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Block 2 Neuro Concepts
CARE OF PATIENTS WITH PROBLEMS OF THE CENTRAL NERVOUS SYSTEM: THE BRAIN
BLOCK 2 FEATURED DISORDERS
SEIZURES & EPILEPSY
MENINGITIS & ENCEPHALITIS
What is the Role of Neurons?

Neurons (also called nerve cells and nerve fibers) are electrically excitable
cells in the nervous system that function to process and transmit information
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Neurons are the core components of the brain, spinal cord and peripheral
nerves

Motor Neurons cause movement or mobility
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Sensory Neurons cause sensation
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Some neurons process information and some retain
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Impulses from one neuron to another may cause excitation or inhibition
Basic Structure of Neurons
Speed Neuron Review
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When a neuron receives an impulse from another neuron, the impulse may be
excitation of inhibition as mentioned in previous slide
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Afferent neurons also known as sensory neurons, are specialized to send
impulses toward the CNS away from the PNS
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Efferent neurons are motor nerve cells that carry signals from the CNS to the
cells in the PNS

Impulses are transmitted to their destinations through the spaces between
neurons

Two distinct types of synapses are neuron-to-neuron or neuron-to-muscle (or
gland)
Seizure versus Epilepsy
Seizure: an abnormal, sudden, excessive, uncontrolled electrical
discharge of neurons within the brain that may result in a change
in level of consciousness (LOC), motor or sensory ability, and/or
behavior, generalized or partial
 Epilepsy: is defined by the National Institute of Neurological
Disorders and Stroke as two or more seizures experienced by a
person- distinguished by different characteristics
 Epilepsy Type
Primary or idiopathic: no known cause, but genetic link
Secondary: known cause for example, tumor, injury, infection

Seizure/Epilepsy Diagnosis

EEG

CT or MRI

Labs
Seizure Risks

May result from:
 Metabolic disorders
 Acute alcohol withdrawal
 Electrolyte disturbances
 Heart disease
 High fever
 Stroke
 Substance abuse
Enrichment Info
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Ethanol is a CNS depressant
Euphoria & behavior excitation at low levels
Acute intoxication at higher levels causes drowsiness,
ataxia, slurred speech, stupor and coma
Short-term effects of ETOH are actions on certain ions
Prolonged consumption leads to tolerance & physical
dependence because ion function changes
Abrupt cessation of ETOH with prolonged ETOH
consumption unmasks the ion changes & leads to ETOH
withdrawal syndrome
Withdrawal includes blackouts, tremors, muscular rigidity,
delirium tremors AND SEIZURES
Seizure Assessment

Questions:

Ask patient or relative how many, how long they last and any
patterns
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Describe movement

Any aura? (pre-ictal phase)

Medications

Any risks?
Seizure Precautions
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Oxygen
Suction equipment
Airway
IV access
Siderails up
Seizure Management
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Depends on type of seizure
Observation and documentation
Patient safety
Side-lying position
No restraints
Nothing in mouth
Acute Seizure Management
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Lorazepam (Ativan)
Diazepam (Valium)
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Drug Therapy
Evaluate most current blood level of medication,
if appropriate
 Be aware of drug-drug/drug-food interactions
 Maintain therapeutic blood levels for maximal
effectiveness
 Do not administer warfarin with phenytoin
 Document and report side/adverse effects

Surgical Management

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Nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Status Epilepticus
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Prolonged seizures that last more than 5 min or
repeated seizures over course of 30 min –
Establish airway
ABGs
IV push lorazepam or diazepam
Rectal diazepam
Loading dose IV phenytoin
Patient & Family Education
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Compliance with medication
Discrimination prohibited (ADA)
Alternative employment may be needed
Meningitis
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Meningitis: is an inflammation of the meninges
that surround the brain and spinal cord
Block 2:
Viral
Bacterial
Physical Assessment & Clinical
Manifestations
Question predisposing history:
infections, procedures or injuries?
 General symptom
 Fever
 Neurological symptoms
 Headache
 Photophobia
 Indications of increased ICP
 Nuchal rigidity
 Positive Kernig’s, Brudzinski’s signs
 Decreased mental status
 Focal neurological deficits
 GI symptoms
 Nausea and vomiting

Laboratory Assessment of Meningitis

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CSF analysis (lumbar puncture)
CT scan
Blood cultures
CBC
X-rays to determine presence of infection
Key Assessment

Priority: Decreased (or change in) level of
consciousness
Priority: Disoriented to person, place, and year

Pupil reaction and eye movements:

Photophobia
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Nystagmus
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Abnormal eye movements
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Motor response: Normal early in disease process

Hemiparesis, hemiplegia & later decreased muscle
tone possible
Key Assessment Continued
Cranial nerve dysfunction, especially CN III, IV, VI, VII, VIII
 Memory changes: Attention span (usually short)
 Personality and behavior changes
 Bewilderment
 Severe, unrelenting headaches
 Generalized muscle aches and pain
 Nausea and vomiting
 Fever and chills
 Tachycardia
 Red macular rash (meningococcal meningitis)

Drug Therapy
Broad-spectrum antibiotic (one exampleVancomycin)
 Hyperosmolar agents (example- mannitol)
 Anticonvulsants (control seizures)
 Steroids (controversial)
 Barbituates (drug induced coma)
 Prophylaxis antibiotic treatment for those in close
contact with meningitis-infected patient
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Patient Care
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ABC
VS & Neuro Checks
Cranial Nerve Assessment- particularly
III, IV, VI, VII, and VIII
Meds
I&O
Labs
Bedrest & HOB 30 degrees
Nurse safety- standard & droplet isolation with bacterial meningitis
Encephalitis

Inflammation of brain tissue and surrounding meninges

Affects cerebrum, brainstem and cerebellum

Viral agent most common but also bacteria, fungi, or parasites (example
malaria is a parasite transmitted form bites of mosquitos)

Virus travels to CNS via bloodstream, along peripheral or cranial nerves or
meninges (varicella zoster)
Inflammatory response but no exudate
NursingDrug therapy- no specific meds for aborviruses or enteroviruses, but
acyclovir is used for herpes encephalitis
 Complications-permanent neuro damage
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Encephalitis
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Pathophysiology-refer to lecture prep notes
Causes-refer to lecture prep notes
Preventative measures-control mosquitos
Physical assessment- The patient may be lethargic,
stuporous, or comatose
Mental status changes are more extensive in the patient
with encephalitis than with meningitis. Changes include
acute confusion, irritability, and personality and behavior
changes (especially noted in the presence of herpes
simplex)
NursingDrug therapy- no specific meds for aborviruses or
enteroviruses, but acyclovir is used for herpes encephalitis
Complications-permanent neuro damage
Encephalitis Management
Nursing Management: similar to meningitis but meds are different
Drug therapy- no specific meds for aborviruses or enteroviruses, but
acyclovir is used for herpes encephalitis
 Complications-permanent neuro damage


Hemorrhagic Encephalitis