Pn2 Neurological Disorders

Front 1

Neurotransmitters

ACh: Acetylcholine: speeds impulse transmission.

A See H E: Acetylcholinesterase: Negates ACh.

Back 1

Nor Epi: Norepinephrine Aids in awakening from sleep and mood regulation.

Dopamine: Involved in the subconscious movements of skeletal muscles and also in emotional responses.

Front 2

Peripheral Nervous System

Back 2

12 Cranial Nerves: 12 pairs of nerves that conduct impulses among the head, neck, and brain. With exception to the vagus nerve, which also serve organs in the thoracic and and cavities

Front 3

Neuro Assessment Part 1. A) Complete History

B) Mental States (Lethargy (listlessness, drowsiness, and apathy), Delirium (Disorganized and disoriented thinking), Stupor (requires continual and vigorous stimuli to respond), Coma (no response).

Back 3

C) Determine LOC: Glascow Coma Scale: Based on eye response, motor response, and verbal response. A score of 8 or less defines coma. Neuro checks q30 minutes.

Front 4

Neuro Assessment Part 2.

D) Assess language/speech capability: Wernickies (comprehend spoken/written), Brochas (cannot speak or use symbols of speech).

E) Cranial Nerve functioning.

Back 4

F) Motor Functioning: Disturbances here are the most commonly seen neuro symptoms.

G) Sensory and perceptual status: most difficult part of assessment. Unilateral Neglect: Unaware and disconnection to half of the body. Hemianopia: Decrease in vision in half of the visual field.

Front 5

Diagnostics CSF

Back 5

CSF: Halos Sign: CSF will separate into concentric rings and test positive for glucose.

Front 6

Diagnostics: Lumbar Puncture

LP: Done to obtain CSF for analysis, to relieve pressure, or to inject dye or medication.

Back 6

Nurse assists patient. to remain motionless in curled-up (fetal) potion while MD inserts needle into back. Patient. must lie flat for several hours and fluids are pushed to replace CSF and decrease the change of a post spinal Headache.

Front 7

Neuro Disorders Headaches Part One.

Headaches: Vascular types: migraines, cluster, and hypertensive headaches

Back 7

Migraines are associated with prodromal Signs and symptoms: visual field defects (light flashes, halos), experiencing unusual smells/sounds, disorientation, paresthesia, partial paralysis.

Management: For migraines: Aspirin, Tylenol, Ibuprophen, Ergotamine tartrate drugs, Inderal, and Imitrex.

Front 8

Neuro Disorders Increased ICP Part One.

Caused by space-occupying lesions (tumors), cerebrospinal problems, and cerebral edema. Ultimately pressure is exerted on surrounding structures and causes a “supratentorial” shift.

Back 8

This shift can result in herniation of the brain. CS with change since the life sustaining mechanisms of consciousness, BP, RR, Pulse, and Temp regulation are impaired.

Front 9

Neuro Disorders Increased ICP Part Two:

Assessing Increase ICP: Early changes: Decrease LOC is the earliest sign of increase ICP. Later changes: Vital signs change (Cushing’s Triad: increase BP, decreased HR and RR.

Back 9

Management: Medicationss: osmotic diuretics (mannitol) to decrease brain edema. Corticosteroids (dexamethasone) to decrease inflammation and anticonvulsants (Dilantin) to decrease seizures.

Front 10

Neuro Disorders Seizures Part One. Epilepsy/Seizures: Electrical overload that occurs in the brain. An aura may precede the actual seizure, which gives the person time to seek safety.

Back 10

Status Epilepticus: Medical emergency whereby a patient doesn’t regain full consciousness between seizures. This requires immediate treatment to prevent brain damage from hypoxia and exhaustion. Medicate with anticonvulsive (Valium is drug of choice).

Front 11

Seizure Types: Grand Mal: Tonic-Clonic movements. Petit Mal: Impairment in or loss of consciousness (absent seizures). Normally occurs in childhood or young adults.

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Assessment: Time/Duration of seizure. This will determine type and future drug treatment.

Front 12

Neuro Disorders Seizures, Part Three.

Diagnostic Tests: EEG. Management: Medical: anticonvulsants (Dilantin, Phenobarbital) in which blood levels are checked to maintain a constant therapeutic level.

Back 12

With Dilantin, good oral hygiene is required as gingival hyperplasia is an Side effect.

Patient Teaching: Do NOT try and pry the jaw open or place anything in the mouth.

Front 13

Neuro Disorders Parkinsons

Back 13

Parkinson’s: Syndrome consists of: bradykinesia and cogwheel rigidity, pill rolling is also common. Either a decrease in dopamine or an increase in Acetylcholene will lead to Signs and symptoms

Mngmt: Levodopa (dopamine replacement) improves Signs and symptoms. Patient is not to take B6 (pyridoxine) or a multivitamin.

Front 14

Neuro Disorders Alzheimer’s Part One: Characterized by a decrease in the size of the cerebral cortex and degeneration of nerve cells. Amyloid plaques and neurofibrillary tangles have been found in Alz patients.

Back 14

Progression: 1st: mild memory loss. 2nd: Confabulation (story telling), 3rd: Apraxia (decreased ability to perform tasks) and wandering. Memory loss is an important indication of Alzheimers.

Front 15

Assessment: Should include cognitive and motor skill evaluation.

Managment: Ativan and Haldol decrease agitation. Cognex, Aricept, and Vit. E will slow progression of Signs and symptoms.

Back 15

Aricept inhibits Acetlycholenesterase to allow Acetylcholene levels to increase this causes more stimulation of muscles, glands, and CNS. Safety: Patients should not be left alone. Assist patient with Activites of daily living. Use reality orientation techniques

Front 16

Neuro Disorders: Myasthenia Gravis: Probably autoimmune. Muscle weakness hallmark. Acetlycholene receptors are attacked by antibodies at the Neuro muscular junction. The goal of Treatment is to reduce these antibodies.

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Signs and symptoms: Eye problems (ptosis, diplopia), skeletal muscle weakness, bowel/bladder sphincter weakness, respiratory muscle weakness.

Front 17

Diagnosis: Anticholinesterase Test: Tensilon, Prostigmin, or Mestinon. These three inhibit Acetylcholenesterase. This delays the degradation Acetylcholene. EMG: Partly responsible for diagnosis.

Back 17

Management: Anticholinesterase Drugs (Prostigmin and Mestinon) improve impulse transmission. Watch for toxicity: muscle rigidity and jaw clenching. Have patient. eat in Fowlers position, use chin tuck and double swallow to prevent aspiration.

Front 18

Neuro Disorders ALS: Amyotrophic lateral sclerosis (ALS,Lou Gehrig’s): Signs and symptoms include: muscle weakness and atrophy, starting in the extremities and moving inward. Total paralysis occurs. Death usually occurs in 2-6 years after diagnosis.

Back 18

Mngmt: No cure, but Rilutek can slow the progression. Many experimental drugs provided in organized programs.

Front 19

Neuro Disorders Huntingtons

Back 19

Huntington’s: Genetically transmitted involving an over activity of dopamine pathway, opposite of Parkinson’s. Characteristic chorea (excessive mvmts that are involuntary).

Mngmt: Increase patient Caloric intake to 4-5k because chorea burns so many calories. Genetic counseling is important.

Front 20

Neuro Disorders CVA (ischemic and hemorrhagic).

Hemorrhage into the brain or artery occlusion by a clot resulting in ischemia. MCA is the vessel most commonly affected. (Middle Cerebral Artery).

Back 20

Causes: Cerebral thrombosis. Symptoms tend to occur after recumbency due to a lowering of BP. Cerebral Embolism: 2nd most common. Emboli originates from endocardium or DVTs. Cerebral hemorrhage: Often cause by an aneurysm.

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Outcomes: Characteristic contralateral weakness of lower face, hands, arms and legs, temporary dysphasia.

Back 21

Treatment: Carotid Endarterectomy. TPA for ischemic strokes-Administered within 3 hours of onset, will increase patients chance of recovery with little disability. Mercy Retriever: threaded through the carotid artery into the brain to pull down clots from arteries. TPA is not given in hemorrhagic stroke.

Front 22

Neuro Disorders Stroke; Assessment: Hemiplegia

Nursing: Help patient achieve his maximal recovery my assisting in speech, physical, and occupational therapies.

Back 22

Compassion, understanding, and patience must be exercised. Patient will have little control over his emotions after a CVA and may cry or direct angry outbursts at family and staff.

Front 23

Neuro Disorders Trigeminal Neuralgia

Back 23

Trigeminal Neuralgia (Tic Douloureux): Stimulation of “trigger points” along the 5th cranial nerve initiates intense pain. Avoid massage, temperature changes, palpation.

Front 24

Neuro Disorders Bells Palsy

Back 24

Bell’s Palsy: Cause is unknown but reactivated herpes simplex virus may be included.

Signs and symptoms:Eye involvement (ptosis of eyelids and a decrease blink reflex), facial numbness, asymmetric appearance, dropping of mouth and cheek on affected side.

Management: Acyclovir to combat the HSV

Front 25

Neuro Disorders Guillain Barre Syndrome

Back 25

Guillain-Barre Syndrome (Postinfectious Polyneuritis) Recent vaccinations such as Varivax and Swine Flu have been linked to Guillain Barre. History of recent infection is significant due to S/S 10-14 days after a nonspecific infection.

Front 26

Guillain Barre Signs and symptoms: Muscle Weakness, Numbness/tingling in Lower Extremities and working upward, Dysphagia, dysarthria, and respiratory difficulties.

Back 26

Lower motor neurons paralysis beginning in the lower extremities moves upward to include the thorax, upper extremities, and face.

Front 27

Neuro Disorders Meningitis

Back 27

Management: Antibiotics in massive doses. (Amp/PCN/Cephalosporin/Cefoxatine) administered simultaneously.

Front 28

Meningococcal Meningitis:

Back 28

Serious and contagious. Causes purple rash. Can progress to coma in a few hours, treat immediately with PCN and chloramphenicol.

Front 29

Neuro Disorders Encephalitis

Back 29

Encephalitis: Viral inflammation of the brain, most commonly caused by HSV.

Signs and Symptoms: Gradual onset. High fever, Headache, seizures, decreased LOC.

Front 30

Neuro Trauma: Craniocerebral Trauma Part One

Hemorrhage is possible.

Epidural Hematoma: Venous blood collection between the dura and the skull, causes a decrease in LOC after patient regains consciousness.

Back 30

Subdural Hematoma: Venous blood collection between the dura and the arachnoid space (decreased rate of formation due to decreases venous pressure.

Front 31

Craniocerebral Trauma Part Two.

Assessment: Vital Signs: baseline is crucial. May change rapidly thereafter.

Back 31

Management: Codeine for pain relief (no sedatives are given since respiratory depression results. Hypothermia treatment used since increased temperature increases brain metabolism resulting in brain damage.

Nursing: Close attention to vitals

Front 32

Neuro Trauma Spinal Cord Trauma Part One

Back 32

Spinal cord Trauma: Bleeding in spinal column causing cord compression and damage; common causes are MVA, diving, surfing, and GSW’s.

Front 33

Complete cord injury: Total transection of the spinal cord (all voluntary movement below injury level to the cord is lost).

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Incomplete cord Injury: partial transection or injury of the cord: The higher the level of injury, the more function is lost. A high cervical injury will cause respiratory failure due to paralysis of the diaphragm.

Front 34

Neuro Trauma: The period Immediatly After Trauma

Back 34

Immediately following the injury:

Spinal Shock: Areflexia occurs: Flaccid paralysis, loss of reflexes below the trauma, vasodilation and hypotension, and tachycardia result. Some functions will return temporarily.

Front 35

Neuro Trauma Injury above t6, assessment, nursing, and management Part One

Back 35

If injury is above T6; hyperreflexia (autonomic dysreflexia) occurs. Most common cause is bladder distention or fecal impaction. signs and symptoms are hypertension (BP could be as high as 300mmHg). Autonomic Dysreflexia is a medical emergency. Requires immediate treatment to prevent blindness, stroke, or death.

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Assessment: Any absences of sensation where sensations could be felt before should be told to the MD STAT. Mark the area for comparison. When permanent damage has been done, patient and family should be informed about reflex spasms.

Back 36

This may cause occasional jerking motions in the legs. These are not an indication of returning functioning.

Front 37

Herniated discs may compress the spinal nerves or the spinal cord itself in any region of the spinal column.

Back 37

If other tx are ineffective, surgery (laminectomy with fusion) will be done. Sensation and mobility in legs must be observed postoperatively.

Front 38

Neuro Trauma Above T6, Part Four

Back 38

Nursing: Begin rehab immediately upon hospitalization so we retain remaining capabilities. Decrease skin breakdown by logrolling pt q2 hours.

Front 39

Neuro Pharmacology Part One

Back 39

Dilantin: Treatment of seizures. Stress good oral hygiene due to gingival hyperplasia.
Prostigmin: Confirm/Rule Out Myasthenia gravis. Anticholinesterase that improves impulse transmission and decreases symptoms.
Acyclovir: Antiviral used in Bells Palsy and Encephalitis.

Front 40

Neuro Pharmacology Part 2

Back 40

TPA: Used in ischemic stroke.
Levodopa: Dopamine replacement improves signs and symptoms of Parkinson’s.
Meningitis Tx: Many Antibiotics at once.
How to decrease ICP: Osmotic Diuretics, Coricosteroids, Anticonfulsants.

Front 41

Trigeminal Neuralgia Tx: Absolute ETOH, Tegretol/Dilantin
Rilutek: Slow progression of ALS. Protects damaged motorneurons.

Back 41

Type of Drug Treatment for ALS: Rilutek and expieremental Drugs.
Treatment of migraines: Ergotamine Tartreate, Inderel, Imitrex, ASA, APAP, Ibuprophen.

Front 42

Note To Self;

Epilepsy: Electrical overload.
MS: Demyleniation.
Parkinson’s: Insufficient amt of dopamine.
Alz: Neurotangles and amyloid plaques.

Back 42

Myasthenia Gravis: Insufficient Ach OR Receptor impairment.
ALS: Overall degeneration of neurons.
Huntington’s: Genetic, Too much Dopamine = Chorea.

Front 43

MS. Caused by centers of demyelination are in the brainstem spinal cord, optic nerves and cerebrum. Signs and symptoms include visual problems, in coordination or weakness, swallowing difficulties, incontinence, fatigue, and impotence.

Back 43

Exacerbations can be brought on by extreme temperature changes as well as fatigue, and emotional disturbances. Assessment includes eye problems such as diplopia and scotomata. MRI is the diagnostic of choice. This shows ventricular enlargement.

Front 44

Management is inclusive of interferon. This decreases the number of exacerbations. Patient must avoid temperature extremes, especially hot temperatures, which may trigger an exacerbation.

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End of Chapter