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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
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizures vs. Epilepsy
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Seizure: A seizure is 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.
Generalize or Partial
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Epilepsy: is defined by the National Institute of Neurological
Disorders and Stroke as two or more seizures experienced by a
person; manifest with different characteristics- look up tonicclonic, absent, etc.
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Types:
Primary or idiopathic: no known cause, but genetic link
Secondary: known cause for example, tumor, injury
infection
,
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
What is the Role of Neurons?
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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.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizure/Epilepsy Diagnosis
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EEG
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CT or MRI
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Labs
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizure Risks
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May result from:
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Metabolic disorders
Acute alcohol withdrawal
Electrolyte disturbances
Heart disease
High fever
Stroke
Substance abuse
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizure Assessment
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Questions:
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Ask patient or relative how many, how long they last
and any patterns
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Describe movement
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Any aura?
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Medications
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Any risks?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizure Precautions
 Oxygen
 Suction equipment
 Airway
 IV access
 Side rails up
 Nothing inserted
into mouth
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Seizure Management
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Depends on type of seizure
Observation and documentation
Patient safety
Side-lying position
No restraints
Nothing in mouth
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Acute Seizure Management
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Lorazepam (Ativan)
Diazepam (Valium)
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Surgical Management
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Nerve stimulation (VNS)
Conventional surgical procedures
Anterior temporal lobe resection
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Patient & Family Education
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Compliance with medication
Discrimination prohibited (ADA)
Alternative employment may be needed
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Meningitis
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Meningitis: is an inflammation of the meninges
that surround the brain and spinal cord
Block 2:
Viral
Bacterial
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Physical Assessment & Clinical
Manifestations
Question for 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- look up what these are
 Decreased mental status
 Focal neurological deficits
 GI symptoms
 Nausea and vomiting
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Laboratory Assessment of Meningitis
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CSF analysis (lumbar puncture)
CT scan
Blood cultures
CBC
X-rays to determine presence of infection
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Assessment
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Priority: Decreased (or change in) level of
consciousness
Priority: Disoriented to person, place, and year
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Pupil reaction and eye movements:
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Photophobia
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Nystagmus
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Abnormal eye movements
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Motor response: Normal early in disease process
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Hemiparesis, hemiplegia & later decreased muscle
tone possible
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Assessment Continued
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Cranial nerve dysfunction, especially CN III, IV, VI, VII,
VIII
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Memory changes: Attention span (usually short)
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Personality and behavior changes
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Bewilderment
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Severe, unrelenting headaches
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Generalized muscle aches and pain
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Nausea and vomiting
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Fever and chills
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Tachycardia
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Red macular rash (meningococcal meningitis)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Drug Therapy
Broad-spectrum antibiotic (one exampleVancomycin)
 Hyperosmolar agents (example- mannitol)
 Anticonvulsants (control seizures)
 Steroids (controversial)
 Barbiturates (drug induced coma)
 Prophylaxis antibiotic treatment for those in close
contact with meningitis-infected patient
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Encephalitis
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Inflammation of brain tissue and surrounding
meninges
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Affects cerebrum, brainstem and cerebellum
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Viral agent most common but also bacteria, fungi,
or parasites (example malaria is a parasite
transmitted form bites of mosquitos)
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Virus travels to CNS via bloodstream, along
peripheral or cranial nerves or meninges (varicella
zoster)
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Inflammatory response but no exudate
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Encephalitis
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Pathophysiology-refer to lecture prep
Causes-refer to lecture prep
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)
Nursing- 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
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Hemorrhagic Encephalitis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.