Download Ignatavicius: Medical-Surgical Nursing, 7th Edition

Ignatavicius: Medical-Surgical Nursing, 7th Edition
Chapter 44: Care of Patients with Problems of the Central Nervous System: The Brain
Key Points

Acute CNS infections and common chronic neurodegenerative diseases of the brain may
impair a person’s needs for mobility and cognition.
 The brain is part of the central nervous system that functions as the body’s center for
controlling movement, sensation, and cognition.
 Health problems involving disease damage of the brain can be acute or chronic and often
affect the patient’s level of independence and quality of life.
SEIZURES AND EPILEPSY
 A seizure is an abnormal, sudden, excessive, uncontrolled electrical discharge of neurons
resulting in alteration in consciousness, motor or sensory ability, or behavior.
 Seizures may be due to a pathologic condition of the brain, such as a tumor.
 Epilepsy is defined as two or more seizures experienced by a person.
 The International Classification of Epileptic Seizures recognizes three broad categories of seizure
disorders: generalized seizures, partial seizures, and unclassified seizures.
 Primary or idiopathic epilepsy is not associated with any identifiable cause.
 Secondary seizures result from an underlying brain lesion, most commonly a tumor, trauma,
or metabolic or other disorders.
 Most seizures can be completely or almost completely controlled through the administration
of antiepileptic drugs, referred to as anticonvulsants.
 Emphasize that the drugs must not be stopped even if the seizures have stopped as the
recurrence of seizures or status epilepticus may occur.
 The actions taken during a seizure should be appropriate for the type of seizure, such as
observation, timing, turning the patient on the side to prevent aspiration and allow secretions
to drain, and removing any objects that might injure the patient.
 For a patient having a tonic-clonic or complete partial seizure, protect the patient from injury.
 Recognize that generalized seizures, such as the tonic-clonic seizure, involve both cerebral
hemispheres. Partial seizures, also called focal or local seizures, usually involve only one
hemisphere.
 For patients who have had one or more seizures, place on “seizure precautions,” which
includes having oxygen and suctioning emergency equipment available, starting an IV access,
and keeping the siderails up at all times. Indicate the reasons for the siderails to meet The
Joint Commission requirements.
 During a seizure, document patient’s body movements and other assessments.
 Patients with status epilepticus have a life-threatening complication. Lorazepam and diazepam
are the major drugs used for this emergency.
 Status epilepticus is a medical emergency characterized by prolonged seizures lasting more
than 5 minutes or repeated seizures over the course of 30 minutes.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
44-2
 Causes of status epilepticus may include withdrawal from antiepileptic drugs, alcohol or other
drugs, head trauma, infections, cerebral edema, and metabolic disturbances.
 Patients who cannot be managed effectively with medication may be candidates for surgery,
including vagal nerve stimulation and conventional surgical procedures.
 Emphasize the importance of taking their antiseizure medications as prescribed. Instruct
patients that they can build up sensitivity to the drugs as they age.
o If sensitivity occurs, tell them they will need to have blood levels of this drug
checked frequently to adjust the dose.
o In some cases, the antiseizure effects of drugs can decline and will lead to an
increase in seizures.
o Because of this potential for “drug decline and sensitivity,” patients need to keep
their scheduled lab appointments.
INFECTIONS
 Meningitis is an inflammation of the meninges surrounding the brain and spinal cord.
 Bacterial and viral organisms are most often responsible for meningitis, although fungal
meningitis and protozoal meningitis also occur.
 Viral meningitis is usually self-limiting and the patient has a complete recovery; but bacterial
meningitis is potentially life-threatening.
 Increased intracranial pressure may occur as a result of blockage of the flow of CSF, change
in cerebral blood flow, or thrombus formation.
 Analysis of the cerebrospinal fluid is used to diagnose meningitis.
 Patients who are older than 60 years of age, immunocompromised, or with signs of increased
intracranial pressure (ICP) usually have a CT scan performed before the lumbar puncture.
 For patients with meningitis, carefully monitor neurologic status, including vital signs and
neurovascular checks. Observe for signs and symptoms of increased intracranial pressure
(ICP).
 Standard precautions are appropriate for most patients with meningitis unless the patient has a
bacterial infection that is transmitted by droplets.
 Encourage people in areas of high population density, such as college dormitories and
crowded living areas, to become immunized against meningococcal meningitis.
 Encephalitis is an inflammation of the brain tissue and often the surrounding meninges,
affecting the cerebrum, the brainstem, and the cerebellum.
 A viral agent elsewhere in the body most often causes the disease, although bacteria, fungi, or
parasites may also be involved.
 Viral encephalitis can be life-threatening or lead to persistent neurological problems such as
learning disabilities, epilepsy, memory loss, and fine motor deficits.
 In severe cases of encephalitis, the patient may exhibit increased ICP resulting from cerebral
edema, hemorrhage, and necrosis of brain tissue.
 Assess level of consciousness (LOC) as a priority in patients with encephalitis.
 Lumbar puncture and diagnostic analysis of CSF may be helpful, depending on the patient’s
condition.
 Supportive nursing care and prompt recognition and treatment of increased ICP are essential
components of management.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points - Print
44-3
 Teach older adults and those with chronic illness to have influenza and pneumonia vaccines.
 Teach people who enjoy outdoor activities to avoid areas where mosquitoes and ticks are
likely to populate, especially near lakes and wooded areas. If they are in contact with these
areas, remind them (especially older adults) to use insect repellent and keep skin exposure at a
minimum.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.