CCCTC



Overview of Anatomy and PhysiologyStructural divisionsCentral nervous system (CNS)Brain and spinal cordPeripheral nervous systemSomatic nervous systemSends messages from the CNS to the skeletal muscles; voluntaryAutonomic nervous systemSends messages from the CNS to the smooth muscle, cardiac muscle, and certain glands; involuntaryOverview of Anatomy and PhysiologyCells of the nervous systemNeuronNeuromuscular junctionNeurotransmittersAcetylcholine; norepinephrine; dopamine; serotoninNeuron coveringsFigure 54-1Overview of Anatomy and PhysiologyCentral nervous systemBrainCerebrumDiencephalonCerebellumBrain stemMidbrain; pons; medulla oblongata; coverings of the brain and spinal cord; ventriclesSpinal cordFigure 54-2Overview of Anatomy and PhysiologyPeripheral nervous systemSpinal nervesCranial nervesAutonomic nervous systemSympathetic nervous systemParasympathetic nervous systemFigure 54-4Overview of Anatomy and PhysiologyEffects of normal aging on the nervous systemLoss of brain weightLoss of neuronsReduction in cerebral blood flowDecrease in brain metabolism and oxygen utilizationDecreased blood supply to spinal cord causes decreased reflexesOverview of Anatomy and PhysiologyPrevention of neurological problemsAvoid drug and alcohol useSafe use of motor vehiclesSafe swimming practicesSafe handling and storage of firearmsUse of hardhats in dangerous construction areasUse of protective padding as needed for sportsAssessment of the Neurological SystemHistoryMental statusLevel of consciousnessGlasgow coma scaleLanguage and speechCranial nerve functionMotor functionSensory and perceptual statusLaboratory and Diagnostic ExaminationsBlood and urineCultureDrug screensArterial blood gasesCerebrospinal fluidComputed tomography (CT)Brain scanMRI scanPET scanLumbar punctureFigure 54-6Laboratory and Diagnostic ExaminationsElectroencephalogramMyelogramAngiogramCarotid duplexDigital subtraction angiographyElectromyogramEchoencephalogramCommon Disorders of the Neurological SystemHeadachesEtiology/pathophysiologySkull and brain tissues are not able to feel sensory painVascular headachesMigraineClusterHypertensive Tension headachesTraction-inflammation headachesCommon Disorders of the Neurological SystemHeadaches (continued)Clinical manifestations/assessmentHead painMigraine headachesProdromal (early sign/symptom)Visual field defects, unusual smells or sounds, disorientation, paresthesiasDuring headacheNausea, vomiting, light sensitivity, chilliness, fatigue, irritability, diaphoresis, edemaCommon Disorders of the Neurological SystemHeadaches (continued)Medical management/nursing interventionsPharmacological managementMigraine headachesAspirin, acetaminophen, ibuprofenErgotamine tartrateCodeine; InderalDietary recommendationsLimit MSG, vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and porkPsychotherapyCommon Disorders of the Neurological SystemHeadaches (continued)Medical management/nursing interventionsCluster headachesNarcotic analgesicsTension headachesNon-narcotic analgesicsTraction-inflammatory headachesTreat causeComfort measuresCold packs to forehead or base of skullPressure to temporal arteriesDark room; limit auditory stimulationCommon Disorders of the Neurological SystemNeuropathic painEtiology and pathophysiologyMay arise from several occurrencesThe pain transmission is not fully understoodClinical manifestationsRanges from mild to excruciatingChanges in ability to carry out ADLsMedical management/nursing implicationsPharmacological managementAnticonvulsants; nonopioid analgesics; antidepressantsComfort measuresCommon Disorders of the Neurological SystemIncreased intracranial pressureEtiology/pathophysiologyIncrease in any content of the craniumSpace-occupying lesions, cerebrospinal problems, cerebral edemaClinical manifestations/assessmentDiplopiaHeadacheDecreased level of consciousnessPupillary signsCommon Disorders of the Neurological SystemIncreased intracranial pressure (continued)Clinical manifestations/assessment (continued)Widening pulse pressureBradycardiaRespiratory problemsHigh, uncontrolled temperaturesPositive Babinski’s reflexSeizures PosturingVomitingSingultusCommon Disorders of the Neurological SystemIncreased intracranial pressure (continued)Medical management/nursing interventionsTreat cause if possiblePharmacological managementCorticosteroidsAntacids; histamine-receptor blockersAnticonvulsantsMechanical decompressionCraniotomyCraniectomyInternal monitoring devicesICP Monitoring:Common Disorders of the Neurological SystemDisturbances in muscle tone and motor functionEtiology/pathophysiologyDamage to the nervous system causes serious problems in mobilityClinical manifestations/assessmentFlaccid or hyperreflexic muscle toneClumsiness or incoordinationAbnormal gaitCommon Disorders of the Neurological SystemDisturbances in muscle tone and motor function (continued)Medical management/nursing interventionsMuscle relaxantsProtect from fallsAssess skin integrityPositioningSit up and tuck chin when eatingEncourage patient to assist with ADLsEmotional supportOther Disorders of the Neurological SystemEpilepsy or seizuresEtiology/pathophysiologyTransitory disturbance in consciousness or in motor, sensory, or autonomic function due to sudden, excessive, and disorderly discharges in the neurons of the brain; results in sudden, violent, involuntary contraction of a group of musclesTypes: grand mal; petit mal; psychomotor; Jacksonian-focal; myoclonic; akineticStatus epilepticusOther Disorders of the Neurological SystemEpilepsy or seizures (continued)Clinical manifestations/assessmentDepends on type of seizureAuraPostictal periodMedical management/nursing interventionsDuring seizure: Protect from aspiration and injuryAnticonvulsant medicationsSurgeryRemoval of brain tissue where seizure occursOther Disorders of the Neurological SystemEpilepsy or seizures (continued)Medical management/nursing interventions (continued)Adequate restGood nutritionAvoid alcoholAvoid driving, operating machinery, and swimming until seizures are controlledGood oral hygieneMedic Alert tagDegenerative DiseasesMultiple sclerosisEtiology/pathophysiologyDegenerative neurological disorder with demyelination of the brain stem, spinal cord, optic nerves, and cerebrumFigure 54-13Demylination:Degenerative DiseasesMultiple sclerosis (continued)Clinical manifestations/assessmentVisual problemsUrinary incontinenceFatigueWeaknessIncoordination Sexual problemsSwallowing difficultiesDegenerative DiseasesMultiple sclerosis (continued)Medical management/nursing interventionsNo specific treatmentPharmacological managementAdrenocorticotropic hormone (ACTH)SteroidsValiumBetaseron (interferon beta-1b)Avonex (interferon beta-1a)Pro-banthine; urecholineBactrim, Septra, and MacrodantinDegenerative DiseasesMultiple sclerosis (continued)Medical management/nursing interventionsNutritionSkin careActivityEnvironmental controlsPatient teachingDegenerative DiseasesParkinson’s diseaseEtiology/pathophysiologyDeficiency of dopamineClinical manifestations/assessmentMuscular tremors; bradykinesiaRigidity; propulsive gaitEmotional instabilityHeat intoleranceDecreased blinking“Pill-rolling” motions of fingersParkinson’s SyndromeFigure 54-14Degenerative DiseasesParkinson’s disease (continued)Medical management/nursing interventionsPharmacological managementLevodopaSinemetArtaneCogentinSymmetrolSurgeryActivityNutritionDegenerative DiseasesAlzheimer’s diseaseEtiology/pathophysiologyImpaired intellectual functioning Chronic, progressive degeneration of the cells of the brainBrain changes include plaques in the cortex, neurofibrillary tangles, and the loss of connections between cells and cell deathDegenerative DiseasesAlzheimer’s disease (continued)Clinical manifestations/assessmentEarly stageMild memory lapses; decreased attention spanSecond stageObvious memory lapsesThird stageTotal disorientation to person, place, and timeApraxia; wanderingTerminal stageSevere mental and physical deteriorationDegenerative DiseasesAlzheimer’s disease (continued)Medical management/nursing interventionsPharmacological managementAgitation: Lorazepam; HaldolDementia: Cognex; AriceptNutritionFinger foods; frequent feedings; encourage fluidsSafetyRemove burner controls at nightDouble-lock all doors and windowsConstant supervisionDegenerative DiseasesMyasthenia gravisEtiology/pathophysiologyNeuromuscular disorder; nerve impulses fail to pass at the myoneural junction; causes muscular weaknessClinical manifestations/assessmentPtosis; diplopiaSkeletal weakness; ataxiaDysarthria; dysphagiaBowel and bladder incontinenceDegenerative DiseasesMyasthenia gravis (continued)Medical management/nursing interventionsPharmacological managementAnticholinesterase drugsProstigminMestinonCorticosteroidsMay require mechanical ventilationDegenerative DiseasesAmyotrophic lateral sclerosis (ALS)Etiology/pathophysiologyMotor neurons in the brain stem and spinal cord gradually degenerateElectrical and chemical messages originating in the brain do not reach the muscles to activate themLou Gehrig’s diseaseDegenerative DiseasesAmyotrophic lateral sclerosis (ALS) (continued)Clinical manifestations/assessmentWeakness of the upper extremitiesDysarthria; dysphagiaMuscle wastingCompromised respiratory functionMedical management/nursing interventionsNo cureRilutec (Riluzole)Multidisciplinary ALS teams; emotional supportDegenerative DiseasesHuntington’s diseaseEtiology/pathophysiologyOveractivity of the dopamine pathwaysGenetically transmittedClinical manifestations/assessmentAbnormal and excessive involuntary movements (chorea)Ataxia to immobilityDeterioration in mental functionsDegenerative DiseasesHuntington’s disease (continued)Medical management/nursing interventionsNo cure; palliative treatmentPharmacological managementAntipsychoticsAntidepressantsAntichoreasSafe environmentEmotional supportHigh-calorie dietVascular ProblemsStroke (cerebrovascular accident)Etiology/pathophysiologyAbnormal condition of the blood vessels of the brain: thrombosis; embolism; hemorrhageResults in ischemia of the brain tissueClinical manifestations/assessmentHeadacheSensory deficitHemiparesis; hemiplegiaDysphasia or aphasiaFigure 54-17Vascular ProblemsStroke (cerebrovascular accident) (continued)Medical management/nursing interventionsThrombosis or embolismThrombolyticsHeparin and CoumadinDecadronNeurological checksNutritional interventionsPhysical, occupational, and/or speech therapyCranial and Peripheral Nerve DisordersTrigeminal neuralgiaEtiology/pathophysiologyDegeneration of or pressure on the trigeminal nerve; tic douloureuxClinical manifestations/assessmentExcruciating, burning facial painMedical management/nursing interventionsTegretolSurgical resection of the trigeminal nerveAvoid stimulation of face on affected sideCranial and Peripheral Nerve DisordersBell’s palsy (peripheral facial paralysis)Etiology/pathophysiologyInflammatory process involving the facial nerveClinical manifestations/assessmentFacial numbness or stiffnessDrawing sensation of the faceUnilateral weakness of facial musclesReduction of salivaPain behind the earRinging in ear or other hearing lossCranial and Peripheral Nerve DisordersBell’s palsy (peripheral facial paralysis) (continued)Medical management/nursing interventionsPharmacological managementCorticosteroidsAntiviral medicationsElectrical stimulationMoist heatMassage of the affected areaFacial exercisesCranial and Peripheral Nerve DisordersGuillain-Barré syndromeEtiology/pathophysiologyInflammation and demyelination of the peripheral nervous systemPossibly viral or autoimmune reactionCranial and Peripheral Nerve DisordersGuillain-Barré syndrome (continued)Clinical manifestations/assessmentSymptoms are progressiveParalysis usually starts in the lower extremities and moves upward; may stop at any pointRespiratory failure if intercostal muscles are affectedMay have difficulty swallowing, breathing, and speakingCranial and Peripheral Nerve DisordersGuillain-Barré syndrome (continued)Medical management/nursing interventionsAdrenocortical steroidsApheresisMechanical ventilationGastrostomy tubeMeticulous skin careRange-of-motion exercisesCranial and Peripheral Nerve DisordersMeningitisEtiology/pathophysiologyAcute infection of the meningesBacterial or asepticIncreased incidence in winter and fall monthsCranial and Peripheral Nerve DisordersMeningitis (continued)Clinical manifestations/assessmentHeadache; stiff neckIrritability; restlessnessMalaiseNausea and vomitingDeliriumElevated temperature, pulse, and respirationsKernig’s and Brudzinski’s signsCranial and Peripheral Nerve DisordersMeningitis (continued)Medical management/nursing interventionsPharmacological managementAntibioticsMassive dosesMultiple typesIV or intrathecalCorticosteroidsAnticonvulsantsAntipyreticsDark, quiet roomCranial and Peripheral Nerve DisordersEncephalitisEtiology and pathophysiologyAcute inflammation of the brain caused by a virusClinical manifestationsHeadacheFeverSeizuresChange in LOCMedical management and nursing interventionsPrimarily supportiveCranial and Peripheral Nerve DisordersWest Nile virusEtiology and pathophysiologyPrincipal route of infection through the bite of an infected mosquito Clinical manifestationsFeverHeadacheBack painMyalgiaPreventionCranial and Peripheral Nerve DisordersBrain abscessEtiology and pathophysiologyAccumulation of pus within the brain tissue Clinical manifestationsHeadacheFeverDrowsiness, changes in LOCSeizuresMedical management/nursing interventionsAntimicrobial therapySupportive careCranial and Peripheral Nerve DisordersAcquired immunodeficiency syndromeEtiology and pathophysiologySymptoms may develop from the infection with HIV or as a result of an associated infectionClinical manifestationsAIDS dementia complex (ADC)Memory lossGlobal cognitive dysfunctionMedical management/nursing interventionsAntiviral, antifungal, antibacterial agentsAnticonvulsantsSafety Cranial and Peripheral Nerve DisordersBrain tumorsEtiology/pathophysiologyBenign or malignantPrimary or metastaticMay affect any area of the brainCranial and Peripheral Nerve DisordersBrain tumors (continued)Clinical manifestations/assessmentHeadacheHearing lossMotor weaknessAtaxiaDecreased alertness and consciousnessAbnormal pupil response and/or unequal sizeSeizuresSpeech abnormalitiesCranial and Peripheral Nerve DisordersBrain tumors (continued)Medical management/nursing interventionsSurgical removal of tumorCraniotomyIntracranial endoscopyRadiationChemotherapyCombination of aboveTraumaCraniocerebral traumaEtiology/pathophysiologyMotor vehicle and motorcycle accidents, falls, industrial accidents, assaults, and sports traumaDirect trauma: Head is directly injuredIndirect trauma: Tension strains and shearing forcesOpen head injuriesClosed head injuriesHematomasTraumaCraniocerebral traumaClinical manifestations/assessmentHeadacheNauseaVomitingAbnormal sensationsLoss of consciousnessBleeding from ears or noseAbnormal pupil size and/or reactionBattle’s signTraumaCraniocerebral trauma (continued)Medical management/nursing interventionsMaintain airwayOxygenMannitol and dexamethasoneAnalgesicsAnticonvulsantsTraumaSpinal cord traumaEtiology/pathophysiologyAutomobile, motorcycle, diving, surfing, other athletic accidents, and gunshot woundsFracture of vertebraComplete cord injuryIncomplete cord injuryFigure 54-24TraumaSpinal cord trauma (continued)Clinical manifestations/assessmentLoss of muscle function depends on level of injurySpinal shockAutonomic dysreflexiaSexual dysfunctionTraumaSpinal cord trauma (continued)Medical management/nursing interventionsRealignment of bony column for fractures or dislocations: Immobilization; skeletal tractionSurgery for spinal decompressionMethylprednisoloneMobility: Slowly increase sitting upUrinary function: Foley catheter; bladder trainingIntermittent catheterizationBowel programNursing ProcessNursing diagnosesAutonomic dysreflexiaCommunication, impairedCoping, compromised familyDisuse syndrome, risk forGrievingInfection, risk forKnowledge, deficientMemory, impairedNursing ProcessNursing diagnoses (continued)Mobility, impaired physicalNutrition, imbalanced: less than body requirementsPain, acute, chronicSelf-care deficitSwallowing, impairedThought process, disturbedTissue perfusion (cerebral), ineffective ................
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