Neurology

‡ By Dennis Jason Alcantara, RN, USRN, MAN can

NEUROLOGY
INTRODUCTION: Nervous System- the body¶s Systemcommunication network coordinates and organizes 3 Division: 1. CNS- central nervous CNSsystem - made up of the brain and the spinal cord -

2. PNS- peripheral nervous system - includes nerves that connect the CNS to the remote body parts - relays and receives messages

3. ANS- autonomic nervous system - regulates the involuntary function of the internal organs.

loss of ability to recognize objects through a particular sensory system.a reflex action of the toes . Axon .inability to coordinate muscle movements. Babinski reflex (sign) .portion of the neuron that conducts impulses away from the cell body. Ataxia .GLOSSARY Agnosia.

Cont«.
- abnormalities in the motor control pathways Clonus - alternating contraction and relaxation of a muscle occurring in rapid succession. Delirium - transient loss of intellectual functioning. Dendrite - portion of the neuron that conducts impulses toward the cell body.

Flaccid - lack of muscle tone Myelography (myelogram) - xray study of spinal cord after injection of a contrast. Photophobia - inability to tolerate light Position sense - awareness of position of parts of the body

Rigidity - increase muscle tone at rest Reflex - an autonomic response to a stimuli. Romberg test - test for cerebellar dysfunction - patient stand with feet together, eyes closed and arms extended.

Spascity ± sustained increase in muscle tension when it is passively lengthened or stretch.

ANATOMY AND PHYSIOLOGY OF THE BRAIN & SPINAL CORD .

governs sensory and motor activity .outer gray layer .divided into four lobes .Cerebrum .governs thought and learning Cerebral cortex .right and left hemisphere .conscious activity of the cerebrum .

Temporal lobe. Frontal lobe. Occipital lobe.pain.prefrontal lobemorals.auditory center .wernicke¶s area for sensory and speech.4 Lobes 1. 4.visual area . Parietal lobe. emotions and judgments 2.Broca¶s area for speech . temp and pressure 3.

Basal Ganglia ‡ Cell bodies in white matter ‡ Smooth voluntary movements .

Diencephalon .

stress response. fluid balance. 2. hypothalamus.part of reticular activating center. thalamus. emotions . appetite.autonomic response of para & sympha nervous system. body temp.relays impulses to the cortex .provides pain gate . .1.

contains cardiac. Pon¶s .motor coordination . centers .afferent and efferent tracts.resp. vomiting and vasomotor center. Medulla oblongata.regulates breathing 3. . midbrain. . resp.visual & auditory reflex center 2.Brainstem 1.

cerebellum .

.‡ Function .posture.coordinates with smooth muscle movement . equilibrium and muscle tone.

motor ‡ 2 Posterior horn.sensory . CSF & adipose tissue ‡ 2 Anterior horn.Spinal cord ‡ Provides neuron and synapse network ‡ Carries sensory information to and motor information from the brain ‡ C1-L2 ‡ Protected by meninges.

‡ Nerve tracts.ascending tract ( sensory ) .white matter .descending tract ( motor ) .

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vascular area * subarachnoid space.bet arachnoid mem and pia matter .fibrous membrane ‡ Arachnoid.delicate membrane. contains fluid ‡ Pia matter.meninges ‡ Dura matter.

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CSF ‡ ‡ ‡ ‡ ‡ ‡ Secreted by the ventricles Reabsorbed in the subarachnoid space 50-175mm H2O 125-150 ml Protection Exchange for nutrients and waste .

ventricles ‡ 4 ventricles ‡ Communicate bet subarachnoid spaces ‡ Produce and circulate CSF .

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chemical transmission of impulses from one neuron to another .Neurons ‡ ‡ ‡ ‡ ‡ Cell body Axons and dendrites Sensory neurons Motor neurons Synapse.

ANATOMY THE NEURON .

Spinal nerves ‡ 31 pairs ‡ Mixed fibers.joining of anterior roots and posterior roots ‡ Posterior roots.motor .sensory ‡ Anterior roots.

Spinal nerves .

produce the opposite effect . inc heart rate & rhythm. ‡ Parasympathetic (cholinergic) fibers .ANS ‡ Sympathetic (adrenergic) fibers ± dilates pupils. contract blood vessels and relax smooth muscle of the bronchi.

DIAGNOSTIC TEST 1. SKULL AND SPINAL RADIOGRAPHY .

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CT SCAN .2.

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3. Magnetic Resonance Imaging .

Lumbar Pucture ‡ Insertion of spinal needle through the L3L4 interspace into the lumbar subarachnoid space ‡ Measure CSF pressure ‡ Instill air. dye or medication ‡ Contraindicated in pt with increase ICP .4.

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Myelogram ‡ Injection of a dye or air into the subarachnoid space to detect abnormalities of the spinal cord and vertebrae .5.

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.6. Cerebral Angiography ‡ Injection of contrast through the femoral artery into the carotid arteries to visualize the carotid arteries and assess for lesions.

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. Electroencephalography ‡ Graphic recording of electrical activity of the superficial layer of the cerebral cortex.7.

Caloric Testing ‡ Provides information about the function of vestibular portion of the VIII cranial nerve and aids in the diagnosis of cerebellum and brainstem lesions.8. .

) The neurologic examination is a systematic process that includes a variety of clinical tests.) Simple screening vs thorough neurologic assessment 3.THE NEUROLOGICAL ASSESSMENT 1. 2.) Indirect examination . observations and assessments designed to evaluate a complex system.

Deep Tendon .5 COMPONENTS Cerebral function Cranial nerves Motor system Sensory system Reflexes .Abnormal reflexes .

CEREBRAL FUNCTION
MENTAL STATUS 1.) Level of Consciousness 2.) Orientation to 3 spheres 3.) Memory & General Intellectual Ability 4.) Insight 5.) Judgment & Abstraction

Glasgow Coma Scale
3 Categories 1.) Eye opening 2.) Motor Response 3.) Verbal Response

Glasgow Coma Scale
1.) Eye opening 4- spontaneous 3- to speech 2- to pain 1- none

2.) Motor Response 6- obeying 5- localizes 4- withdraws 3- decorticate 2- decerebrate 1- none

3.no verbal response intubated: 1 .confused 3.) Verbal Response 5.oriented 4.inappropriate 2.incomprehensible 1.

Modified GCS for Pediatric patients ‡ Verbal Response 5.irritable to touch 3. babbles 4.moans to pain 1.no response .cries.cries to pain 2.

subject to change ‡ 7 & below : poor prognosis .GCS Results ‡ 12 ± 15 : good prognosis ‡ 8 ± 11 : fair prognosis.

decorticate 7 ± unconscious.REACTIVE LEVEL SCALE ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 1 ± alert 2 ± drowsy. responds to strong stimuli 4 ± unconscious. responds to light stimuli 3 ± very drowsy. withdraws 6 ± unconscious. localizes 5 ± unconscious. decerebrate 8 ± comatose .

) Immediate recall 2. MEMORY 1.) Remote memory 4.B.) General Intellectual ability  General information  Serial subtraction  calculations .) Orientation to 3 spheres 5.) Recent memory (past 24 hours) 3.

Coordination of muscle movements requires four areas of the nervous system function: ‡ The motor system ‡ For muscle strength ‡ The cerebellar system ‡ For rhythmic movement and steady posture ‡ The Vestibular system ‡ For balance ‡ For coordinating eye. and body movements ‡ The Sensory system ‡ For position sense . head.

observe patient¶s performance in: ‡ ‡ ‡ ‡ Rapid Alternating movements Point-to-point movements Gait Stance .To assess coordination.

± As rapidly as possible .Rapid Alternating Movements ‡ ARMS ± Show patient how to strike one hand on the thigh ± Then raise the hand. turn it over ± Then strike the back of the hand down on the same place.

Rapid Alternating Movements ‡ Fingers ± Finger tapping ± Tap distal joint of thumb with the tip of the index finger ± As rapidly as possible .

Rapid Alternating Movements ‡ LEGS ± Ask patient to tap your hand with the ball of each foot in turn ± Note any slowness or awkwardness .

Rapid Alternating Movements ‡ In cerebellar disease: ± one movement cannot be followed quickly by its opposite. irregular and clumsy ‡ Disdiadochokinesis . ± Movements are slow.

Rapid Alternating Movements ‡ LEGS ± Ask patient to tap your hand with the ball of each foot in turn ± Note any slowness or awkwardness .

± Note accuracy and smoothness of movements. watch for tremors .Point-toPoint-to-point Movements ‡ ARMS ± Ask patient to touch your index finger and then his nose alternately several times ± Move your finger about ± So that the patient has to alter directions and extend the arm fully to reach it.

Point-toPoint-to-point Movements ‡ These maneuver tests: ± Position sense ± Functions of both labyrinth and cerebellum ‡ Cerebellar disease causes incoordination that may get worse with eyes closed .

‡ Past pointing: ± Repetitive and consistent deviation to one side ± Worse with eyes closed ± Suggests cerebellar or vestibular disease. .Point-toPoint-to-point Movements ‡ Inaccuracy that appears with eyes closed suggest loss of position sense.

the heel is lifted too high and the patient tries to look.Point-toPoint-to-point Movements ‡ LEGS ± Ask the patient to place one heel on the opposite knee ± Then run it down the shin to the big toe ± Repetition with eyes closed tests for position sense. performance is poor. ± With eyes closed. . ± When position sense is lost.

.Point-toPoint-to-point Movements ‡ In cerebellar disease. the heel may ± Overshoot the knee ± And then oscillate from side to side down the shin.

and movements of the legs.Gait ‡ WALK ACROSS ROOM ± Observe posture. swinging of the arms. balance. ± Normally ‡ balance is easy ‡ Arms swing at the sides ‡ Turns are accomplished smoothly .

Gait ‡ A gait that lacks coordination. with reeling and instability is called: ‡ ATAXIC ‡ Ataxia may be due to: ± Cerebellar disease ± Loss of position sense ± Intoxication .

Gait ‡ TANDEM WALKING ± Walk heel-to-toe in a straight line ± May reveal an ataxia not previously obvious. .

Gait ± Ask patient to walk on the toes ± Tests for plantar flexion of the ankles. . as well as balance ± Walking on toes and heels may reveal distal muscular weakness in the legs. as well as balance ± Ask patient to walk on the heels ± Tests for dorsiflexion of the ankles.

Gait ‡ HOP IN PLACE ± Ask patient to hop in place on each foot in turn. ± Involves the proximal muscles of the legs as well as distal ones ± Requires both good position sense and normal cerebellar funciton .

Gait ‡ Difficulty in hopping may be due to: ± Weakness ± Lack of position sense ± Cerebellar dysfunction .

then on the other. first on one leg. ± Support patient¶s elbow if you think he is in danger of falling ± Difficulty here suggest proximal weakness (extensor of the hip) or weakness of the quadriceps (extensor of the knee) .Gait ‡ SHALLOW KNEE BEND ± Ask patient to do a shallow knee bend.

.Stance ‡ ROMBERG TEST ± Mainly a test of position sense ± Feet together and eyes open ± Then close both eyes for 20 to 30 seconds without support ± Note patient¶s ability to maintain an upright position ± Normally only minimal swaying occurs.

the patient has difficulty standing whether eyes are open or closed.Stance ± In ataxia due to loss of position sense. vision compensates for the sensory loss ‡ (+) Romberg sign ± In cerebellar ataxia. .

may do it in a sitting position ± with both arms straight forward.Stance ‡ TEST FOR PRONATOR DRIFT ± Let patient stand for 20 to 30 seconds ± If unable to stand. ± Eyes closed . ± Palms up.

Stance ± Normally person can hold this arm position well ± The pronation of one forearm suggests a contralateral lesion in the corticospinal tract. .

The Cranial Nerves ‡ 12 pairs of special nerve .

CN I ± Olfactory Nerve ‡ Function ± Sensory ± Sense of Smell ‡ What to test? ± Smell .

Techniques of Examination ‡ Sense of Smell ± Familiar and non-irritating odors ‡ Cloves. close eyes ± Occlude one nostril. and test smell in the other. coffee. . vanilla ± Be sure each nasal passage is open ± Let pt. soap.

‡ Note: ± Loss of smell has many causes: ‡ ‡ ‡ ‡ ‡ ‡ Nasal disease Head trauma Smoking Aging Use of cocaine May be congenital .

CN II.Optic Nerve II‡ Function ± Sensory ± Vision ‡ What to test? ± Vision Acuity ± Visual field ± Ocular fundi ± Pupillary reactions .

Techniques of Examination ‡ Visual Acuity ± Snellen Eye Chart. if possible ‡ Test acuity of central vision ± Special handheld card ‡ Test near vision .

‡ Optic Fundi ± Ophthalmoscope .

‡ Pay special attention to the optic disc .

‡ Visual Field ± Screen by Confrontation .

CN III.Oculomotor Nerve III‡ Function ± Pupillary constriction ± Opening the eye ± Most EOM ‡ What to test? ± Pupillary reactions ± EOM .

Techniques of Examination ‡ Pupillary reaction to light ± CN II (Optic) and CN III (Oculomotor) ± Ask patient to look into the distance ± Shine a bright light obliquely into each pupil in turn. .

‡ What to observe? ± Direct reaction ‡ Pupillary constriction in the same eye ± Consensual reaction ‡ Pupillary constriction in the opposite eye ± Size and shape of pupils ± Compare one side with the other .

± Watch for pupillary constriction with near effort .If abnormal or questionable« ‡ Near response ± Test near reaction in normal room light ± Test one eye at a time ± Hold finger or pencil about 10 cm from the patient¶s eye ± Ask to look alternately at it and into the distance directly behind it.

CN IV .Trochlear ‡ Function ± Motor ± Downward and inward EOM ‡ What to test? ± EOM .

Masseter muscles ‡ Lateral movement of jaw .CN V .Trigeminal ‡ Function ± Motor: ‡ Temporal Muscles.

CN VI ± Abducens Nerve ‡ Function ± Motor ± Lateral deviation of the eye ‡ What to test? ± EOM .

Techniques of Examination ‡ CN III. VI ± Extraocular movements ± Six Cardinal directions . IV.

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Which cranial nerve is affected? .

± Sensory: ‡ Facial ‡ Three division: ± Ophthalmic division ± Maxillary division ± Mandibular division .

Trigeminal ‡ What to test? ± Motor: ‡ Jaw movements ± Sensory: ‡ Corneal reflexes ‡ Facial sensations .CN V .

Techniques of Examination

‡ Motor:
± Palpate temporal and masseter muscles ± Clench teeth

‡ Pain sensation
± Use a suitable sharp object ± Ask patient to report whether it is ³SHARP´ or ³DULL´ and to compare sides

‡ Test for light touch
± Use wisp of cotton

‡ Test the Corneal Reflex
± Ask patient to look up and away from you. ± Approach from the other side, out of patient¶s line of vision, and avoiding the eyelashes ± Touch the cornea lightly with a fine wisp of cotton.

normal response ± Sensory limb ± CN V ± Motor response ± CN VII .‡ Note: blinking of the eyes.

CN VII ± Facial Nerve ‡ Function ± Motor: ‡ Facial movements ± Sensory: ‡ Taste on the anterior 2/3 of the tongue ‡ What to test? ± Facial movements ± Taste .

Techniques of Examination ‡ Raise both eyebrows ‡ Frown ‡ Close both eyes tightly ‡ Show both upper and lower teeth ‡ Smile ‡ Puff out cheeks ‡ Note any weakness or asymmetry .

CN VIII .Vestibulocochlear ‡ Function ± Sensory ± Hearing (cochlear division) ± Balance (vestibular division) ‡ What to test? ± Hearing ± Balance .

Techniques of Examination ‡ Assess hearing ‡ Test for Lateralization ± Weber Test .

‡ Compare air and bone conduction ± Rinne Test .

CN IX ± Glossopharyngeal Nerve ‡ Function ± Motor: ‡ Pharynx ± Sensory: ‡ Posterior portion of the eardrum and ear canal ‡ Pharynx ‡ Taste on the posterior tongue .

CN IX ± Glossopharyngeal Nerve ‡ What to test? ± Swallowing ± Gag reflex .

larynx ± Sensory: ‡ Pharynx. larynx ‡ What to test? ± Swallowing ± Rise of the Palate ± Gag Reflex .CN X ± Vagus Nerve ‡ Function ± Motor: ‡ Palate. pharynx.

Techniques of Examination CN IX and CN X ‡ Voice quality: ± Hoarseness in vocal cord paralysis ± Nasal voice in paralysis of the palate ‡ Is there difficulty in swallowing? .

‡ Ask patient to say ³AH´ or yawn ± Watch movement of soft palate and pharynx ‡ Soft palate normally rises symmetrically ‡ Uvula should remain at the midline ‡ Posterior pharynx moves medially like a curtain .

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‡ Test the Gag Reflex ± Stimulate the back of the throat lightly on each side in turn ± Note presence of gag reflex .

CN XI ± Spinal Accessory Nerve ‡ Function ± Motor ± Sternomastoid ± Upper portion of the trapezius ‡ What to test? ± Shoulder movement ± Neck movement .

Techniques of Examination ‡ Look for atrophy or fasciculation in the trapezius muscles ± Compare one side with the other ‡ Shoulder shrug ± Note strength and contraction of the trapezius .

‡ Head turn to sides ± Ask patient to turn head at each side against your hand ± Observe contraction of the opposite sternomastoid muscle ± Note force of the movement against your hand .

CN XII ± Hypoglossal Nerve ‡ Function ± Motor ± Tongue ‡ What to test? ± Tongue symmetry and position .

Techniques of Examination ‡ Listen to the articulation of the patient ± (CN V. VII. X and XII) ‡ Observe for atrophy or fasciculation ‡ Ask patient to protrude tongue ± Look for symmetry ± Atrophy ± Deviation from the midline ‡ Ask to move tongue from side to side .

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ABNORMALITIES .

hydrocephalus .INCREASE INTRCRANIAL PRESSURE CAUSES .edema .Trauma .inflammation .tumors .hemorrhage .

Ct scan result .

most sensitive and earliest indication of increasing ICP ‡ Headache ‡ Abnormal respiration ‡ Inc BP ‡ Slowing of pulse ‡ Elevated temp ‡ Vomiting ‡ Pupil changes .assessment ‡ LOC.

widened pulse presure. slowed HR .assessment ‡ Changes in motor function from weakness to hemiplegia ‡ Positive babinski reflex ‡ Decorticate or decerebrate posturing ‡ Siezure ‡ Late signs: inc systolic BP.

environmental stimuli .PCO2 at 30. Ventilator.35mmhg Maintain normal temp Prevent shivering Dec.Nursing interventions ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Semi-fowlers position Prevent flexion if the neck and hips Monitor resp status Do not give morphine sulfate Mech.

Continuation« ‡ Monitor electrolyte levels and acid base balance ‡ Monitor intake and output ‡ Limit fluid to 1200ml/day ‡ Instruct client to avoid valsalva maneuver .

trauma .malformation .tumors .hemorrhage .infection .Hydrocephalus ‡ Imbalance of CSF absorption or production ‡ Causes.

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frontal bossing and sunsetting eyes .thin.inc.cracked pot sound .tense. head circum. .Assessment ‡ Infant . . widely separated bones of thye head. bulging anterior fontanel and non-pulsating -dilated scalp veins.macewen¶s sign.

ataxia .headache on awakening .late signs: high shrill cry : seizure activities .Child .nystagmus .nausea and vomiting .irritability and lethargy .

prevent further CSF accumulation a.Treatment ‡ Surgery Goal. Ventriculoperitoneal shunt b. atrioventricular shunt .

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HA & Loss of appetite .Intervention post-op post‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Monitor vs and neurological signs Position patient on the unoperated site Flat on bed Observe inc ICP Monitor signs of infection and assess dressing Measure head circum Administer meds Toddler.

skull fractures .use of nasal spray .Meningitis ‡ Inflammation of the arachnoid and pia mater of the brain and spinal cord ‡ Bacteria or viral ‡ PF: .URTI .immunocompromized ind .brain or spinal injury .

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Assessment ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Mild lethargy Memory changes Short attention span Personality and behavior changes Severe headache Gen muscle aches and pains Nausea and vomiting Fever and chills .

continuation ‡ ‡ ‡ ‡ ‡ ‡ Tachycardia Deterioration of LOC Photophobia Kernig¶s sign (+) Brudzinski¶s sign (+) Red macular rash with meningococcal miningitis ‡ Abdominal and chest pain in viral .

Nursing interventions ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Monitor VS and neurological signs WOF Inc ICP Seizure precaution Perform cranial nerve assessment Assess peripheral vascular status Iso in bacterial cause Resp iso for pt with pneumococcal meningits Administer antibiotics .

Open.Head injury ‡ Trauma to the skull resulting in mild to extensive damage to the brain.fracture in the skull .scalp laceration . hematoma. cerebral bleeding and seizure ‡ Types 1. ‡ Complications.Inc ICP.interruption of the dura mater .

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Neurological signs .Airway and breathing pattern changes .concussion .Inc ICP .fractures ASSESSMENT: .continuation 2.contusions . Closed.Changes in LOC .

weakness and paralysis .seizure activity . pupillary changes.CSF drainage from the ear of nose .visual disturbances. papilledema.‡ Continuation« . nausea and vomiting . extraoccular eye movement .nuchal rigidity .HA.

motor and sensory function .Nursing interventions ‡ ‡ ‡ ‡ ‡ ‡ ‡ Monitor resp status Monitor neurological status and VS Monitor for inc ICP Elevate head Prevent nck flexion Normothermia measures Assess CN function. reflexes.

do not clean Notify pt if there is drainage Avoid coughing Monitor for signs of infection Prevent complication of immobility .continuation ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Seizure precaution Monitor for pain and restlessness Do not give morphine sulfate Ear and nasal drainage.

Spinal Cord Injury ‡ Trauma to the spinal cord which causes partial or complete disruption of nerve tracts and neurons ‡ Contusion. reflex activity. laceration or compression of the cord ‡ Loss of motor function. bowel and bladder control . sensation.

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Most common causes ‡ ‡ ‡ ‡ ‡ ‡ Motor vehicle accidents Fall Sporting Industrial accidents Stab wounds Gunshot wounds .

6.Most frequently involve vertebrae ‡ Cervical 5. 7 ‡ Thoracic 12 ‡ Lumbar 1 .

assessment ‡ ‡ ‡ ‡ ‡ ‡ Dependent on the level of the cord injury Resp status chages Sensory and motor changes Total sensory loss and motor paralysis Loss of reflex Loss of bowel and bladder control .

critical .maintain a patent airway . rotation or extension -logroll the client .avoid head flexion.Nursing intervention ‡ Emergency .immobilized client .always suspect a spinal cord injury .

Hospital interventions ‡ ‡ ‡ ‡ ‡ ‡ Resp system Cardiovscular Neuromuscular GIT Renal system integumentary .

Spinal Shock ‡ Neurogenic shock ‡ Sudden depression of reflex activity in the spinal cord just below the level of injury(areflexia) ‡ Occurs within the 1st hr of injury and can last days to months ‡ Muscles are paralyzed and flaccid ‡ Ends when reflexex are regained .

assessment ‡ ‡ ‡ ‡ Flaccid pralysis Hypotension Bradycardia Loss of reflex activity below the level of injury ‡ Paralytic ileus .

Nursing interventions ‡ ‡ ‡ ‡ ‡ ‡ ‡ Monitor signs of spinal shock WOF hypotension and bradycardia Monitor for reflex activity Assess bowel sounds Monitor for bowel and urinary retentions Supportive measures Monitor the return of reflexes .

Autonomic Dysreflexia ‡ Autonomic hyperflexia ‡ Visceral distention from a distended bladder or impacted rectum ‡ Neurological emergency ‡ Generally occurs after spinal shock ‡ Occurs with lesions above T6 or in cervical lesions .

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Assessment ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Hypertention Bradycardia Flushing of the face and neck Severe. restlessness Dilated pupils and blurred vision . throbbing HA Nasal stuffiness Piloerection Sweating. nausea.

Nursing intervention ‡ Notify physician ‡ Assess the potential cause and remove the stimulus ‡ High-fowlers position ‡ Loosen tight clothing ‡ VS q 15 mins ‡ Assess for bladder distention. fecal impac ‡ Administer antihypertensive .

Cerebral Aneurysm ‡ Dilatation of the walls of a weakened cerebral artery ‡ Can lead to rupture .

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Diplopia 4. Nausea 7. Blurred vision 5. Pain 3. Headache 2. nuchal rigidity 9. irritability 10.assessment 1. Tinnitus 6. seizure . Hemiparesis 8.

darkened room .fluid restriction .Nursing intervention ‡ ‡ ‡ ‡ ‡ Maintain a patent airway Administer oxygen Monitor VS Avoid taking temp via the rectum Aneursym precaution.avoid stimulants in the diet .bedrest in semifowlers position .

tumors . excessive discharge of electrical activity within the brain ‡ Epilepsy.infection .genetic factors . sudden.chronic seizure that indicates brain or CNS irritation ‡ Causes.Seizure ‡ Abnormal.toxicity .circulatory or metabolic disorders .

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Occurences before.assessment . loss of motor activity .Prodromal signs .Aura .partial seizure .Type of seizure.general seizure .LOC. during and after .Seizure history .

Nursing intervention ‡ Note the time and duration of seizure ‡ assess behavior before attack ‡ Place pt on the floor and protect body and the head ‡ Maintain patent airway ‡ Administer O2 ‡ Suction secretion ‡ Turn the client¶s head to the side .

continuation ‡ ‡ ‡ ‡ ‡ ‡ Prevent injury during seisure Do not restrain client Loosen restrictive clothing Monitor incontinence Administer meds Avoid alcohol. fatigue . excessive stress.

EEG. focal neurological deficit Anoxia lasting more than 10 mins diagnosis: CT scan. cerebral angiography .Cerebrovascular accident ‡ ‡ ‡ ‡ CVA Sudden .

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Thrombosis Embolism Hemorrhage TIA . 4. 2. 3.causes 1.

Risk factors ‡ ‡ ‡ ‡ ‡ ‡ ‡ Atherosclerosis Hypertension Anticoagulation therapy DM Stress Obesity OC .

contralateral Airway patency.slow and bounding Respiration( cheyne-stokes) BP HA. nausea and vomiting Facial drooping Nuchal rigidity Visual changes .Assessment ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Depend on the area of the brain affected Cerebral hemisphere.priority Pulse.

heat and cold Bowel and bladder dysfunction paralysis .‡ ‡ ‡ ‡ ‡ ‡ Ataxia Dysphagia Speech changes Dec sensation to pressure .

repeat names of object freq used .task 1 step at a time .broca¶s area ‡ 2. global or mixed. receptive ± wernicke¶s area ‡ 3.both ‡ Intervention for aphasia .provide repetitive direction . expressive.pic board or comm board .aphasia ‡ 1.

fatigue.pregnancy. stress.Multiple Sclerosis ‡ ‡ ‡ ‡ Chronic.infection and trauma ‡ LP. progressive. noncontagious Demyelinization of the neurons Ages 20-40 PF. normal serum globulin ‡ Remission and exacerbation .inc gamma globulin.

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ataxia and intentional tremors.nystagmus. ‡ Urinary retention or incontinence ‡ Constipation ‡ Dec sexual activity . diplopia. scotoma ‡ Impaired sensation ‡ Mood swings or euphoria ‡ Impaired motor function ‡ Impaired cerebellar function.Assessment ‡ Visual disturbances.blurring of vision.

MYASTHENIA GRAVIS ‡ NEUROMUSCULAR DISEAESE CHARCTERIZED BY CONSIDERABLE WEAKNESS AND ABNORMAL FATIGUE OF THE VOLUNTARY MUSCLE ‡ A DEFECT IN THE TRANSMISSION OF NERVE IMPULSES AT TNE MYONEURAL JUNCTION .

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CAUSES ‡ INSUFICIENT SECRETION OF ACETYLCHOLINE ‡ EXCESSIVE SECRETION OF CHILENESTERASE ‡ UNRESPONSIVNESS OF THE MUSCLE FIBERS TO ACETYLCHOLINE .

ASSESSMENT ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ WEAKNESS AND FATIGUE DIFFICULTY IN CHEWING DYSPHAGIA PTOSIS DIPLOPIA WEAK HOARSE VOICE DIFFICULTY BREATHING DIMINISHED BREATH SOUNDS RESPIRATORY PARALYSIS AND FAILURE .

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‡ MG .

INTERVENTIONS ‡ MONITOR RESP STATUS ‡ SUCTION AND EMERGENCY EQUIPMENT AT BEDSIDE ‡ MONITOR vs ‡ MONITOR SPEECH AND SWALLOWING ABILITIES ‡ CONSERVE STRENGTH ‡ SHORT ACTIVITIES .

MS ‡ Give medication ‡ Monitor myasthenia and cholinergic crisis ‡ Avoid stress. infection. fatigue and over the counter medication ‡ Medic alert bracelet .

Anticholinesterase meds ‡ Inc levels of acetylcholine at the myoneural junction ‡ Neostigmine bromide(prostigmine) ‡ Pyridostigmine bromide( mestinon. regonol) ‡ Edrophonium chloride( tensilon) .

Side effects ‡ ‡ ‡ ‡ ‡ ‡ Sweating Salivation Nausea Diarrhea and abdominal cramps Bradycardia hypotension .

intervention ‡ Give meds on time ‡ 30 mins before meals and with milk and crackers ‡ Monitor and record muscle strength ‡ Antidote: atropine sulfate .

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SCD. PROGRESSIVE DSE THAT RESULTS IN A CRIPPLING DISABILITY ‡ DEBILITATION CAN RESULTS IN FALLS.LATER .PARKINSONS DISEASE ‡ DEGENERATIVE DISEASE CAUSE BY THE DEPLETION OF DOPAMINE ‡ SLOW. FAILURE OF BODY SYSTEMS AND DEPRESSION ‡ MENTAL DETERIORATION.

‡ PD .

ASSESSMENT ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Bradykinesia Akinesia Monotonous speech Changes in handwriting Pill rolling Rigidity with jerky interrupted movement Restlessness Mask-like face .

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stooped position and propulsive gait .PD ‡ ‡ ‡ ‡ Difficulty swallowing Difficulty speaking Loss of coordination and balance Shuffling steps.

intervention ‡ ‡ ‡ ‡ ‡ ‡ ‡ Assess neurological status Assess ability to swallow and chew Small frequent feeding Inc fluid intake Promote independence Avoid rushing client with activities Instruct client to rock back and forth to initiate movement .

prone position without a pillow ‡ PT ‡ administer meds ‡ Antiparkinsonian meds .PD ‡ Wear low heeled shoes ‡ Lift feet when walking and avoid prolonged sitting ‡ Provide firm mattress.

PD ‡ Avoid Vit B6 ‡ Avoid monoamine inhibitors .

GUILLAINGUILLAIN-BARRE SYNDROME ‡ ACUTE INFECTIOUS NEURONITIS OF THE CRANIAL AND PERIPHERAL NERVES ‡ AUTOIMMUNE REACTION ‡ USUALLY PRECEEDED BY A MILD UPPER RESP INFECTION OR GSTRO ENTERITIS ‡ RECOVERY IS A SLOW PROCESS ‡ MAJOR CONCERN-DIFF IN BREATHING .

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ASSESSMENT ‡ PARESHTESIAS ‡ WEAKNESS OF LOWER EXTREMITIES ‡ GRADUAL PROGRESSIVE WEAKNESS OF UPPER EXTREMITIES AND FACIAL MUSCLES ‡ POSSIBLE PROGRESSION TO RESP FAILURE .

GBS ‡ CARDIAC ARRYTHMIAS ‡ CSF REVEAL AN ELEVATED PROTEIN LEVEL ‡ ABNORMAL EEG .

CARDIAC STATUS ‡ ASSESS FOR COMPLICATIONS ‡ PROVIDE THE CLIENT AND FAMILY WITH SUPPORT .INTERVENTIONS ‡ CARE DIRECTED TOWARD THE TX OF SYMPTOMS ‡ MONITOR RESP.

RN . Catungal.Thank you very much The end Ferdinand G.

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