces the number of seizures in about
40% of people.
 Epilepsy
25

 Nursing Management
 Obtain health and seizures history, including prodromal signs
and symptoms, seizure behaviour, postictal state, history of
status epilepticus
 Document the seizure activity:
 Circumstances before attack, Description of movement, Position of
the eyes and head, Presence of automatisms, Incontinence of urine
or feces, Duration of each phase, Unconsciousness and duration,
behaviour after attack.
 Psychosocial effects of seizures
 History of drug or alcohol abuse
 Compliance and medication taking strategies
 Epilepsy
26

 Status Epilepticus
 This is considered a medical emergency because the seizure does
not stop. This is the most serious seizure disorder and starts when
electrical discharges occur throughout the brain, causing a
generalized ‘tonic-clonic’ seizure.
 This diagnosed is made when a seizure lasts more than 5 minutes or
when people do not completely regain consciousness between two or
more seizures.
 People have convulsions with intense muscle contractions and often
cannot breathe adequately. Body temperature increases. Without
rapid treatment, the heart and brain can become overtaxed and
permanently damaged, sometimes resulting in death.
 Epilepsy
27
 Nursing Interventions
 Establish an airway and assess vital signs
 Obtain blood studies (glucose, anticonvulsant drug levels,
electrolyte, blood urea nitrogen)
 Administer oxygen
 Establish IV access and keep open. Maintain fluid adminitration
 Administer anticonvulsants
 Monitor patient (vital signs (respiratory depression) , seizure
activity, neurological)
 Mechanical ventilation as needed (patient remains unconscious
and unresponsive)
 If initial treatment is unsuccessful, general anesthesia with a
short-acting barbiturate (eg methohexital) may be used.
 Assist with investigation of precipitating factor
 Epilepsy
28

 Plan care for these patients under the following

NANDA stems:
 Altered Cerebral Tissue Perfusion

 Risk for Injury

 Ineffective
Individual Coping/Ineffective Health
Maintenance.
 Epilepsy
29

 Patient Teaching
 Know your clues to seizure (if they are any)
 Take prescribed dosage of medication to maintain blood levels
 Consult your doctor if you are unable to take your medication
eg because of illness
 Observe for side effects of your anticonvulsant drug. Do not
stop taking medication because of annoying side effects,
consult your doctor first.
 Wear a medical alert band
 Notify doctor is seizure activity is not being controlled by
treatment
 Do not take over the counter medication without doctor
consultation.
 Epilepsy
30

 Patient Teaching
 Exercise is recommended and social activities are encouraged.
 Avoid seizure triggers, such as alcoholic beverages, electrical
shocks, stress, caffeine, constipation, fever, hyperventilation, and
hypoglycemia.
 They should refrain from activities in which a sudden loss of
consciousness could result in serious injury (operating power tool,
climbing etc)
 Thorough oral hygiene after each meal, gum massage, daily flossing,
and regular dental care
 Report signs of toxicity so dosage can be adjusted. Common signs
include drowsiness, lethargy, dizziness, difficulty walking,
hyperactivity, confusion, inappropriate sleep, and visual
disturbances.
 Epilepsy
31

 Patient Teaching
 During a seizure (inform family and general public):
 Protect the person from falling
 Loosen clothing around the neck
 Place a pillow under the head
 Roll the person over to one side (recovery position)
 If a pillow is unavailable, helpers can put their foot or place an
item of clothing under the person’s head.
 People who have had a seizure should not be left alone until they
have awakened completely
32
Spinal Cord Injury
33
 Spinal Cord Injury
34

 Spinal cord injury is damage to any part of

the spinal cord or nerves at the end of the spinal
canal.

 The injury often causes permanent changes in

strength, sensation and other body functions below
the site of the injury.
 Spinal Cord Injury
35

Traumatic Non-Traumatic

 Motor vehicle accidents  Arthritis

 Football  Multiple sclerosis
 Falls  Cancer Osteoporosis
 Gymnastics  Inflammation of the
 Violence spinal cord
 Diving into shallow
water
 Spinal Cord Injury
36

Spinal cord injuries of any kind may result in one or more

of the following signs and symptoms based on the level
and extent of injury:
 Loss of movement
 Loss of sensation, including the ability to feel heat, cold, touch and
pro-prioception (ability of know your body’s position in space)
 Loss of bowel or bladder control
 Exaggerated reflex activities or spasms
 Changes in sexual function, sexual sensitivity and fertility
 Pain or an intense stinging sensation caused by damage to the nerve
fibers in your spinal cord
 Difficulty breathing, coughing or clearing secretions from your lungs
 Spinal Cord Injury
37

 Emergency signs and symptoms of spinal cord injury

after an accident may include:
 Extreme back pain or pressure in your neck, head or back
 Weakness, incoordination or paralysis in any part of your body
 Numbness, tingling or loss of sensation in your hands, fingers,
feet or toes
 Loss of bladder or bowel control
 Difficulty with balance and walking
 Impaired breathing after injury
 An oddly positioned or twisted neck or back
 Spinal Cord Injury
38

 Actions in emergency situations:

 Don’t move the injured person — permanent paralysis and
other serious complications may result
 Call for emergency medical assistance

 Keep the person still

 Place heavy towels on both sides of the neck or hold the head
and neck to prevent them from moving until emergency care
arrives
 Provide basic first aid, such as stopping any bleeding and
making the person comfortable, without moving the head or
neck
39
Peripheral Nervous System
40
41
 Spinal Cord Injury
42

 The lowest part of your spinal cord that functions normally

after injury is referred to as the neurological level of your
injury. The severity of the injury is often called “the
completeness” and is classified as either of the following:
 Explain injury levels eg if injury occur at T6 from T6 down
not functional
 Complete. If almost all feeling (sensory) and all ability to
control movement (motor function) are lost below the spinal
cord injury, your injury is called complete.
 Incomplete. If you have some motor or sensory function
below the affected area, your injury is called incomplete.
There are varying degrees of incomplete injury.
 ASIA Impairment Scale
43

A Complete: No motor or sensory function is preserved in the sacral

segments S4–S5.

B Incomplete: Sensory but not motor function is preserved below the

neurologic level, and includes the sacral segments S4–S5.

C Incomplete: Motor function is preserved below the neurologic level, and

more than half of key muscles below the neurologic level have a
muscle grade less than 3.

D Incomplete: Motor function is preserved below the neurologic level, and at

least half of key muscles below the neurologic level have a
muscle grade of 3 or greater.

E Normal: Motor and sensory function are normal.

ASIA-American Spinal Injury Association.

Spinal Cord Injury
44
45
 Spinal Cord Injury
46

 Lumbarsacral: The effects of injuries to the lumbar

or sacral regions of the spinal cord are decrease or
lost of control of the legs, hips, bladder, bowels and
sexual functioning.
 Anterior cord syndrome [flexion] (damage to front of
the spinal cord resulting in impaired touch, pain,
temperature below level of injury)
 Central cord syndrome [flexion or extension]
(damage to center of spinal cord resulting in loss of
function to arms and legs)
 Spinal Cord Injury
47

 Posterior cord syndrome [extension](damage to back

of cord resulting in poor coordination)
 Lateral cord syndrome or Brown-sequard syndrome
[penetrating trauma] (damage to one side of the
spinal cord resulting in loss of movement but
sensation on one side of the body to a preserve
movement and loss of sensation on the other side.
 Spinal Cord Injury
48

 Diagnostic test
 A CT (“cat”) scan. This approach uses computers to form a
series of cross-sectional images that may show the location and
extent of the damage and reveal problems such as blood clots
(hematomas).
 An MRI (magnetic resonance imaging) scan. An MRI machine
“takes a picture” of the injured area using a strong magnetic
field and radio waves. A computer creates an image of the
spine to reveal herniated disks and other abnormalities.
 A myelogram. This is an X-ray of the spine taken after a dye is
injected.
 Spinal Cord Injury
49

 Diagnostic test cont’d

 SomatoSensory Evoked Potential (SSEP) testing or
magnetic stimulation. Performing these tests may show if
nerve signals can pass through the spinal cord.
 Spine X-rays. These may show fracture or damage to the
bones of the spine.
 A neurological examination is done to diagnose the severity
of the injury and predict the likely extent of recovery by
testing the patient’s muscle strength and ability to sense
light touch and a pinprick.
 Spinal Cord Injury
50

 Complications
 Autonomic Dysreflexia - is a syndrome in which there is a sudden
onset of excessively high blood pressure. It is more common in
people with spinal cord injuries that involve the thoracic nerves of
the spine or above (T6 or above).
 Spinal (Neurogenic shock) – Loss of all reflex, motor, sensory and
autonomic activity below the level of lesion/injury. The vital organs
are affected, causing decreases in blood pressure, heart rate, and
cardiac output, as well as venous pooling in the extremities and
peripheral vasodilation. In addition, the patient does not perspire in
the paralyzed portions of the body, because sympathetic activity is
blocked.
 DVT and Thromboembolic complication
 Acute Respiratory Failure
 Neuropathic pain
 Spinal Cord Injury
51

 Treatment
 Unfortunately, there’s no way to reverse damage
to the spinal cord.
 Inthe meantime, spinal cord injury treatment
focuses on preventing further injury and
empowering people with a spinal cord injury to
return to an active and productive life.
 Spinal Cord Injury
52

 Early (acute) stages of treatment

 In the emergency room, doctors focus on:

 Maintaining your ability to breathe

 Preventing shock
 Immobilizing your neck to prevent further spinal cord
damage
 Avoiding possible complications, such as stool or urine
retention, respiratory or cardiovascular difficulty and
formation of deep vein blood clots in the extremities
 Patients may be sedated so that don’t move and sustain
more damage while undergoing diagnostic tests for spinal
cord injury.
 Spinal Cord Injury
53

 Treatment
 Medications. Intravenous (IV) methylprednisolone (A-
Methapred, Solu-Medrol) is a treatment option for an acute
spinal cord injury. If methylprednisolone is given within eight
hours of injury, some people experience mild improvement.
 It appears to work by reducing damage to nerve cells and
decreasing inflammation near the site of injury. However, it's
not a cure for a spinal cord injury.
 Immobilization. You may need traction (eg halo traction) to
stabilize your spine, to bring the spine into proper alignment
or both. In some cases, a rigid neck collar may work. A special
bed also may help immobilize your body.
 Spinal Cord Injury
54

 Treatment
 Surgery. Often surgery is necessary to remove fragments of
bones, foreign objects, herniated disks or fractured vertebrae
that appear to be compressing the spine. Surgery may also be
needed to stabilize the spine to prevent future pain or
deformity.
 Experimental treatments. Scientists are trying to figure
out ways to stop cell death, control inflammation and promote
nerve regeneration. Ask your doctor about the availability of
such treatments.
 Spinal Cord Injury
55

Surgical Management
 Surgery is indicated in any of the following
situations:
 Compression of the cord is evident.
 The injury results in a fragmented or unstable vertebral body.
 The injury involves a wound that penetrates the cord.
 Bony fragments are in the spinal canal.
 The patient’s neurologic status is deteriorating.
 Research indicates that early surgical stabilization
improves the clinical outcome of patients compared
to surgery performed later during the clinical course.
 Spinal Cord Injury
56

Surgical Management
 The goals of surgical treatment are to preserve
neurologic function by removing pressure from the
spinal cord and to provide stability.
 Spinal Cord Injury
57

 Nursing Diagnosis
 Ineffective breathing patterns related to weakness or paralysis of
abdominal and intercostal muscles and inability to clear secretions
 Ineffective airway clearance related to weakness of intercostal muscles
 Impaired bed and physical mobility related to motor and sensory
impairments
 Disturbed sensory perception related to motor and sensory impairment
 Risk for impaired skin integrity related to immobility and sensory loss
 Impaired urinary elimination related to inability to void spontaneously
 Constipation related to presence of atonic bowel as a result of autonomic
disruption
 Acute pain and discomfort related to treatment and prolonged
immobility
 Further Reading
58

 Text
 Brunner & Suddarth’s textbook of medical-surgical
nursing. — 12th ed. Unit 14. Nursing Process: The
Patient With Acute Spinal Cord Injury. & The Patient
With Tetraplegia or Paraplegia. Pg 1938-1947
Meningitis

59
 Meningitis
60

 Meningeal inflammation, often extends to cerebral

cortex
 Pathophysiology and Etiology
 Bacteria (most serious, most contagious form); Viruses; Fungi,
Parasites
 Signs and Symptoms
 Headache; Fever; Nuchal rigidity

 Nausea and Vomiting; Photophobia; Kerning’s sign

 Brudzinski sign; Opisthotonos; Petechiae

 Meningitis
61

 Diagnostic Findings
 Lumbar puncture; CSF analysis
 C & S (culture and sensitivity)
 CT scan; CBC; Blood culture, etc.
 Medical Management
 Reduction of ICP

 IV fluids; Antimicrobial therapy

 Anticonvulsants

 Immunizations
 Nursing Process
62

 Assessment
 Health history

 Vital signs

 Neurologic examination

 Diagnosis, Planning, and Interventions

 Risk for impaired gas exchange

 Hyperthermia; Acute pain; Seizures

 Evaluation of Expected Outcomes

Encephalitis
63
 Encephalitis
64

 Inflammatory process  Brain edema; Pathologic

changes in gray, white matter, surrounding
meninges
 Pathophysiology, Etiology: Vector-borne viral
infection; Vaccination adverse effect
 Encephalitis
65

 Signs and Symptoms: Sudden fever; Severe HA; Stiff

neck, Vomiting; Drowsiness
 Later: Tremors; Seizure; Paralysis; Weakness
 Diagnostics: Lumbar puncture; EEG; MRI
 Medical Management: Supportive treatment;
Medication therapy
 Nursing Management
Guillain-Barré Syndrome
66
 Guillain-Barré Syndrome
67

 Pathophysiology, Etiology: Autoimmune reaction;

Myelin destruction
 Signs and Symptoms: Tingling; Progressive
weakness; Paralysis
 Diagnostic tests
 Medical Management
 Plasmapheresis; IV immune globulin
 Recovery
 Nursing Management
 Monitor respiratory distress, vital signs; Prevent immobility
complications; Meticulous skin care
Brain Abscess
68
 Brain Abscess
69

 Pathophysiology and Etiology

 Infection; Intracranial surgery; Head trauma

 Assessment Findings
 IICP; Fever; Headache; Neurologic changes

 Diagnostic tests: Labs; CT; MRI; Radiographs

 Medical and Surgical Management: Antimicrobial

therapy; Craniotomy
 Nursing Management
 Assess: LOC; Sensory, motor function; Signs of IICP
 Monitor vital signs; Intake, output
Multiple Sclerosis
70
 Multiple Sclerosis
71

 Pathophysiology, Etiology
 Unknown cause: Autoimmune disorder; Progressive
demyelinating disease
 Signs and Symptoms (vague, can be temporary):
Fatigue; Vision changes; Weakness; Clumsiness;
Paresthesias; Incontinence
 Diagnostic Findings: Lumbar puncture; CSF with
electrophoresis; CT; MRI
 Medical Management: No cure
 Maintaining functional capacity
 Drug therapy
 Multiple Sclerosis
72

Figure 37-6 The process of demyelination

 Nursing Process
73

 Assessment
 Neurologic; Respiratory; Muscle strength; Coping ability;
Elimination patterns
 Diagnosis, Planning, and Interventions
 Risks: Ineffective breathing pattern; Airway clearance;
Impaired: Swallowing, physical mobility, skin integrity;
Altered nutrition; Urinary incontinence; Constipation
 Evaluation of Expected Outcomes
Myasthenia Gravis
74
 Myasthenia Gravis
75

 Severe weakness of one or more skeletal muscle groups

 Pathophysiology, Etiology
 Cause: Unknown; Believed autoimmune origin
 Signs and Symptoms: Muscle weakness; Difficulty
swallowing; Ptosis; Diplopia; Mask-like expression
 Diagnostic tests: IV: Edrophonium; Radiograph;
Electromyography
 Medical and Surgical Management: Drug therapy;
Plasmapheresis; Thymus removal; Respiratory support
 Nursing Management
 Amyotrophic Lateral Sclerosis (ALS)
76

 Progressive, fatal; Unknown cause

 Pathophysiology, Etiology: Motor neuron
degeneration
 Signs and Symptoms: Progressive muscle weakness,
wasting, fasciculations; Difficulty speaking,
swallowing; Paralysis
 Diagnostic tests: Difficult to diagnose
 Medical Management: No specific treatment
 Death: Respiratory complications, infection
 Nursing Management
 Cranial Nerve Disorders: Trigeminal Neuralgia
77
(Tic Douloureux)
 Pathophysiology and Etiology: Possible fifth cranial
nerve root compression
 Assessment Findings
 Severe cyclic pain
 Skull radiography; MRI; CT
 Medical Management
 Narcotic analgesics; Anticonvulsants

 Correction of dental malocclusion

 Surgical Management: Surgical division of the

trigeminal nerve
 Nursing Process: The Client With Trigeminal
Neuralgia
78

 Assessment
 Complete history

 Affected area; Oral cavity

 Record weight and ability to eat food

 Diagnosis, Planning, and Interventions

 Acute pain

 Evaluation of Expected Outcomes

 Pain; Client cooperation
Nursing Process: The Client With Trigeminal
79
Neuralgia

Figure 37-9 Areas innervated by the three

branches of the trigeminal nerve
 Cranial Nerve Disorders: Bell’s Palsy
80

 Pathophysiology and Etiology

 Suspected viral link

 Inflammation of seventh cranial nerve

 Assessment Findings
 Facial pain; Numbness; Diminished blink reflex; Ptosis

 Diagnosis: Symptoms; Visual examination

 Medical Management: Short-term corticosteroid

therapy with prednisone; Analgesics; Electrotherapy
 Nursing Process: Client With Bell’s Palsy
81

 Assessment
 History; Physical examination; Speech; Chewing

 Diagnosis, Planning, and Interventions

 Risks: Eye infection; Impaired oral mucous membranes, verbal
communication
 Evaluation of Expected Outcomes
 Understanding eye medication techniques

 No infection; Unaffected vision

 Intact mouth tissue and teeth

 Satisfactory spoken communication

Extrapyramidal Disorders: Parkinson’s Disease
82

 Pathophysiology and Etiology:

 Deficiency of dopamine

 Slow deterioration

 Assessment Findings
 Signs and symptoms: Hypophonia; Pill-rolling;
bradykinesia; Drooling
 Diagnostic findings: Neurologic examination
 Extrapyramidal Disorders: Parkinson’s Disease
83

 Medical Management
 Drug therapy; Rehabilitation

 Surgical Management
 Stereotaxic pallidotomy; DBS; Gene therapy

 Nursing Management
Extrapyramidal Disorders: Huntington’s Disease
84

 Pathophysiology and Etiology

 Genetic transmission

 Assessment Findings
 Choreiform movements; Intellectual decline; Elimination
difficulties
 Diagnosis: History; PET; Genetic testing

 Medical Management
 Antiparkinson drugs; Genetic counseling

 Nursing Management
85
 Brain Tumors
86

 Pathophysiology and Etiology

 Congenital; Head trauma; Viral infection

 Radiation; Immunosuppression

 Assessment Findings: Signs and Symptoms

 IICP; Seizures; Neurologic function

 Assessment Findings: Diagnostic Findings

 CT; Brain scan; MRI; Angiography

 Medical Management
 Radiation, chemotherapy, and drug therapy
 Brain Tumors
87

 Surgical Management
 Craniotomy; Craniectomy

 Gamma-knife; Radiosurgery

 Nursing Management
88

End of Presentation