NEUROLOGIC DISORDERS

HEAD INJURY
 It is a broad classification that includes injury to the
scalp, skull, or brain.
 A head injury may lead to conditions ranging from
mild concussion to coma and death the most serious
form is known as a traumatic brain injury

INCIDENCE
 It occurs in about seven million Americans every year.
 More that 500,000 are hospitals.
 100,000 experience chronic disable.
 2000 left on a persistent vegetables state.

Pathophysiology of Brain Injury

Primary Injury
 Tissue deformation, axonal shearing, contusion,
necrosis, blood-brain barrier disruption
Secondary Injury
 Cerebral edema, increase in inflammatory cytokines,
mitochondrial damage, excitotoxicity, ischemia

Management of Brain
  CT Scan  Preventing Sleep Pattern Disturbance
 MRI Scan  Supporting Family Coping
 PET Scan  Monitoring and Managing Potential Complications.

Medical Therapeutics EVALUATION

o Oxygen • Expected patient outcome may include the following:
1. Attains or maintains effective airway clearance,
o Hyperventilation
ventilation, and brain oxygenation
o Mannitol
2. Achieve satisfactory Fluid and Electrolyte balance.
o Indwelling urinary catheter 3. Attains adequate nutritional status.
o Sedations 4. Avoid Injury
o High dose 5. Demonstrate intact skin integrity
o Barbiturate coma
o Propofol (Diprivan) Transient Ischemic Attack
o Formerly referred to as a cerebrovascular disease
NURSING ASSESSMENT (stroke) or "brain attack." is a sudden loss of function
ASSESSMENT: resulting from disruption of the blood supply to a part
The nurse may elicit information from the patient, from family or of the brain. High-risk groups include people older
from witnesses or emergency rescue personnel. than 55 years.
 When did the injury occur? o Early treatment with thrombolytic therapy for ischemic
 What caused the injury? An striking the head? A fall? stroke results in fewer stroke symptoms and less loss
 What was the direction and force of the blow? of function
NURSING DIAGNOSIS:
o Ineffective airway clearance and impaired gas
Modifiable Risk Factors
exchange related to brain injury.
o Ineffective cerebral tissue perfusion related to o Ischemic Stroke
increased ICP, decreased CCP and possible o Asymptomatic carotid stenosis
seizures. o Atrial fibrillation
o Diabetes (associated with accelerated atherogenesis
o Dyslipidaemia
o Excessive alcohol consumption
o Hypercoagulable states
o Hypertension (controlling hypertension, the major risk
factor, is the key to preventing stroke)
o Obesity
o Sedentary Ifestyle
o Sleep apnoea
o Smoking

PLANNING
o Maintenance of Patent airway, adequate CPP, fluid
and electrolyte balance, adequate nutritional status.
o Prevention of secondary injury.
o Maintenance of body temperature, maintenance of
skin Integrity.

NURSING INTERVENTION
 Monitoring Neurologic Function
 Level of Consciousness
 Vital Sign
 Motor Function
 Stablish and Maintain an Adequate Airway
 Monitor Fluid and Electrolyte Balance.
 Promoting Adequate Nutrition.
 Preventing Injury
 Maintaining Skin Integrity
 Improving Gognitive Functioning

MEDICAL MANAGEMENT
1. Patients who have experienced a TIA or stroke should have
medical management- for secondary prevention
o Anticoagulant (e.g., warfarin)
o If anticoagulant is contraindicated, antiplatelet will do
(e.g., aspirin)
o Statin (e.g., simvastatin)
2. Thrombolyale Therapy - used to treat ischemic stroke by
dissolvind the blood clot that is blocking blood flow to the brain
It works bir binding to fibrin and converting plasminogen to
plasmin, which stimulates fibrinolysis
the clot
Example:
 t-PA (tissue plasminogen activator)
3. Enhancing Prompt Diagnosis - immediate referral to Neuro
team once arrived at the hospital.
If with increased ICP due to hemorrhagic TIA, osmotic diuretic
(e.g. mannitol) could be prescribed.
Other treatment measures:
o Providing supplemental oxygen if oxygen saturation is
below 95%
o Elevation of the head of the bed to 30 degrees to
assist the patient in handling oral secretions and
decrease IC
o Possible hemicraniectomy of increased ICPfrom brain
edema in a very large stroke
o Intubation with an endotracheal tube to establish a
patent airway if necessary
o Continuous hemodynamic monitoring
o Frequent neurologic assessments
Nursing Management
1. Monitor neurologic functions:
o change in level of consciousness or responsiveness
as evidenced by movement, resistance to changes of
position, and response to stimulation; orientation to
time, place, and person
o Ability to speak Volume of fluids ingested or given;
volume of urine excreted each
24 hours
o Presence of bleeding Maintenance of blood pressure
within the desired parameters
Monitoring of continuous oxygen saturation
2. Improve mobility and prevent joint
deformities though appropriate positioning
o Preventing Shoulder Adduction - place a pillow in the
axilla while on bed
o Positioning the Hand and Fingers - hand is placed in
slight supination |
3. Changing position
4. Established exercise program
5. Assisting with nutrition
6. Attaining bladder and bowel control
7. Improving thought process
8. Improving communication
Transient Ischemic Attack
 Prevention
A healthy lifestyle including not smoking, engaging in physical
activity (at least 40 minutes (a day, 3 to 4 days a week),
maintaining a healthy weight, and following a healthy diet
(including modest alcohol consumption), can reduce the risk of
having a stroke
 Specific Diet Recommended by the Dietary
Approaches to Stop Hypertension (DASH)
High in fruits and vegetables, moderate in low fat dairy
products, and low in animal protein)
Hemorrhagic Stroke (HS)
HIS - is a bleeding into the brain tissue. the ventricles, or the
subarachnoid space.
Causes:
  Primary intracerebral hemorrhage from a
spontaneous rupture of small vessels accounts for
approximately 80% of hemorrhagic strokes and is
Intracranial Pressure
caused chiefly by uncontrolled hypertension
Pathophysiology
 Subarachnoid hemorrhage results from a ruptured
 Increased ICP affects many patients with acute
Intracranial aneurysm
neurologic conditions because pathologic conditions
 May result to increased ICP
alter the relationship between intracranial volume and
ICP.
Intracranial Pressure
 Increased ICP from any cause decreases cerebral
 Is pressure is a rise in the pressure inside the skull
perfusion stimulate rather swelling (edema), and may
that can result from or cause brain injun
shift brain tissue, resulting in herniation-a dire and
 The rigid cranial vault contains brain tissue (1400g), frequently fatal event.
blood (75ml), and CSF (75ml). The bolume and
 Decrease plood flow resulling to ischemia which
pressure of the three components are usually in a
manifests slow bounding pulse and respiratory
state of equilibrium
irregularities
 Monro-Kellie hypothesis
 Cerebral edema
 Cushing triad
Tool to monitor increase ICP
1. Widening pulse pressure (rising systolic, declining
How ICP is calculated
diastol
 Subtract the ICP from the mean arterial pressure
2. Irregular respirations (Biot's breathing)
(MAP).
3. Bradycardia
Example, if the MAP is 100 mm Hg and the ICE is 15 mm Hg,
then the CPP is 85 mm Hg. The normal CPP is 70 to 100 mm
Hg.
Patients with a CPP of less than 50 mm Hg experience
irreversible neurologic damage.
Therefore, the CPP must be maintained at 70-16 80 mm Hg to
ensure adequate blood flow to the brain.

Causes of ICP
o Aneurysm rupture and subarachnoid hemorrhage
o Brain tumor
o Encephalitis
o Hydrocephalus (increased fluid around the brain
o Hypertensive brain hemorrhage
o Intraventricular hemorth
o Meningitis
o Severe head-injury
o Subdural hematoma
o Status epilepticus
o Stroke

Clinical Manifestations of ICP

 The earliest sign of increasing ICP is a change in
LOC. Agitation, slowing of speech; and delay in
response to verbal suggestions may be early
indicators.
 As ICP increases, the patient becomes stuporous,
reacting only to loud or painful stimuli
 As neurologic function deteriorates further, the patien
becomes comatose and exhibits abnormal motor
responses in the form of decortication (abnormal
flexion of the upper extremities and extension of the
lower extremities), decerebration (extreme extension
of the upper and lower extremities), or flaccidity.

Diagnostic
 MRI or CT scan of the head can often determine the
cause and confirm the diagnosis.
 Doppler studies provide information about cerebral
blood flow
Medical Management
o Decrease cerebral edema, lowering the volume of
CSF, or decreasing cerebral blood volume while
maintaining cerebral perfusion.
o Accomplished by administering osmotic diuretics,
restricting fluids, draining CSF, controlling fever,
maintaining systemic blood pressure and
oxygenation, and reducing cellular metabolic
demands
o Monitored ICP with the use of an intraventricular
catheter (ventriculostomy), a subarachnoid bolt, an
epidural or subdural catheter, or a fibreoptic
transducer-tipped catheter placed in the subdural
space or in the ventricle