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Nervous System Disorder II
Terms in this set (38)
Seizure Disorders- Etiology
-An involuntary contraction or a series of contractions of muscles resulting from abnormal cerebral stimulation
-Epilepsy- permanent recurrent seizure disorder
-Types of Seizures
-Begins in specific area of cerebral cortex.
-May progress to generalized seizure. Further classified according to impaired LOC
-Four types of simple partial seizures that do not impair consciousness:
-Involves entire brain
-Person loses consciousness
*Absence seizures: common in childhood.
May predict future seizure disorder.
*Tonic-Clonic: Grand mal, most closely
associated with epilepsy. Increased muscle tone followed by rhythmic/jerky contraction and relaxation of all body muscles. Lasts 2-5 minutes.
Seizures Assessment/ Diagnostics
*Patient's awareness of disorder, precipitating factors, presence of an aura
*Number of seizures, characterof seizure (duration, movement, sounds, incontinent), behaviors noted, any injuries
Seizures Medical Management
*Antiepileptic drugs: phenytoin, phenobarbitol, carbamazepine, valproate sodium
*Act by blocking the initiation or spread of seizures
*Goal is maximum seizure control with minimum side effects
*Surgical removal of brain tissue where seizure activity occurs.
Nursing Interventions during Seizure
>Main objective is to prevent injury
-Watch the clock
-Do not restrain
-Remove glasses or constricting clothing
-Turn to side to prevent aspiration
-Remain with patient.
Seizures Nursing Observations (what to document)
-First movement, position of head and eyeballs
-Parts of body involved
-Incontinence or feces
-Duration of each phase
-Unconscious and the duration
-After seizure, any paralysis, weakness, inability to speak, drowsiness.
Seizures Nursing Interventions
-Period of impaired consciousness after seizure is post-ictal state
*Includes confusion, sleep or fatigue
-Ongoing seizure =status epilepticus
*Results in severe hypoxia and lactic acidosis.
*May lead to brain injury- needs immediate medical care.
Seizures Patient Teaching
-Continue taking medications
-Medical alert bracelets- some patients do not wish to wear
-Cautious use of alcohol
-Oral hygiene if taking Dilantin
-Driving restrictions may apply.
-Cranium encloses brain tissue, blood and CSF
*Absorption or reduced production of CSF
*Decreased cerebral blood volume.
Etiology Intracranial Pressure
-Caused by lesions, cerebrospinal problems and cerebral edema
-Increased pressure may occur slowly
Compensation occurs and blood flow decreases to the brain
-Leads to inadequate perfusion which leads to increased edema
-With increased pressure, supratentorial shift can occur and cause herniation
-Herniation compresses the brainstem and interferes with life-sustaining mechanisms.
Intracranial Pressure Assessment
-Rise in systolic pressure and unchanged diastolic pressure= widening pulse pressure
-Bradycardia, abnormal respirations are late signs of increased ICP
-Subjective: visual changes, personality or mental changes, nausea, pain or headache
-Objective: change in LOC, pupillary responses (ipsilateral pupil, blown pupil), changes in BP and pulse, posturing.
-Bradycardia, hypertension and bradypnea
Herniation will occur without intervention
-First change noticed: Change in LOC
-Any sudden change is significant: Significant changes in mental status and vital signs.
Intracranial Pressure Complications
-Brain stem herniation
*If pressure too high, reduced blood flow to brain
*Result of decreased secretion of ADH
*Result of increased secretion of ADH.
Intracranial Pressure Medical Management
*Identify increased ICP before damage done
-Increased ICP= Medical Emergency
*Decrease cerebral edema
*Decrease volume of CSF
*Decrease cerebral blood volume but
-Decrease Cerebral Edema
*Excessive drainage may cause collapse of
Intracranial Pressure Medical Management II
*Cardiac output (maintain blood pressure)
*Inotropics - dobutamine hydrochloride or norepinephrine
*Lowering body temp
*Still being studied
*Paralyzing agents - propofol (Diprivan).
Intracranial Pressure Nursing Interventions
-Breathing- check med side effects
*IV fluids to avoid or limit hypotension and prevent secondary brain injury
*HOB up (30 degreess)
-Monitor for changes
*Observe for spinal fluid leakage (nose, ear or both)
-Prevent straining, restraining, coughing, vomiting.
Intracranial Pressure Nursing Diagnoses
-Ineffective breathing pattern RT neuromuscular impairment
-Decreased intracranial adaptive capacity RT edema secondary to head trauma
-Ineffective tissue perfusion, cerebral RT decreased cellular exchange.
-Inflammation of the meninges
*Caused by bacteria
*Meningococcus, strep, staph, pneumococcus
*Caused by virus or secondary to leukemia or HIV.
Meningitis Clinical Manifestations
-Positive Kernig's sign= inability to extend legs
-Positive Brudzinski's sign= flexion of hip and knee when the neck is flexed
-Later symptoms include:
-Death may occur in few hours after onset.
Meningitis Medical Management
-Prophylaxis antibiotics- start within 24 hrs of exposure
-Antibiotics as treatment
Meningitis Nursing Interventions
-Monitor neurological status
-Monitor respiratory status
-Prevent complications of immobility
*Respiratory isolation- infection control
*Reduce noise and stimulation
*Safety precautions- seizures.
-Infectious disease of the central nervous system
-Characterized by changes in both white and gray matter
-Caused by :
*Virus transmitted by mosquitos
*Poisoning by drugs such as lead.
-Manifestations are similar to meningitis except more gradual onset. (flu-like symptoms)
-Include neuro changes
-Medicine and nursing strive for supportive cares
-Diagnostics: MRI, PET, viral studies of CSF
-Mortality rate is 5-20%
-Long term symptoms may include memory loss, epilepsy, personality changes.
Guillain Barre Syndrome Etiology
-Acute postinfectious polyneuropathy
-Inflammation and degeneration of the myelin sheath of peripheral nerves
-Affects: PNS- spinal nerve roots
*Nerve conduction is interrupted
-Antibodies attack the Schwann cells causing the sheath to break down
-Demyelination is self-limiting and Schwann cells rebuild
-Cause is unknown but thought to be a viral agent or autoimmune reaction.
Guillain Barre Syndrome Clinical Manifestations
-Reflexia and ascending weakness
*Ascending weakness begins in lower
extremities, spreading upwards to trunk
-Paresthesis in the limbs and pain
-Respiratory muscle weakness may occur and autonomic neuropathy which may lead to hypertension, cardiac dysrhythmias, paralytic ileus and urinary retention
-Cranial nerves may be affected- sensory function.
Guillain Barre Syndrome Medical Treatments
-IV Ig- Immunoglobulins contain healthy antibodies from blood donors. High doses of immunoglobulins can block the damaging antibodies in blood that may contribute to GBS.
-First choice in treatment because fewer side effects.
Guillain Barre Syndrome Nursing Interventions
-Monitor respiratory function
-Prevention of complications of immobility
-Medications to reduce neuropathic pain
-Provide Communication method.
-Collection of purulent material within brain
-Caused by bacterial infection
*Neuro changes, seizures, paralysis,
*Administer meds per orders (antimicrobials, corticosteroids, anticonvulsants)
*If not effective, abscess needs to be removed
*Seizures, paralysis, mental deterioration.
Multiple Sclerosis Etiology
-Chronic, progressive disease of the brain and spinal cord
-Lesions cause degeneration of the myelin sheath and interferes with conduction of motor nerve impulses
-Multiple areas of demyelination and remyelination lead to transitory nature of disease
-Onset: young adult, increased incidence in women
-Progression: unpredictable, periods of exacerbation and remission
-Cause: unknown, may be autoimmune disease.
Multiple Sclerosis Clinical Manifestations
>Symptoms vary with individual
-Fatigue- most common complaint
-Vision problems: diplopia, blurred vision, nystagmus (involuntary eyeball movement)
-Extremities: weakness, numbness, tingling, paralysis, pain
-Speech: slowed, slurred, swallowing problems
-Emotional: mood changes, depression
-Intellectual: loss of judgement, memory.
Multiple Sclerosis Medications
-Disease modifiers - injectables
-Symptom treatment: treat bladder and bowel dysfunction, fatigue, spasticity and tremors.
Multiple Sclerosis Nursing Diagnoses
>Impaired physical mobility RT weakness, muscle spasticity
-Goal -promote physical mobility
>Impaired urinary elimination RT inability to recognize bladder cues sec to MS
-Goal-continence during day
>Ineffective individual coping RT uncertainty of course of MS
-Goal-develop coping strengths.
Myasthenia Gravis Etiology
-Autoimmune disorder- acetylcholine receptor antibodies destroying nerve endings
-Muscular weakness and fatigue that worsens with exercise and improves with rest
-Fewer acetylcholine receptors sites lead to defect in transmission of nerve impulses
Myasthenia Gravis Clinical Manifestations
-Increasing weakness with sustained muscle contraction
-Ptosis, diplopia- ocular muscles
-Skeletal muscle involvement- dysphagia, difficulty chewing, mask like expression
-Muscle weakness - difficult breathing
-Motor disorder, no effect on sensation or coordination.
Myasthenia Gravis Medical Management
-Supportive care if resp status compromised
Myasthenia Gravis Nursing Interventions
-Medications as ordered- same time each day to maintain therapeutic levels
-Monitor VS and observe for resp distress
-Nutrition- monitor I &O
-Conserving energy as needed for ADL's.
Myasthenia Gravis Myasthenic Crisis
-Resp distress, dysphagia, dysarthria, ptosis, diplopia and severe muscle weakness
-First priority: Ventilator and frequent resp assessments
-Second priority: Clear secretions- need chest physiotherapy, suctioning
-Supportive measures- labs, I & O, tube feedings
-Caused by disease exacerbation or specific event such as respiratory infection.
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