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Chapter 14
Care of the Patient with a
Neurologic Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Woo Family Neurological Issues
Rosa
• Meningitis at 6 months
• Cerebral Palsy diagnosis
at 11 months
• Seizure history
Mingzhu
• TIA
• CVA with IICP

Broca’s area
• Motor aphasia


Hemiparalysis
Impaired swallow
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Slide 2
Continued
Beatrisa & Pierre
• Alzheimer’s disease
Therese
• Parkinson’s disease
Andres
Neuropathy
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Slide 3
Overview of Anatomy and
Physiology
• Structural divisions

Central nervous system (CNS)
• Brain and spinal cord

Peripheral nervous system
• Somatic nervous system

Sends messages from the CNS to the skeletal muscles;
voluntary
• Autonomic nervous system

Sends messages from the CNS to the smooth muscle,
cardiac muscle, and certain glands; involuntary
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Overview of Anatomy and
Physiology
• Cells of the nervous
system



Neuron
Neuromuscular
junction
Neurotransmitters
• Acetylcholine;
norepinephrine;
dopamine; serotonin

Neuron coverings
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Slide 5
Overview of Anatomy and
Physiology
• Central nervous system

Brain
•
•
•
•
Cerebrum
Diencephalon
Cerebellum
Brain stem

Midbrain; pons; medulla oblongata; coverings of the brain
and spinal cord; ventricles
• Spinal cord
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Slide 6
Figure 14-2
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Sagittal section of the brain (note position of midbrain).
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Slide 7
Overview of Anatomy and
Physiology
• Peripheral nervous
system

Spinal nerves
 Cranial nerves
 Autonomic nervous
system
• Sympathetic nervous
system
• Parasympathetic
nervous system
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Slide 8
Overview of Anatomy and
Physiology
• Effects of normal aging on the nervous system

Loss of brain weight
 Loss of neurons
 Reduction in cerebral blood flow
 Decrease in brain metabolism and oxygen utilization
 Decreased blood supply to spinal cord causes
decreased reflexes
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Overview of Anatomy and
Physiology
• Prevention of neurological problems

Avoid drug and alcohol use
 Safe use of motor vehicles
 Safe swimming practices
 Safe handling and storage of firearms
 Use of hardhats in dangerous construction areas
 Use of protective padding as needed for sports
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Slide 10
Assessment of the Neurological
System
• History
• Mental status
• Level of consciousness

•
•
•
•
Glasgow coma scale
Language and speech
Cranial nerve function
Motor function
Sensory and perceptual status
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Slide 11
Laboratory and Diagnostic
Examinations
• Blood and urine



Culture
Drug screens
Arterial blood gases
• Cerebrospinal fluid
• Computed
•
•
•
•
tomography (CT)
Brain scan
MRI scan
PET scan
Lumbar puncture
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Slide 12
Laboratory and Diagnostic
Examinations
•
•
•
•
•
•
•
Electroencephalogram
Myelogram
Angiogram
Carotid duplex
Digital subtraction angiography
Electromyogram
Echoencephalogram
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Slide 13
Common Disorders of the
Neurological System
• Headaches

Etiology/pathophysiology
• Skull and brain tissues are not able to feel sensory pain
• Vascular headaches



Migraine
Cluster
Hypertensive
• Tension headaches
• Traction-inflammation headaches
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Slide 14
Common Disorders of the
Neurological System
• Headaches (continued)

Clinical manifestations/assessment
• Head pain
• Migraine headaches


Prodromal (early sign/symptom)
o Visual field defects, unusual smells or sounds,
disorientation, paresthesias
During headache
o Nausea, vomiting, light sensitivity, chilliness, fatigue,
irritability, diaphoresis, edema
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Slide 15
Common Disorders of the
Neurological System
• Headaches (continued)

Medical management/nursing interventions
• Pharmacological management

Migraine headaches
o Aspirin, acetaminophen, ibuprofen
o Ergotamine tartrate
o Codeine; Inderal
• Dietary recommendations

Limit MSG, vinegar, chocolate, yogurt, alcohol, fermented
or marinated foods, ripened cheese, cured sandwich
meat, caffeine, and pork
• Psychotherapy
• What would Svetlana use for her migraines?
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Slide 16
Antimigraine Medications

Ergotamine Derivatives


Migranal
• dihydroergotamine
 Ergomar
• ergotamine
 Cafergot
• caffeine & ergotamine

Serotonin Receptor
Agonists (-triptans)
Axert


Maxalt


sumatriptan
Zomig


rizatriptan
Imitrex *


almotriptan
zolmitriptan
Relpax

elatriptan
Common Disorders of the
Neurological System
• Headaches (continued)

Medical management/nursing interventions
• Cluster headaches

Narcotic analgesics
• Tension headaches

Non-narcotic analgesics
• Traction-inflammatory headaches

Treat cause
• Comfort measures



Cold packs to forehead or base of skull
Pressure to temporal arteries
Dark room; limit auditory stimulation
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Slide 18
Common Disorders of the
Neurological System
• Neuropathic pain

Etiology and pathophysiology
• May arise from several occurrences
• The pain transmission is not fully understood

Clinical manifestations
• Ranges from mild to excruciating
• Changes in ability to carry out ADLs

Medical management/nursing implications
• Pharmacological management


Anticonvulsants; nonopioid analgesics; antidepressants
What would Andres take for his neuropathy?
• Comfort measures
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Slide 19
Common Disorders of the
Neurological System
• Increased intracranial pressure

Etiology/pathophysiology
• Increase in any content of the cranium
• Space-occupying lesions, cerebrospinal problems,
cerebral edema
• Is this an acute or a chronic problem?

Clinical manifestations/assessment
•
•
•
•
Diplopia
Headache
Decreased level of consciousness
Pupillary signs
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Slide 20
Common Disorders of the
Neurological System
• Increased intracranial pressure (continued)

Clinical manifestations/assessment (continued)
•
•
•
•
•
•
•
•
•
Widening pulse pressure
Bradycardia
Respiratory problems
High, uncontrolled temperatures
Positive Babinski’s reflex
Seizures
Posturing
Vomiting
Singultus
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Slide 21
Common Disorders of the
Neurological System
• Increased intracranial pressure (continued)

Medical management/nursing interventions
• Treat cause if possible
• Pharmacological management



Corticosteroids
Antacids; histamine-receptor blockers
Anticonvulsants
• Mechanical decompression


Craniotomy
Craniectomy
• Internal monitoring devices
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Slide 22
Common Disorders of the
Neurological System
• Disturbances in muscle tone and motor function

Etiology/pathophysiology
• Damage to the nervous system causes serious
problems in mobility
• What are Mingzhu’s symptoms during the acute phase?

Clinical manifestations/assessment
• Flaccid or hyperreflexic muscle tone
• Clumsiness or incoordination
• Abnormal gait
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Slide 23
Common Disorders of the
Neurological System
• Disturbances in muscle tone and motor function
(continued)


Consults: speech therapy, physical therapy & OT
Medical management/nursing interventions
•
•
•
•
•
•
•
Muscle relaxants
Protect from falls
Assess skin integrity
Positioning
Sit up and tuck chin when eating (90 degree)
Encourage patient to assist with ADLs
Emotional support
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Slide 24
Skeletal muscle relaxants
• Lioresal (baclofen)
• Flexeril (cyclobenzaprine)
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Slide 25
Other Disorders of the
Neurological System
• Epilepsy or seizures

Etiology/pathophysiology
• Transitory 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 muscles
• Types: grand mal; petit mal; psychomotor; Jacksonianfocal; myoclonic; akinetic
• Status epilepticus
• Which type of seizure does Rosa have? What
medications might she take?
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Slide 26
Other Disorders of the
Neurological System
• Epilepsy or seizures (continued)

Clinical manifestations/assessment
• Depends on type of seizure
• Aura
• Postictal period

Medical management/nursing interventions
• During seizure: Protect from aspiration and injury
• Anticonvulsant medications
• Surgery

Removal of brain tissue where seizure occurs
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Slide 27
Other Disorders of the
Neurological System
• Epilepsy or seizures (continued)

Medical management/nursing interventions
(continued)
•
•
•
•
Adequate rest
Good nutrition
Avoid alcohol
Avoid driving, operating machinery, and swimming until
seizures are controlled
• Good oral hygiene
• Medic Alert tag
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Slide 28
Anticonvulsants or Antiepileptic
Drugs




Seizures: sudden muscle contractions that
happen without conscious control
Etiology: disease or disorders; head injury;
idiopathic
Four major drug classes
Drug Table 16-3
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29
Barbiturates
Action
 Long duration of action and sedative effect on
the brain; action occurs in the brainstem
Uses
 Status epilepticus; to prevent and control
grand mal seizures
 May treat seizures caused by tetanus, fever,
or drugs
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30
Benzodiazepines
Action
 CNS depressants; suppress electrical
discharge in seizures
Uses
 Treat minor motor seizures; Lennox-Gastaut
syndrome (petit mal)
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31
Benzodiazepines



End in –lam or –pam
Anticonvulsant as well as sedative
Valium


Klonopin


diazepam
clonazepam
Ativan

lorazepam
Hydantoins
Action
 Work primarily on the motor cortex, where
they stop the spread of seizure activity by
increasing or decreasing Na+ ion movement
across the motor cortex during the generation
of nerve impulses
Uses
 Grand mal and psychomotor seizures, status
epilepticus, migraines, and trigeminal
neuralgia
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
33
Hydantoins



Cause gingival hyperplasia
Cannot be given NG with feeding. MUST hold
feeding for 2 hours before and after med.
Cerebyx (name alert! Not Celebrex)


fosphenytoin
Dilantin

phenytoin
Succinimides
Action and Uses
 Elevation of the seizure threshold in the
cortex and basal ganglia and reduced
synaptic response to low-frequency repetitive
stimulation; controls petit mal seizures
Adverse Reactions
Drug Interactions
 Other antiseizure agents and bone marrow–
depressing drugs
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
35
Succinimides
Action and Uses
 Elevation of the seizure threshold in the
cortex and basal ganglia and reduced
synaptic response to low-frequency repetitive
stimulation; controls petit mal seizures
Drug Interactions
 Other antiseizure agents and bone marrow–
depressing drugs
 RX: Zarontin (ethosuximide)
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36
Succinimides (cont.)
Nursing Implications and Patient Teaching
 Assessment
 Diagnosis
 Planning
 Implementation
 Evaluation
 Patient Teaching
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37
Other Common Anticonvusants

Diamox






lamotrigine
Keppra


levetiracetam
topiramate
Depakene / Depakote


primidone
Topamax

gabapentin
Lamictal


carbamazepine
Neurontin
Mysoline

acetazolamide
Tegretol


valproic acid
Trileptal

oxcarbazepine
Sedative-Hypnotic Medications
Action and Uses
 Sedative agent: relaxes the patient and
allows him or her to sleep
 Hypnotic agent produces sleep in the patient
 Used to relax patients and induce sleep
before medical testing and surgical
procedures; used to treat insomnia caused by
mental and physical stress
Drug Tables 16-13, 16-14, 16-15
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39
Sedative-Hypnotic Medications
(cont.)



Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
40
Degenerative Diseases
• Multiple sclerosis

Etiology pathophysiology
• Degenerative
neurological disorder
with demyelination of
the brain stem, spinal
cord, optic nerves, and
cerebrum
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Slide 41
Degenerative Diseases
• Multiple sclerosis (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
Visual problems
Urinary incontinence
Fatigue
Weakness
Incoordination
Sexual problems
Swallowing difficulties
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Slide 42
Degenerative Diseases
• Multiple sclerosis (continued)

Medical management/nursing interventions
• No specific treatment
• Pharmacological management







Adrenocorticotropic hormone (ACTH)
Steroids
Valium
Betaseron (interferon beta-1b)
Avonex (interferon beta-1a)
Pro-banthine; urecholine
Bactrim, Septra, and Macrodantin
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Slide 43
Degenerative Diseases
• Multiple sclerosis (continued)

Medical management/nursing interventions
•
•
•
•
•
Nutrition
Skin care
Activity
Environmental controls
Patient teaching
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Slide 44
Degenerative Diseases
• Parkinson’s disease

Etiology/pathophysiology
• Deficiency of dopamine

Clinical manifestations/assessment
•
•
•
•
•
•
Muscular tremors; bradykinesia
Rigidity; propulsive gait
Emotional instability
Heat intolerance
Decreased blinking
“Pill-rolling” motions of fingers
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Slide 45
Figure 14-14
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Nigrostriatal disorders produce parkinsonism.
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Slide 46
Degenerative Diseases
• Parkinson’s disease (continued)

Medical management/nursing interventions
• Pharmacological management





•
•
•
•
Levodopa
Sinemet
Artane
Cogentin
Symmetrol
Surgery – deep brain stimulator
Activity
Nutrition
Which interventions would Therese choose?
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Slide 47
Antiparkinsonian Agents
Actions
 Change the neurotransmitters produced in the
brain: excessive acetylcholine, deficient
dopamine
 Block the uptake of acetylcholine and elevate the
functional levels of dopamine in the motor
regulatory centers
Uses
 Control of the symptoms of Parkinson disease
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48
Antiparkinsonian Agents (cont.)
Adverse Reactions
 Dysrhythmias, muscle twitching, GI
symptoms, etc.
 Anticholinergic agents
Drug Interactions
 Many; read product information closely
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
49
Antiparkinsonian Agents (cont.)
Nursing Implications and Patient Teaching






Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching
Drug Table 16-5
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
50
Antiparkinsonian Agents (cont.)
Adverse Reactions
 Dysrhythmias, muscle twitching, GI
symptoms, etc.
 Anticholinergic agents
Drug Interactions
 Many; read product information closely
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
51
Degenerative Diseases
• Alzheimer’s disease

Etiology/pathophysiology
• Impaired intellectual functioning
• Chronic, progressive degeneration of the cells of the
brain
• Brain changes include plaques in the cortex,
neurofibrillary tangles, and the loss of connections
between cells and cell death
• How has Alzheimer’s disease affected Pierre and
Beatrisa?
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Slide 52
Degenerative Diseases
• Alzheimer’s disease (continued)

Clinical manifestations/assessment
• Early stage

Mild memory lapses; decreased attention span
• Second stage

Obvious memory lapses
• Third stage


Total disorientation to person, place, and time
Apraxia; wandering
• Terminal stage

Severe mental and physical deterioration
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Slide 53
Degenerative Diseases
• Alzheimer’s disease (continued)

Medical management/nursing interventions
• Pharmacological management


Agitation: Lorazepam; Haldol
Dementia: Cognex; Aricept
• Nutrition

Finger foods; frequent feedings; encourage fluids
• Safety



Remove burner controls at night
Double-lock all doors and windows
Constant supervision
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Slide 54
Degenerative Diseases
• Myasthenia gravis

Etiology/pathophysiology
• Neuromuscular disorder; nerve impulses fail to pass at
the myoneural junction; causes muscular weakness

Clinical manifestations/assessment
•
•
•
•
Ptosis; diplopia
Skeletal weakness; ataxia
Dysarthria; dysphagia
Bowel and bladder incontinence
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Slide 55
Degenerative Diseases
• Myasthenia gravis (continued)

Medical management/nursing interventions
• Pharmacological management


Anticholinesterase drugs
o Prostigmin
o Mestinon
Corticosteroids
• May require mechanical ventilation
• Nutrition
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Slide 56
Degenerative Diseases
• Amyotrophic lateral sclerosis (ALS)

Etiology/pathophysiology
• Motor neurons in the brain stem and spinal cord
gradually degenerate
• Electrical and chemical messages originating in the
brain do not reach the muscles to activate them
• Lou Gehrig’s disease
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Slide 57
Degenerative Diseases
• Amyotrophic lateral sclerosis (ALS) (continued)

Clinical manifestations/assessment
•
•
•
•

Weakness of the upper extremities
Dysarthria; dysphagia
Muscle wasting
Compromised respiratory function
Medical management/nursing interventions
•
•
•
•
No cure
Rilutec (Riluzole)
Multidisciplinary ALS teams; emotional support
Nutrition
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Slide 58
Degenerative Diseases
• Huntington’s disease

Etiology/pathophysiology
• Overactivity of the dopamine pathways
• Genetically transmitted - dominant

Clinical manifestations/assessment
• Abnormal and excessive involuntary movements
(chorea)
• Ataxia to immobility
• Deterioration in mental functions
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Slide 59
Degenerative Diseases
• Huntington’s disease (continued)

Medical management/nursing interventions
• No cure; palliative treatment
• Pharmacological management



Antipsychotics
Antidepressants
Antichoreas
• Safe environment
• Emotional support
• High-calorie diet
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Slide 60
Psychotherapeutic Agents





Antianxiety Medications
Antidepressants
Antipsychotic Drugs
Antimanic Drugs
Sedative-Hypnotic Medications
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61
Antianxiety Agents (cont.)
Action
 Produce a calming effect
Uses
 Relieve anxiety, tension, and fear


May be used to manage alcohol withdrawal
symptoms; used preoperatively; used to relieve
muscle spasm
Problematic when it interferes with a person’s
ability to perform activities of daily living
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62
Antianxiety Agents (cont.)
Nursing Implications and Patient Teaching






Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient and Family Teaching


Dosing; appointments and follow-up; adverse reactions; safety
with storage; drug and alcohol interactions
Habit-forming: should be used for the shortest time possible
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63
Vascular Problems
• Stroke (cerebrovascular accident)


Now that Mingzhu’s acute phase is over, let’s see how
the CVA will affect her:
Etiology/pathophysiology
• Abnormal condition of the blood vessels of the brain:
thrombosis; embolism; hemorrhage
• Results in ischemia of the brain tissue

Clinical manifestations/assessment
•
•
•
•
Headache
Sensory deficit
Hemiparesis; hemiplegia
Dysphasia or aphasia
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Slide 64
Figure 14-17
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Three types of stroke.
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Slide 65
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Slide 66
Vascular Problems
• Stroke (cerebrovascular accident) (continued)

Medical management/nursing interventions
• Thrombosis or embolism


•
•
•
•
Thrombolytics
Heparin and Coumadin
Decadron
Neurological checks
Nutritional interventions
Physical, occupational, and/or speech therapy
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Slide 67
Cranial and Peripheral Nerve
Disorders
• Trigeminal neuralgia

Etiology/pathophysiology
• Degeneration of or pressure on the trigeminal nerve;
tic douloureux

Clinical manifestations/assessment
• Excruciating, burning facial pain

Medical management/nursing interventions
•
•
•
•
Tegretol
Surgical resection of the trigeminal nerve
Avoid stimulation of face on affected side
Nutrition
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Slide 68
Cranial and Peripheral Nerve
Disorders
• Bell’s palsy (peripheral facial paralysis)

Etiology/pathophysiology
• Inflammatory process involving the facial nerve

Clinical manifestations/assessment
•
•
•
•
•
•
Facial numbness or stiffness
Drawing sensation of the face
Unilateral weakness of facial muscles
Reduction of saliva
Pain behind the ear
Ringing in ear or other hearing loss
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Slide 69
Cranial and Peripheral Nerve
Disorders
• Bell’s palsy (peripheral facial paralysis) (continued)

Medical management/nursing interventions
• Pharmacological management


•
•
•
•
•
Corticosteroids
Antiviral medications
Electrical stimulation
Moist heat
Massage of the affected area
Facial exercises
Nutrition
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Slide 70
Cranial and Peripheral Nerve
Disorders
• Guillain-Barré syndrome

Etiology/pathophysiology
• Inflammation and demyelination of the peripheral
nervous system
• Possibly viral or autoimmune reaction
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Slide 71
Cranial and Peripheral Nerve
Disorders
• Guillain-Barré syndrome (continued)

Clinical manifestations/assessment
• Symptoms are progressive
• Paralysis usually starts in the lower extremities and
moves upward; may stop at any point
• Respiratory failure if intercostal muscles are affected
• May have difficulty swallowing, breathing, and speaking
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Slide 72
Cranial and Peripheral Nerve
Disorders
• Guillain-Barré syndrome (continued)

Medical management/nursing interventions
•
•
•
•
•
•
Adrenocortical steroids
Apheresis
Mechanical ventilation
Gastrostomy tube
Meticulous skin care
Range-of-motion exercises
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Slide 73
Cranial and Peripheral Nerve
Disorders
• Meningitis


How did Rosa contract meningitis?
Etiology/pathophysiology
• Acute infection of the meninges
• Bacterial or aseptic
• Increased incidence in winter and fall months
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Slide 74
Cranial and Peripheral Nerve
Disorders
• Meningitis (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
Headache; stiff neck
Irritability; restlessness
Malaise
Nausea and vomiting
Delirium
Elevated temperature, pulse, and respirations
Kernig’s and Brudzinski’s signs
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Slide 75
Cranial and Peripheral Nerve
Disorders
• Meningitis (continued)

Medical management/nursing interventions
• Pharmacological management




Antibiotics
o Massive doses
o Multiple types
o IV or intrathecal
Corticosteroids
Anticonvulsants
Antipyretics
• Dark, quiet room
• Nutrition
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Slide 76
Cranial and Peripheral Nerve
Disorders
• Encephalitis

Etiology and pathophysiology
• Acute inflammation of the brain caused by a virus

Clinical manifestations
•
•
•
•

Headache
Fever
Seizures
Change in LOC
Medical management and nursing interventions
• Primarily supportive
• Nutrition
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Slide 77
Cranial and Peripheral Nerve
Disorders
• West Nile virus

Etiology and pathophysiology
• Principal route of infection through the bite of an
infected mosquito

Clinical manifestations
•
•
•
•


Fever
Headache
Back pain
Myalgia
Prevention
Nutrition
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Slide 78
Cranial and Peripheral Nerve
Disorders
• Brain abscess

Etiology and pathophysiology
• Accumulation of pus within the brain tissue

Clinical manifestations
•
•
•
•

Headache
Fever
Drowsiness, changes in LOC
Seizures
Medical management/nursing interventions
• Antimicrobial therapy
• Supportive care and nutrition
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Slide 79
Cranial and Peripheral Nerve
Disorders
• Acquired immunodeficiency syndrome

Etiology and pathophysiology
• Symptoms may develop from the infection with HIV or
as a result of an associated infection

Clinical manifestations
• AIDS dementia complex (ADC)
• Memory loss
• Global cognitive dysfunction

Medical management/nursing interventions
• Antiviral, antifungal, antibacterial agents
• Anticonvulsants
• Safety and nutrition
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Slide 80
Cranial and Peripheral Nerve
Disorders
• Brain tumors

Etiology/pathophysiology
• Benign or malignant
• Primary or metastatic
• May affect any area of the brain
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Slide 81
Cranial and Peripheral Nerve
Disorders
• Brain tumors (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Headache
Hearing loss
Motor weakness
Ataxia
Decreased alertness and consciousness
Abnormal pupil response and/or unequal size
Seizures
Speech abnormalities
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Slide 82
Cranial and Peripheral Nerve
Disorders
• Brain tumors (continued)

Medical management/nursing interventions
• Surgical removal of tumor


•
•
•
•
Craniotomy
Intracranial endoscopy
Radiation
Chemotherapy
Combination of above
Nutrition
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Slide 83
Trauma
• Craniocerebral trauma

Etiology/pathophysiology
• Motor vehicle and motorcycle accidents, falls, industrial
accidents, assaults, and sports trauma
• Direct trauma: Head is directly injured
• Indirect trauma: Tension strains and shearing forces
• Open head injuries
• Closed head injuries
• Hematomas
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Slide 84
Trauma
• Craniocerebral trauma

Clinical manifestations/assessment
•
•
•
•
•
•
•
•
Headache
Nausea
Vomiting
Abnormal sensations
Loss of consciousness
Bleeding from ears or nose
Abnormal pupil size and/or reaction
Battle’s sign
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Slide 85
Trauma
• Craniocerebral trauma (continued)

Medical management/nursing interventions
•
•
•
•
•
•
Maintain airway
Oxygen
Mannitol and dexamethasone
Analgesics
Anticonvulsants
Nutrition
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Slide 86
Trauma
• Spinal cord trauma
• How did Stefan come to have spinal cord trauma?

Etiology/pathophysiology
• Automobile, motorcycle, diving, surfing, other athletic
accidents, and gunshot wounds
• Fracture of vertebra
• Complete cord injury
• Incomplete cord injury
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Slide 87
Figure 14-24
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Mechanisms of spinal injury.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 88
Trauma
• Spinal cord trauma (continued)

Clinical manifestations/assessment
•
•
•
•
Loss of muscle function depends on level of injury
Spinal shock
Autonomic dysreflexia
Sexual dysfunction
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Slide 89
Trauma
• Spinal cord trauma (continued)

Medical management/nursing interventions
• Realignment of bony column for fractures or
dislocations: Immobilization; skeletal traction

Surgery for spinal decompression
• Methylprednisolone
• Mobility: Slowly increase sitting up
• Urinary function: Foley catheter; bladder training

Intermittent catheterization
• Nutrition
• Bowel program
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Slide 90
Nursing Process
• Nursing diagnoses

Autonomic dysreflexia
 Communication, impaired
 Coping, compromised family
 Disuse syndrome, risk for
 Grieving
 Infection, risk for
 Knowledge, deficient
 Memory, impaired
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Slide 91
Nursing Process
• Nursing diagnoses (continued)

Mobility, impaired physical
 Nutrition, imbalanced: less than body requirements
 Pain, acute, chronic
 Self-care deficit
 Swallowing, impaired
 Thought process, disturbed
 Tissue perfusion (cerebral), ineffective
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Slide 92
Central Nervous System
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93
Antiemetic-Antivertigo Agents
Action


Factors that may provoke nausea and vomiting: some
drugs, metabolic disorders, radiation, motion, gastric
irritation, vestibular neuritis, or increases in central trigger
zone dopamine levels or vomiting center acetylcholine
levels
Agents act to redirect stimulation by stopping or reducing
stimulation of the vomiting center
Uses




Prevent and treat motion sickness or the nausea and
vomiting that occur with surgery, anesthesia, and cancer
treatment
Dramamine
Benadryl
Antivert
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
94
Antiemetic-Antivertigo Agents
(cont.)
Adverse Reactions
 Drowsiness and drug tolerance with longterm therapy
 Anticholinergic effects
Drug Interactions
 CNS depressants
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95
Attention Deficit Hyperactivity
Disorder (ADHD)






Ritalin
Concerta
Straterra
Vyvanse
Adderall
Characteristics

CNS stimulants
• Monitoring
• Adverse effects
• Patient counseling
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96