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Hydrocephalus

Characterized by an increased in the amount of CSF within the ventricle of the brain.

Types • Communicating • Noncommunicating

Types • Communicating • Noncommunicating . Characterized by an increased in the amount of CSF within the ventricle of the brain.

Types Communicating • Also known as non-obstructive or Extraventricular • Impaired absorption of CSF in subarachnoid space Non-communicating • Also known as obstructive or Intraventricular • Obstruction to the flow of CSF within the ventricle .

Predisposing Factors • Genetics • Age Precipitating Factors • Prematurity • Hemorrhage • Idiopathic • Infection • Tumor • • Increase intraventricular Pressure dilatation of pathways proximal to the site of obstruction CSF forms in the Choroid plexus of the lateral ventricle Obstruction in the aqueduct of Sylvius Dilatation of the 3rd and lateral ventricles Obstruction of CSF flow through the ventricular system Ventricles enlarge and disrupts the ventricular lining and the underlying white mater .

lethargy. bulging fontanelle. sleepiness. shiny scalp. reduced activity and drowsiness Alteration in cerebral circulation . dilated scalp veins Interhemispheric fissure become elongated and thinned out Axonal and myelin destruction Expansion of the skull and thinning and atrophy Irritability.Increase water content Edematous parenchyma become spongy Enlaged head.

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Signs and Symptoms • Increase head circumference • Cranial suture separation • Downward rotation of eyes • Increased ICP .

ICP monitoring can be used to estimate cerebral perfusion pressure (CPP) or cerebral blood flow. cerebral edema. A level greater than 15 mmHg is considered abnormal. Normal CPP is at least 50 mmHg. ICP normally ranges from 1-10 mmHg. Increased ICP may occur with an increased in the CSF volume. Cerebral circulation ceases if ICP ever exceeds  . or space occupying lesions such as tumors. blood entering the CSF.

MAP=(SBP-DBP)/3+80    . then adding the sum to 80. dividing the result by 3. CPP is calculated by subtracting the mean intracranial pressure (MICP) from the mean arterial pressure (MAP) MAP-MICP = CPP Mean arterial pressure is determined by subtracting the diastolic B/P (DBP) from (SBP) reading.

. calculate the MAP. Using the formula. Follow this example: A child has a blood pressure of 100/70 mmHg and an ICP of 10 mmHg.

    3 incompressible elements : .  .Brain tissue -CSF .Blood Expansion of any one of these incompressible elements must be balanced by proportional constriction of one or both or there will be an increase in ICP.

Diagnostics Tests •Serial Transilluminations •CT Scan .

Management • Shunting (Ventriculoperitoneal & Ventriculoatrial) • Insertion of a flexible tube into the lateral ventricle of the brain (peritoneum or right atrium) .

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Medications • Acetazolamide (Diamox) • Isosorbide – osmotic diuretics • Furosemide (Lasix) • Mannitol (Osmotril) • Corticosteroids – Dexamethasone (Decadron) • Anticonvulsants – Phenytoin (Dilantin) • Analgesics .

Check neuro status 3.Nursing Responsibility 1. Post-op care  DO NOT flex neck on the side where the shunt is placed  Observe for signs of infection  Observe for signs of ICP 4. Parental teaching      H-ead of bed (not more than 30 ) E-valuate A-irway D-rainage S-afety . Pre-op care 2.

Prognosis If treated  Learning Disabilities  Memory Deficits  Psychological Deficits  Motor Skill Disabilities  Hearing Difficulties  Vision Problem  Seizure  Hormonal Imbalance If not treated  Decrease cerebral perfusion  Decrease PO2 leading to hypoxia  Brain damage  DEATH .

Neural Tube Defects .

4mg of folic acid in women of childbearing age will prevent 50%-70% of all cases of neural tube defects .  Abnormalities that are derived from the embryonic neural tube Constitute the largest group of congenital anomalies that is consistent with multifactorial inheritance Prevention • Intake of 0.

Encephalocele .

 is a neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull. .

& dura No motor and no sphincter Continuous voiding and defecation . nasal or nasopharyngeal Protrusion of brain and meninges covered fully by skin.Folic Acid Deficit Unformed Occipital area of the skull.

• Only half survive to birth. skull.Incidence • Frequently associated with other cranial (head. • Cause is unknown . • Commonly in females than males. • Approximately 1-4 per 10.000 live births. or brain) and/or facial abnormalities.

Diagnostic Tests • Ultrasound • The alpha-fetoprotein levels are not typically elevated with this defect because the defect is covered by skin • Thorough examination • Fetal MRI by perinatologists .

• Done more quickly if there is no skin covering over the defect or if there is hemorrhage. • When surgical correction is not urgent. .Management Surgery • Done between birth to 4 months of age. the baby is evaluated for other problems before surgery. airway obstruction or impairment of vision.

but no surgical procedures are done and the baby's life is not extended with any type of life support machinery. if large and with other anomalies . • These babies can even go home with hospice support if that is desired.Management Palliative Care • Support the baby with food. comfort and oxygen as needed.

Spina Bifida .

 is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. .

 Spina bifida may also be nearly inconsequential. or may be reparable through surgery .

 is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. .

Types • Spina bifida occulta – Hidden • Spina bifida cystica – Vissible .

Spina bifida occulta • Occurs very frequently and is usually found accidentally in x-rays or in an examination of the back. .

Normal Newborn Vertebra Spina bifida occulta .

Spina bifida occulta •In some cases may cause: •Chronic back pain •Enuresis •Cold feet •Lateness in learning to walk .

Spina bifida cystica •Besides fissures of the osseous structures. •The membranous covering can be present or absent. . one also finds abnormalities of the meninges and/or of the spinal cord itself.

Spina bifida cystica •Subdivided into 3 types •Meningocele •Myelomeningocele *(with or without cysts) •Myeloschisis .

The mildest form is the meningocele where merely the meninges protrude under the skin through the cleft in the malformed vertebral arch. Normal Newborn Vertebra Meningocele .

Normal Newborn Vertebra Myelomeningocele . They are visible as a protrusion under the skin.Myelomeningocele meninges as well as the spinal cord (myelon) are found outside of the vertebral arch.

In addition. In this case one speaks of a myelocystomeningocele Normal Newborn Vertebra Myelomeningocele . the central canal is bloated and forms a cyst.

Normal Newborn Vertebra Myeloschisis .Myeloschisis (rachischisis) is the severest form of the spina bifida cystica. The nerve tissue is here fully bare and a dermal or meningeal covering is absent.

Folic Acid Deficiency Unformed vertebrae Lack of sphincter Protrusion of meninges and spinal cord Lost of bladder and bowel movement Damage lower motor and sensory neuron Continuous dibbling of Urine and stool Flaccid lax infant legs Lack of Sensation .

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Postpartal  X-ray  CT Scan of skull  Myelogram  Encephalogram  U/A culture & sensitivity  BUN  Creatinine clearance . Prenatal  Ultrasound  Amniocentesis 2.Diagnostic Tests 1.

brace.Medical Management ◦ Surgery  Closure of the sac  Shunt procedure  Orthopedic procedures ◦ Drug therapy  Antibiotics  Anticholinergic * ◦ Immobilization (casts. traction) .

Nursing Interventions ◦ Preventing trauma to the sac  Cover with sterile dressing soaked with normal saline  Prone or side-lying position  Protective barrier drape  Signs of infection  Antibiotics .

joint deformities  Intermittent urinary catheter  Medications  PROM . meningitis.Nursing Interventions ◦ Prevent complications  Signs of hydrocephalus.

meds. feeding. diapering.Nursing Interventions ◦ Nutrition ◦ Sensory stimulation ◦ Emotional support for parents/family ◦ Client teaching & discharge planning  Wound care. PT. support/community  Adjust objects according to position  Stimulate other senses. complications. . positioning.

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Cerebral Palsy

a group of non-progressive, noncontagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement.
T y p e s

• spastic (stiff and difficult movement) • ataxic (disturbed sense of balance and depth perception) • athetoid (involuntary and

PRENATAL - Genetics - Altered neurologic development - Trauma or anoxia to mother (TORCH)

PERINATAL - Drugs at delivery - Precipitate delivery - Fetal distress - Breech deliveries with delay

POSTNATAL - Kernicterus - Head trauma (falls/accidents)

DAMAGE TO THE CELLULAR STRUCTURES OF THE UPPER MOTOR NEURON Weak or absent voluntary movt with increased muscle tone SPASTIC TYPE TYPE Muscles become Too tight CEREBELLUM Hypotonia or Atonia BASAL GANGLIA Difficulty initiating movement (Bradykinesia) ATHETOID TYPE = MIXED

ATAXIC TYPE Low muscle tone and poor coordination

Smooth and coordinated movements and Body posture is altered Choreiform movts Ballism Rigidity Dystonia Involuntary grimacing Tongue thrusting Drooling and speech problems

Limb deformities Contractures Hyperreflexia Stiff and jerky movements (limited movt) Have a hard time moving from one position to another. Have a hard time holding and letting go of objects.

Intentional/ terminal tremor Nystagmus Dysdiadochokineasia Dysarthria Unsteady and shaky even when handling small objects Accomploshes tasks slower Wide-based gait

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Diagnostic Tests •X-RAY or Sonogram – Cerebral assymetry •EEG – spikes .

Safety environment. Assist with ADL (including feeding) – Careful teaching and demonstration. 4. and childhood history. Observe child’s behavior in various situations. (Pad the crib and wear helmet) 5.Nursing Interventions 1. Physical therapy – prevent contractures and assist in mobility (braces) 6. 2. Obtain pregnancy. Discharge and Teaching plan  Nature of the disease  Care of orthopaedic devices  Need for continued physical. birth. 3. occupational and speech therapy  Provision for child’s return to school  Availability of support group .

Reye’s Syndrome .

  An acute encephalopathy with fatty degeneration of the liver Potentially fatal disease that causes numerous detrimental effects to many organs. . especially the brain and liver. as well as causing a lower than usual level of blood sugar (hypoglycemia).

. and while it has been associated with aspirin consumption by children with viral illness. it also occurs in the absence of aspirin use. The exact cause is unknown.

Cause: UNKNOWN Predisposing factors: or varicella) Genetics Use of SALICYLATES in viral-induced fever and flu (Influenza A & B FEVER VOMITING LOSS OF APPETITE LISTLESSNESS Exhaustion of Glycogen HYPOGLYCEMIA ACCUMULATION Signs and symptoms of hypoglycemia Brain Edema CNS Symptoms MOBILIZATION OF FATTY ACID LACTIC ACID Interfering with mitochondrial function Accumulation of fats In tiny intercellular Vesicles of: HEART KIDNEYS SKELETAL MUSCLES ACIDOSIS Liver dysfunction Increased Ammonia Increased bilirubin Increased liver enzymes Other tissues .

heavy vomiting that is not relieved by not eating Generalized lethargy Confusion Nightmares High fever Headaches Stage 2 Stupor caused by encephalitis Hyperventilation Fatty liver (found by biopsy) Hyperactive reflexes .Stage 1 Rash on palms of hands and feet Persistent.

Stage 3 Continuation of Stage I and II symptoms Possible coma Possible cerebral oedema Rarely. respiratory arrest Stage 4 Deepening coma Dilated pupils with minimal response to light Minimal but still present hepatic dysfunction .

Stage 5 Very rapid onset following stage IV Deep coma Seizures Multiple organ failure Flaccidity Hyperammonemia (above 300 mg/dL of blood) Death .

urine SG) • IV Therapy • I&O .Nursing Management Stage 1 • Assess Hydration Status (Skin turgor. mucous membrane.

Nursing Management Stage 2 . cyanosis • Assess circulatory status: V/S. procedures and conferences • Parental and community education . skin color and temperature.5 • Assess respiratory status: Note rate. restlessness. pattern. heart sounds • Support child and family: Explain treatment. agitation. neck vein distention.

pupils. posturing. extremity movement. motor coordination. orientation. LOC.5 • Assess neurological status.Nursing Management Stage 1 . seizure activity .

Meningitis .

or other microorganisms.Meningitis is inflammation of the protective membranes covering the brain and spinal cord. and less commonly by certain drugs . known collectively  The inflammation as the meninges  may be caused by infection with viruses. bacteria.

therefore the condition is classified as a medical emergency . Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord.

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Neurosurgical procedure By way of the predisposing factors. Opisthotonos 5. Increased CHON and Decreased glucose 3. and lymphs into the CNS Fever and Chills Increased WBC Causative agent multiplies and sets in infection Activation of inflammatory process CSF Changes Meningeal inflammation Meningeal irritation Signs and Symptoms 1. Nuchal rigidity 2. Headache Veins and arteries traveling in the subarachnoid space become inflamed 1. the microorganisms travels through the blood. (+) Kernig’s sign 4.Established infection . Increased CSF Pressure Vasculitis and endothelial damage causing necrosis of vessel walls and thrombosis Cellular debris and fibrin can block CSF outflow WATERHOUSEFRIDERICHSEN SYNDROME HYDROCEPHALUS INCREASED ICP CEREBRAL INFARCTION . Vomiting 8.Hematogenous spread from an URTI. (+) Brudzinski’s sign 3. Seizures 7. Cloudy CSF 4.Cause: Bacteria or Virus Meningococcus (Nissera meningitides) Pneumococcus (Stretococcus pneumoniae) (Haemophilus influenzae) Streptococcus (E coli & Group B Strep) Predisposing factors: . otitis media. CSF. or pneumonia . (+) for the causative agent 2. Photophobia 6.

Assessment Findings • Malaise • Chills • Fever • Headache • Stiff neck and back • Photophobia .

Assessment Findings • Vomiting • Exaggerated deep tendon reflexes • Visual alterations (diplopia—two images of a single object) • Confusion • Delirium • Deep stupor • Coma • Increase ICP • Irritability .

purpuric.Assessment Findings • Petechial. or ecchymotic rash on the lower part of the body (meningococcal meningitis) • Seizures • Twitching .

Assessment Findings • Positive Brudzinkis sign (client flexes hips or knees when the nurse places her hands behind his neck and bends it forward) .

Assessment Findings • Positive Kernig’sign (pain or resistance when the client’s leg is flexed at the hip or knee while he’s in a supine position) .

Assessment Findings • Opisthotonos (a spasm in which the back and the extremities arch backward so that the body rests on the head and heels) .

Diagnostic Evaluation • CSF analysis reveal: • WBC count reveals leukocytosis • Elevated pressure • cloudy or milky white • high protein level • positive Gram stain and culture • depressed CSF glucose concentration .

Nursing Diagnoses • Decreased intracranial adaptive capacity • Hyperthermia • Risk for injury .

V.Collaborative Management      Bed rest Hypothermia I. possibly with ET intubation and mechanical ventilation Medications     Antibiotics – depending on the isolated microorganism Diuretic: mannitol (Osmitrol) Anticonvulsant: phenytoin (Dilantin). fluid administration O2 therapy. Phenobarbital (Luminal) Analgesic or antipyretic: acetaminophen (Tylenol) .

• Monitor CVP • Administer antibiotics. which may signal an impending crisis • Monitor fluid balance.Nursing Interventions • Assess neurologic function. • Evaluate for an increasing ICP • Watch for deterioration in the client’s condition. • Maintain adequate fluid intake. as ordered .

Nursing Interventions • Watch for adverse reactions to I.V. antibiotics. • Position the client carefully to prevent joint stiffness and neck pain • Assist with ROM exercises to prevent contracture • Implement increased ICP precautions • Reassure the family behavioral changes usually disappear to allay anxiety. • Follow strict aseptic technique.

Preventive Measures • Vaccination – meningococcal conjugate vaccine • Prophylactic antibiotics

• Respiratory isolation

Myasthenia gravis

An autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability.  It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the stimulative effect of the neurotransmitter acetylcholine.

Normal Myasthenia gravis .

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Assessment

• Muscle weakness
• Dyspnea/dysphagia /  activity • Fatigue

• Ptosis
• Diplopia • Impaired speech • Strabismus • Mask-like facial expression • Drooling

Drooping of the eyelid is called ptosis. Ptosis may result from damage to the nerve that controls the muscles of the eyelid, problems with the muscle strength, or from swelling of the lid.

Diagnostic Test

• Tensilon Test (Edrophonium)

• EMG • MRI • Serum anti-acetylcholine receptor antibodies

Collaborative Management • Assess swallowing / gag reflex • Administer meds. 20 – 30 mins. a.c. • Administer meds. at precise time • Protect from falls • Aspiration precaution • Start meal with cold beverage

•Adequate ventilation •X exposure to infection •Adequate rest with activity •Plasmapheresis •Surgery :Thymectomy •Intravenous immune globulin

Collaborative Management

Collaborative Management • Pharmacotherapy • Cholinergics (Anticholinesterase) • Neostigmine (Prostigmin) • Pyridostigmine (Mestinon) • Ambenomium (Mytelase) • Glucocorticoids • Cytotoxic medication • Azathioprine • Cyclosporine • Cyclophosphamide • Antacids .

Nursing Management Myasthenic Crisis Under medication Respiratory distress Cholinegic Crisis Over medication Diaphoresis Bowel/bladder incontinence Diarrhea Abdominal cramps Excessive salivation Blurred vision Facial muscle twitching Sudden decrease in BP Bradycardia Atropine sulfate Neostigmine .

Survival Guide (MG) • Reschedule daily task • Secure ―handicapped‖ parking sticker • Frequent rest periods • Take medications on time – (alarm clock) • Eye patch. cigarette smoke . tonic water. if with diplopia • Start meal with cold beverage • X very hot / cold weather • X aerosol. pesticides/ cleaners • X alcohol.

Multiple Sclerosis .

leading to demyelination and scarring as well as a broad spectrum of signs and symptoms. an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged. .

30 – 40 years old  Chronic. cerebrum) then later gray matter Destruction of myelin sheath (SCHWANN’s CELLS) Interruption / distortion of impulse (slowed / blocked) . with remissions/ exacerbations  Causes    Unknown Viral Infections Autoimmune Dis. women. SC. Multiple foci of demyelination in the white matter (brainstem. optic nerves.

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Assessment • Diplopia • Scotoma • Blindness • Muscle Spasm • Weakness / Numbness • Fatigue •  susceptibility to URTI • Emotional Instability • Bowel / Bladder Problems .

Assessment • Charcot’s Triad • Scanning speech • Intention tremors • Nystagmus • Lhermitte’s Sign • Dysphagia • Ataxic Gait .

IgG .Diagnostic Test • CSF .

Clinical Pattern .

Clinical Pattern .

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Collaborative Management • Diet • Speech Therapy • Plasmapheresis • Muscle Relaxants • Baclofen (Lioresal) • Physical Therapy • Force Fluids • Glucocorticoids • Prednisone • Dexamethasone • Corticotropin .

Medication Avonex Betasero n Copaxone Rebif Decrease T-cell Proliferation Decrease number of new lesions Inhibits antigen specific T-cell activation .

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Trigeminal Neuralgia .

. with remissions lasting from several months to years. Incidence: ◦ above 40 ◦ more common in women  Can subside spontaneously.   also called Tic Douloureux Is a painful disorder of one or more branches of the fifth cranial (trigeminal) nerve that produces paroxysmal attacks including facial pain.

Possible Causes • Unknown • Trigeminal nerve compression secondary to tumor • Occasionally. it can be a manifestation of multiple sclerosis or herpes zoster .

or talking • Drinking hot or cold beverages temperature . smiling.Assessment Findings • Searing pain in the facial area • Triggers: • Light touch to a sensitive area of the face (trigger zone) • Exposure to hot or cold • Eating.

and tumors .Diagnostic Evaluation • Skull X-rays. and CT scan rule out sinus or tooth infections. tomography.

Nursing Diagnoses • Acute pain • Powerlessness • Anxiety .

Collaborative Management Anticonvusant drugs • Carbamazepine (Tegretol) • Phenytoin (Dilantin) .

Collaborative Management Nerve block • injection of alcohol or phenol into one or more branches of the nerve. (temporary effect last: 6-18 months) .

Collaborative Management Surgery • Microvascular decompression • Radio-frequency Thermal Coagulation (RFTC) • Percutaneous Balloon Microcompression .

.Nursing Interventions • Observe and record the characteristics of each attack. • Health teachings on good oral hygiene. • Provide adequate nutrition in small frequent meals at room temperature. • Reinforce natural avoidance of stimulation. (Temperature extremes may cause an attack) • Place food in the unaffected side of his mouth when chewing.

Bell’s Palsy .

. Also known as idiopathic facial paralysis. is a form of facial paralysis resulting from dysfunction cranial nerve VII (the facial nerve) that results in the inability to control facial muscles on the affected side.

Assessment Findings • Inability to close eye completely on the affected side • Pain around the jaw or ear • Unilateral facial weakness • Eye rolls upward and tears excessively when the client attempts to close it • Ringing in the ears • Taste distortion on the affected anterior portion of the tongue .

Nursing Diagnoses • Acute pain • Disturbed sensory perception • Disturbed body image .

Collaborative Management • Electrotherapy after the 14th day of prednisone therapy to help prevent facial muscle atrophy • Moist heat • Medications: • Corticosteroid: prednisone (Deltasone) to reduce facial nerve edema and improve nerve conduction and blood flow .

• Immunosuppression • Hyperglycemia (diabetics must be monitored) • Apply moist heat to the affected side of the face. . watch for adverse reactions: • GI distress (usually relieved with an antacid) • Fluid retention. taking care not to burn the skin to reduce pain.Nursing Interventions • During treatment with prednisone.

Give reassurance that recovery is likely within 1 to 8 weeks to allay the client’s anxiety.Nursing Interventions •Massage the client’s face with a gentle upward motion two to three times daily for 5 to 10 minutes. • Arrange for privacy at mealtimes to reduce embarrassment • Oral care (as residue is common) • Psychological support. .

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Cerebrovascular Disease .

exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect.  A group of brain dysfunctions related to disease of the blood vessels supplying the brain. endothelium. . Hypertension is the most important cause. it damages the blood vessel lining.

deformed. uneven and more vulnerable to fluctuations in blood pressure. . stiff. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow.

Functions such as movements. occurs when there is ischemia(distrupted blood supply) to a part of the brain or hemorrhage into the brain that results in the death of the brain cells. .sensations or emotions that are controlled by the particular part is affected.

 -It occurs due to vascular occlusion and severe hypoperfusion.  -It occurs due to extravasation of blood into the brain and subarachnoid space. Ischemic Stroke Hemorrhagic stroke .

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obstructing the flow of blood through the circulatory system • A thrombus starts with damage the endothelial lining of the vessel • Atherosclerosis is the primary culprit • Atherosclerosis causes fatty materials to deposit and form plaque on vessel walls • Thrombotic stroke is the most common type of stroke in people with diabetes .Causes Thrombosis • Is the formation of a blood clot inside a blood vessel.

detaches and travesls through the cerebral cerculation until it lodges in and occludes a cerebral artery .Causes Embolism • Occlusion of a cerebral artery by an embolus • An embolus forms outside the brain.

which causes bleeding to the brain tissue • Is often secondary to hypertension and most common after 50 years of age • Produce extensive residual function lose and have the slowest recovery of all the stroke .Causes Hemorrhage • Result from rupture of a cerebral vessel.

Causes TIA • Occurs when the blood supply to a part of the brain is interrupted or totally occluded • Ultimate survival of ischemic brain tissue depends on the length of time it is deprived plus the degree of altered brain metabolism • Last for few seconds or minute but not more than 24hr. .

Causes TIA • Occurs when the blood supply to a part of the brain is interrupted or totally occluded • Ultimate survival of ischemic brain tissue depends on the length of time it is deprived plus the degree of altered brain metabolism • Last for few seconds or minute but not more than 24hr. .

Risk Factors • Hypertension • Cardiovascular disease • Atrial fibrillation • Diabetes mellitus • Carotid stenosis • hx of TIA .

Risk Factors • Hyperlipidemia • Cigarette smoking • Excessive alcohol consumption • Cocaine use • Obesity • Increase dose of estrogen oral contraceptive .

Assessment • Sign and symptoms of increase ICP • Perceptual defects • Aphasia • Hemianopsia .

Collaborative Management • Emergency care • Promote nutrition • Promote activity • Promote elimination • Promote communication .

Emergency Care • Elevate head but neck should not be flexed • Maintain patent airway • Promote drainage of saliva from the airway .

Emergency Care Restore Cerebral blood flow • Using thrombolytic agent • Anticiagulant • ASA • Coumadin • Heparin • Antiplatelet • Thrombolytic therapy • Streptokinase (x if > 3 hours) .

Contraindication to thrombolytic therapy • More than 3 hours of onset • Intercranial hemmorhage of CT scan • Intercranial surgery or head trauma • Uncontrolled hypertension .

Emergency Care Prevent Complication • Bleeding • Cerebral edema • Mannitol • Dexamethasone • Non-steroidal anti-inflammatory .

Emergency Care Other complications • Coma • Hyperthermia .

Specific Deficits after Stroke • Hemiparesis and Hemiphgia • Aphasia • Wernicke’s (Sensory or receptive) aphasia • Broca’s (Motor or expressive) aphasia • Global Aphasia • Dysarthria • Dysphagia .

Specific Deficits after Stroke • Visual Changes Homonymous hemianopsia Binasal hemianopsia Bitemporal hemianopsia .

Specific Deficits after Stroke • Horner’s syndrome • Ptosis • Anhidrosis • Myosis • Enophalmia • Loss ciliospinal reflex • A lag on dilation • Agnosia .

Specific Deficits after Stroke • Unilateral neglects • Failure to attend to one side of the body • Failure to respond to stimuli on one side of the body • Failure to use one extremity • Failure to orient the head and eyes to one side .

Collaborative Management • Care of the client with aphasia • Say one word at a time • Identify one object at a time • Give simple commands • Anticipate needs • Allow to verbalize • Reinforce success in speech • Assist in speech therapy .

Collaborative Management • Compensate for Perceptual Difficulties • Care of the client with hemianopsia • Approach from the unaffected side • Place articles at the unaffected side • Teach scanning techniques • Provide emotional support • Provide patient teaching .

Rehabilitation Care • Physical therapy • Occupational therapy • Speech therapy .

Primary Prevention of Stroke • Maintaining an ideal body weight • Maintaining safe cholesterol levels • Smoking cessation • Use of low dose estrogen contraceptives • Reduce alcohol consumption • Eliminate illicit drug use .

Secondary Prevention of Stroke • Adequate BP control • Care of DM • Treatment of CVD. TIA and atrial fibrillation .

Parkinson’s Disease .

It results from the death of dopaminecontaining cells in the substantia nigra. the cause of cell-death is unknown.  A degenerative disorder of the central nervous system. a region of the midbrain. .

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balance. locomotion) Causes:    Unknown Viral Infections Drugs :     phenothiazines reserpine haloperidol methyldopa .   Males / Females. 50 – 60 years Degenerative disease  EPS   Dopamine (EPS – posture.

excitatory Mechanisms are unopposed .Dopamine< acetylcholine Encephalitis Arteriosclerosis CO poisoning Depigmentation of the substantia nigra of the BASAL GANGLIA Loss of neurons  DOPAMINE (loss of inhibitory influence.

Tremors Pillrolling tremors Resting tremors Cogwheel rigidity Absence of arm swing Mask -like appearance Drooling Dysphagia 3 Cardinal Signs Rigidity Dyskinesia Akinesia Bradykinesia Shuffling gait Microphonia Monotomous low voice with poor articulation Festinating gait .

Assessment • Moist. oily skin • Emotional instability • Fatigue • Microphonia • Micrographia • intellectual impairment • loss of sensation • true paralysis .

Diagnostic Test • CT SCAN. EEG .

Collaborative Management  Diet   residue. X pillows Prone position Hold hands folded at the back when walking  Aspiration precaution   fluid intake .  Caloric. Soft  Position    to prevent contractures Firm bed.

: blurring of vision dryness of mouth / throat constipation urinary retention dysarthria mental disturbance  .e.Collaborative Management  Anticholinergics Cogentin (Benztropine Mesylate)  Artane ( Trihexyphenidyl)  Akineton (Biperidine) s.

Collaborative Management  Drugs  Anti – Parkinsonian Agents (Dopaminergics)  Levodopa  Carbidopa with Levodopa (Sinemet)  Antiviral / Dopamine Agonists  Amantadine HCl (Symmetrel)  Bromocriptine (Parlodel)  Antispasmodics  Procyclidine HCl (kemadrin) .

B6) MAOI (Parnate. Pyridoxine(Vit. pork. Reserpine. dried beans. Nardil)   Enhances NE activity Hypertensive crisis Potentiate effect of LEVODOPA)  Methyldopa  Block desired action of Levodopa  Avoid the following foods   B6 – rich foods:tuna. beef liver Tyramine rich foods . salmon. Marplan.Collaborative Management  Avoid the following drugs: (Levodopa)   Phenothiazines.

Collaborative Management            Cheese Cream Yogurt Coffee Chocolate Bananas Raisins Italian green beans Liver Pickled herring sausage Tyramine-rich foods     Soy sauce Yeast Beer Red wine .

Alzheimer’s Disease .

including memory and reasoning. which become severe enough to impede social or occupational functioning. . A progressive neurologic disease of the brain leading to the irreversible loss of neurons and the loss of intellectual abilities.

and Senile Dementia of the Alzheimer Type (SDAT) . Alzheimer's disease is also known as simply Alzheimer's. .

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Memory Loss  Stage  Stage 1 II Mild memory lapses Obvious short – term memory lapses  Stage  Stage III IV Disintegration of personality Terminal stage – physical and mental deterioration .

     Vascular dementia (abnormalities in the vessels that carry blood to the brain) Lewy bodies variant (LBV). also called dementia with Lewy bodies Parkinson's disease Frontotemporal dementia .

Diagnostic Test • CT Scan • Neuropsycho Testing: change in ability to think to test .

 Promote activity.Collaborative Management  Protect from injury.  Avoid agitation / violence  Avoid fatigue     Change of routine Excessive demands Overwhelming situation Physical stressors Escalate behavioral dysfunction .  Promote sleep.

Collaborative Management  Avoid scolding / embarrassing  Avoid arguing / reasoning  Address by name .

Huntington’s Disease .

 A neurodegenerative genetic disorder that affects muscle coordination and leads to cognitive decline and dementia. .

Huntington’s Disease Normal Brain .

sinuous.Assessment Findings • Loss of musculoskeletal control • Dementia • Choreic movements . usually violent and purposeless.rapid. writhing movements. accompanied by • Dysarhria (indistinct speech) • Athetoid movements (slow. especially of hands) • torticollis (twisting of the neck) • Personality change .

Diagnostic Test • Family History & S/Sx • CT Scan & MRI • Recombinant DNA technology .

Management • Neuro check • Medications • Thiothixene HCl (Navane) & Haloperidol Duanate (Haldol) • Reserpine • Tetrabenazine • Antiparkinsonism drugs (Levodopa) • Antidepressants • Antipsychotics .

swallowing problems. limitation in ambulation & losing • bowel & bladder function • Speech therapy • Genetic counseling .Management • Psychotherapy • Surgical implantation of fetal neural allografts • Health teaching • Medications • manage chorea.

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Head and Spinal cord Injury .

aphasia.TYPE OF INJURY Concussion DESCRIPTION A blow to the head causes the brain to strike the skull SYMPTOMS Headache. transient loss of consciousness. Hemorrhage Fracture . can be anywhere Skull is cracked or broken Decreased level of consciousness. amnesia. cerebrospinal fluid leakage from nose or ear. nausea Contusion A blow to the head causes a bruise to the brain Blood accumulates in the head. hemiplegia Depends on the area affected Headache at site.

Halo device Nursing Interventions -ABC .Immobilization -Prevent complications of immobility Chronic injury Sensory and motor dysfunction may be partial or complete.Prevent complications of immobility -Meticulous pin site care . based on level of spinal cord injury -ABC .Type of injury Acute injury Description Spinal Shock Symptoms Absence of reflexes Flaccid paralysis Urine retention Hypotension Bradycardia Temperature lability Traction as indicated -Gardner-Wells (Cervical tongs) .

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Care of the Client with SCI Causes • Falls • Diving • Vehicular accident .

Care of the Client with SCI Effects • Paralysis • Loss of reflexes • Loss of sensory function • Loss of motor function • Autonomic dysfunction .

muscle paralysis • Bowel / bladder retention .Care of the Client with SCI Cervical SCI •  C4 – fatal • Quadriplegia • Resp.

Care of the Client with SCI Thoracic SCI • Paraplegia • Poor control of upper trunk • Bowel / bladder retention Lumbar SCI • Paraplegia (flaccid) • Bowel / bladder retention .

 probability to perform sexually . probability to perform sexually •  lesion .Care of the Client with SCI Sacral SCI • S2 •  erection • X ejaculation • S2 – S4 • X erection • X ejaculation •  lesion .

Care of the Client with SCI • Paraplegia • Bowel / bladder INCONTENENCE .

AUTONOMIC DYSREFLEXIA ) .Collaborative Management • Respiratory function • Immobilize in a flat. firm surface • Cervical collar • Transport as a unit • X attempt to realign body parts • Traction • Cast • Surgery (Complications of SCI :SPINAL SHOCK.

End Here… .

Brain Tumor .

ischemia.  An abnormal mass found in the brain resulting from unregulated cell growth and division. and increased ICP. . edema. Can cause compression of blood vessels.

Classified according to the tissue or origin ◦ Gliomas .  Can be primary (originating in the brain tissue) or secondary (metastasizing from another area of the body).neurological cells ◦ Meningiomas – meninges  Astrocytomas .

(NEOPLASIA) • Secondary • Benign (meningiomas) • Malignant ( Gliomas) .Management Etiology • Idiopathic Risk Factors • Primary • Environmental factors • Genetics • Viral Theory • Immunologic factors • Alteration in the regulatory control mechanism of normal cells of brain.

Pathophysiology Growth of Tumor _______________________________________________ Obstruction of CSF flow nerve Hydrocephalus fxns Osteoclast stimulation Focal brain damage compression of brain & cranial skull thinning various alterations of CNS Increased ICP Altered CNS fxns .

tumor may lead to:   motor seizures sensory impairment .Assessment Findings A   tumor in any area of the brain may lead to: deficits in cerebral function headache  In the frontal lobe. tumor may lead to:  aphasia  seizures  In the parietal lobe.

Assessment Findings  In  the occipital lobe tumor may lead to: homonymous hemianopsia (defective vision or blindness affecting the right halves or the left halves of the visual field of the two eyes) visual hallucinations visual impairment    In the cerebellum. tumor  impaired coordination  impaired may lead to: equilibrium .

Diagnostic Evaluation • CT scan and MRI shows location and size of tumor .

Nursing Diagnoses
• Disturbed sensory perception (kinesthetic) • Anxiety • Risk for injury

Collaborative Management
 Craniotomy  Radiation
  

therapy  Medications:
anticonvulsant Antineoplastic: vincristine (oncovin), lomustine (CeeNu), carmustine (BiCNU) Diuretic – decrease ICP

 Glucocorticoid:

dexamethasone (Decadron) – relieve inflammation

Nursing Interventions
 Assess

status  Assess pain.  Assess for increased ICP.  Monitor V/S, I/O  Monitor for signs and symptoms of SIADH  Turn and reposition client every 2 hours to maintain skin integrity  Maintain the client’s diet to promote healing

neurologic and respiratory

Nursing Interventions
 Encourage

the client to drink fluids to maintain hydration  Administer I.V. fluids to maintain hydration if client can’t drink adequate amounts  Administer oxygen to prevent ischemia  Administer enteral nutrition or total parenteral nutritioun (TPN), as indicated, to meet nutritional needs

Nursing Interventions
 Implement

increased ICP precautions  Encourage the client to verbalization of feelings.  Maintain seizure precautions.

Seizure Disorder .

Effects of the Seizures • Mental status • LOC • Sensory and Special senses • Motor function • Autonomic function .Sudden excessive disorderly electrical discharges of the neurons.

Care of the Client with Seizure Disorder Types of Seizures • Partial • Generalized • Grand mal • Tonic/clonic • Focal • Absence • Status Epilepticus .

but traditionally it is defined as one continuous unremitting seizure lasting longer than 5 minutes. It is always considered a medical emergency.[1] or recurrent seizures without regaining consciousness between seizures for greater than 5 minutes. . (SE) is a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary.

Care of the Client with Seizure Disorder .

Care of the Client with Seizure Disorder Collaborative Management • Do not leave alone • Protect from injury • Loosen constricting clothings • Turn to sides • Do not apply restraints • Do not insert tongue blade during tonic – clonic movements • Pad side – rails • Make relevant observation and documentation .

Care of the Client with Seizure Disorder Collaborative Management • Patient Education • Take medication at regular basis • Avoid alcohol • Adequate rest • Well – balanced diet • Avoid driving. swimming • Lead an active life . operating machines.

Head Ache .

 Diffuse pain in the different parts of the head .

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quiet. dark environment.  Medications  Symptomatic  Non-narcotic analgesics  Fiorinal  Midrin  Sumatriptan (inutrix)  Ergotamine tartrate (gynergen) or ergotamine with caffeine (cafergot)  Prophylactic to prevent migraine attacks  Methysergide maleate (sansert)  Propanolol (inderal) & amytriptyline (Elavil) .Management  Assess details of headache.  Provide.

Management  Intervention for pain  Discharge & teaching plan  Identification of factors that precipitate attacks ( include diet)  Examination of lifestyle. coping behaviors  Daily exercise & relaxation  Use & S/E of medications . stressor.

Encephalitis .

Transmission vectors or through ingestion of infected goat’s milk and accidental injection or inhalation of the virus. Eastern equine encephalitis may produce permanent neurologic damage and is commonly fatal. .   Is a severe inflammation and swelling of the brain.

Possible Causes • Exposure to virus .

Pathophysiology Intense lymphocytic infiltration of brain tissues and the meninges ↓ Cerebral edema ↓ Degeneration of the brain’s ganglion cells. and diffuse nerve cell destruction ↓ Signs and symptoms .

Assessment Findings • Sudden onset of fever • Headache • Meningeal irritation (stiff neck and back) and neuronal damage (drowsiness. organic psychoses) • Vomiting • Coma (following the acute phase of illness) • Sensory alterations . coma. seizures. paralysis. ataxia.

• EEG reveals abnormalities such as generalized slowing of waveforms • CT scan may be ordered to rule out cerebral hematoma .Diagnostic Evaluation • Blood CSF analysis studies identify the virus and confirm diagnosis.

Nursing Diagnoses • Disturbed thought processes • Hyperthermia • Impaired physical mobility .

effective only if administered before the onset of coma) • Analgestic and antipyretic: asprin or acetaminophen (Tylenol) (relieves headache and reduces fever) • Diuretic: furosemide (Lasix) or mannitold (Osmitrol) (reduces cerebral swelling) • Laxative: bisacodyl (Dulcolax) • Sedative: lorazepam (Ativan) for restlessness .Collaborative Management • Medications: • Antiviral: acyclovir (Zovirax) (effective only against herpes encephalitis.

• Assist with ROM exercises to maintain joint mobility • Maintain adequate nutrition. • Administer medications. . as ordered.Nursing Interventions • Assess neurologic function often • Maintain adequate fluid intake but avoid fluid overload • Measure I/O. • Careful handling of the patient.

• Reassure the client and his family that behavioral changes caused by encephalitis usually disappear to decrease anxiety. • Darkening the room may decrease photophobia and headache.Nursing Interventions • Give a stool softener or mild laxative (prevent straining) • Provide good oral care • Maintain a quiet environment. • Provide emotional support. .

Herpes Simple Virus Encephalitis • Infection of buccal mucosa • Spread along the trigeminal nerve Fungal Encephalitis • Related to geographic area and compromised immune system • Enters the body via inhalation .

Arthropod-Borne Virus Encephalitis • Common vector is mosquito Vectors transmit several type of viruses: 4 types • La Crosse Encephalitis • St. Louis Encephalitis • Western Equine Encephalitis • Eastern Equine Encephalitis .

Guillain-Barre Syndrome .

The client’s airway is compromised when the disease reaches the diaphragm . The disease causes motor weakness symmetrically and in an ascending fashion. a disorder affecting the peripheral nervous system.  An acute inflammatory demyelinating polyneuropathy (AIDP).

Pathophysiology .

possibly accompanied by opthalmoplegia [ocular paralysis]) .Assessment Findings • Muscle weakness (ascending from the legs to arms) • Dysphagia (difficulty swallowing) or dysarthia (poor speech caused by impaired muscular control) • Facial diplegia (affecting like parts on both sides of the face.

Assessment Findings • Hypertonia (excessive muscle tone) and areflexia (absence of reflexes) • Paresthesia • Stiffness and pain in the form of a severe ―charley horse‖ • Weakness of the muscles supplied by cranial nerve XI. this is a less common finding. the spinal accessory nerve. these muscles affect shoulder movement and head rotation .

ECG • 4. CSF studies (increase CHON) • 2. Propanolol • 5. Mechanical ventilation • 2. Plasmapheresis • 3.Diagnostic Test • 1. AtSO4 . EMG: slowed nerve conduction Medical Management • 1.

observe for signs of autonomic dysfunction fluctuating with hypotension. arrhythmia • Corticosteroids . tachycardia.Nursing Management • Adequate ventilation • Check muscle groups q 2 hrs to check for progression of muscle weakness • CN function • V/S.

Nursing Management • Anti.arrhythmias • Prevent complications of immobility • Promote comfort • Optimum nutrition • Psychologic support • Rehabilitation .

End Here… .

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Common Health Problems of the Neonate and Infant Hydrocephalus Encephalocele Spina Bifida .Unit 1 .

Unit 2 .Common Health Problems of the Child and Adolescent Cerebral palsy Reye’s Syndrome Meningitis .

Unit 3 .Common Health Problems of the Young Adult Myasthenia gravis Multiple Sclerosis .

Common Health Problems of the Middle Aged Adult Myasthenia gravis Multiple Sclerosis .Unit 3 .

3 incompressible elements : • Brain tissues • Blood supply • CSF • Expansion of any one of these incompressible elements must be balanced by proportional constriction of one or both or there will be an increase in ICP .

Common Health Problems of the Child and Adolescent Hydrocephalus Encephacele .Unit 2 .

Amyotrophic Lateral Sclerosis .

. A form of motor neuron disease caused by the degeneration of neurons located in the ventral horn of the spinal cord and the cortical neurons that provide their afferent input.

Pathophysiology .

Assessment  Dysphagia  Fatigue  Awkwardness (1st sign) of fine finger movement  Muscle wasting  Muscle weakness  Atrophy  Fasciculations  Dysarthria .

Assessment • Jaw clonus • Respiratory difficulty • Spasticity of flexor muscles • Unilateral disability of UE & LE Death • 5 to 10 years (resp./ bulbar paralysis) Diagnostic Test • EMG (No definite test) • CPK-MM .elevated .

Collaborative Management: Symptomatic     Gastrostomy feeding Assist with ADL Prosthesis to support weakened muscle Promote effective AW clearance    Emotional support (Complete dependency as disease progresses) Drug: Riluzole ( Rilutele).neuroprotective effect  X ASPIRATION SUCTION TUCKED chin pos. when eating / drinking .

Brain vasodilatation Cerebral Edema Bony Skull Cerebral Hypoxia Increase in Intracranial Pressure No Room For Expansion Cerebral Ischemia Monro’s Theory Increase in the Bulk of the Brain Compression of Brain Structures and Blood Supply .

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