NEUROLOGI

C
PATHOPHYSIOLO
GY
ARCHIE D. ALVIZ, R.N., R.M., N.C.II
 Cranial Nerves
❖ 12 pairs ◼ I—Olfactory nerve
❖ emerge from the ◼ II—Optic nerve
undersurface of ◼ III—Oculomotornerve
the brain. ◼ IV—Trochlearnerve
❖ Cranial nerve ◼ V—Trigeminal nerve
conducts impulses ◼ VI—Abducensnerve
(motor and ◼ VII—Facial nerve
sensory ◼ VIII - Acoustic/Vestibulocochlear
information)
◼ IX—Glossopharyngealnerve
◼ X—Vagusnerve
◼ XI—Accessory nerve
◼ XII—Hypoglossal nerve
 Spinal Nerves
◼ Spinal nerves
◼31 pairs
◼8 cervical, 12 thoracic, 5 lumbar
◼ 5 sacral, 1
coccygeal

◼Two roots
❖ The dorsal rootscontains sensory fibers that relay
information from sensory receptors to the spinal
cord
❖ The ventral rootcontains motor fibers that relay
information from the spinal cord to the body’s
glands and muscles.
Diagnostic Tests
 Diagnostic Procedure
Computed Tomography
Scanning
➢Cross section visualization
➢noninvasive and painless
➢has a high degree of sensitivity
for detecting lesions.
WITH or WITHOUT CONTRAST
Nursing Interventions
✓ Assess forclaustrophobia–
needs sedation
✓ Assess foriodine/shellfish
allergy.
✓
teaching the client about
the need to lie quietly
throughout the procedure.
✓ NPO if with contrast
medium, for 4 hrs.
✓ Inform about warmth
feeling andmetallic taste
during administration
✓ WOF: flushing, nausea and
vomiting.
✓ EXCRETION
 Diagnostic Procedure Nursing Interventions

MRI
✓ Assess forclaustrophobia–
needs sedation
➢Strong magnet +
✓ Assess for history of
metal
radiofrequency waves implants
✓ Procedure lasts for 30
-90
➢3 D images mins
✓ Painless
✓ Inform that machine makes
drum-like or knocking
sound
✓ Remove metals
✓ C/I – pacemakers,
prosthesis
Neurologic
Functioning
 Neurologic Assessment
◼ Mental Status- time, place and person
◼ Short term, recent and remote

◼ LOC
- Level 1- Conscious, coherent, cognitive
- Level 2- Confused, lethargic
---obtunded
- Level 3- Stuporous
- Level 4- Light coma and deep coma
Neurologic Assessment
GLASGOW COMA SCALE
1. Restlessness
2. Headache
3. Nausea and vomiting
4. Diplopia
5. Pupillarychanges
- Anisocuria- OCULOMOTOR
- Pinpoint pupils - PONS
- Dilated pupils – BRAIN HERNIATION
 Parkinson’s disease
◼ Degeneration and destruction of nerve
cells of the basal ganglia throughout the
brain
◼ loss of dopamine

◼ men and women -60

Incidence: (50y/o)

◼ : unknown
Cause
 Parkinson’s disease

◼Nursing management:
◼Levo
-dopa to increase dopamine
◼Carbidopa
-Levodopa
◼Sinemet to prevent breakdown of

dopamine
◼Anticholinergics to reduce rigidity

and tremors (akineton)

Myasthenia Gravis
◼ Decreased - acetylcholine
receptor sites
◼ increased – cholinesterase

◼ Etiology:autoimmunity

◼ Incidence:young adults
(women)
◼ Neuronitisof cranial and peripheral
nerves
◼ MAIN PROBLEM: DOB

◼ Clinical manifestation:

- Ascending paralysis

◼ Management:

- READY TRACHEOSTOMY
- PLASMEPHERESIS– same with ALS
◼ Degenerative disorder of cerebral cortex resulting
to microscopic plaques
◼ Impaired intellectual function and progressive

loss of function
◼ Recent memory occurs

◼ 4 As

Amnesia
Agnosia
Aphasia
Apraxia
◼ STAGES:

Stage 1: EARLY CONFUSION

- Difficulty recalling names

Stage 2: MODERATE
- Unable to perform complex task (e.g. planning a
dinner party)
Stage 3: EARLY DEMENTIA
- Needs assistance for survival

- Reminders to bath and other daily function

Stage 4: SEVERE DEMENTIA
- Forgets spouse and family

- Unaware of surroundings

- Disruption of 3 spheres

- Paranoia, delusions, agitations

Stage 5: VERY SEVERE DEMENTIA

- Limited to 5 words or less

- Person may scream or make other sounds

- Unable to hold head erect

Stroke/Cerebrovascular Accident
Definition: 1. ischemic (a
Disruption of the Blood thrombus or embolus
-sudden loss of blocks circulation
neurologic funtion 2. hemorrhagic (a
blood vessel ruptures)
Note: Risk factors:
❖ Increased alcohol
Middle Cerebral Artery
intake or cocaine ❖
is commonly affected.
Cardiac disease
❖ Cigarette smoking
Classification: ❖ DM
❖ Familial hyperlipidemia
❖ Family history of stroke
❖ Hx of TIA ❖ Sickle cell disease
❖ HPN ❖ Use of hormonal
❖ Obesity,sedentary contraceptives
lifestyle
Craniocerebral Trauma (Head
Injury)
❖Concussions.Jarring of the brain and its sudden,
forceful contact with the rigid skull.
- There is transient period of unconsciousness.

❖Contusion(bruising). A structural alteration

characterized by extravasion of blood cells.
❖Laceration. Tearing of tissue caused by sharp
fragment or object or shearing force.

❖Compression of the Brain. Result from

depressed fracture causing edema and hemorrhage.
 AUTONOMIC DYSREFLEXIA
❖ Above T6 damage
❖ Hyperstimulationof the sympathetic nervous system

❖ PROBLEM:
- BLADDER DISTENTION
- FECAL IMPACTION
- HYPERTENSION

◼ MANAGEMENT:
- Sitting position
- Catheterization
- Manual extraction
- Mannitol