NEUROLOGIC

SYSTEM

1
 Neurologic System

Communication network

_y' ③ cognitive
It processes
from the outside .

world
⑦ Judgment
-

coordinates and Motor

-

organizes the -

Insight
-

sensoria I
functions of all the •

memory
Lopatin
-

other body systems

-

Acetylcholine
2
 Brain
A

÷
3
A Brain
centimes tense

substantia Nigra
1.
Dopamine
1.
GABA
NEUROLOGICAL
DISORDERS

4
5
6
1

3 7
ACUTE DISORDERS

8
SEIZURE DISORDERS
(EPILEPSY)

9
• Seizure - an unconditioned discharge of
neurons

May be:
• as a blank stare
• lasting several minutes

10
 B
• Theories: ¥ :#
1. P electrical impulse
transmitter
1
2. Lawn ✓ →

B
,

n① 11
• Epilepsy -
recurrent seizures

– Classified as:
• Partial
-

• Generalized
• Unclassified

12
 Epilepsy seizure time

1. Phial
'

.
Petit mi -
25min
Ahsesnnt

2. Generalized Grand ml < To mins

tonic clonic

3. Unclassified lack of data

- -

4. status-
epilepticus
.
-

> Doming
 Assessment
Flickering / flashes
• Aura premonition
-

off lights
• Irregular breathing
Disorientation

/
•
Tonio clonic
• Loss of coordination SL
• Altered LOC

13
 Level of Consciousness
DESCRIPTION

Conscious and coherent Alert

Slight alert reduction, less aware, thinks slowly
Moderate alert reduction; clouding of
Lethargy
consciousness;
Obtunded
Sleep-like state; arousal is brief with vigorous
stimulation Stupor
Complete unresponsiveness, (+) reflexes
Light com

Complete unresponsiveness, (-) reflexes

sleep come
(-) Brain waves
Death
 Diagnostic Evaluation
non -
invasive
✓
• EEG -
painless
• CT Scan / MRI

15
 Nursing Interventions

• Before seizure
– PRIORITY: Safety!
a) Poise 4 pad tie side rails

b) lower the bed

16
During seizure
• Safety

• DON’T RESTRAIN!

• Lower to a flat surface

• Respiratory support
– Maintain a patent airway side lying
– Administer oxygen -
mask
– Suction as needed

me , onset , duration
'

• Note:

• Provide a calm

environment ✗ 17
After seizure
• Assess /
LOC ?
– VS and neurologic status - AVPU / GCS
⇐

• Allow verbalization of feelings.

18
 AVPU SCALE /
GLASGOW COMA SCALE
AVPU Scale
A
V
P
U
The AVPU scale is a system by which a
health care professional can measure
and record a patient’s LOC. It is mostly
used in emergency medicine protocols,
and within first aid.
Glasgow Coma Scale
The GCS provides a practical
method for assessment of
impairment of LOC in response to a
defined stimuli.
GCS-P Scale
The GCS-P is used:
• As an index of “overall” brain damage
• In distinguishing head injuries of
differing severities
• Monitoring their progress and
prognosis
 The GCS Total Scores....
15 Minor injury
9-12 Moderate injury
3-8 Severe injury
 The GCS Total Scores....
15 Best response
8 or less Comatose
3 Unresponsive
Score Motor Response Verbal Response Eye Opening

1 None None None

2 Extension Sounds To pressure

3 Abnormal Flexion Words To speech

4 Withdrawal Confused Spontaneous

5 Localizing Oriented

6 Obeying Commands
 Pupil Reactivity Score
(Pupils UNREACTIVE to light)

Both

One Pupil

Neither Pupil
 For total GCS, subtract pupil
reactivity score from calculated
GCS.
Example: A 37-year-old patient with a traumatic
head injury is admitted to the ER. The admission
assessment are as follows:
She does not open her eyes, she moans, and
displays abnormal flexion in her limbs to pain. On
examination of her pupils, they are both fixed and
dilated.
 Parameters Assessment Score

Motor Response Abnormal flexion

Verbal Response She moans (sound)

Eye Opening Does not open her eyes

Total calculated GCS

Both are fixed and
Pupil reactivity
dilated
GCS-P SCORE
• Preventive
t.pt
– Administer medications, as
.

2. red-orange urine
ordered.
g. Gingival hyperplasia
Ante =
2-3×1 week oral hygiene
/
-

A) Valium 1 diazepam ) massage

-

41 BM depression
preventive b WMC
ldilnulir
11-4 )
-

a) phenytoin 5. Avoid abrupt

withdrawal
34
 ( b 5kt
Agranulocytosis WMC

Triad 1 . T grade fever

2. Skin rashes
3. sore throat
 TRAUMATIC
HEAD INJURY

35
• Results from a trauma to the head,
leading to
• brain injury - swelling / inflammation

↳ • bleeding within the brain -

+ tip

36
• Classified by brain injury type:

• A. Fractures
I • Depressed -
bone in pressed inward
2 • Comminuted -

fragmented
? • Linear -

write on one side

37
 B. Hemorrhages
a) a) • Epidural
b) • Subdural
• Intracerebral
4
c) b)

38
 Possible Causes
toddlers 4 preschooler
• Fall elderly
^

• Automobile accident - Adults

• Assault I

39
Assessment Findings
• S/sx of increase in ICP
(N: 0-15 mmHg)
• ALOC ⑤ until G-

]
• Paresthesia Hemi paresis ipsilateral
-
-

• Paralysis ⑨ -
Hemiplegia after 4-
• Dementia ⑥ -

contralateral
Ytsalmr 40
Monroe -
Kellie Hypothesis
a) Blood

}
④ 0-15 mmHg
b) CSF

c) Tissues
 Slsx of TICP
cushing's Triad

31
BP 9 Temp =P .
Systolic HTN

pi.pl/tR--bz .
widened pulse pressure
Altered Loc 3
.
Bradycardia

irritability / agitation / restlessness

rilv
Seizures
 Nursing Interventions
Otorthea
• Safety
– Seizure precautions Minormen "

– CSF leak
↳ Basilar skull Fracture
• Airway & breathing
– Monitor
• VS ⇐
Base :
Mpi centers THIS
• LOC Reflex centers
• Pulse oximeter / ABG a) swallowing
• Reflexes
b) with
• Fluids and Electrolytes
• Medications, as ordered C) Gag
41
It ) aware

1. Blotting
2. kelodiastix Reagent ship /
aww ship
3. Laboratory
• Medications:

– For pain : codeine 5044

– Swelling / Inflammation : steroids

– Edema : Mannitol
hemostatic
– Bleeding i Vasopressin =

• Surgeries
42
 Surgeries : them
1. Epidural / subdural =

craniotomy
⇐

1. Intracerebral -
OBS
a) Barbiturates -

6- 12ms

b) Methamphetamine
SPINAL CORD INJURY

43
CLASSIFICATIONS

44
A. Type of injury

1. Laceration

2. Transaction

3. Concussion

45
 B. Level of injury

•Cervical: quadriplegia
•Thoracic & Lumbar: paraplegia

46
47
B. Force / Mechanism

Compression Hyperextension Hyperflexion

48
 Diagnostic Evaluation

• Spinal X-rays-

Emotive
• CT scan or MRI =

• Myelography -
exact location
• EEG
0

49
 Possible Causes
• Trauma
– Fall
– Vehicular accident
– Diving Kyphosis
/
• Congenital anomalies Lordosis
• Tumors
1-
←
Scoliosis
 Assessment Findings

• Loss of muscular or sensory function

51
 Nursing Interventions

• Assess VS and
neurologic status.
• Immobilize, reduce

and align

52
• Safety
– Bed rest on a firm surface

• Airway and Breathing

– Oxygen
Deep breathing 4 coughing techniques
– DBCT ✗

• Assess for Autonomic Dysreflexia

53
SPECIALTY BEDS

B Stryker frame
Poto rest 54
55
• Autonomic
Dysreflexia
– an exaggerated
sympathetic
response to a
noxious stimulus
– SCI above T7

56
– Signs and symptoms:
• Hypertension
• Pounding headache + complain
• Flushing
• Diaphoresis
• Blurred vision
• Bradycardia

the noxious
Treatment: parole
stimuli
57
CEREBROVASCULAR
ACCIDENT

58
• AKA stroke or brain attack
• Sudden disruption in cerebral circulation.

• Types

• Obstructive
-

• Thrombus - atherosclerosis

• Embolus 30 cc

• Hemorrhage -
20 ATH 160 cc
59
60
61
Assessment Findings
• Altered LOC
• Headache
• Nuchal rigidity
• Signs of increased ICP

62
 Diagnostic Evaluation

Blood
• CSF analysise-

• CTS / MRI
• Cerebral angiogram
• EEG

63
 Nursing Interventions
• Safety: Seizure precautions
• Promote respiratory support
– Oxygen, as ordered
– DBCT
– Pulse oximetry or ABG
– Reflexes
– NPO and NGT
, TPE
• CBR
64
• Diet:
– Low-sodium "

– Low cholesterol
-

– Low-fat -

65
• Administer medications, as
ordered: Diuretics
– Antihypertensives ✗
Vasodilators
– Anticholesterol statin -
" "

– Anticoagulants
diet
Heparin
#
-

✗ as
-

Warfarin
Maintain Activity
④ a
healthy lifestyle Alcohol moderation
66
 Heparin warfarin

pate 14 / Sc Omt
Partial Prothrombin
Labs
thromboplastin Time
Time
Advantage Fast-acting long half liter
-

Antidote protamine Vitamin K

soy
• Prepare for surgery if
indicated

67
68
CHRONIC DISORDERS

69
70
Format:
Disorder / other name
Involvement - Mcs

Pathophysiologic Basis +

Assessment =

Diagnostic
Management
71
ALZHEIMER’S DISEASE
Senile Dementia

72
ALZHEIMER’S DISEASE
tsvbshnm
Involvement: Cognitive Lead
/ Arsenic
Predisposing Factor/s:
Nicotine
Pathophysiologic Basis:
Aluminum
→
b Acetylcholine 2. Age -66510
gimmes
73
ALZHEIMER’S DISEASE
Assessment:
1h11 mark : Dementia
ADL
51s ✗ i 1 .
Apraxia -
✗

2. Agnosia -
✗ people 4
objects
3. Aphasia -

✗ talk / say words

4. Eye while dysfunction
✗ learn new information
→ invent 74
ALZHEIMER’S DISEASE

Diagnostic:
Neurofibrillary plaques 1
CT Scan
MRI g →
tangle
b Ach

Confirmatory: Autopsy
75
ALZHEIMER’S DISEASE

Stages:
Forgetfulness 11-3 )
years
difficulty in remembering appointments
→

Adyanad 14-8 years )

past I last 6 )
→
difficulty remembering Mos
→
sundown syndrome
Terminal 19 )
Pylon
dehydration
→

starvation h
→
severe forgetfulness 76
ALZHEIMER’S DISEASE
1. Clock "

Management: 2S6C 2. calendar

✗ Blue
red
- I 3. color
✗ Green
Yellow
1. Safety ✓
✗ violet
4. consistency
2. security -

Personnel
-

activities
"N "
g. aovstodial care

Ariapt
J g. aniiuesterse inhibitors
77
MYASTHENIA GRAVIS

78
A

•
i.
/ a

B
79
MYASTHENIA GRAVIS

Involvement: Motor

Predisposing Factor/s: Autoimmune

↳
post yiml exposure
Pathophysiologic Basis:
b Aah ( t ) Ab
=

↳
bbik Aoh receptor sites

80
B- lymphocytes T-lymphocytes
Bursae / Mone )
Murrow
Thymus gland
Bacteria
Csvyeillance)
threef-YIM.gg
protozoa
1AM'Yated)
MYASTHENIA GRAVIS

t
.

81
MYASTHENIA GRAVIS

Assessment:
Earliest symptom: ptosis
Hallmark : Muscle weakness
Am
strong
-

→
weak
-

pm

82
MYASTHENIA GRAVIS

Diagnostic:
1. CTS
2. MRI ]My 0mn

Ab
3. Blood test = Its
4. Tensilon Test confirmatory
-

( Edropnomium Hey
↳ anti cholinesterase
83
 Tension Test
-

pm
Routes : onset Half-life
-

a) 14 -
ideal -

immediate 1-3 mins

b) 1M -

hx .
of -

3-5 mins 1-3 mins

cholinergic crisis
 Tensilon Test
Milo Stig mine -

g- lot
1. ⬆muscle strength (t) MG
cfpyridostiymim-p.im
=

=
p
2. ⬇muscle strength =
CH cholinergic crisis
=
AD : Atropine soy
④ steroids -

3. ❌ effect A) Brittle crisis

b) Plnwssmnpheresis -

c) Thyme do my
✗
1" IgE
84
MYASTHENIA GRAVIS

Management: 2. Bowel 4
" Sahin
Airway app
-

Breathing
-
=
) 2.02 tank
3. Meihiyentilntion
bladder

4. side -

lying
5. P.o. / ABG
Assist Thickened
AN 1. Nutrition
a)
c-

b) NGT
* ptiyer
medications e) TPM 86
AMYOTROPHIC LATERAL
SCLEROSIS Ahs)
(

Other name: Lou Gehrig's Dse .

Incidence - F3:M1
100
ALS

Involvement: Motor
Genetics
unnecessary radiation
Predisposing Factor/s:
Nutrition detiit exposure
Nit .BR
-

Pathophysiologic Basis:slow
attired
-

complex
→
Local demyelination virus
↳ rhabdo

101
 '
-

"

a" o
Schwann i.

/
'
A M ,

102
"
ALS
pan in Brain →

murder

-
0 103
ALS

Assessment:
Itm : Muscle atrophy

104
ALS CK B B
-
=
brain
Diagnostic: MB
=

myocardium
1. CTS
2. MRI }
local demyelination

3. CSF Analysis P- total protein

4. EMG
5. CK-MM I

•
'

105
ALS
Management:

G)
MMG

106
 MULTIPLE SCLEROSIS

20 - 40 years old
With remissions and exacerbations

107
Multiple Sclerosis

Involvement: CS
Predisposing Factor/s: ¥
¥
Pathophysiologic Basis:
stemio Demyelination
108
Multiple Sclerosis

Assessment:
Earliest symptom: Diplopia
Hallmark§ Chariot's Triad

Scanning of speech
International tremors
Nystagmus 109
Multiple Sclerosis
Diagnostic:
1. CTS Systemic demyelination
2. MRI ]
3. CSF Analysis

110
Multiple Sclerosis
Management:
Safety :
Eye patch

FYI
A
✓
physical

/! !!!!!
b) Lack
stress

of sleep
Prevent exacerbation temp .

111
Guillain - Barre Syndrome
Other name: Idiopathic Polyneuritis
Has the best prognosis.
go -90%
112
GBS

Involvement: /
motor sensory
Predisposing Factor: debilitates
Legio
postural exposure 1- Epstein Barr
? SARs £2 Zika
Pathophysiologic Basis:

Polyneuritis
113
GBS
Assessment:
Paresthesia 4 Paralysis
1. Ascending
2. Bilateral
3. Consummated

114
GBS
Diagnostic:
1. CTS
2. MRI } Polyneuritis
3. ESR
Erythrocyte
P sedimentation
Rate
10-1*00
mm / IN
115
GBS
Management:

Safety CBR
-

Breathing
-

Airway
IN
red .
-

corticosteroids
116
 Parkinson’s Disease
Other names: Shaking Palsy
Paralysis Agitates
117
Parkinson’s Disease

Involvement: motor

Predisposing Factor/s:
i. Damage to the substantia Nigra
/ ¥
a. Antipsychotic meds .
T

Pathophysiologic Basis:
b
Dopamine →
pitch
It GABA )
118
Parkinson’s Disease

Assessment:
1. pill -

rolling tremors 19AM

2. muscle rigidity
a) Early ←
ON 7 4 11
Mask like five gait
Shuttling
-
-

stooped posture
→
propulsive gait
-

cogwheel rigidity
-

119
b) late - CN 9 4 12

↳ Tardive dyskinesia →
aspiration
Earliest : -

lip smacking
-
vermiform tongue my 't .
Parkinson’s Disease

Diagnostic:
1. CTS
2. MRI

120
Parkinson’s Disease

Management: stable : Walker

/
Safety AWD '
-

Portable :
lane

t.FI?4/tDoraminergig-ae-sinemetl aiodopn-Carbioo
2. Anticholinergic Copntin
pal

ton Arrive
ryevhdyrryl
Artane 121
 Huntington’s Disease
Other names: Huntington's chorea

Hereditary chorea

Incidence: Female
middle-age
122
Huntington’s Disease

Involvement: motor / cognitive

Predisposing Factor/s:
Genetics / Hereditary =

Jeng
Pathophysiologic Basis:
/ Basal Ganglia
Legion \
Cerebral cortex 123
yxyxyxyx -

3rd -

8
41144
☒ yx and
y
4
-
-

V4
y * -

1st

Y
✗
Huntington’s Disease

Assessment:
1. Dementia
zitmihorea -

jerking / swaying
% Fatigue

g. Depression
! gvideide
124
Huntington’s Disease

Diagnostic:
1. CTS
2. MRI

125
Huntington’s Disease

Management:
/ Suicide .
.

1.
safety \
Injury selective
2. ADD serotonin
Antidepressants :

3. Meds ✗ Receptor
major tranquilizers Inhibitor
" "

zine
126
 Bell’s Palsy Trigeminal Neuralgia
- -

(Tic Doloreux)
Cause
-

unknown .
-

Cranial Nerve
7- Emin 5- Trigeminal
Predisposing factor
Trauma
, Infection ,
tumor
Diagnostics
CTS / MRI
paresthesia
'fPwñy§
Symptoms
's Pain
Treatment
127
 Bell 's
Palsy Trigeminal Neuralgia
1. warm 1. Nerve blocks
compress ___

Gentle massage

] Rhizotomy
2. 2.
E

3.
Electrotherapy 3. Avoidance of

4. steroids stimulation
a) Hot / cold
" " b) Facial motif .

Searing