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Neurologic Disorders


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Disorders of the Cranial Nerves
Trigeminal Neuralgia & Bell's Palsy
Trigeminal Neuralgia
Degeneration or pressure on the fifth cranial nerve causes EXCRUCIATING PAIN. Sudden severe stabbing pain, which radiates from the angle of the jaw.
What are the signs and symptoms of Trigeminal Neuralgia?
Repetitive shock-like pain along the eye and back over the forehead, upper lip, nose and cheek under eye, lower lip pain and the outer border of the tongue on the affected side.
Nursing Interventions for Trigeminal Neuralgia
Medications (Tegretol, dilantin, or baclofen), Surgery to relieve pressure, sympathectomy (injection of alcohol along course of nerve branch)
Nursing Actions with Trigeminal Neualgia
ASSESS PAIN QUALITY, location, effects of meds. Instruct in oral hygiene measures and eating (chewing on unaffected side to prevent mouth injuries.
Bell's Palsy
A disorder of the 7th cranial nerve (Facial) which causes unilateral facial paralysis. Has a sudden onset. Possibly caused by edema along the nerve.
Resolution usually within 3 months
What are the signs and symptoms of Bell's Palsy?
Distorted facial expressions (drooping), drooling and tearing on the affected side; INABILITY TO CLOSE EYELIDS.
What are the interventions for Bell's Palsy?
An EYE PATCH and lubricant to affected eye, corticosteroids for approx 1 week
Nursing actions for Bell's Palsy
Assess for resolution of signs/symptoms, instruct in interventions to protect the eye, encourage to chew on unaffected side.
Diagnostic Procedures
Carotid Arteriogram, CAT scan, MRI, Lumbar puncture, Myelogram, and EEG
X-ray of spinal cord, through lumbar puncture.
Follow-up care for lumbar punctures and myelograms
Bedrest in a flat position for 4-8 hours to prevent CSF leakage causing headaches, increase fluids
What are signs of neurological problems?
Ankle Clonus, Caloric, Babinski signs, Romberg's sign and meningeal signs
Caloric Testing
Used to evaluate the vestibular portion of the auditory nerve. Water warmer or cooler than body temp is infused into the ear, normal response is vertigo(spinning) and nystagmus(involuntary eye movements) within 20-30 seconds
Nursing- fast for several hrs before, bedrest after with careful into of fluids to prevent N/V
Meningeal signs
Brudzinski- chin to chest- knees will flex (b/c of meningies)
Kerning Sign-sitting with legs bent up, when try to straighten they come back up.
These are not conclusive.
Guidlines for assessing neurovascular
1. stimulate enough to get a true picture
2.Compare values to baseline data
3.Assess LOC FIRST*- it is the 1st thing to go bad, check memory
-Ability to follow commands(highest level of functioning)
4.Assess pupils (keep meds in mind they may affect results)
5.Can not assess cranial nerves on an unconscious patient
Patients blood pressure spikes accompanied by bradycardia and abnormal respirations what may this cause?
It may cause herniation of the brain if no actions are taken, this is a very bad sign.
How do you assess motor response
localized pruposefl movement, apply central stimulus(sternal rub, or squeezing of trapezeus) if the whole body responds it's ok if not do peripheral stimulus (press nail beds), and observe for abnormal posturing
What is Multiple Sclerosis?
A chronic, progressive, degenerative disorder of the CNS. It involves destruction of the myelin. Varies from patient to patient. An autoimmune disease r/t a viral infection earlier in life(exact cause unknown).
What does MS affect?
Cerebrum, spinal cord, cerebellum, brainstem, optic nerves
Pathopysiology of MS
The myelin sheath is damaged, causing an inflammatory response which reduces the thickness of the myelin sheath. Impulses are still transmitted but are not as effective.
What are astrocytes?
the cells that remove the damaged myelin sheath, they also form scar tissue.
Multiple Sclerosis Assessment-History
MS often mimics other neurologic diseases, thourogh hx is very important. Ask about vision changes, motor skills, and sensations(early indicators of MS)
Multiple Sclerosis Signs and syptoms
The signs and symptoms reflect the area of damage.
Motor-Fatigue, resistance to muscle stretching, decreased abd reflex, double vision
Sensory-Numbness, tingling
Cerebellum-balance, coordination, bowel and bladder impairment, and sexual dysfunction
Multiple Sclerosis Diagnosis
1.Rule out other diseases.
2.History-s/s of neurological dysfunction
3.CSF analysis-increased lymphocytes & monocytes
4.CAT scan-areas of demylination.
5.MRI-for detection of sclerotic plaques only caused by MS, Definitive diagnosis.
Multiple Sclerosis Medications
Immunosuppressive Drugs
Antiviral Agents-Interferon (reduces # of flare-ups) side effects-CHF
Antispasmodics-Baclofen, Valium, Ditropan
Multiple Sclerosis Surgical proceures
Myelotomy- neuro fibers in spinal cord are severed.
Rhizotomy- resection of specific nerve root.
Multiple Sclerosis Nursing Considerations
Assess when rested and again when fatigued or tired to compare
Nursing Diagnoses for Multiple Sclerosis
-Impaired physical mobility
-Risk for injury
-Self care deficits
-Alteration in urinary elimination
-High risk for UTI
Alteration in bowel elimination
Multiple Sclerosis- Examples of short and long term goals
STG: Client will have improved muscle strength AEB ability to transfer self from the bed to the W/C within one week from today.
LTG: Client/family will be able to verbalize knowledge of the disease process and treatment, s/s to report by discharge
Parkinsons Disease
Progressive neurological disorder characterized by specific motor dysfunctions. (tremors, bradykinesia, and rigidity)--2 out of 3 of these symptoms is positive to parkinsons
Parkinsons Disease patho
Nerve cell loss and deterioration in basal ganglia as well as deficiency in nerve impulses. (basal ganglia is learned and automatic movements)
Deterioration and loss of dopamine producing neurons.
What does Parkinsons Disease effect?
The basal ganglia leading to a decrease in dopamine.
The imbalance between _______ and ______ are the cause of parkinson-like symptoms.
Acetylcholine(excites) & Dopamine(inhibits)
Parkinson symptoms-motor dysfunction
1.Rigidity-assess by resistance to passive ROM
2.Bradykinesia to total akinesia-most difficult to treat
3.Tremors-mostly at rest
4.Loss of postural reflexes-shuffling gait, festination gait
Parkinsons Disease:
A decrese in cognitive function causes________?
memory impairment
Other signs and syptoms of Parkinsons Disease
1.Impaired function of facial muscles
2.Elimination abnormalities
3.Depression and/or anxiety
4.Dementia (40% of pts)
5 Stages of Parkinsons
1.Flexion of affected arm (unilateral limb involvement, lean towards unaffected side)
2.Shuffling gait and loss of arm swing (move faster to try to keep balance)
3.Increased difficulty walking (holding on to things when walking)
4.Increased weakness (assist with walking, walker/aide)
5.Increased disability (W/C or bedridden
Diagnosis of Parkinsons Disease
-History and s/s (2 out of 3)
-MRI for cerebral abnormalities
-EEG shows decreased activity
-CAT scan- the brain shrinks
-Response to antiparkinson meds- sure fire diagnosis
Parkinsons Disease: Treatment goals
Relief of symptoms and prevention of complications.
Parkinsons Disease: Medication goals
-Enhance the release and/or supply of dopamine
-Antagonize or block the effects of cholinergic neurons
Parkinsons Disease: Medications
Antihistamines-for tremors and rigidity (Benadryl)
Antiviral Agents-
MAO inhibitors (Eldepryl)
Parkinsons Disease: Diet
Diet-low protein during the day, the AA in protein compete with levadopa for entry into CNS at BBB
Myasthenia Gravis
Autoimmune neurological disease affecting transmission of neurologicl impulses. Involves a decrease in the # and effectiveness of acetylcholine in neuro junction.
Myasthenia Gravis: Patho
Antibodies are produced against acetylcholine receptors, decreasing receptor sites. Prevents acetylcholine molecules from attaching
Myasthenia Gravis: Exacerbartion of symptoms
Emotions, heat, sun, antibiotics (some) all exacerbate.
Myasthenia Gravis: Signs and symptoms
Fatigue of skeletal muscles: eyes/eylids, chewing/swallowing, speaking/breathing, neck, shoulders and hips. No sensory loss and normal reflexes.
Myasthenia Gravis: Severe signs
Respiratory failure and quadrapolegic
Myasthenia Gravis: Medical Diagnosis
Eye test, EMG, tesilon test, serum test for antibodies, and CAT scan of thymus
Myasthenia Gravis: Treatment Goals
Improve neurological function and Reduce and remove circulating antibodies
Myasthenia Gravis: Drug Therapy
Anticholinerterase, Corticosteroids, immunosuppressants,
Myasthenia Gravis: Treatments
Thymectomy and Plasmapheresis
Myasthenia Gravis: Crisis
Sudden onset due to infection, surgery, labor/delivery, or failure to take medication
-Maintain Gas exchange-recognize s/s of resp failure, and manage secretions
-May need mechanical ventilation
2 types- viral or bacterial

Bacterial must be treated immediately. IV antibiotics started asap
Meninigitis: signs and symptoms
Fever/chills, severe headaches, N/V, confusion/lethargy, stiff neck, photophobia, skin rash, seizures
Patients with Aphasia often have difficulty in what areas?
Understanding what is said to them, speaking, reading, writing, calculating

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