MEDICAL-SURGICAL NURSING

DATE: JULY 18, 2023 Type of Care: Palliative Care

NEUROLOGICAL DISORDERS  Terminal

 Self-Limiting
"1.Some 2.Scientist 3.Makes 4.Money 5.But 6.My  Idiopathic
7.Brother 8.Says 9.Beautiful 10.Babies 11.Makes
PREDISPOSING FACTORS
12.More""
 Autoimmune
3 PARTS OF NEUROLOGICAL SYSTEM (CAP)
 Genetics
1.) CNS (Central Nervous System) - Brain & Spine,  Trauma
 Infection
irreversible
"TIC DOULOUREUX" - other term for trigeminal
2.) ANS (Autonomic Nervous System) -
neuralgia
Sympha/Parasympha (fight/flight) (Rest/ Digest/
Sleep)  Tic - Twitching (Involuntary)
 Doulou - Pain
3.) PNS (Peripheral Nervous System)- spinal nerve,  Reux - Face
cranial nerves. Spinal nerve - 62 nerves, 31 pairs,
cranial nerve - 24, 12 pairs. Has capacity to TN is a MOTOR AND SENSORY DISORDER.
regenerate

TRIGEMINAL NEURALGIA
CLINAL MANIFESTATIONS
PNS CONDITION (NERVE PAIN)
1. Facial Twitching/Grimacing
2. Frequent Blinking/Tearing of Eyes
Is a cranial nerve 5 (trigeminal nerve)
3. Poor Eating Habits - they develop
The patient felt the pain: SSS ANOREXIA

- (loss of appetite)
 Sudden
 Severe - weight loss
 Shooting
- malnutrition
Commonly bound half of face (one-side of the face)
4. Poor Hygiene Habit - Risk for Infection,
The normal function cranial number 5 Dental Condition
5. Social Isolation -can lead to depression
 Corneal Reflex (decrease level of serotonin)
 Facial Sensation Low grade depression
<2 weeks
 Chewing & Mastication <4 5ymptoms
Major Depressive Disorder
Common in Elderly Women or Ladies >2 weeks
> 4 Symptoms
CAUSE: IDIOPATHIC - an unknown cause DIAGNOSTIC TEST
 MEDICAL-SURGICAL NURSING
1. MRI 4. Muscle Relaxant - ex. Baclofen (Lioresal) the
2. CT Scan
3. Nerve Conduction Velocity Test only type that will go straight to spinal canal
(intrapical)

MANAGEMENT DRUG OF CHOICE FOR TN

1. Soft Diet at room temp (avoid too hot, avoid 1. Carbamazepine (Tegetol)
- Anticonvulsants
too cold), if not tolerated, NGT or Parenteral - Muscle Relaxant
- Analgesic Effect (Neuropathic Pain)
Nutrition WOF: Sore throat and fever
Adverse Effect: Agranulocytosis ( Blood
Basic Height of NGT Dyscrasia) risk for infection
- Upper GI tube - 12 inch Monitor CBC
- Lower GI tube-18 inch
2. IF MEDICATIONS ARE NOT EFFECTING,
pH : 4-5 below
YOU CAN USE NERVE BLOCK
2. Analgesics
3. Antidepressants (THYMOLEPTICS) as a. Nerve Block: Inject: Alcohol (Phenol) in face
needed
3 Groups of Thymoleptics b. Temp. Anesthesia - 6-18 months average
1. SSRI - Elevates Serotonin (Safest) Best
taaken at AM because it causes insomia, c. Surgery- (Intracranial Surgery): Retrogasserian
Antidote: Diperidine Rhizotomy (Permanent Anesthesia) Risk for Injury
WOF: Sodium Loss, Sexual Disfunction

2. TCA - Elevates Serotonin and

Norepheniprine (Best taken PM, it causes
drowsiness)
WOF: Cardio Toxicity (may trigger
arrythmia, CHF)
Antidote: Physostimine (cholinergic)
3. MAOI - Elevates Serotonin,
norepheneprine, and Dopamine. Most
Dangerous. (Best taken in AM because it
causes insomia). Never administer with
foods rich in thyramine (Fermented)
WOF: Hypertensive Crisis
Antidote: Phentolamine (Direct-acting
vasodilator)
THESE ARE TAKEN ONE AT A TIME TO
PREVENT SEROTONIN SYNDROME, WAIT OR
STOP 1-2 WEEKS BEFORE SHIFTING A NEXT
TYPE OF ANTIDEPRESSANT
IT TAKES 2-4 WEEKS TO MAKE THE DRUG
THERAPEUTIC
BELL'S PALSY
A PNS CONDITION
is a cranial nerve number 7 (Facial Nerve), thus a
facial nerve problem (motor and sensory loss =
paralysis) 2/3 anterior tongue affected
More common in women than in men
- Suffering from a temporary facial paralysis
commonly in half of your face (1 side)
Temporary Facial Paralysis
- Self Limiting
- Average recovery - 3-5 weeks
LEADING CAUSE OF BELL'S PALSY
1. Autoimmune (stress)- all autoimmune will be
exahibited by exacerbation (present, on) and
remission (removal of signs and symptomsm,
 MEDICAL-SURGICAL NURSING
assymptomatic). All autoimmune will use - Soft Diet (avoid oo hot, chew unaffected) NGT or
cortcosteroids Parenteral if both sides affected

2. Viral Infection- virus has a very fast
morphology (mutation). It confuses immune
response
3. Vaccines (Immunization)- Ex. Flu Vaccine,
OPD vaccine, HPV vaccne
- Artificial Tears, lubricating eye drops
- Wear protected dark glasses at AM and eye patch at
PM to prevent injury
- Manually close the eyelids

4. Trauma and tumor growth can cause bell's - Avoid use of aerosol products
palsy. Acoustic Neurama]
CN 7 + CN 8 (Auditory Nerve) "Vestibulo cochlear"
(Balance and Hearing)

CLINICAL MANIFESTATION Balance is priority, rissk for falls

 Facial Palsy "Acoustic" - Sensory Nerve

Focus Assessment in these Three Areas
CN 7 + CN 8 = malfunction =
1. Smile and teeth
2. Nasolabial Folds (watch out for RAMSAY HUNT'S SYNDROME (HERPES
flattening) ZOSTER OTICUS)
3. Eyes/ Eyebrows
 Facial Dropping PNS Disorder
 Loss of expression and sensation on the
affected side CAUSE:
 Corneal redness and dryness (risk for eye
 Viral Infection (Leading: Shingles [Herpes
injury)
Zoster])
 Loss of taste ad sensation over the anterior
 Autoimmune
2/3 of the tongue (risk for burn)
CLININCAL MANIFESTATIONS
DIAGNOSTIC TEST
1. Herpetic Rashes (Painful Lesions)
 MRI
2. Facial Palsy
 CT Scan
3. Impaired Balance/ Hearing = Ataxia (affects
 Nerve Conduction Velocity Test
gait, balance, coordination)
MANAGEMENT OF THE CONDITION 4. Hearing Loss

- Drug of Choice: Diagnostic for Ataxia

 Cortecosteroids (risk for infection) 1. finger to nose test-upper

- Reverse Isolation
2. heel to sheen- lower
- PPPP: Positive Pressure Protects Patient
 Vitamin B-complex: [B1(Thyamine), 3. romberg's test (check for balance) - check for
B6(Pyridoxine), B12(Cyanocobalamine)] cerebellum/ cerebalance
Neuroprotectives
DIAGNOSTICS
 MEDICAL-SURGICAL NURSING
 MRI Diziness- Short term, Motion Sickness,
 CT Scan
 Nerve Conduction Velocity Test Sensulfulness
 Hearing Test
CLINICAL MANIFESTATION (MENIERE'S
 Romberg's Test
TRIAD)
MANAGEMENT
Cardinal Sign (Pathogneumonic)
 Palliative Care
B- Bertigo (Vertigo)
MENIERE'S DISEASE (ENDOLYMPHATIC
T- Tinnitus
HYDROPS)
S - Sensorineural Hearing Loss
ENDO - Affects inner ear

Lymphatic - lymphatic network

DIAGNOSTIC TEST
Hydrops- Over production/ Over Accumulation
"Fluids"  Hearing Test
 Otoscopy
- Elevates otic pressure = cause CN 8 malfunction
 MRI/ CT Scan
(impingement)
 Romberg's Test
Non gender specific  Finger to Nose Test
 Heel to Shin
CAUSE: Idiopathic

PREDISPOSING FACTORS:
MANAGEMENT OF THE CONDITION
- Autoimmune
 Low sodium diet, limit fluids
- Genetic  Analgesics
 Diuretics, Ex. Furosemide (LASIX)-
- Trauma Effective for 6 hours (half-life)
 Ambulation assistance (avoid turning your
- Infection
head fast) Turning your head slowly and if
SIGNS AND SYMPTOMS turning is necessary, turn with your body
not your head.
- Diziness  Anti Emetics (Metocloparamide Setron)
"setron"
- Nausea and Vomiting  Anti vertigo- Ex. Betahistine (Serc),
Maclizine (Bonamine)
- Retching
 Surgeries:
- Ataxia - Tympanostomy - is for drainage
- Myringotomy- is for drainage also
- Ear Pain - Labyrinthectomy - you remove a portion
of vistibullar to corrct balance
- Sense of Fulness
Hearing will comeback average 4-6 weeks after
Vertigo - progressive, long term, vision is spinning
surgery
 MEDICAL-SURGICAL NURSING
Increased Acetylcholinesterase (erases acetylcholine)
a relaxant
MYSTHENIA GRAVIS
|
- is a CNS Condition, a problem of the brain, an
irreversible condition General Muscle Weakness

- A neuromascular condition Voluntary = "Skeletal"

- More common in women/ female (Ave. 15-35 yrs IN MG, THE ACETYLCHOLINESTERASE IS
old) MORE THAN ACETYLCHOLINE

Normal DIAGNOSTIC TEST

ACH (Acetylcholine)- Stimulating 1. Tensilon test = The confirmatory test of the

condition, a systemic checkup of muscles
ACH Receptors (2 Types) Give IV = Endorphonium Chloride (Fast-
Acting Cholinergic) causes a relief of
1. Muscarinic
symptoms from average 5-10 minutes. Can
2. Nicotinic - more problem, affected by M.G
be use in emergency case like myasthenic
2 Types of Nicotinic Receptor crisis
To rule out crisis
N1- is found on voluntary muscles (skeletal muscles) 2. Ice Test = is a localized checkup of muscles.
causes muscle contraction Cold exposure causes temporary strength in
the affected area
N2- is found in brain (cerbral cortex) , causes 3. Plasma Analysis or Immmunoglobulin Test
cognitive function (Think, Learn, Memory) - checks plasma for IgA, IgG, or excess
antibodies
Decreased N1 + Decreased ACH = MG
4. MRI/ CT Scan/ PET Scan-
Decreased N2 + Decreased ACH = Alzheimers "gram" uses contrast media, especially
iodine
CAUSE "Scan" also uses contrast but radioactive dye
5. EMG - Electro Myography- It records
(R1) Leading cause= Autoimmune
electrical activity of the mucles. It is an
| invasive procedure, with discomfort, no
Damage ACH Receptor anesthesia but give analgesics. No uppers
and downers before the tst
Sites (N1) Hematoma: monitor for color and size

General Muscle Weakness CLINICAL MANIFESTATIONS

Voluntary= "Skeletal 1. Generalized Muscle Weakness

(descending pattern)
2. Respiratory weakness

(R2) Second Cause: Decreased ACH INITIAL/ EARLY SYMPTOMS

| 1. Ptosis (Drooping of Eyelids (Levator

Palpebrae)
 MEDICAL-SURGICAL NURSING
2. Diplopia - Diaphoresis - Increase Saliva
3. Strabismus
4. Mask-like Facial Expression ALL ARE FLUIDS
 Flat AFFECT= No reaction
ADVERSE EFFECT: CHOLINERGIC CRISIS
 Blunt AFFECT= Littlle Reaction
5. Dysphagia- risk for chocking, risk for Should be taken on an empty stomach (before meals)
aspiration
6. Dysponia- generate a weak tone (weak
voice). It can cause nasal voice or nasal
"twang". It can also develop monotonous
sound, and hoarseness voice
7. Dysarthria - difficulty in speaking "slurred
speech"
8. Shortness of Breath/ Difficulty in Breating
( Respiratory Depressed) Loss of
ambulation
-Muscle Atrophy Wasting

Myasthenic Crisis (MC) Cholinergic Crisis (CC)

Worsened signs and Worsened Signs and

COMPLICATIONS:
symptoms of MG Symptoms of MG +
cholinergic symptoms
Cause of Death: STRESS, INFECTION,
SURGERY STRESS, ENFECTION,
1. Respiratory Failure (ARDS) "Stiff lung" SURGERY
"Shock lung"'
2. Pneumonia
Leading cause of MC is
DRUG OF CHOICE UNDERMEDICATION, Overmedication "stigmine"
"stigmine" - "Anticholinestrase"
1. Cortecosteroids (Prednisone) "Anticholinesterase cholinergic drug

2. Immunosuppresants ex methotrexate,
cyclophospamide, cyclosporine

3. Anti-cholinesterase (cholinergic), the medication Management Management

will usually end with "stigmine". Ex. neostigmine,
pyridostigmine, physostigmine 1. Give its relieve Tenselon 1. Relieve by a fast-acting
(enterphenium) anticholinergic "atropine
- a long-acting cholinergic drug, use for sulfate" ATSO4
maintainance, prophylaxis and prevention. 2. Increase the dose of
Anticholinersterase 2. Lower the dose of
Side Effect: Cholinergic Symptoms "stigmine" anticholinesterase
"stigmine"
- Diuresis - nausea and vomiting
3. Usually worsened by
- Diarrhea - Tearing givin Tensilon
 MEDICAL-SURGICAL NURSING
This is an Idiopathic cause

There is no motor neuron

GENERAL MANAGEMENT: Irreversible condition

1. Soft diet, (no clear liquid, must thick liquid) Popularized by Ice Bucket Challenge

2. NGT-TPN 1. Financing (reserch purposes)

3. O2 Theraphy, Green= Oxygen, Blue-Nitrous 2. Awareness

Oxide
2 Motor Neuron
4. Mechanical Ventelation is needed
Lower MN- found in spinal chord (anterior horn of
5. Bedside equipment: spinal chord)= sclerosis - peeled of or getting damage

- ET/ Tacheo Set Posterior horn- contains sensory neuron is still intact

- Bag-valve mask (AmbuBag) Upper MN- found on the anterior portion of cerbreal
cortex.
6. Isometric- move muscles only, not joints

Anterior (cord)- sclerosis

Isotonic- move joints and muscles (ROM)
Anterior (cortex)- sclerosis
Must use Isotonic Passive Range of Motion (PROM)
Ascending (weakness)
7. PLASMAPHERESIS - removal of the excess
antibodies This is more common in male than female
individuals (40-70yrs. old)
8. Surgery of Choice- Thymectomy- to decreases T-
cell and immunity response and also decreases Other Name: "Lou Gehrig's Disease"
acetylcholinersterase. Thymus is a part of immune
response The average lifespan of a person suffering from this
condition is 2-6 years.

Type of care: Palliative Care

ALS (Amyotropic Lateral Sclerosis)
-There is no cure/ specific treatment.
Sclerosis- Hardening/ damage (something got feel
off) Signs and Symptoms

Is a neuromascular condition, CNS Condition  There is still progressive weakness of

muscle
In the early stage: spinal cord  There is loss of ambulation. (From lower
extremities first to upper)
late stage: brain.  Shortness of Breath/ Difficulty in Breathing,
Resiratory distress
Considered as a progressive motor neuron disease =
sclerosis
 MEDICAL-SURGICAL NURSING
 Dysphagia, ridk for aspiration, risk for
choking, cardinal sign of choking is
clunching of neck
 Facsciculations- Involuntary muscle
twitching everytime you attempt to move
Antidote: Acute / Anaphylactic Shock -
Epheniphrine
 Nerve Conduction Velocity Test
 Srem Glutamate Level

Management:
PREDISPOSING FACTORS
- Encourage the patient to speak for
assessment  Increased Glutamine
If can still speak and make sound- Partial - If it is too much nephrotoxic, can cause
Obstruction brain damage
- Encourage patient to cough  Autoimmune
- Tap at the back between the shoulder  Genetics
blades  Old Age
-Finger swift
If there is no sound or can't speak -
MANAGEMENT:
Complete Obstruction
Heimlich Manuever if patient is conscious 1. Palliative Care
Abdominal Thrust if patiient is 2. Drug of Choice
unconscious
 Dysphonia (having a weak voice) This drug is NOT a CURE
- Nasal Voice
- Monotaunus - Riluzole (RILUTEK) (Glutamate Antagonist)
- Hoarseness = this will weaken/ delay the progress of the
 Dysarthria - slurred speech condition.
 Mask-like facial expression
- FLAT APECT
- BLUNT APECT
 Strabismus, dropping, diplopia
MULTIPLE SCLEROSIS (DISSIMINATED
CAUSE OF DEATH SCLEROSIS)

 Respiratory Distress (ARDS) - is a CNS condition - Brain and Spinal Chord

 Pneumonia
- More common in female then male for 20-40 years
old

- The damage/ deterrioration of Myelin Sheath

DIAGNOSTIC TEST
 CT Scan/ MRI/ PET Scan
 EMG (Electromyography)
 Muscle Biopsy
 Myelogram- CHECK KFT
Need to hydrate (watch out for allergies)
(demyleinization of CNS) leads to altered
commumication.
Myelin Sheath -bundles/ keeps nerves together/ intact
for it to work properly
Leads to Impaired Nerve Impulse Conduction
(transmission)
 MEDICAL-SURGICAL NURSING
- Miscommunication will cause impairment of body
function
DIAGNOSTIC TEST
CAUSE
 CONFIRMATATORY TEST: MRI
1. Autoimmune Can be seen white matter and grey matter
2. Viral Infection are damage (WM:70%, GM:30%)
3. Vaccines  CT Scan/ PET Scan
 Myelogram- Knee Chest, C position, Fetal,
SIGNS AND SYMPTOMS Genu-pectoral, Common in site in spine L3,
L4, L5
1. Cardinal Sign: Charcot's Triad
 Nerve Conduction Velocity Test
Scanning Speech= "STACATTO SPEECH"  EMG (Electromyogram)
 Plasma Analysis (Immunoglobulin Test)
Intentional Tremors

M.S.- Everytime you attempt to move,

you shake

PARKINSON'S- Everytime you park, that MANAGEMENT

is the time it will shake (RESTING
Drug of Choice:
TREMORS, PILL ROLLING
TREMORS) 1. Corticosteroids

Nystagmus - Involuntary eye rolling/ eye 2. Immuno suppresants

moveent
- cyclosparine
2. Other Manifestations (BAD SISA)
- tacrolimus
 Bladder and Bowel Dysfunction
Alternating Diarrhea and Constipation - - methotexate
Irretable Bowel Syndrome
 Ataxia 3. IVIg (Inravenous Immunoglobulin)
 Diplopia/ Depression and other mental con
4. Interons - contains anti inflammatory,
dition
immunosuppresant, antiviral which delays the
 Spasticity (Spactic Muscle)- produces of
progress
lactic acid because of muscle contration
which leads to pain EX. ABC
 Impotence
 Scotoma (having blind spots) and Seizures A- Avonex
 Apraxia- difficulty in performing purposeful
ADL B- Betasetron

In rare cases, possible paralysis may happen in later C- Copaxone

stage
BEST TIME TO TAKE AM
- It is a descending pattern
Side Effect: Flu-like Symptom
This is exhibited by exacerbated & remission
 MEDICAL-SURGICAL NURSING
5. Plasmapheresis - Urine Retention- Constipations - develop absent/
decreased DTR (deep tendon reflex)
6. Palliative Care
- Pressure Ulcers/ Bed sores, commonly in bony
Ex. - Seizure Precautions, Anticonvulsants, Diuretics, areas (most common in sacral)
Cholinergics
- SOB/DOB
7. Rehab= Multi-discilinary Approach
- Respiratory Distress

- Tachyarrythmias -involves vagus nerve, vagal

bagal causing the heart rate slow

- Dysphagia

GUILLIAN-BARRE SYNDROME (GBS) -Dysphonia

-is a non-gender specific and can happen in any age - Dysarthria

- is a PNS condition, spinal nerves and cranial nerves - Facial Palsy

- Other term: Acute Polyneuritis (Radiculo - Pstosis

Polyneuritis, Viral Polyneuritis)
-Diplopia
- Peripheres are inflammed
-Strabismus
- Due to demyolenization of your PNS which is on
spinal nerve on early stage, and cranial nerve in late RECOVERY:
stage
-Descending Pattern (unlike the progession)
- Cause altered nerve impulse conduction/
transmission - This is self-limiting

- PNS shuts function down (motor and sensory - Average Recovery is 3-6 months
function of PNS)

- It will cause TEMPORARY paralysis

CAUSE
SIGNS AND SYMPTOMS
1. Autoimmune
CLINICAL MANIFESTATIONS
2. Give viral infection
Cardinal Sign: Ascending Paralysis (Landry's
- Corona Virus
Paralysis)
- Rotavirus- GI virus, causes gastrointeritis,
1. early/1st/intral
common in child
- Parasthesia (Lower Extremities)
3. Vaccines (immunizations)
- Clumsiness (Risk for Falls)

CAUSE OF DEATH
 MEDICAL-SURGICAL NURSING
1. Respiratory Failure 1. Thrombotic- is more common especially to
people who have sedentary lifestyle
2. Pneumonia
2. Embolic
3. Cardiac Arrest
3 Major Classifications of Hemorrhagic Stroke (SID)

S- Subaracnoid - bleeding happens outer spaces/

DIAGNOStIC TEST sides of the brain. Easist to treat. Crainiotomy

- Same with MS I - Intracerebral - Bleeding is inside the brain.

Hardest to treat and the most dangerous.

D- Dural (Epi/Surs)- Bleeding in the outer layer of

MANAGEMENT:
the brain
1. Corticosteroids

2. Immunosupressants

3. IV Ig
CVA
4. Plasmapheresis
- due to total loss/ disruption of oxygenated blood
5. Palliative Care flow (brain tissue) leading to cerebrl ischemia, and
not treated, it will lead to brain cell damage. It is
irreversible

CVA: STROKE (Cerebro Vascular Accident/ STAGES OF DEVELOPMENT

Disease/ Brain Attack/ Brain Infraction)
Stage 1- TIA (Transcient Ischemic Attack)(Mini
2 Different types of Stroke: Stroke)

Ischemic- due to the poor/ absent circulation of
oxygenated blood going to the brain
Ischemic is more comon than hemorrhagic
Hemorrhagic- due to bleeding in the brain. brain will
start to dwell.
It is more fatal in hemorrhagic
IT IS POSSIBLE THAT H WILL LEAD TO I
Hemorrhagic Stroke;
 Increased ICP
 Loss of Blood
 Clot
2 Subtypes of Ischemic Stroke
- Is a temporary ischemic attack (loss of blood)
- warning sign of stroke
- Intermittent neurological deficit but spontaneus
relief
The symptoms comes out one by one.
-Symptoms least for 24 hours
Intial Symptoms to WOF (BEFAST)
 Balance
 Eyes (pupils) normal size 3-8mm
 Face- check facial palsy
 Arms and legs - maintain raised hands 10
seconds atleast 90 degrees, WOF- Drifting
Legs- 5 seconds at 45 degree angle
 MEDICAL-SURGICAL NURSING
 Speech - assess for slurred speech 3. If you are suffering viscous blood ex.
 Time and tongue - assess the tongue, what Diabetes Mellitus, Ex. level of cholesterol
time it started (Atherosclerosis), Dehydration
4. Infection
If left untreated, it will lead to Stage 2 5. VIRCHOW's Triad - A triad that makes
"clot" (SHE)
Stage 2
Stasis
Stoke is in evolution Hypercoagulations -genetic conditions
Endothelial Injury - injury in the blood
- Progressive signs and symptoms, there is longer vessel
duration of symptoms 6. Arrythmia- ex. A. Fibrillation

- It will last for hours to days CLINICAL PRESENTATION

- There is already signifacant neuro deficits 1. Altered LOC

2. Severe Headache (Increased ICP[5-
-2 or more Symptoms 15mmHg][8-25cmH2o])
3. Contralateral Hemiplegia/ Hemipheresis
- reversible, has a relief
Hemiplegia- half of body is paralysis
If let untreated it will lead to Stage 3 Hemipheresis-half of body is weakness
"Lateralization"
Stage 3 4. Quadrophlagia- both sides of the brain are
hit
- Stroke Completion
5. Neglect Syndrome (Extinction Inattention)-
- it develop permanent neuro defecits is psycho-physiological problem cause of
stres, epression disorders
- Chronic or long term symptoms 6. Pupillary changes
Fixed-Dilated Pupil- Ominous sign= is a
- Total loss of oxygenated blood flow sign of comatose, brain dead. This happens
when both side of brain are affected
- Permanent Damage, brain celll damage
7. Unilateral or Ipsilateral Dilation of pupils.-
- Irreversable when the side has the increased ICP, that is
where the pupil is not dillating
- It takes to 2-3 days n average prior to stroke, due to
the collateral circulation on the circle of Willis BODY- OPPOSITE
(Compensation). Compensatory Circulation.
VISION- OPPOSITE
- The speed of development also depends on the
PUPILS- SAME
number and the size of the blood vessels involve.
VISION CHANGES
PREDISPOSING FACTORS FOR CVA (Risk
Factors) Ex. Hemianopsia- loss of the half of the visual field
of one eye (2 out of 4 are loss in quadrant)
1. Leading risk factor is Hypertension
For Adults - Hypertrophy (Stenosis) Homonymous- loss of the half of the visual field of
For Geria - Ruptured Aneurism the both eye.
2. Trauma- can cause bleeding= clot=trauma
 MEDICAL-SURGICAL NURSING
Quadrantenopia- loss one out of four of your visual R side Stroke requires more assistance in
field; 3 or 4 quadrant loss is considered blind ; The communication
best is touch and hearing but focus on touch; Nausea
and Vomitting; Fever (Low-grade) More cautious behaviour

R SIDE CVA L SIDE CVA DIAGNOSTIC TEST FOR CVA

Risky and  They develop  MRI - the best

impulsive lag/ slow -  CT Scan/ PET Scan
patient thinking  Cerebral Arteriogram to trace bloodflow
 Controls spacio  Cognitive/ Epheniprine Administration
function intellectual SQ/IM- if conscious, SQ preffered
 It calculates malfunction IV/ET -unconscious, ET is best
space Ex. Amnesia  Carotid Echogram (ultrasound) (Doppler
 Spatial Problems with Ultrasound)
Dysfunction Analysis
MANAGEMENT
 Emotional and Academic
behavioral Skills 1. Treat the underying cause
dysfunction Aphasia- issues
(aggresive and in 2. Stroke rehab- to return normal function or atleast
short-tempered communication functional level
fraustrated)
3 Major Types of Rehab starts during the admission
 They develop
more problems Aphasia (BEA)
Physical Rehab starts when stable
in physical and
Brocas
behavioural 3. To prevent further deterioration
changes Expressive
 Need more 4. Assistance in affected side, unaffected side give
assistance in Aphasia cane.
ambulation
- problem in speaking/ 5. Personal belongings
 Higher risk for
injury expressing yourself
- Unaffected within reach= acute
It is caused by L stroke
-Affected out of reach - during rehab to prevent
or frontal lobe is
neglect
destroyed
6. Instruct the patient to turn the head from side to
Receptive Aphasia -
side or scan visual field during ambulation
can't understand
7. Always approach in the good field of vision
Temporal Lobe Damage
Ischemic
Wornick's Aphasia- if
cannot understand, 1. Give thrombolytics- (tPA for less bleeding) "-
cancer in temporal lobe kinase/-plase
Global Aphasia- can't Natural Thrombolytics- Plasmin- Fibrin,
speak, can't understand Plasminogen Fibrigen.
 MEDICAL-SURGICAL NURSING
Window period of opportunity of thrombolytics More than 500mL of blood loss causes
within 3 hours in CVA, whereas MI is 6 hours. shock
2.) Frequent swallowing
2. Anticoagulants-
Pituitary Gland is deemed to a master gland of
3. Antiplatelet hormones. It has direct and indirect effect to most of
hormones.
COMMON SURGERY OF CHOICE
2 Basic Parts of Pituitary Gland
1. Carotid endarterectomy
1. Anterior Pituitary (APG)- Adenohypophysis
Hemorrhagic
- Produces stimulating hormones
1. Tranexamic Acid (Hemostan)
2. Posterior Pituitary (PPG)- Neurohypopysis
2. Aminocaproic Acid - promotes clotting
- Produces nothing (not a producing gland) it is
Surgery
only a storage.
1. Craniotomy(Borrhole)
Hypothalamus produces and PPG stores and releases
2 Types of Craniotomy as needed the hormone

1. Supratentorial - position upright after surgery Hypothalamus Produces:

(postprocedure)
1. Oxytocin- for uterine contraction. Induction of
2. Infratertorial - Flat on bed to put prevent ICP labor is 5-6cm for primi gravida, 1-4cm cervical
going out(postop) ripening, 5-10cm cervical opening. Milk let dawn
Reflex..
2. Craniectomy- is tthe removal of a large portion of
the skull or skullcap. O- OUT

2. ADH (Anti-diuretic Hormone) (vasopressin)

Anti dehydraton
ENDOCRINE SYSTEM
PITUITARY GLAND (Hypophysis) - found in the
base of the brain, directly below the hypothalamus. Functions:

Common route removal of pituitary gland is 1. ALL FLUIDS DIRECTLY INTO VASCULAR
Transpinoidal. AREAS AND INTO KIDNEYS

Hypophysectomy 2. Is a very potent vasopressin, it causes

vasocontrictor, increases BP
Complication:
3. Blood Pressure Regulation
 Bleeding
1.) The early symptom of bleeding is rapid DIABETES INSIPIDUS (DI DAGHAN IHI):
heart rate (tachycardia) DEFICIENCY/ ABSENCE ADH
Initial (UP BP, UP HR)
Late (DOWN BP)
 MEDICAL-SURGICAL NURSING
Syndrome of Inappropriate of ADH (SIADH)

Syndrome of Increase of ADH

-syndrome high levels of ADH

2 types of Dehydration

1. Vascular Dehydration

2. Cellular Dehydration

Fluid Compartment

1. Vascular- the most imortant space for the

fluid to stay. Systematically connected
2. Cellular-
3. Interstitial- largest space, third spacing,
must water to cause edema.