Cns Disorders..table

Disease

Definition

Risk Factors

CONTUSION

Is an injury to the soft tissue produced by a blunt force

Injury, trauma, fall, battered, collide, MVA

CONCUSSION

A temporary loss of consciousness that results from a transient interruption of the brain’s normal functioning

Injury, trauma, fall, battered, collide, MVA

HEMATOMA

Well-defined pocket of blood and fluid beneath the skin

Injury, trauma, fall, battered, collide, MVA

SKULL FRACTURE

A break in one or more of the cranial bones

Injury, trauma, fall, battered, collide, MVA

Signs and Symptoms hemorrhage into injured part (ecchymosis), pain and swelling, hyperkalemia may be present if extensive 4.pale, clammy skin, shallow respiration, temporary amnesia of recent events, loss of consciousness Temporary disorientation, blurred vision, double vision, irritability, dizziness, emotional changes

>epidural – ipsilateral pupil changes, contralateral hemiparesis >subdural – deterioration of LOC, ipsi and contralateral hemiparesis, memory lapse, confusion, drowsiness, personality changes >intracerebral – increase ICP Headache, bruises, laceration , rhinorrhea, otorrhea, Battle sign, conjuctival hemorrhage, seizure

Complications

Diagnostics

>Permanent brain >damage (intellect, speech, gait, seizure, paralysis) >Systemic infection >Increased ICP >Posttraumatic alterations >Cerebral edema, neurologic shock, >F & E disturbance, >venous thrombosis, >infection

>MRI >CT scan >neurophysiokogical test >CBC

>Systemic infection >Increased ICP >Brain herniation >Posttraumatic seizure disorder >Neurobehavioral alterations >Cerebral edema, neurologic shock, >F & E disturbance, >venous thrombosis, >infection

>MRI >CT scan >neurophysiological test >CBC

>Cerebral edema, neurologic shock, >F & E disturbance, >venous thrombosis, >Systemic infection >Increased ICP >Brain herniation >Posttraumatic seizure disorder >Neurobehavioral alterations

>MRI >CT scan

>Systemic infection >Increased ICP >Brain herniation >Posttraumatic seizure disorder >Neurobehavioral alterations >Cerebral edema, neurologic shock, >F & E disturbance, >venous thrombosis,

>MRI >CT scan >Radiographic studies

Medical Management >Osmotic Diuretic >intubation >management of increased ICP >Antibiotics- to prevent infections >Supportive care >oxycodone (opiate), propanolol (beteadrenergic blocker), clonidine (alphaadrenergic antagonist), dantrolene (muscle relaxant) >Osmotic Diuretic >intubation >management of increased ICP >Antibiotics- to prevent infections >Supportive care >oxycodone (opiate), propanolol (beteadrenergic blocker), clonidine (alphaadrenergic antagonist), dantrolene (muscle relaxant) >Osmotic Diuretic >intubation >management of increased ICP >Antibiotics- to prevent infections >Supportive care >oxycodone (opiate), propanolol (beteadrenergic blocker), clonidine (alphaadrenergic antagonist), dantrolene (muscle relaxant)

>Osmotic Diuretic >Corticosteriod >Ventilatory support

Surgical Management >Drill hole to release pressure >Supratentorial >Infratentorial

Nursing Management 1.Observe LOC, neurologic status, Glasgow Coma Scale, respiratory status 2.Notice in changes in vital signs 3.Assist in intubation 4.Begin nutritional support

>Drill hole to release pressure >Supratentorial >Infratentorial

1.Observe LOC, neurologic status, Glasgow Coma Scale, respiratory status 2.Notice in changes in vital signs 3.Assist in intubation 4.Begin nutritional support

>Craniotomy >Craniectomy >Craniectomy

1.Proper positioning 2.Neurologic Assessment 3.Maintain patent airway 4.Monitior ICP 5.Monitor respiration 6..If intracerebral hematoma, stop bleeding

>Burr holes >Debridement of scalp and skull

1.Maintain patent airway 2.Assess discharges 3.Provide adequate nutrition and possible nasogastric feedings 4.Observe sensory changes 5.Care of surgical

SPINAL CORD INJURY

Include fractures, contusion, or compression of the vertebral column with damage to the spinal cord

Accident, violence, contact sports

Tetraplegia, paraplegia, hemiplegia, hemaparesis, muscle spasm

SPINAL CORD COMPRESSION

Is the tissue compression surrounding the spinal cord

Tumor, nerve root compression, spinal injury, age, disease that weakens the vertebrae

Weakness, paralysis, paresthesia, pain especially when lifting heavy objects

CEREBRAL ANEURYSM

Is a distention of an artery brought about by a weakening/ destruction of the arterial wall

Atherosclerosis, Heredity, Infection, Trauma, Immunologic Conditions, Hypertension, Local infection, congenital weakness of vessels

Headache, increase ICP, n/v, loss of consciousness, dizziness,

CVA

Is the onset and persistence of neurologic dysfunction lasting longer than 24 hours and resulting from disruption of blood supply to the brain and

Aterioscelorosis, emboli, occlusion, hemorrhage

Headache, numbness, weakness, loss of motor ability, dysphagia, aphasia, alteref cognitive abilties

site 6.Avoid driving, avoid straining during bowel 1.Do not move client until adequate personnel or equipment are available 2.Keep the neck aligned 3.Immobilize the head and neck 4.Maintain patent airway 5.Prepare client for sugery 6.Perform passive range of motion exercises 7.Promote normal bowel and bladder elimination

>Respiratory arrest, >pressure ulcer due to immobility >renal calculi >C1,C2,C3 –affect respiration, quadriplesia, impaired bowel and movement >C4,C5- no sensation >C6,C7,C8- problem on sensation on thumb. No sensation on chest >T1-T6 –paralysis, no sensation on midchest >T7-T12- decrease sensation below waist >L1-L2-hip abduction impaired >L3-L5- motor movement impaired >S1-S5- decrease bowel and bladder control >Respiratory impairment, >mobility impairment >sensory losses >bladder or bowel dysfunction >Fatal hge >myocardial ischemia >stroke >paraplegia

>Spinal radiography >CT scan

>Dextra, plasma expanders – used to increase capillary blood flow within the spinal cord >Dantrolene, Baclofen – to prevent muscle spasticity

>decompressive laminectomy

>lumbar tap >neurologic examination >x-ray > bone scan >MRI

>corticosteroids >skeletal muscle relaxant >tranquilizer >antianxiety >aspirin >analgesic >phenybutazone >anticonvulsant >corticosteroid >osmotic diuretic >amino caproic acid >antiemetic

>laminectomy. >diskectomy

1.Neurological assessment 2.Provide safety measures 3. Bedrset

>craniotomy

>Aspiration >pneumonia, >spasticity, >contractures >DVT >pulmonary embolism >brain stem herniation >post stroke

>carotid UTZ >CT >CT angiogram >Cerebral angiography >PET

1.Avoid Valsalva maneuver 2.Fluid restriction 3.Provide normal bowel elimination 4.Seizure precaution 5.Use antiembolic stockings 6.Avoid emotional situation 1.Neurological assessment 2.Monitor bowel and bladder contro 3.Maintain functional position of all extremities 4.Safety measures 5.Facilitate communication

>Radiographic studies >cerebral angiography >lumbar puncture >CT scan >UTZ >Spiral CT >Ateriography

>thrombolytic therapy – tPA >Antihypertensive agents >Vasopressor agents >colloids and volume expanders

indicates infarction MULTIPLE SCLEROSIS

GUILLAIN BARRE SYNDROME

ALZHEIMER’S DISEASE

depression

A progressively disabling demyelinating disease affecting nerve fibers of the brain and spinal cord and marked by periodic exacerbation and remissions >classification: 1. relapsing remitting(RR) 2. secondary progressive (SP) 3. primary progressive(PP) 4. progressive relapsing(PR) Is an acute, rapidly progressing, ascending inflammatory demyelinating polyneuropathy of the peripheral sensory and motor nerves and nerve roots

Autoimmune dysfunction, heredity, infections

Fatigue, weakness, abnormal reflexes, double vision, nystagmus, tremor, paresthesia, dysarthria,

>Respiratory dysfunction >infections >complications from immobility >dysarthria

>MRI >lumbar puncture >CSF analysis

>corticosteroids >immunosuppressive agents >interferon beta-1a (Rebif, Avonex) >interferon beta-1b >copolymer-1 – reduce relapse rate

Autoimmune d/o, viral infection

>Respiratory failure >cardiac dysrhythmias >paralysis >anxiety and depression

>lumbar puncure >CSF analysis >electrophysiologic studies

>plasmapheresis >high-dose immunoglobulin therapy >analgesics >muscle relaxants

progressive, irreversible, degenerative, neurologic diease that begins indiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect

genetic/familial female gender advanced age viruses environmental toxins silent brain infarcts previous head injury

Paresthesia, dysthesias, acute onset of progressive muscle weakness beginning from the legs and ascending, difficulty in swallowing, decreased or absent deep tendon reflex, automic dysfunction, decreased vital capacity S/Sx Early:short term memory impairment Mild anomia Poor abstract reasoning and orientation Topographic disorientation Visual and spatial disorientation Middle:Apraxia Perseveration Nocturnal restlessness Apraxia Aphasia Agraphia

>injury >malnutrition

>Noncontrast computed tomography >Magnetic resonance imaging >Single Photon emission computed tomography >Complete blood count >Commercial assasys for CSF

>Cholinesterase inhibitors >Donepezil ( Aricept) >antidepressant >Galantamine (Reminyl) >Memantine (Namenda)

6.Teach px to use unaffected side fro activities of daily living 1.Assess client’s sleep and rest patterns 2.Encourage adequate rest 3.Assist client in planning lifestyle 4.Encourage relaxation and coordination exercises 5.Maintain patent airway 6.Promote measures to enhance body image

1.Explain all procedures and care to help reduce client’s anxiety 2.Monitor respiratory status 3.Prevent complications of immobility 4.Maximize effective communication 5.Promote adequate nutrition to prevent muscle wasting 1.Provide rest periods 2.Provide adequate lighting 3.Pncourage use of assistive safety devices 4.Ensure physical activity as tolerated or provide ROM exercises 5.Maintain quiet and relaxing environment

Advanced:

MYASTHENIA GRAVIS

chronic autoimmune disorder affecting the neuromuscular transmission of impulses in the voluntary muscles if the body , characterized by varying degrees of weakness.

genetic environmental factors women

PARKINSON’S DISEASE

chronic, progressive neurologic disease affecting the brain centers responsible for control and regulation of movement

genetic atherosclerosis head trauma toxicity from pesticides, herbicides, methylphenyltetrahydropyridine or welding fumes

progression of sign and symptoms Dysarthria Paranoid delusions Short attention span Wandering Hyperactivity Pacing Restlessness Agitation Hallucinations Los of spontaneity and social inhibitions Urinary and fecal incontinence Emaciation Increased irritability Unresponsiveness extreme muscular weakness easy fatigability diplopia ptosis masklike facial expression dysarthria dysphagia dysphonia sudden respiratory distress tachycardia anxiety Bradykinesia Tremors Rigidity Resting “pillrolling” tremors Poor balance Autonomic disorderssleeplessness, salivation, orthostatic hypotension, dizziness Depression Dementia Gait difficulties Micrographia Head bent forward Masklike expressions Drooling Losss of postural

>Aspiration >Respiratory failure >Complications of decreased physical mobility

>serum test for acetylcholine receptor antibodies >Edrophonium (Tensilon) test >Electrophysiologic testing >CT Scan

>oral anticholinesteraseneostigmine bromide (Prostigmin), pyridostigmine (Mestinon, Regonol) >immunosuppressive drugs- prednisone, azathioprine (Imuran) >Palsmapheresisremoves antibodies from blood >Edrophonium (tensilon)

>Thymectomy

1.Monitor respiratory status 2.Monitor speech and swallowing activities 3.Administer medications as prescribed 4.Provide rest periods 5.Instruct to avoid muscle stress

>dementia >aspiration >injury from falls

>Positron Emission Tomography

>anticholinergicstrihexyphenidyl(Artane), benztropine(Cogentin), NS procyclidine(Kemadrin) >Amantadine (Symmetrel) – reduce transmission of cholinergic pathways >Levadopa -carbidopa (Sinemet)-inhibit destruction of levadopa in the bloodstream >Levadopa >Bromocriptine(Parlodel), pergolide(Permax), pramipexole(Mitrapex), ropinirole(Requip) >Monoamine oxidase inhibitor- selegiline, deprenyl(Eldepryl) >Tolcapone(Tasmar),

>Pallidotomyelectrode destroys cells in the globus pallidus and improves longstanding symptoms chronic deep brain stimulation of the thalamus, electrodes implanted in the thalamus or globus pallidus brain tissue transplant

1.Encourage patienty to participate in daily exercises 2.Advise stretching and postural exercises 3.Encourage to take warm baths and receive massages 4.Suggest smaller meals and additional snacks 5.Encourage compliance to medications 6.Exercise facial muscles 7.Encourage foods with moderate fiber content and

reflexes

entacapone(Comtan)

increase water