паталогии ЦНС

Сентябрь 3, 2022

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паталогии ЦНС

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2. Increased Intracranial Pressure (pg. 666) The cranium consists of 1. Brain tissue 2. Blood 3. Cerebrospinal
4. Increased Intracranial pressure The skull cannot expand so a tumor, cerebral edema, brain abscess, or bleeding
5. Increased Intracranial Pressure If not recognized, the brainstem will herniate thru the foramen magnum brainstem controls
6. ICP Signs and symptoms develop rapidly or slowly If slow it may be over looked Keep
7. Level Of Consciousness Confusion, restlessness, disorientation and drowsiness may or may not be a symptom of
8. Headache Pain is usually intermittent--if constant condition usually grave coughing, sneezing, straining at stool increases headache
9. Vomiting and ICP Commonly occurs without warning of nausea and without a relationship to eating projectile
10. Papilledema Papilledema (edema of optic nerve caused by obstruction of venous drainage due to ICP Can
11. Posturing Decorticate--arms flexed--problem with cervical spinal tract or cerebral hemisphere Decerebrate--arms extended (more serious as brainstem
13. Symptoms of ICP Change in LOC headache vomiting papilledema vital signs--temp rises, b/p rises and pulse
14. Vital signs Temp rises, B/P rises and pulse pressure widens. These 3 s/s are called Cushing’s
15. Medical and surgical management Osmotic diuretics (mannitol, glycerol); steroids to reduce cerebral edema If clot then
16. Medical & surgical management Restrict fluids, lumbar punctures to remove CSF and hyperventilation via ventilator to
17. Medical Management May order: insertion of foley NG tube for gastric decompression or feedings Stool softener
18. Normal ICP In the Ventricles Norm: 1 to 15 Moderate ↑: 15 to 40 High: >
19. Nursing care ICP Teach to remain quiet in bed and not to turn in bed without
20. Nursing Care ICP ICP can affect temp regulation so cooling blanket may be needed Neuro assessment
21. Nursing Care ICP A neurologic flow sheet that includes the Glasgow Coma Scale or Ranchos Los
22. Nursing Care ICP Laboratory findings such as serum electrolyte levels and arterial blood gas measurements are
23. Nursing Care ICP Keep head straight and head of bed slightly elevated If a basal skull
24. Activities That increase ICP Coughing range of motion exercises sneezing hip flexion of 90 degrees or
25. Activities that increase ICP Straining to have a BM (valsalva maneuver holding breath digging heels into
26. Nursing Care ICP Hourly I&O may be done If steroids given, monitor glucose as ordered test
27. Nursing Care ICP Monitor I&O…fluids may be restricted to reduce cerebral edema and prevent vomiting and
28. Infectious & Inflammatory Disorders Meningitis Encephalitis Gullian-Barre Syndrome Poliolmyelitis Brain Abscess
29. Meningitis (Covering of the Brain) pg 669 Inflammation of meninges (three membranes that cover the brain-dura,
31. Meningitis Most adults with bacterial meningitis recover without permanent neurologic damage or dysfunction. When complications do
32. Meningitis S/S Fever, nuchal rigidity (pain and stiffness of neck); inability to place chin on chest
33. Kernig’s Sign Positive Kernig’s sign ( inability to extend the leg when the thigh is flexed
34. Brudzinsi’s Sign Brudzinski’s sign--flexion of neck produces flexion of knees and hips
35. Diagnostic findings: Meningitis Lumbar puncture done if bacterial meningitis the CSF is cloudy and pressure is
37. Medical Management IV fluids, antibiotics, anticonvulsants are used to treat sulfonamide given to people who are
38. Encephalitis (Brain Inflammation) pg 676 Infectious disease of CNS characterized by changes in both white and
39. Encephalitis (brain inflammation) Symptoms similar to meningitis Caused by bacteria, fungi, or virus cause virus: Polio,
40. Encephalitis occurs after a viral infection elsewhere (measles or vaccinations) Poisoning by drugs and chemicals, such
41. Encephalitis Onset of viral is sudden with fever, severe headache, stiff neck, vomiting and drowsiness lethargy
42. Encephalitis Muscle weakness, incoordination, incontinence and visual disturbances (photophobia, involuntary eye movement, double or blurred vision
43. Encephalitis--brain inflammation Lumbar puncture done…CSF pressure elevated but fluid clear EEG has slow wave forms treatment
44. Encephalitis Mild cases are common and may go unrecognized complications and deaths are more common in
45. Guillain-Barre’ syndrome Pg.677 Rare, inflammatory condition involving the CNS that causes rapid weakness and loss of
46. Guillain-Barre’ Syndrome May be autoimmune response to viral infection Takes approx 1 month to start improving
47. Guillain Barre’ Syndrome Weakness, tingling, and numbness in arms and legs may be 1st symptoms Weakness
48. Medical Management Guillian Barre’ Plasmaphoresis removal of plasma from the blood and reinfusion of the cellular
50. Nursing Management Monitory respiratory status/distress Use IS R/T incapacitated by immobility, provide meticulous skin care and
51. Brain abscess Pg. 678 A collection of pus caused by a bacterial infection in the brain—if
53. Brain abscess May occur from infection of teeth, sinus, middle ear, or from an infection in
54. Brain abscess Risk increases with head injury, illness that lowers resistance (esp. diabetes) recent infection (esp
55. Brain abscess I&O fluids may be restricted as over-hydration may cause cerebral edema antibiotics usually given
56. General Nursing Care for Inflammatory Disorders Swallowing may be affected---give PO drugs slowly…no narcotics REPORT sudden
57. Nursing Care for Inflammatory Disorders Monitor vitals…complete care neuro checks…use Glasgow Coma scale Seizure precautions—insert a
58. Neuromuscular disorders PG 678 Involves the nervous system and indirectly affects the muscles Multiple Sclerosis Myasthenia
59. Multiple sclerosis PG 678 Chronic, progressive disease of the peripheral nerves. Onset in young adult and
60. Multiple sclerosis Permanent degeneration as patchy destruction of myelin sheath of nerve fibers of brain and
61. Multiple sclerosis Myelin sheath swells (exacerbation) when it is deteriorating when swelling goes down then there
62. Multiple sclerosis Weakness of arms and legs may progress to paraplegia may be incontinent visual disturbances
63. Multiple sclerosis Intellectual functioning may be impaired late in disease loss of memory, impaired judgment shallow
64. Drugs for MS Lioresal and Dantrium--muscle spasticity and rigidity Antibiotics, urinary infectives, tranquilizers for mood swings
65. Nursing Sensory impairment: be careful with hot, cold, avoid injury REST, conserve energy Polyunsaturated fate, linoleic
66. Myasthenia Gravis pg 681 Disorder of muscles, with increasing fatigue and weakness as muscles are used
67. Myasthenia Gravis Most common symptoms are ptosis of eyelids, difficulty chewing and swallowing, diplopia, voice weakness,
68. Myasthenia Gravis Diagnosed by giving IV Tensilon which relieves symptoms in a few seconds if it
69. Myasthenia gravis Treatment is Mesitonon or Myelelase Atropine is antidote for mestinon and other anticholinesterase drugs
70. Mestinon or Mytelase Observe for drug overdose….abdominal cramps, clenched jaws, muscle rigidity Give drug at exact
71. Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682 Progressive, fatal neuro disorder of unknown cause Degeneration of motor
72. Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682 Periods of inappropriate laughter or crying Causes resp failure and
73. Cranial Nerve disorders Pg. 683 Trigeminal Neuralgia (Tic douloureux) Bell’s palsy Temporomandibular Disorder (TMD)
74. Trigeminal Neuralgia (Tic douloureux) pg 683 Painful condition that involves the 5th cranial nerve—which has 3
75. Trigeminal Neuralgia (Tic douloureux) pg 683 Attacks can be initiated by slight stimulus such as cold,
76. Trigeminal Neuralgia The pain is described as sudden, severe, and burning It ends as quickly as
77. Trigeminal Neuralgia Analgesics, surgery on nerve root or branches post op there is no feeling in
78. Trigeminal Neuralgia Slightest stimulus may start attack (vibration from music, breeze, temp change they avoid washing
79. Trigeminal Neuralgia Post-op eating may be a problem as may bite tongue without knowing it food
80. Trigeminal Neuralgia (Tic Douloureux) Chew on opposite side Avoid hot and cold foods and use mouth
81. Trigeminal Neuralgia Dilantin and tegretol used to reduce pain as analgesics not too successful narcotics may
82. Bell’s Palsy 7th cranial nerve—responsible for movement of the facial muscles facial nerve usually affects one
83. Bell’s Palsy causes weakness and paralysis of facial muscles and eyelid facial pain, pain behind ear,
84. Bell’s Palsy Speech and chewing difficulty may occur Must rule out CVA, tumor no specific test
85. Bell’s palsy If ptosis and blinking reflex affected must wear eye patch corneal ulcerations and infection
86. Temporomandibular Disorder pg 685 TMD is a cluster of symptoms that are localized at and about
87. TMD S/S Jaw pain, headache, tinnitus, ear pain clenching of jaw, inability to open mouth Clicking
88. TMD S/S Pronounced spasm and tenderness of the masseter and temporalis muscles Dental x-rays help with
89. TMD Medical Management Treatment is referred to a dentist Analgesics are prescribed Custom-fitted mouth guard is
90. TMD Medical Management TENS (transcutaneous electrical nerve stimulation), injection of a local anesthetic to relieve muscle
91. Extrapyramidial disorders pg 686 Parkinson’s disease Huntington’s disease One primary characteristic is abnormal movement.
92. Parkinson’s Usually begins after age 50 early signs include stiffness, tremors of hands, pill rolling and
93. Parkinson’s Intention tremor: when tremors increase during voluntary movement…may be seen in some patients Later, tremors
94. Parkinson’s Have difficulty turning or redirecting forward motion arms seldom swing while walking rigidity develops more
95. Parkinson’s Levodopa and cogentin are drugs of choice physical therapy…in extreme cases surgery done to destroy
96. Parkinson’s Symptoms usually begin on one side and may take 15 years to spread bilaterally late
97. Huntington’s Disease pg. 689 Hereditary, degeneration of basal ganglia and cerebral cortex Causes mental apathy, emotional
98. Huntington’s Treatment is supportive, no cure tranquilizers and antiparkinsonian drugs to relieve choreiform movements late in
99. Huntington’s 1/2 children of affected parent will develop the disease but will not find out about
100. Huntington’s Personality changes (obstinanacy, moodiness and lack of interest Inappropriate behavior may start before the involuntary
101. Huntington’s chorea Difficulty chewing and swallowing, speech difficulty, intellectual decline loss of bowel and bladder control
102. Nursing care extrapyramidial 43-2 pg 690 Offer fluids hourly I&O, keep suction available to prevent aspiration
103. Nursing Care extrapyramidial Avoid stress, fatigue bowel and bladder incontinent retraining program may be helpful early,
104. Seizure disorders pg 692 Abnormal electrical discharge of neurons can be focal or generalized idiopathic (no
106. Seizure disorders Epilepsy is a permanent, recurrent seizure disorder causes include brain injury at birth, head
107. Seizure disorders Too much electrical discharges from nerve cells in the brain Different types: partial or
108. Seizure disorder Jacksonian: begins at one place and spreads to another in an orderly fashion psychomotor
109. Seizures Generalized seizure: Entire brain involved; can last several minutes, loss of consciousness absence; brief change
110. Generalized seizure Myoclonic: brief involuntary muscular jerks of extremities or body Tonic-clonic: Grand mal--emotional changes, aura
111. Seizure--Grand mal Clonic phase; alternating spasms and relaxations---thrashing and jerking breathing is spasmodic frothing saliva, jaws
113. Grand mal seizure Postictal stage: consciousness is regained, does not remember seizure confused, difficulty speaking, headache
114. During a seizure Turn to side to keep airway patent and to prevent aspiration of saliva
116. During a Seizure Protect from injury…do not forcibly restrain arms, legs or head stay with patient
118. After a seizure Keep bed flat; turn to side until awake and responding keep room lighting
120. Nursing Observe closely and chart activity before and after turn on side--prevent aspiration, protect from injury
121. Nursing Assess for injury, allow to rest, report activity, time elapsed and client reaction pad side
123. Status Epilepticus Several tonic-clonic seizures without consciousness returning this is an emergency may be from stopping
125. Medications for seizures Dilantin phenobarbital Tegretol Zarontin depakene Valium drug of choice to stop status epilepticus
126. Brain Tumor pg. 697 Can result in death even if benign They take up space and
127. Brain tumor Projectile type vomiting without nausea, speech difficulty, double vision, paralysis Causes brain stem herniation
128. Brain Tumor Keep as pain free as possible IV fluids and TPN may be needed--keep I&O
129. Brain Tumor Chemotherapy, radiation and surgery used to treat craniotomy (incision thru skull) or craniectomy (part
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Increased Intracranial Pressure (pg. 666)
The cranium consists of
1. Brain tissue

2. Blood
3. Cerebrospinal fluid (CSF)
If one or more of these increases significantly without a decrease in one or the other two, ICP becomes elevated.

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Increased Intracranial pressure
The skull cannot expand so a tumor, cerebral edema,

brain abscess, or bleeding compresses the brain and causes increased intracranial pressure (ICP)
As pressure increases, the cerebral blood flow decreases and PCO2 increases causing cerebral edema which increases the ICP even more

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Increased Intracranial Pressure
If not recognized, the brainstem will herniate thru the

foramen magnum
brainstem controls vital signs so death will occur

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ICP
Signs and symptoms develop rapidly or slowly
If slow it may be

over looked
Keep check on baseline and observe closely
change in LOC is usually earliest sign
alterations may be difficult to determine

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Level Of Consciousness
Confusion, restlessness, disorientation and drowsiness may or may not

be a symptom of impending change in LOC
Report sudden change to Dr stat
Change in LOC is one of the earliest signs of ICP

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Headache
Pain is usually intermittent--if constant condition usually grave
coughing, sneezing, straining at

stool increases headache
lying in bed with head elevated reduces ICP and headache

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Vomiting and ICP
Commonly occurs without warning of nausea and without a

relationship to eating
projectile in nature

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Papilledema
Papilledema (edema of optic nerve caused by obstruction of venous drainage

due to ICP
Can be seen only with an ophthalmoscope
Affects pupillary response to light.
Normal pupil response to strong light is rapid constriction. In IICP the response is sluggish or nonexistent (fixed)

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Posturing
Decorticate--arms flexed--problem with cervical spinal tract or cerebral hemisphere
Decerebrate--arms extended (more

serious as brainstem damage, problems within midbrain or pons
see page 660 for picture

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Symptoms of ICP
Change in LOC
headache
vomiting
papilledema
vital signs--temp rises, b/p rises and pulse

pressure widens
pupils sluggish or fixed
decorticate or decerebrate position

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Vital signs
Temp rises, B/P rises and pulse pressure widens. These 3

s/s are called Cushing’s triad. A late sign in IICP.
Pulse may increase at first but later becomes slow (40-60) and bounding
resp rate is irregular or cheyne-stokes (shallow, rapid, then decreases and then apnea)

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Medical and surgical management
Osmotic diuretics (mannitol, glycerol); steroids to reduce cerebral

edema
If clot then it is removed;
surgery for depressed skull fx, tumor or bleeding…fix the cause stat

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Medical & surgical management
Restrict fluids, lumbar punctures to remove CSF and

hyperventilation via ventilator to cause resp alkalosis which constricts cerebral arteries and reduces ICP

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Medical Management
May order:
insertion of foley
NG tube for gastric decompression or feedings
Stool

softener to prevent straining
Histamine antagonist (Pepcid) to prevent stress ulcers
Cooling blankets if hyperthermia

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Normal ICP In the Ventricles
Norm: 1 to 15
Moderate ↑: 15

to 40
High: > 40 mm Hg
Although the ICP varies, a rise of 2 mm HG from a previous measurement is cause for concern.

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Nursing care ICP
Teach to remain quiet in bed and not to

turn in bed without help
avoid ROM until ICP normal and Dr orders
suction only when absolutely necessary…gently remove secretions with gauze
give oxygen before suctioning

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Nursing Care ICP
ICP can affect temp regulation so cooling blanket may

be needed
Neuro assessment should be done q 30 min
Avoid extreme flexion of hip because this increases intraabdominal, ICP and intrathoracic pressure

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Nursing Care ICP
A neurologic flow sheet that includes the Glasgow Coma

Scale or Ranchos Los Amigos Scale and ICP pressure measurement (see chapter 42) is used to establish a data base and record
Intake and output and daily weights are recorded to monitor the fluid and nutritional status of the client.

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Nursing Care ICP
Laboratory findings such as serum electrolyte levels and arterial

blood gas measurements are analyzed to detect fluid, electrolyte, and acid-base complications, or to evaluate the effectiveness of medical management.
Bowel sounds are present in all quad’s and palpated to determine if there is distention.
Bowel elimination patterns are monitored.

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Nursing Care ICP
Keep head straight and head of bed slightly elevated
If

a basal skull fx and ICP may be kept flat but in no case must the head be allowed to be lower than body
Reduce noise and bright lights, limit movement, space activity

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Activities That increase ICP
Coughing
range of motion exercises
sneezing
hip flexion of 90 degrees

or greater
vomiting
suctioning

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Activities that increase ICP
Straining to have a BM (valsalva maneuver
holding breath
digging

heels into bed to help in repositioning
turning in bed without help

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Nursing Care ICP
Hourly I&O may be done
If steroids given, monitor glucose

as ordered
test stools for blood
assess bowel and bladder elimination and prevent straining
complete care given until ICP normal
monitor temp q 4 hours & prn

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Nursing Care ICP
Monitor I&O…fluids may be restricted to reduce cerebral edema

and prevent vomiting and coughing which raise pressures
calculate IV fluids so given over 24 hours
nutrition may be total parenteral nutrition (TPN)
assess skin turgor and electrolytes

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Infectious & Inflammatory Disorders
Meningitis
Encephalitis
Gullian-Barre Syndrome
Poliolmyelitis
Brain Abscess

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Meningitis (Covering of the Brain) pg 669
Inflammation of meninges (three membranes

that cover the brain-dura, arachnoid, & pia mater)
May affect cerebral cortex and decrease blood flow to the brain
Meningococcus, strept, staph and pneumococcus most common cause (contagious—meningococcal)
Reaches brain by the bloodstream or ear or sinus infection

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Meningitis
Most adults with bacterial meningitis recover without permanent neurologic damage or

dysfunction.
When complications do occur, they usually are serious.

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Meningitis S/S
Fever, nuchal rigidity (pain and stiffness of neck); inability to

place chin on chest
nausea and vomiting, photophobia, headache, restlessness, irritability and seizures
severe may cause opisthotonus (arching of back and neck hyperextended

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Kernig’s Sign
Positive Kernig’s sign ( inability to extend the leg

when the thigh is flexed on abdomen

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Brudzinsi’s Sign
Brudzinski’s sign--flexion of neck produces flexion of knees and

hips

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Diagnostic findings: Meningitis
Lumbar puncture done
if bacterial meningitis the CSF is cloudy

and pressure is elevated, glucose is decreased, protein is elevated and WBC & RBCs are elevated
Cultures are done
If culture negative then it is viral in nature

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Medical Management
IV fluids, antibiotics, anticonvulsants are used to treat
sulfonamide given

to people who are exposed
observe for altered LOC, signs of airway obstruction and cardiac arrhythmias

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Encephalitis (Brain Inflammation) pg 676
Infectious disease of CNS characterized by changes in

both white and gray matter of spinal cord and brain
Extensive nerve cell destruction may occur

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Encephalitis (brain inflammation)
Symptoms similar to meningitis
Caused by bacteria, fungi, or virus
cause

virus: Polio, herpes, measles, mumps, chickenpox, mono, hepatitis,,St. Louis virus and Eastern and Western equine virus

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Encephalitis
occurs after a viral infection elsewhere (measles or vaccinations)
Poisoning by drugs

and chemicals, such as lead, arsenic, or Carbon monoxide, may closely resemble encephalitis clinically!!!

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Encephalitis
Onset of viral is sudden with fever, severe headache, stiff neck,

vomiting and drowsiness
lethargy is a prominent symptom and coma and delirium may occur
Tremors, seizures, spastic or flaccid paralysis, irritability

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Encephalitis
Muscle weakness, incoordination, incontinence and visual disturbances (photophobia, involuntary eye movement,

double or blurred vision may occur
speech changed, increased ICP and shock

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Encephalitis--brain inflammation
Lumbar puncture done…CSF pressure elevated but fluid clear
EEG has slow

wave forms
treatment supportive only as viral
Total care, LOC, vital signs monitored

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Encephalitis
Mild cases are common and may go unrecognized
complications and deaths are

more common in infants and elderly
usually recover in 2-3 weeks unless severe

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Guillain-Barre’ syndrome Pg.677
Rare, inflammatory condition involving the CNS that causes rapid

weakness and loss of sensation.
History of recent infection (esp. resp tract); recent surgery or vaccinations
also seen in malignancy and Lupus.
The affected nerves become inflamed and edematous.
Mild to severe ascending muscle weakness or paralysis develops.

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Guillain-Barre’ Syndrome
May be autoimmune response to viral infection
Takes approx 1 month

to start improving and may take 1 year or longer to recover
Muscle weakness or paralysis can occur and be permanent.
Immobility complications kills (pneumonia & infection)

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Guillain Barre’ Syndrome
Weakness, tingling, and numbness in arms and legs may

be 1st symptoms
Weakness usually starts in legs and moves to arms and face
may affect the muscle of respiration
Muscle weakness may be followed by paralysis.
chewing, talking, and swallowing become difficult if cranial nerves involved

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Medical Management Guillian Barre’
Plasmaphoresis removal of plasma from the blood and

reinfusion of the cellular components with saline, has been shown to shorten the course of the DX. If performed within the first 2 weeks.
If the respiratory muscles are involve, endotracheal intubation & mechanical ventilation become necessary.
Difficulty chewing—may need IV fluids, gastric feedings, or TPN

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Nursing Management
Monitory respiratory status/distress
Use IS
R/T incapacitated by immobility, provide meticulous skin

care and change position every 2 hours.
Give passive ROM q 2 hours

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Brain abscess Pg. 678
A collection of pus caused by a bacterial

infection in the brain—if untreated it can be fatal!!
Causes: infection that spreads from an infected skull (osteomyelitis, mastoiditis, sinusitis)
infection spreads thru bloodstream or trauma

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Brain abscess
May occur from infection of teeth, sinus, middle ear, or

from an infection in other organs.
common after endocarditis, pulmonary or abdominal infection, or intracranial surgery
fever, headache, ↑ IICP s/s, seizures, muscle weakness, paralysis and lethargy

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Brain abscess
Risk increases with head injury, illness that lowers resistance (esp.

diabetes) recent infection (esp around eye, nose, or face) Iv drug users and immuno-suppressed

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Brain abscess
I&O fluids may be restricted as over-hydration may cause cerebral

edema
antibiotics usually given 4 to 6 weeks; craniotomy may be needed
seizure precautions; pad side rails, decrease stimuli

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General Nursing Care for Inflammatory Disorders
Swallowing may be affected---give PO drugs

slowly…no narcotics
REPORT sudden increase in headache
Dr. must order ROM but turn and give skin care….cooling blanket may be needed for temp

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Nursing Care for Inflammatory Disorders
Monitor vitals…complete care
neuro checks…use Glasgow Coma scale
Seizure

precautions—insert a padded tongue blade in the mouth ONLY IF THE TEETH ARE NOT TIGHTLY SHUT!!
lung sounds and suction PRN******caution it raises ICP
elevate head of bed 30 degrees
keep oral airway at bedside

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Neuromuscular disorders PG 678
Involves the nervous system and indirectly affects the

muscles
Multiple Sclerosis
Myasthenia Gravis
Amyotrophic lateral sclerosis (Lou Gehrig)

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Multiple sclerosis PG 678
Chronic, progressive disease of the peripheral nerves.
Onset in

young adult and early middle life (20 to 40)
May be autoimmune
people in colder climates at higher risk

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Multiple sclerosis
Permanent degeneration as patchy destruction of myelin sheath of nerve

fibers of brain and spinal cord
Impulses cannot go thru without myelin so muscles become paralyzed
scar tissue replaces myelin (sclerotic)

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Multiple sclerosis
Myelin sheath swells (exacerbation) when it is deteriorating
when swelling goes

down then there is a remission
may go for years without symptoms
each exacerbation causes the symptoms to last longer and more severe

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Multiple sclerosis
Weakness of arms and legs may progress to paraplegia
may be

incontinent
visual disturbances may eventually progress to blindness
infection and emotional upsets may cause exacerbations
NO CURE

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Multiple sclerosis
Intellectual functioning may be impaired late in disease
loss of memory,

impaired judgment
shallow breathing can cause pneumonia (most common cause of death)
may live 20 years with the disease

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Drugs for MS
Lioresal and Dantrium--muscle spasticity and rigidity
Antibiotics, urinary infectives, tranquilizers

for mood swings
Ditropan---urinary incontinence
Urecholine for retention
Steroids

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Nursing
Sensory impairment: be careful with hot, cold, avoid injury
REST, conserve energy
Polyunsaturated

fate, linoleic acid--found in sunflower oil may help

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Myasthenia Gravis pg 681
Disorder of muscles, with increasing fatigue and weakness

as muscles are used
Fatigue appears to be caused by a defect in nerve impulses from nerve endings to muscles
Receptor sites destroyed
Thought to be autoimmunne

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Myasthenia Gravis
Most common symptoms are ptosis of eyelids, difficulty chewing and

swallowing, diplopia, voice weakness, masklike facial expressions and weakness of arms and legs
May affect respirations

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Myasthenia Gravis
Diagnosed by giving IV Tensilon which relieves symptoms in a

few seconds if it is Myasthenia
Chest x-ray may show tumor of thymus

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Myasthenia gravis
Treatment is Mesitonon or Myelelase
Atropine is antidote for mestinon and

other anticholinesterase drugs
Thymus gland may be surgically removed as it may cause destruction of nerve endings

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Mestinon or Mytelase
Observe for drug overdose….abdominal cramps, clenched jaws, muscle rigidity
Give

drug at exact intervals to maintain therapeutic blood levels
Watch for resp distress if drugs not affective
May aspirate as cannot swallow

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Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682
Progressive, fatal neuro disorder of unknown

cause
Degeneration of motor neurons of CNS which causes wasting and weakness of muscles
Fasciculations (twitching) and difficulty speaking or swallowing

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Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682
Periods of inappropriate laughter or crying
Causes

resp failure and total paralysis
No specific tests or treatment
Care is supportive…may need help with ADLs
Will become total care

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Cranial Nerve disorders Pg. 683
Trigeminal Neuralgia (Tic douloureux)
Bell’s palsy
Temporomandibular Disorder (TMD)

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Trigeminal Neuralgia (Tic douloureux) pg 683
Painful condition that involves the 5th

cranial nerve—which has 3 major branches: mandibular, maxillary & ophthalmic.
This sensory and motor nerve is important to chewing, facial movement, and sensation.

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Trigeminal Neuralgia (Tic douloureux) pg 683
Attacks can be initiated by slight

stimulus such as cold, heat, light touch and air, vibration of music, a passing breeze, a temperature change

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Trigeminal Neuralgia
The pain is described as sudden, severe, and burning
It

ends as quickly as it began, usually lasting a few seconds to several minutes.
The cycle is repeated many times a day
During a spasm, the face twitches and the eyes tear.

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Trigeminal Neuralgia
Analgesics, surgery on nerve root or branches
post op there is

no feeling in the area
corneal reflex (blinking) may be gone so need eye drops and shield

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Trigeminal Neuralgia
Slightest stimulus may start attack (vibration from music, breeze, temp

change
they avoid washing face, shaving
forehead over eyebrow is a common trigger spot so avoid touching face
Do not jar the bed

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Trigeminal Neuralgia
Post-op eating may be a problem as may bite tongue

without knowing it
food gets caught in mouth and swallowing is difficult as they lose sensation after nerve cut
small sips, inspect mouth for breaks in mucus membranes

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Trigeminal Neuralgia (Tic Douloureux)
Chew on opposite side
Avoid hot and cold foods

and use mouth rinses after eating
dental appointment to check for problems as no sensations from cavity or abscess

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Trigeminal Neuralgia
Dilantin and tegretol used to reduce pain as analgesics not

too successful
narcotics may be given
Dentist should be seen as may be caused by dental deformities

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Bell’s Palsy
7th cranial nerve—responsible for movement of the facial muscles
facial nerve

usually affects one side

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Bell’s Palsy
causes weakness and paralysis of facial muscles and eyelid
facial pain,

pain behind ear, numbness
diminished blink reflex
ptosis of eyelid, tearing of affected side

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Bell’s Palsy
Speech and chewing difficulty may occur
Must rule out CVA, tumor
no

specific test
Prednisone, analgesics, electrotherapy to prevent atrophy of facial muscles
most show improvement in a few weeks

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Bell’s palsy
If ptosis and blinking reflex affected must wear eye patch
corneal

ulcerations and infection of eye may develop
eye shield at night
antibiotic ointment in eye
eye assessment needed

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Temporomandibular Disorder pg 685
TMD is a cluster of symptoms that are

localized at and about the jaw.
TMD caused by arthritis of mandibular joint, malocclusion of teeth, and excessive movement of jaw at time of endotracheal intubation in general anesthsesia

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TMD S/S
Jaw pain, headache, tinnitus, ear pain
clenching of jaw, inability

to open mouth
Clicking of the jaw when the joint is moved, or the jaw can lock, which interferes with opening the mouth

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TMD S/S
Pronounced spasm and tenderness of the masseter and temporalis

muscles
Dental x-rays help with diagnosis

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TMD Medical Management
Treatment is referred to a dentist
Analgesics are prescribed
Custom-fitted mouth

guard is worn during sleep

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TMD Medical Management
TENS (transcutaneous electrical nerve stimulation), injection of a local

anesthetic to relieve muscle spasm, and ice water oral irrigations are also used to reduce and relieve discomfort.
Surgery is available if conservative methods are ineffective

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Extrapyramidial disorders pg 686
Parkinson’s disease
Huntington’s disease
One primary characteristic is abnormal movement.

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Parkinson’s
Usually begins after age 50
early signs include stiffness, tremors of hands,

pill rolling and difficulty performing movement
Tremors decrease with voluntary movement

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Parkinson’s
Intention tremor: when tremors increase during voluntary movement…may be seen in

some patients
Later, tremors of head, mask-like expression, stooped posture
Monotonous speech and shuffling gait

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Parkinson’s
Have difficulty turning or redirecting forward motion
arms seldom swing while walking
rigidity

develops more than tremors
reflexes and power of contraction are not affected but speed and movement are

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Parkinson’s
Levodopa and cogentin are drugs of choice
physical therapy…in extreme cases surgery

done to destroy part of the thalamus so excessive muscle contraction decreased
fetal tissue transplanted in brain has helped some patients

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Parkinson’s
Symptoms usually begin on one side and may take 15 years

to spread bilaterally
late symptom is drooling and problems with swallowing
eyes may roll up or down and stay in that position for days

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Huntington’s Disease pg. 689
Hereditary, degeneration of basal ganglia and cerebral cortex
Causes

mental apathy, emotional disturbances, choreiform movement (uncontrollable withering and twisting of body) grimacing

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Huntington’s
Treatment is supportive, no cure
tranquilizers and antiparkinsonian drugs to relieve choreiform

movements
late in the disease, may have hallucinations, delusions, impaired judgment, and becomes totally dependent

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Huntington’s
1/2 children of affected parent will develop the disease but will

not find out about it until well past child bearing age
must have disease to transmit trait
most do not develop disease until between age 30 to 50

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Huntington’s
Personality changes (obstinanacy, moodiness and lack of interest
Inappropriate behavior may start

before the involuntary jerky, irregular choreic movements
gait is wide paced and prancing (ST. vitus dance)

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Huntington’s chorea
Difficulty chewing and swallowing, speech difficulty, intellectual decline
loss of bowel

and bladder control
severe depression may lead to suicide
paranoia is common

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Nursing care extrapyramidial 43-2 pg 690
Offer fluids hourly
I&O, keep suction available

to prevent aspiration
soft diet, allow time to chew, cut food into small bites
may need to feed in later stages
skin care,
maintain self care as long as possible

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Nursing Care extrapyramidial
Avoid stress, fatigue
bowel and bladder incontinent retraining program may

be helpful early, not too effective late
Prone to injury, assist when ambulating or getting up…may climb over rails or wander
observe frequently

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Seizure disorders pg 692
Abnormal electrical discharge of neurons
can be focal or

generalized
idiopathic (no known cause
causes---high fever, electrolyte imbalance, uremia, hypoglycemia, hypoxia, brain tumor

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Seizure disorders
Epilepsy is a permanent, recurrent seizure disorder
causes include brain injury

at birth, head injury, metabolic disorders or idiopathic
convulsive disorder and seizure disorder the same

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Seizure disorders
Too much electrical discharges from nerve cells in the brain
Different

types: partial or focal--from a localized area, cause specific symptoms and may spread to entire brain
lasts from seconds to about one minute

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Seizure disorder
Jacksonian: begins at one place and spreads to another in

an orderly fashion
psychomotor and psychosensory: seizure with hallucinatory sights, sounds and odors
mumbles and non-sense words, smacking lips

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Seizures
Generalized seizure: Entire brain involved; can last several minutes, loss of

consciousness
absence; brief change of consciousness lasting 1 to 10 seconds, mostly children
blank stare, mouth arm or eyelid movement, vacant stare, Petit mal

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Generalized seizure
Myoclonic: brief involuntary muscular jerks of extremities or body
Tonic-clonic: Grand

mal--emotional changes, aura (seconds or minutes before), epileptic cry, loss of consciousness
tonic-stiffness and rigidity

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Seizure--Grand mal
Clonic phase; alternating spasms and relaxations---thrashing and jerking
breathing is spasmodic
frothing

saliva, jaws clenched, incontinence
labored breathing and cyanosis
lasts 2 to 5 minutes

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Grand mal seizure
Postictal stage: consciousness is regained, does not remember seizure
confused,

difficulty speaking, headache
fatigue, soreness and may sleep for hours

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During a seizure
Turn to side to keep airway patent and to

prevent aspiration of saliva and vomitus
suction PRN
remove pillow, bedding and clothing that can obstruct breathing
loosen restrictive clothing

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During a Seizure
Protect from injury…do not forcibly restrain arms, legs or

head
stay with patient
Give privacy…clear onlookers

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After a seizure
Keep bed flat; turn to side until awake and

responding
keep room lighting dim and noise to a minimum
Take vitals stat and q 30 minutes until awake
inspect lips, tongue, oral cavity for injury
change linen if incontinent

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Nursing
Observe closely and chart activity before and after
turn on side--prevent aspiration,

protect from injury
do not restrain, do not force objects in mouth
Stay with patient
take vitals after a seizure

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Nursing
Assess for injury, allow to rest, report activity, time elapsed and

client reaction
pad side rails
good mouth care--gingival hyperplasia
dilantin levels
give meds on schedule

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Status Epilepticus
Several tonic-clonic seizures without consciousness returning
this is an emergency
may be

from stopping seizure meds
life threatening

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Medications for seizures
Dilantin
phenobarbital
Tegretol
Zarontin
depakene
Valium drug of choice to stop status epilepticus

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Brain Tumor pg. 697
Can result in death even if benign
They take

up space and block flow and absorption of CSF so cause ICP to occur
headache, vomiting and papilledema is common
headache usually early in AM and becomes more severe as tumor grows

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Brain tumor
Projectile type vomiting without nausea, speech difficulty, double vision, paralysis
Causes

brain stem herniation so resp rate deeper, labored, periodic…temp usually rises but B/P stays stable

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Brain Tumor
Keep as pain free as possible
IV fluids and TPN may

be needed--keep I&O
encourage mobility as long long as possible…assist
radiation & chemotherapy causes oral lesions…keep mouth moist, give sips of water

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Brain Tumor
Chemotherapy, radiation and surgery used to treat
craniotomy (incision thru skull)

or craniectomy (part of skull removed) done, laser beams or radioisotopes inserted into tumor also done

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паталогии ЦНС

Содержание

Increased Intracranial Pressure (pg. 666)The cranium consists of 1. Brain tissue

Increased Intracranial pressureThe skull cannot expand so a tumor, cerebral edema,

Increased Intracranial PressureIf not recognized, the brainstem will herniate thru the

ICPSigns and symptoms develop rapidly or slowlyIf slow it may be

Level Of ConsciousnessConfusion, restlessness, disorientation and drowsiness may or may not

HeadachePain is usually intermittent--if constant condition usually gravecoughing, sneezing, straining at

Vomiting and ICP Commonly occurs without warning of nausea and without a

PapilledemaPapilledema (edema of optic nerve caused by obstruction of venous drainage

PosturingDecorticate--arms flexed--problem with cervical spinal tract or cerebral hemisphereDecerebrate--arms extended (more

Symptoms of ICPChange in LOCheadachevomitingpapilledemavital signs--temp rises, b/p rises and pulse

Vital signsTemp rises, B/P rises and pulse pressure widens. These 3

Medical and surgical managementOsmotic diuretics (mannitol, glycerol); steroids to reduce cerebral

Medical & surgical managementRestrict fluids, lumbar punctures to remove CSF and

Medical ManagementMay order:insertion of foleyNG tube for gastric decompression or feedingsStool

Normal ICP In the Ventricles Norm: 1 to 15Moderate ↑: 15

Nursing care ICPTeach to remain quiet in bed and not to

Nursing Care ICPICP can affect temp regulation so cooling blanket may

Nursing Care ICPA neurologic flow sheet that includes the Glasgow Coma

Nursing Care ICPLaboratory findings such as serum electrolyte levels and arterial

Nursing Care ICPKeep head straight and head of bed slightly elevatedIf

Activities That increase ICPCoughingrange of motion exercisessneezinghip flexion of 90 degrees

Activities that increase ICPStraining to have a BM (valsalva maneuverholding breathdigging

Nursing Care ICPHourly I&O may be doneIf steroids given, monitor glucose

Nursing Care ICPMonitor I&O…fluids may be restricted to reduce cerebral edema

Infectious & Inflammatory DisordersMeningitisEncephalitisGullian-Barre SyndromePoliolmyelitisBrain Abscess

Meningitis (Covering of the Brain) pg 669Inflammation of meninges (three membranes

MeningitisMost adults with bacterial meningitis recover without permanent neurologic damage or

Meningitis S/SFever, nuchal rigidity (pain and stiffness of neck); inability to

Kernig’s Sign Positive Kernig’s sign ( inability to extend the leg

Brudzinsi’s Sign Brudzinski’s sign--flexion of neck produces flexion of knees and

Diagnostic findings: MeningitisLumbar puncture doneif bacterial meningitis the CSF is cloudy

Medical Management IV fluids, antibiotics, anticonvulsants are used to treatsulfonamide given

Encephalitis (Brain Inflammation) pg 676 Infectious disease of CNS characterized by changes in

Encephalitis (brain inflammation)Symptoms similar to meningitisCaused by bacteria, fungi, or viruscause

Encephalitisoccurs after a viral infection elsewhere (measles or vaccinations)Poisoning by drugs

EncephalitisOnset of viral is sudden with fever, severe headache, stiff neck,

EncephalitisMuscle weakness, incoordination, incontinence and visual disturbances (photophobia, involuntary eye movement,

Encephalitis--brain inflammationLumbar puncture done…CSF pressure elevated but fluid clearEEG has slow

EncephalitisMild cases are common and may go unrecognizedcomplications and deaths are

Guillain-Barre’ syndrome Pg.677Rare, inflammatory condition involving the CNS that causes rapid

Guillain-Barre’ SyndromeMay be autoimmune response to viral infectionTakes approx 1 month

Guillain Barre’ SyndromeWeakness, tingling, and numbness in arms and legs may

Medical Management Guillian Barre’Plasmaphoresis removal of plasma from the blood and

Nursing ManagementMonitory respiratory status/distressUse ISR/T incapacitated by immobility, provide meticulous skin

Brain abscess Pg. 678A collection of pus caused by a bacterial

Brain abscessMay occur from infection of teeth, sinus, middle ear, or

Brain abscessRisk increases with head injury, illness that lowers resistance (esp.

Brain abscessI&O fluids may be restricted as over-hydration may cause cerebral

General Nursing Care for Inflammatory DisordersSwallowing may be affected---give PO drugs

Nursing Care for Inflammatory DisordersMonitor vitals…complete careneuro checks…use Glasgow Coma scaleSeizure

Neuromuscular disorders PG 678Involves the nervous system and indirectly affects the

Multiple sclerosis PG 678Chronic, progressive disease of the peripheral nerves.Onset in

Multiple sclerosisPermanent degeneration as patchy destruction of myelin sheath of nerve

Multiple sclerosisMyelin sheath swells (exacerbation) when it is deterioratingwhen swelling goes

Multiple sclerosisWeakness of arms and legs may progress to paraplegiamay be

Multiple sclerosisIntellectual functioning may be impaired late in diseaseloss of memory,

Drugs for MSLioresal and Dantrium--muscle spasticity and rigidityAntibiotics, urinary infectives, tranquilizers

NursingSensory impairment: be careful with hot, cold, avoid injuryREST, conserve energyPolyunsaturated

Myasthenia Gravis pg 681Disorder of muscles, with increasing fatigue and weakness

Myasthenia GravisMost common symptoms are ptosis of eyelids, difficulty chewing and

Myasthenia GravisDiagnosed by giving IV Tensilon which relieves symptoms in a

Myasthenia gravisTreatment is Mesitonon or MyelelaseAtropine is antidote for mestinon and

Mestinon or MytelaseObserve for drug overdose….abdominal cramps, clenched jaws, muscle rigidityGive

Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682Progressive, fatal neuro disorder of unknown

Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682Periods of inappropriate laughter or cryingCauses

Cranial Nerve disorders Pg. 683Trigeminal Neuralgia (Tic douloureux)Bell’s palsyTemporomandibular Disorder (TMD)

Trigeminal Neuralgia (Tic douloureux) pg 683Painful condition that involves the 5th

Trigeminal Neuralgia (Tic douloureux) pg 683Attacks can be initiated by slight