DISORDER SYMPTOMATIC HEADACHE

DEFINITION - CEPHALGIA (Headache) – most common symptoms of a neurologic disorder. Also

associated with many other diseases and disorders. Not a disease in itself but
rather a symptom of an underlying disorder.
CAUSES Co-morbidity conditions
- Eye strain
- Sinusitis
- Muscle strain
- Ligament strain
- Cervical degenerative changes
- Emotional tension
- Stress
- Hypertension (HTN)
- Increased intracranial pressure (ICP)
Persistent or recurring headaches are frequently associated with
- True neurologic diseases or disorders
- Brain tumors
- Aneurysms
DIAGNOSTICS Medical history
Family history
Evaluation of individual patterns of the headaches
History of trauma
Knowledge of changes in behaviors or LOC
X-ray examinations of the head and sinuses
Food elimination diets (particularly, dairy and cheese products)
CT, MRI, or PET
NURSING →Nonjudgmental acknowledgement of the individual’s pain is essential because pain
CONSIDERATIONS thresholds differ among clients.
→Educating the client & family in the various treatment alternatives presented by the
health-care provider.
→Offer analgesics as needed (PRN) & encourage compliance with the medication regimen.
→If the headache is triggered by foods, major changes in eating habits may be necessary.
DISORDER CLUSTER HEADACHE
DEFINITION - Tend to occur in groups or clusters, often at night.
OTHER NAME - Histamine headache
CAUSES - Vascular disturbances
AFFECTED GROUP - Common in men than in women
MANIFESTATIONS SYMPTOMS SIGNS
- Severely disabling headache Symptoms of vasodilation
- Occurs suddenly and severely, often affecting only - Edema
one side and involving the eye, neck, & face on - Lacrimation (tear formation)
that side - Rhinorrhea (runny nose)
- Face & head are sensitive to external touch - Diaphoresis (sweating)
- May disappear as suddenly as it occurs or it may - Flushing of the affected side
continue for several days. Pupil constricts
Eye may appear to bulge
TREATMENT →No specific cure
→Vasoconstrictor drugs
→Corticosteroids
→Indomethacin (Indocin)
DISORDER MIGRAINE HEADACHE
OTHER NAME - Vascular Headaches
CAUSES - Unknown
- Vascular disturbance-brain’s blood vessels dilate abnormally
- Family history
- Co-morbidity - asthma, hay fever, & food allergies.
- Stress
Triggers
- Caffeine (or its sudden withdrawal)
- Nicotine
- Cheese
- Alcohol
- Certain food preservatives (e.g., monosodium glutamate)
- Fasting & missing meals
- Premenstrual fluid retention
- Certain drugs, include oral contraceptives & reserpine (Serpasil), an
antihypertensive agent
MANIFESTATIONS SYMPTOMS SIGNS
- Sensory warnings or premonitions (aura) Vomiting
Aura
- Mood changes
- Anorexia
- Numbness of a body part
- Visual symptoms, such as flashing lights
or floating spots
- Unilateral throbbing or steady pain
- Nausea
TREATMENTS →Abortive therapy
- Includes drugs designed to interfere with the cause of the headache,
that is, to stop the headache.
→Symptomatic relief
- Is used to treat headache’s pain or nausea.
→Preventative therapy
- Uses medications to prevent the headaches.
→Dietary and lifestyle changes
→Relaxation exercises
→Biofeedback - The idea behind biofeedback is that, by harnessing the power
of your mind & becoming aware of what's going on inside your body, you can
gain more control over your health.
→Deep breathing

 Progressive muscle relaxation -- alternately tightening and then

relaxing different muscle groups
 Guided imagery -- concentrating on a specific image (such as
the color and texture of an orange) to focus your mind and make
you feel more relaxed
 Mindfulness meditation -- focusing your thoughts and letting go
of negative emotions

→Acupuncture
→Application of cold to the back of the neck or the base of the skull
DISORDER SEIZURE
OTHER NAME - Convulsion
DEFINITION An episode of abnormal motor, sensory, cognitive, & psychic activity caused by erratic &
abnormal electrical discharges of brain cells.
Seizure disorders – repeated episodes of seizures.
Epilepsy – used to describe any recurrent pattern of seizures.
- Cerebral palsy
- Autism
- Variety of metabolic or developmental disorders.
Status Epilepticus – refers to the occurrences of a single, unremitting seizure that lasts
longer than 5 minutes or frequent clinical seizures without an interictal return to baseline. (It
is a MEDICAL EMERGENCY).
CAUSES - Birth trauma - Genetic predisposition
- Head injuries - Brain infections & abscesses
- Toxicity - Fever
- Metabolic & nutritional disorders - Tumors
- Brain malformations
DIAGNOSTICS - Client’s history Physical examination
- EEG
- Laboratory tests – indicate electrolytes imbalance, drug toxicity, or underlying disorders.
(Hyponatremia, Hypocalcemia, Hypomagnesemia)
- CT Scan & MRI – identify tumor, bleeding, or brain lesions
- Cerebral Angiogram – differentiate between brain tumor and blood vessel
malformation.
- Videotelemetry monitoring - helpful to the physician in diagnosing the specific seizure
type.
DURATION Ictal phase – duration of the seizure.
Postictal phase - period following the seizure.
(Person may be confused or fall into a deep sleep lasting minutes or hours).
CLASSIFICATIONS PARTIAL/FOCAL SEIZURES - occur in one PRIMARY GENERALIZED-SEIZURES- involves both
part (focus) of the brain – might spread hemispheres of the brain
within seconds or minutes to involve
widespread areas of the brain. •Tonic-clonic (grand mal)—stiffening of the body,
repeated jerking, & loss of consciousness. Most
•Partial simple—Localized shaking common type of generalized seizure. Most life-
movements, usually does not result in a threatening seizure.
loss of consciousness.
•Absence (petit mal)—no convulsions; may see
•Complex partial (psychomotor)— twitching facial muscles, fluttering eyelids, rapid
Consciousness is impaired but not totally blinking, or a few seconds staring into space.
lost; may be associated with an aura
(unpleasant sensation of impending •Tonic—severe stiffening of muscles, especially
seizure). of the back, legs, & arms.

•Jacksonian—Rhythmic jerking •Clonic—repeated bilateral jerking movements.

movements start in one muscle group
and spread.
•Adversive—Person may become
combative.
•Sensory—Person has unpleasant
hallucinations, talks unintelligibly, or
•Atonic—brief periods, usually in children,
complete loss of muscle tone & consciousness
•Myoclonic—quick jerking movements of one or
more limbs or trunk; may be brief, but repetitive;
no loss of consciousness.
 experiences vertigo. •Status epilepticus—a medical emergency;
convulsions with intense muscle contractions &
dyspnea lasting 15 minutes or more.
UNCLASSIFIED SEIZURES-include all seizures that cannot be classified.
- High fevers
- Genetic abnormality
- Metabolic disorders
Hyperglycemia - Sugar
Hypercalcemia - Calcium
Hypermagnesemia - Magnesium
Hypernatremia - Sodium
- Structural damage
Trauma
Stroke
Tumor
- Unknown (idiopathic)-about half of the causes of seizures.
SIGNS/SYMPTOMS - Individual may cry out and experience aura, knowing that seizure is imminent.
- Person falling down because of brief loss of muscle tone (flaccidity)
- Rigid contraction of body muscles (tonic phase)
- Alternates with rhythmic jerking movements (clonic phase)
KEY NOTES - Any type of seizure can develop into status epilepticus.
- An individual who has had a seizure does not necessarily have epilepsy.
Ex.:
A child who has had a febrile seizure
A pregnant woman who has had eclampsia
- The nurse’s role during a seizure is to protect and observe. During a seizure, observe the
client for respiratory depression and have emergency airway equipment readily
available.
MEDICAL - Pharmacologic therapy
SURGICAL - Anticonvulsants – works by raising the individual’s seizure threshold.
TREATMENT - Sometimes several drugs are combined to control seizures.
- Routine blood levels of the drugs are monitored to ensure a therapeutic dose.
- If person is experiencing status epilepticus, anticonvulsants are typically given IV.

- Brain tissue that is thought to initiate seizure is removed surgically.

- Brain mapping is done before surgery to identify the important brain structures to avoid.
ANTICONVULSANTS THERAPEUTIC BLOOD CONSIDERATIONS
LEVEL
MEDICATIONS • diazepam (Valium) 0.2-2 mcg/ml Keep in mind that these drugs
are given for status epilepticus,
• lorazepam (Ativan) 50-240 ng/ml there is danger of overdose

• phenobarbital (Luminal) 10-30 mcg/ml Be alert for CNS signs

- Drowsiness
• phenytoin (Dilantin) 10-20 mcg/ml - Lethargy

• thiopental sodium (Pentothal) Respiratory depression

• valproic acid (Depakote) 50-100 mcg/ml CV signs

- Hypotension
- CV Collapse

Monitor kidney function.

 May cause kidney damage.
NURSING SEIZURE PRECAUTIONS
CONSIDERATIONS •Oral airway.
- It assists in maintaining a patent airway. Do not insert if seizure activity has already
begun.
•Suction setup.
- This is useful if the client has difficulty in handling secretions.
• Setup of piggyback port on an open IV.
- This provides a ready access if the client needs emergency drugs.
•Rectal or tympanic temperature probe.
- Oral thermometers are unsafe to use.

→Oxygen and suction apparatus available

→Privacy provided as soon as possible
→Side rails up and padded – hospital protocol may require documentation for use of side
rails because it can be considered, a restraint.
→Loosened clothing
→Bed in lowest position – to minimize injuries that may occur if the client climbs over the
rails.
→Pillow under head
→Patient in side-lying position (immediately post-seizure)
→Blankets on the bed side rails, headboard and footboard fastened with adhesive tape – it is
important to protect the client’s limbs, head and feet from injury during a seizure while in
bed.

MAINTAINING THE CLIENT’S SAFETY DURING SEIZURE

• Protect the client from nearby hazards. Move the over bed tray table and other dangerous
items away from the client. The client will be unable to control muscle movements or
reactions during the seizure.

• Loosen restrictive clothing, such as a client’s tie or shirt collar. Loosening clothing helps to
maintain an unobstructed airway.

• Do not place anything in the person’s mouth after a seizure has begun.
Doing so could cause the client’s teeth to break by forcing an object into the mouth.

• Do not attempt to restrain the client. Injury may result from forcible restraint against the
contraction of the muscles.

• Place a small, soft padding beneath the client’s head, such as a folded jacket. Padding the
area helps to protect the head from injury.

• Turn the client’s head to the side. Turning the client’s head to the side helps to maintain a
clear airway and prevent aspiration.

• Monitor the seizure activity and location carefully. Note the exact time the seizure begins
and ends. Test the extremity strength and tone. This information is important to aid in
determining the type of seizure that the client experienced.

• Call the client’s name. Give a simple command, such as asking him or her to grab your hand
and to let go. Responses to these evaluative techniques assists in evaluating the type and
severity of the seizure.
 • Give the client a “memory test” by asking him or her to remember two unrelated words.
Whether or not the client is able to remember the words helps provide additional information
about the type of seizure.

• After the seizure, ask the client if there was an aura (warning). The client may learn to take
protective measures before a seizure occurs.

• Check the tongue and oral cavity for any bite injuries. The client may have injured him- or
herself during the seizure; evidence of injury indicates a need for treatment.

• Observe and document carefully.

Documentation helps to provide communication and assists healthcare personnel in treating
the client.

• Offer reassurance and emotional support. Seizures can be frightening to the client and to
those who witnessed the seizure. The client is often embarrassed and may have been
incontinent or confused.
DOCUMENTATION Event form on which to document all seizures.
- What the person was doing at the seizure’s onset
- Where the seizure began
- If and how the person fell
- Time of day
- Triggering events
- Seizure progression and symmetry
- Eye response
- Responsiveness
- Results of commands and memory tests
- Duration
- Direction of eye gaze and eye movements
- Confusion
- Incontinence
- Drooling
- Diaphoresis
- What the client says about the seizure
- How he or she behaves
- Check eye signs and LOC
- Describe clusters of seizures
TEACHING TOPICS TO • Explanation of seizure disorder
ADDRESS • Specific information about the particular seizure type the client experienced
• Safety and prevention of injury during a seizure
• Care of the client during and after a seizure
• Importance of taking medications as prescribed
• Medication side effects
• Importance of family observation of seizure, so they can fully describe it to the neurologist
• Importance of adequate sleep, balanced diet, and suitable physical activities
• Avoidance of situations that can precipitate a seizure
• Importance of wearing a MedicAlert tag and regular follow-up with physician
• Importance of having blood drawn to determine blood levels of antiepileptic medications
DISORDER STROKE
DEFINITION - A sudden or gradual interruption of blood supply to a vital center in the
brain.
OTHER NAME - Cerebral (brain) infarct, cerebrovascular accident (CVA)
CAUSES - Atherosclerosis of the cerebral blood vessels
SIGNS/SYMPTOMS - Complete or partial paralysis (Hemiplegia)
COMPLICATION - Death
TREATMENTS Refer to nursing care plan 78-1

DISORDER NEURALGIA
DEFINITION - Pain in a nerve
CAUSES - Pain caused by a herniated intervertebral disk (IVDD)
SIGNS/SYMPTOMS - fleeting pain in the shoulder and upper arm
TREATMENTS - External heat
- Analgesics (Aspirin)
- Medical Evaluation
DISORDER TRIGEMINAL NEURALGIA
OTHER NAME - Tic douloureux
DEFINITION - Root of the trigeminal (5th cranial) nerve becomes painful.
CAUSE - Unknown
AFFECTED GROUP - Older population
TRIGGERS - Slightest touch to various parts of the face
- Even by a breeze
- Change in temperature
- Mouthful of food, depending on the trigger zone’s location
SIGNS/SYMPTOMS - Pain is excruciating
- Comes in spasms that can last for seconds to hours, occurring in the jaw and
parts of the face.
TREATMENT Medications – may help temporarily
Surgery.
- Partial removal of the nerve roots eliminates the pain permanently, although it
may leave burning, tickling sensations for several weeks or months.
KEY NOTES - After surgery, various symptoms may occur, depending on which nerve branches
were sectioned.
- In addition to adjusting to a certain amount of numbness, the client may have
some eye irritation or difficulty eating.
- The client learns to avoid situations that previously triggered pain.

DISORDER BELL’S PALSY

DEFINITION Is a temporary, partial, one-sided facial paralysis and weakness
CAUSES Ischemia or inflammation of the 7th cranial nerve. (Facial)
Brain lesion – Bell’s palsy-type syndrome.
SIGNS/SYMPTOMS Lopsided facial appearance
Eye on the affected side will not close
Cannot control the mouth on the affected side, often leads to drooling
Mouth does not turn up when the client smiles
Emotional upset due to symptoms
TREATMENT →Special eye care
→Heat & massage
→In the early stages, prednisone maybe used.
KEY NOTE Usually, symptoms subside gradually, but they may take months to do so.
DISORDER SHINGLES
OTHER NAME - Herpes zoster
DEFINITION - Acute viral inflammation of a nerve. Caused by reactivation of latent virus cells
residing in dorsal root or cranial nerve ganglion cells.
MICROORGANISM - Varicella-zoster virus (same virus that causes chickenpox)
CAUSES Immunocompromised clients
- HIV/AIDS
- TB
- Lymphoma
Sometimes an injury or an injection of a drug may trigger the inflammation.
MANIFESTATIONS SYMPTOMS SIGNS
- Mild to moderate pruritus (itching), - (Vesicles follow the distribution of
- Tenderness or pain(excruciating) - sensory nerves), the forehead, face,
Pain can be quite severe, even if and buttocks. Normally, only one site
vesicles are not visible on the skin. The is affected, either left or right side.
pain can last for several weeks or Eruption may encircle the trunk.
months. - Scarring may occur.
- Gastrointestinal upset - Conjunctivitis – results to blindness
- General malaise
KEY NOTES - The interval between pain and eruption of vesicles averages 3–5days.
- Lesions erupt for several days and usually disappear within 3–4 weeks.

- This is common in clients with human immunodeficiency virus or acquired

immunodeficiency syndrome (HIV/AIDS), tuberculosis, and lymphoma.

- Generally, the disorder is self-limiting and localized.

- Herpes usually heals without complications.

- In rare cases, the infection may invade the eyes and cause conjunctivitis.

- If it is not checked, blindness may result in the affected eye (ophthalmic zoster).

- In clients with serious underlying conditions that suppress the immune system,
serious complications may develop.

- Post herpetic neuralgia (pain along the nerves after a herpes infection) may cause
pain and discomfort for 8 weeks or more. This is most common in clients older than
60 years of age.
TREATMENTS - Shingle vaccination for adult age 60 and older. Single dose of Zostavax.
- Pediatric immunization against chickenpox
- Symptomatic
- Relief of pain and pruritus
- Narcotics and/or anti-inflammatory agents
- Wet dressings with Burow’s solution may be useful during the vesicular stage of the
infection.
- Calamine lotion
- Antihistamines
- IV acyclovir (Zovirax)
- Improves the rate of healing of skin lesions & shortened the period of pain.
- Oral corticosteroids
- have been used in clients aged 50–60 years and older to decrease post herpetic
neuralgia.
NURSING - All causes of neuralgia need adequate evaluation of pain and pain control
CONSIDERATIONS measures. Environmental conditions may need to be adjusted so that the client can
have a quiet environment with minimal stimulus.

- With herpes zoster, infection control measures are necessary to prevent cross-
contamination.

- It is possible for individuals who have never had chickenpox to develop chickenpox
from contact with someone with shingles.

- Transmission-based Precautions are necessary.

- All healthcare providers should avoid touching the lesions directly.

- Be sure to wear gloves whenever there is a possibility of exposure to drainage and

secretions.

- Instructions on how to avoid pain triggers and measures for appropriate pain
management are key areas to stress in client and family education.

- Emotional support also is important because the client may have a disturbed body
image related to paralysis, muscle twitching, or outbreaks of vesicles.
DISORDER SPINAL CORD DISORDERS
CATEGORIES/CAUSES Congenital Defects
- Malformations that occur in the developing fetus.
- Affect the CNS by disrupting the flow of CSF.
Tumors
- Located within the vertebral column, taking up space and causing compression of
the cord.
- It interferes with blood supply and CSF.
Trauma
- Caused by blunt or penetrating forces such as displaced vertebrate or foreign
objects such as bullet.
MANIFESTATIONS SYMPTOMS SIGNS
- Paraplegia - paralysis of the legs and lower body. - Spinal shock
Below T1 - Respiratory
- Tetraplegia/Quadriplegia – usually as a result from arrest
above T1 vertebrate injury.
- Injury above C4 – requires ventilator assistance.
- Numbness and tingling in the extremities
- Total loss of body sensation.
- Severe, shooting pain that results from nerve
damage.
- Pain Triggers – injections, kidney stones, fecal
impaction
- Phantom pain in a paralyzed area of the body due to
nerve damage – ring-like fashion at the level of injury
- Muscle weakness to paralysis
DIAGNOSTIC/ - X-ray examination to determine extent of injury.
TREATMENT - Surgical removal of tumor.
- Surgery to remove a portion of vertebral bone pressing on spinal cord or to
stabilize the vertebrae to prevent further damage.
- Spinal fusion – prevent further damage to spinal cord and enables more mobility
later.
- Treat shock and hemorrhage
- Skeletal traction – applied to immobilize the damaged cervical vertebrae.
- Rehabilitation must begin immediately on hospitalization to maintain cardiac and
pulmonary reserves.
- Rehabilitate all spheres – body, mind, and spirit.
- Enter a rehabilitation center as soon as possible.
- Lifestyle adjustments.
NURSING - Support client and family due to stress, anxiety, and shock.
CONSIDERATIONS - Minor modification to total alterations in lifestyle need to be made
- Changes include adaptations in a home’s physical set-up, installation of elevator
and ramps, and changes in employment.
- Assistance with ADL is generally necessary.
- Adaptation to accommodate the client’s needs for transportation, including
driving a car.
- Rehabilitation and occupational therapy.
- Encourage self-care
- Observe the client closely when providing care.
- Check for minute changes in client’s condition that are not yet evident to others.
- Passive/active exercises to develop muscle strength and movement.
- Begin measures immediately to prevent disuse disorders.
- Measures to prevent skin breakdown and plantar flexion (footdrop)
 - Allow client to express frustration and discouragement and acknowledge these
feelings
- Provide realistic feedback and encouragement, pointing out positive gains client
has made regardless of how small they may be.
COMPLICATIONS - Impaired circulation - Muscle spasms
- Bowel and bladder incontinence - Contractures
- Bone demineralization - Increased body temperature
- Skin breakdown - Gastric distention
- Anemia - Respiratory complications
- Blood clots in the legs
- Atelectasis
- Pneumonia
- Autonomic Dysreflexia
- Neurogenic shock
KEY NOTES Spinal cord
- Is the communication system between the brain and the periphery of the body
- Responsible for the reflex arc (built-in protective mechanism)
- Composed of gray matter, sensory and motor tracts
- It lies in an enclosed and confined space called vertebral column
Gray matter – tight cluster of nerve cell bodies
Sensory – ascending tract
Motor – descending tract
- If the spinal cord is severed or compressed, communication between the brain
and the rest of the body is literally cut off.
- Transection (severing) of the cord
- Partial – has the best prognosis. The deficit depends on which nerves are
severed, sensory or motor.
- Complete – all sensations and voluntary movements below the site of injury are
lost.
Paralysis in Female Clients - Considerations
- Menses usually resumes within 3 months following the injury
- The use of tampons is dangerous
- The use of birth control pills is not recommended
- The use of Intrauterine devices (IUDs) is not recommended.
- Labor and childbirth may be dangerous.
EMERGENCY - Head, neck, and spine must be stabilized with person lying flat on a firm surface.
TREATMENT - Never lift the person with a known or suspected SCI by the head, shoulder or
feet.
- A victim of trauma should never be moved without proper precautions, unless
the circumstances are such that the individual’s safety is compromised and
remaining in place would jeopardize the client’s life.
- Treatment for shock and hemorrhage maybe necessary
DISORDER AUTONOMIC DYSREFLEXIA
OTHER NAME - Autonomic hyperreflexia
DEFINITION - An exaggerated response to stimuli below the level of the lesion in
clients with lesion at or above T6, is a medical emergency that requires
prompt treatment.

- Characterized by a sudden and dangerous elevation of BP that is a

result of an autonomic response to various stimuli (called noxious
stimuli) that are harmless to people with an intact spinal cord.
CAUSES Clients with injury to the upper spinal cord.
Triggers
- Distended bowel or bladder
- Fecal Impaction
- UTI
- Constrictive clothing, shoes, or device
- Noxious stimuli such as pain, pressure or strong smell
COMPLICATIONS - Seizures
- Strokes
- Hemorrhage
MANIFESTATIONS SYMPTOMS SIGNS
- Sudden onset of - Sudden, significant increase in BP of
pounding headache 20 to 40 mmHg above baseline.
- Blurred vision or spots - Pallor
in the visual field - Bradycardia, arrhythmias
- Apprehension - Profuse sweating (diaphoresis)
- Anxiety - Goose flesh (goose bumps) –
piloerection
- Flushing above the level of injury
- Nasal congestion
- Increased heart rate
TREATMENTS - Elevate the head or have the client sit up if possible
- Notify the HCP
- Loosen any constrictive clothing or devices
- Quickly check the client for possible causes of pressure, such as
blocked urinary catheter
- Monitor BP every 2 to 5 minutes
- Be vigilant in monitoring for possible triggers.
- Antihypertensive medications for severe HTN
- Teach the client and family preventive measures, such as preventing
constipation and visually inspecting catheters for patency.
DISORDER MULTIPLE SCLEROSIS
DEFINITION - One of the most common nerve disorder in the US. The myelin sheath
covering the nerves is destroyed.
AFFECTED GROUP - Young adults
- People living in northern temperate climates
- Slightly more common in females
CAUSES - Unknown
- Autoimmune
- Viral – Epstein-Barr virus (EBV) (infectious mononucleosis)
DIAGNOSTIC - MRI – detects changes in myelin sheath (plaque changes)
- No specific diagnostic blood tests for MS
RULE OUT - Lyme disease
- Collagen-vascular diseases (SLE)
CLINICAL PROGRESSION - Relapsing-remitting (RRMS) – Most common 85-90%
- Secondary-progressive (SPMS) – 65% of clients
- Primary-progressive (PPMS) – 10-15% of clients who have never had
remission after initial MS symptoms.
- Progressive-relapsing (PRMS) – Rare <10% have neurologic steady
decline
MANIFESTATIONS SYMPTOMS SIGNS
- “Pins and needles” numbness - Difficulty in walking
- Visual changes - Loss of vision - Tremors
- Hearing loss - Lack of coordination
- Paralysis
- Dysphagia
- Bladder and bowel dysfunction
- Cognitive dysfunction
- Depression
- Emotional upsets
- Difficulty thinking
- Difficulty reasoning
- Difficulty remembering
- Fatigue
- Headaches
- Pain
- Seizures
- Spasticity
- Dizziness
- Nausea/Vomiting
- Spastic paraplegia (exaggerated
reflexes and muscle tone)
- Exuberant and euphoric
TREATMENTS - Maintain general health with periods of rest, adequate sleep, & a
balanced diet
- Stress reduction is important
Avoidance of physical triggers such as
- Infection
Avoidance of emotional triggers such as
- Emotional distress
- Employment stress
- Excitement
- Depression
Physical Therapy – prevent deformities and maintain muscle strength
 Occupational Therapy – to provide rehabilitation for lost abilities.
IV corticotrophin (ACTH) given 6-7 days, then decreased to weekly injections
for another month.
Nonsteroidal immunosuppressive drugs
- Beta-1b (Betaseron)
- Beta-1a (Avonex)
- Fingolimod (Gilenia) –
- Teriflunomide (Aubagio)
- Dimethyl fumarate (Tecfidera)
Action - might be able to reduce relapses and delay disability in some clients.
KEY NOTES Myelin – maintains electrical impulse strength.
Demyelination – results in weak electrical impulses and weak muscle
contractions.
This disease is marked by remission and exacerbation
CONSIDERATIONS - Encourage client to schedule periods of rest and adequate sleep
- Encourage a well-balanced diet.
- Monitor intake including fluids
- Good skin care
- Prevent hazard of immobility – contractures, pneumonia, and social
isolation.
- Body repositioning, maintain proper body alignment to prevent
deformities
- Deep breathing
- May need indwelling urinary catheter due to possible retention
- Incontinent care as needed
- Bowel retraining program may be initiated due to constipation
- Encourage to live a normal life as possible
- May work until he could no longer perform the job
- Lifestyle readjustment according to goal
- Alert family and client that stress, temperature changes, fatigue, and
illness exacerbate or worsen MS.

DISORDER PARKINSON’S DISEASE

OTHER NAME - Parkinsonism
STATISTICS - 2nd most common neurologic disease in older adults.
- Affects slightly more men than women
- Usually appears in people in their 60’s
- Can occur in younger individuals
DEFINITION - A chronic, progressive disease affecting the dopamine-producing cells
of the brain.
CAUSES/ETIOLOGIES Side effects of some medications – tricyclic antidepressants
(Parkinson’s-like symptoms)
- Amitriptyline.
- Amoxapine.
- Desipramine (Norpramin)
- Doxepin.
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline.
- Trimipramine.
DIAGNOSTICS - No test to predict Parkinson’s disease
MANIFESTATIONS SYMPTOMS SIGNS
- Bradykinesia (slowness of movement)
- Fine, rhythmic tremors of the hands,
arms, legs, jaw, and face.
- The limbs and trunk become rigid and
stiff
- Difficulty maintaining balance and
coordination (Ataxia)
- Shuffling and unsteady gait
(appears as if the person is dragging
their feet as they walk. Steps may also
be shorter in stride (length of the step)
It is also seen with the reduced arm
movement during walking)
- Postural instability
- Progressive difficulty with walking,
talking, eating, and completing ADL
because the disease affects automatic
movements.
- Movement of small muscles that
control facial expressions is affected.
Unable to blink or smile.
- As the muscles become rigid, the face
presents masklike.
- Drooling
- Two to five shakes in a second with the
thumb beating against the fingers in a
sort of pill-rolling movement.
- Sits and stands in stooped position
- Arm no longer swing when the person
walks
- Unable to shift position quickly to keep
balance.
- Emotional lability (fluctuations)
- Slowed thinking process
- Depression
COMPLICATIONS - State of immobility
TREATMENT - No preventive treatment
- Antiparkinsonism drug – Carvidopa-levodopa (Sinemet)
- Advanced Parkinson’s Disease or Poor response to medication may
have:
- Surgery – deep brain stimulation (Electrode is implanted deep in part
of the brain that controls movement. Control of the stimulation is via
pulse generator (a pacemaker-like device) placed subcutaneously that
attaches wires to the electrodes.
NURSING CONSIDERATIONS - Physical Therapy – promotes activity and enables self-feeding,
dressing, and transferring from bed to chair.
- ROM exercises for the legs and fingers
- Ways to maintain balance and to prevent neck muscles from
contracting.
- Handling food, chewing, and swallowing are difficult, the person may
not eat enough nutritious food. Specific vitamins (except vitamin B),
High-calorie, high-protein diets are prescribed.
 - Check food consistency and teach about food preparation.
- Prepare food easy to swallow and chew (ground meat/mashed
potatoes), use straw for liquids.
- Encourage to eat, help to make agreeable and safe menu selections.
- Stool softener may be given Docusate Sodium (Colace),
- Encourage fluids (4-6 glasses of fluids/juice each day).
- Help client learn how to use adaptive techniques and devices
- Help family make adaptations to the home and in homemaking.
- House check and eliminate hazards, throw rugs and highly waxed
floors.
- Arrangement for bathroom facilities and a bedroom on the first floor.
- Handrails may need to be installed in bathrooms, stairs, and hallways.
- Night lights are also helpful.
KEY NOTES - Dopamine – a neurotransmitter (chemical messenger) that sends
signals within the brain. Without dopamine, neurons fire out of
control, and individuals cannot control muscle movements.
- It is not considered as inherited disorder
- Exercising does not eliminate tremors but does help prevent rigidity.
EDUCATING CLIENT • Be as independent as possible.
• Protect against unnecessary stress and fatigue.
• Use adaptive techniques and devices.
• Protect against injuries.
• Take medications on time. Avoid foods and vitamins that negatively interact
with medications.
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
- Metoclopramide (Reglan)
- Drugs that deplete dopamine (reserpine and tetrabenazine)
worsen Parkinson's disease
• Be sure to eat a well-balanced diet with plenty of fluids for optimum
functioning.
• Have regular eye examinations to check intraocular pressure. (12-22 mmHg)
• Follow pertinent exercises, as prescribed or recommended.
• Use adaptive feeding utensils, as necessary.
MEDICATIONS FOR PARKINSON’S DISEASE

•Levodopa (L-dopa, Dopar, Levodopa)

•Levodopa plus carabidopa (Sinemet)— The initial drug of choice replenishes

missing dopamine, a neurotransmitter found in the brain; helps reduce
tremors and rigidity of Parkinson’s syndrome. And because it is combined with
carbidopa, it prevents nausea.

•Dopamine agonists: bromocriptine mesylate (Parlodel), pramipexole

(Mirapex), ropinirole (Requip)—Mimics effects of dopamine; used to promote
consistency of levodopa’s effects.

•MAO B inhibitors: selegiline (Emsam), rasagiline (Azilect)—Help to prevent

breakdown of dopamine.

•Anticholinergics: trihexyphenidyl and benztropine (Cogentin)—Assists in

reduction of the tremors of Parkinson’s syndrome.
 •(N-methyl-D-aspartatic acid inhibitor): amantadine (Symmetrel)—Used
alone, may help in early stages of syndrome; used in later stages to reduce
dyskinesia.

Medication Nursing Considerations

• L-dopa may cause hemolytic anemia (a disorder in which red blood cells are

destroyed faster than they are made) and dyskinesia (involuntary muscle
movements).
• The beneficial effects of levodopa tend to diminish or become less consistent
as the disease progresses.
• All classifications of Parkinson’s syndrome drugs have significant side effects

DISORDER MYASTHENIA GRAVIS

DEFINITION - A progressive disorder of weakness of the voluntary muscles.
- Considered acquired autoimmune disorder.
AFFECTED GROUPS - Women younger than 40 years
- Men older than 60 years
- Occur at any age – including neonate and during childhood
- All ethnic group
CAUSES Autoimmune disorders
Genetic factors
- Neonatal Myasthenia gravis – usually recovers within 2 months after
birth
- Congenital myasthenic syndrome – a rare hereditary form of
myasthenia.
Breakdown in the normal communication between nerves and muscles.

Acetylcholine (neurotransmitter/chemical messenger) – cannot transmit

messages because antibodies (immune molecules) block, alter, or destroy its
receptors at the neuromuscular junction.

Antibody-negative myasthenia gravis -

The thymus gland, which is abnormal, develops abnormal clusters of lymphoid

tissues, including tumors of the thymus gland (thymomas). Generally, these
tumors are benign, but malignancies can occur.
RISK KACTORS - Illness
- Fatigue
- Extreme heat
- Some anesthetics and antibiotics
- Certain meds as beta-blockers, quinidine gluconate, quinidine sulfate,
quinine (Qualaquin), and phenytoin (Dilantin).
CO-MORBIDITIES - Thyroid hyperactive or hypoactive
- SLE
- Rheumatoid arthritis
DIAGNOSTICS Pulmonary function studies
- used as predictors of respiratory abilities.
- Indicators of potential myasthenic crisis.
- Laboratory testing to detect antibodies to acetylcholine receptors.
Endrophonium test – aids in diagnosis
- Edrophonium chloride (Tensilon) is injected IV. The client with MG will
 experience a temporary relief of symptoms.
Nerve conduction studies
- Is a measurement of the speed of conduction of an electrical impulse
through a nerve. NCS can determine nerve damage and destruction.
During the test, the nerve is stimulated, usually with surface electrode
patches attached to the skin.
Electromyography
CT
MRI
- To identify thyroid tumor
MANIFESTATIONS SYMPTOMS SIGNS
- Muscles feel weak after Eyes muscles affected first
exercise but returns with - Looks sleepy & expressionless
rest. - Unable to smile
- Drooping eyelids (ptosis)
Facial muscles may be affected
- Chewing
- Swallowing (dysphagia)
- Choking
- Coughing
- Speaking (dysphasia) – soft, nasal
sounding
Weakness in the striated (skeletal)
muscles
- Extraocular
- Pharyngeal
- Facial
- Respiratory muscle – difficulty
breathing
Double vision (diplopia) – maybe
horizontal or vertical, improves or
resolves when one eye is closed.

Greater weakness in arm than legs

Waddle-like gait (moves from side to side

when walking. Involves taking short steps
as well as swinging the body).

Difficulty holding the head upright

MYASTHENIC CRISES A life-threatening condition
Respiratory muscle weakness – mechanical ventilation needed
- Dysphagia
- Dysphasia
- Ptosis
- Diplopia
- Respiratory depression
TREATMENTS No cure
Maintain an open (patent) airway
Respiratory assistance
Increasing muscle strength by the use of Anticholinesterase agents,
(Neostigmine and Pyridostigmine) (Mestinon)
 Potent immunosuppressive drugs, such as prednisone, cyclosporine, and
azathioprine, can suppress the production of the antibody

Thymectomy

High doses of IV immune globulin may be given to provide the client with a
temporary dose of normal antibodies

Plasmapheresis – antibodies are removed from the blood.

IPPB
- Intermittent positive pressure breathing (IPPB) therapy uses a
mechanical respirator to deliver a controlled pressure of a gas to assist
in ventilation or expansion of the lungs, thereby providing an increased
tidal volume for patients with a variety of pulmonary conditions.
Tracheostomy may be required.
CONSIDERATIONS - Assure client that current medication and therapies can greatly improve
muscle strength.
- Be aware about emotional upsets and infections can intensify and
precipitate a crisis.
- Teaching is an important aspect of care.
- Tube feeding/TPN during acute episodes
- Suctioning to remove secretions – machine at bedside readily available
KEY NOTES It is not considered inherited disorder
It is not contagious
Medication teachings include
• These medications play a vital role in the client’s ability to swallow and to
handle respiratory secretions.
• Medications must be given on time and can be given with food (to minimize
side effects).
• Side effects must be reported immediately.
DISORDER HUNTINGTON’S DISEASE
OTHER NAME - Huntington’s chorea
DEFINITION - A chronic, progressive, hereditary condition in which brain cells in the
basal ganglia prematurely die. Symptoms involves a combination of
physical, intellectual, and emotional symptoms.

- The basal ganglia are a group of structures found deep within the

cerebral hemispheres.

DIAGNOSTICS - Thorough medical and family history

- Genetic test to search for HD gene
- Neurologic test and laboratory tests to differentiate HD from other
nervous system disorders.
CAUSES Genetic
- A child with a parent who has the HD gene has a 50-50 chance of
STATISTICS inheriting the gene.
- Only children who inherit the gene will develop the disease.
- Only children who inherit the gene can pass the gene to the next
generation.
- All children who inherit the gene eventually will develop HD.
COMPLICATIONS - Loss of bowel and bladder control
- Loss of purposeful movement (Motor activity requiring the planned and
consciously directed involvement of the patient)
- Pneumonia
- Others associated with immobility
- Death
MANIFESTATIONS SYMPTOMS SIGNS
Personality changes Abnormal involuntary movements
- Irritability (chorea)
- Mood swings - Fidgeting
- Depression - Jerking
- Loss of judgement - Spasms
- Carelessness
Early intellectual symptoms
- Difficulty making decisions
- Difficulty in learning new things
Constant writhing
- (continual twisting, squirming
movements or contortions of
the body.)
Uncontrollable movement
Changes in speech
Inability to swallow
Great weakness
Severe personality disorder
Psychosis
TREATMENT - No cure for HD
- Symptomatic relief of physical symptoms such as fatigue, restlessness,
or hyperexcitability
- Medications for depression
CONSIDERATIONSS - Client may remain home until ADL cannot be managed.
- Home care adaptation can provide quality of life.
- Use lamps with a touch base
 - Hand rails at the proper height that are strong enough to support full
body weight
- Use electric razor or toothbrush
- To steady the hands and arms, can sit down and rest elbows on a table
when shaving or brushing
- If can swallow liquids, can use straws cut to just above the rim of the
glass.
- Use a thickening agent (Thick-It) to make swallowing easier.
- Cutting a spot out of a Styrofoam cup for the person’s nose to make
drinking easier and safer.
KEY NOTES - Age of onset varies, although symptoms generally do not appear until
the person is older than 30.
- The disease progresses at different rate.
- Genetic counseling before deciding whether to have children.

DISORDER AMYOTROPHIC LATERAL SCLEROSIS

OTHER NAME - Lou Gehrig’s disease
DEFINITION - A rapidly progressive, fatal neurologic disorder resulting in destruction
of motor neurons of the cortex, brain stem, and spinal cord. Voluntary
muscle movement gradually degenerates.
AFFECTED GROUP - More men than women
- Ages 50-70 years
COMPLICATIONS - Respiratory dysfunction
- Death
MANIFESTATIONS SYMPTOMS SIGNS
- Weakness - Muscular atrophy – due to loss of
- Fatigue motor neurons
- Spasticity of the arms - Frequent falls
- Flaccid quadriplegia - Lose control of hands and arms
- Respiratory muscles
involvement
TREATMENT - No cure
- Riluzole (Rilutek)
- Palliative treatment – focusing on support and symptom management.
CONSIDERATIONSS - Provide physical, emotional, and spiritual support to the client and
family.
- Provide direction and compassion to the family when discussing such as
disease progression and death and dying.
KEY NOTES - There is no Remission
- Course of the disease is within 5 years after onset
- Although may vary

DISORDER BRAIN ABSCESS

DEFINITION - A collection of pus in the brain.
CAUSES - Infection of the ears, mastoids, sinus, or skull.
- Brain surgery
COMPLICATIONS - Meningitis
- Brain damage
MANIFESTATIONS SYMPTOMS SIGNS
- Fever
- Increased ICP and seizure
TREATMENT - Massive dosage of IV antibiotics given pre and post operatively.

DISORDER MENINGITIS
DEFINITION Inflammation of the meninges, the membrane that cover the brain and the
spinal cord.
CAUSES BACTERIAL MENINGITIS
- Streptococcus pneumonia – Pneumococcal meningitis
- Neisseria meningitides – meningococcal meningitis (Incubation period 2-10
days) which are present in the throat and CSF
- Haemophilus influenza type b
VIRAL MENINGITIS – (aseptic meningitis) – may resolve without specific
treatment
- Enterovirus
- Herpesvirus
- Mumps virus
- The illness lasts 7-10 days, and client generally recovers without disability.
FUNGI
OTHER microorganisms
Secondary infection caused by microorganisms which have traveled to the
meninges from nearby structures, such as sinuses of the middle ear.
Blood stream may carry the infection - sepsis
SPREAD OF INFECTION - Direct contact with respiratory secretions
- Early days of meningitis.
AT RISK GROUP - People living in close proximity to others
- Children and caregivers in daycare centers
- Individuals who have contact with another person’s secretions (as kissing)
- Refugees
- Military personnel
- College students living in dormitories
- Infants and young children
- People who are exposed to active or passive tobacco smoke.
DIAGNOSTICS General neurologic examination
Signs of meningeal irritation
- Kernig’s sign
- Brudzinski’s sign
Lumbar Puncture
CSF culture and sensitivity test
Antibiotic usually large doses – may cause sight and hearing damage.
KERNIG’S SIGN

The client lies on the back Pain or resistance indicates meningeal and
and brings one leg up so that spinal root inflammation.
the hip and knee are both Positive indicator of meningitis
flexed at 90 degrees. He or
she then straightens the
knee (the sole of the foot
 toward the ceiling).
BRUDZINSKI’S SIGN Pain or resistance indicates meningeal
irritation, arthritis, or a neck injury.

The client lies on the back If the person responds by flexing the hips and
and brings the head forward knees, meningeal inflammation is indicated.
toward the chest. Also considered a positive indicator of
meningitis

COMPLICATIONS - Brain damage

- Hearing loss
- Disabilities
- Death
MANIFESTATIONS SYMTOMS SIGNS
- Chills - Increased ICP
- Severe Headache - Fever
- Nausea - Vomiting
- Nuchal rigidity (stiff - Change in LOC
neck) - Kernig’s Sign
- Irritability - Confusion/disorientation
- Brudzinski’s sign
- Photophobia (intolerance to light)
- Pain when eyes move from side to side
- May have seizure
- Petechial purpuric rash
- Opisthotonos – acute spasm in which the
body is bowed forward, with the head and
heels bent backward.
- Children have tense or bulging fontanels
- High-pitched cry.
TREATMENT - Immunization as preventive measure
- Bedrest
- Good Hydration
- Adequate nutrition
- Analgesics for headache and fever
- Antiviral medications may be useful.
NURSING CONSIDERATIONS - Awareness that the person is critically ill.
- Seizure precaution
KEY NOTES - Meningitis can be a contagious infection
- Death is more in Bacterial than Viral Meningitis
- The best protection for Health care providers against meningitis is
thorough and frequent hand washing.
- Side rails raised and padded
Elevate HOB at least 30 degrees
Monitor LOC
Keep environment subdued – both visual and auditory
- Do not turn on bright over-the-bed lighting
- Do speak quietly in the room
- Minimize traffic in and out of the room

- Carefully monitor respiratory status

- Endotracheal intubation may be necessary if the respiratory status
 deteriorates
- Hypothermia blanket and antipyretic medications for fever
- Analgesics for pain
- Give IVF and nourishing liquids as ordered
- Tube feedings or TPN
- Caution caregiver and the client not to flex the individual’s neck because it
could obstruct venous flow and increase ICP.
- Avoid hip flexion because it could increase intra-abdominal and
intrathoracic pressures.

DISORDER ENCEPHALITIS
DEFINITION - Inflammation of the white and gray matter of the brain. May be associated
with meningitis.
CAUSES - Virus
- Bacteria
- Chemicals such as lead poisoning
- May follow vaccination or viral infection such as measles
- More prevalent after influenza epidemics.
- Common vectors - Mosquitoes
COMPLICATIONS - Mental changes
- Seizure disorders
- Parkinsonian symptoms
- Disabilities
MANIFESTATIONS SYMPTOMS SIGNS
- Violent headache - Fever
- Nausea - Vomiting
- Drowsiness - Tremors
- Muscular weakness
- Visual disturbances
TREATMENT - No drug specific for treatment of encephalitis
- Similar to the care of client with meningitis
NURSING CONSIDERATIONS - Reducing fever
- Maintaining quiet environment
- Warm, moist packs to relieve muscle spasms
- Tube feedings or TPN – for unresponsive
- In acute respiratory distress
- Endotracheal Intubation
- Mechanical ventilation
- Subject to seizure – seizure precaution is needed
- Family instructions for safety to prevent injury
- Family awareness that the client may exhibit mental changes such as
irritability and confusion.

DISORDER GUILLAIN-BARRE SYNDROME

OTHER NAME - Acute febrile
- Acute idiopathic
- Infectious polyneuritis
DEFINITION - An autoimmune disorder of the peripheral nervous system. Antibodies start
to destroy the myelin sheath of peripheral nerves. When the sheath is
damaged, it cannot transmit nerve signals to the muscles.
AFFECTED GROUP - Both male and females
 - Can occur at any age
CAUSES - Autoimmune
- Viral illness – respiratory or GI infections
Triggers
- Surgery
- Vaccinations
DIAGNOSTICS - Careful history and review of systems
- No differential diagnostic procedure or laboratory test exists.
- LP revealing increased protein levels in CSF
MANIFESTATIONS SYMPTOMS SIGNS
- Paresthesia (tingling sensation) - Muscle atrophy
- Nerves cannot transmit sensory - Non-specific febrile illness, often
messages such as pain, heat, or onset is sudden.
texture.
- Symmetrical pain and weakness. It
begins in the lower extremities,
ascends, and may progress to
total paralysis.
- Compromised breathing, HR, BP.
TREATMENT - Plasmapheresis – removes antibodies that destroy the myelin sheaths.
- Injection of high-dose immunoglobulins – provides normal support to an
immune system that is under abnormal attack
- However, effects of both are just temporary
- Steroid therapy is controversial because of significant non-beneficial side
effects.
NURSING CONSIDERATIONS Emergency interventions
- Endotracheal intubation
- Mechanical ventilation
Providing PROM exercise
Working with Physical Therapy
Adequate nutrition – use of tube feedings or TPN
Family and other caregivers instructions on ROM exercises, skin care,
positioning, and ADL
Emotional support
KEY NOTES - The nurse must keep in mind that this client has an excellent chance of total
or nearly total recovery. Therefore, excellent nursing care is necessary to
prevent permanent damage.
DISORDER ACUTE TRANSVERSE MYELITIS
DEFINITION - Inflammatory condition affecting the spinal cord. It results from
inflammation or destruction of the myelin sheath of the spinal cord
neurons.
CAUSES - Viral infection
- Collagen-vascular disease
- Syphilis
- HIV or AIDS
MANIFESTATIONS SYMPTOMS SIGNS
- Generalized weakness of the - Impaired bowel and bladder
extremities function
- Loss of sensation
NURSING CONSIDERATIONS Supportive and preventive measures
Be alert for
- Urinary retention
- Constipation
- Skin breakdown
- Thrombus formation
- Other complications of immobility
KEY NOTES - If the disease is diagnosed as post infectious, it usually begins 5-20 days
after a viral infection.
- Prognosis varies – some individuals recover fully, and others do not.
DISORDER HEAD TRAUMA
DEFINITION - Common cause of motor and sensory symptoms, including brain damage,
coma, and paralysis.
CAUSES - Violent blows to the head
COMPLICATIONS Increased ICP caused by:
- Swelling
- Hemorrhage
- Inflammatory process
Seizure and epilepsy later in life
DIAGNOSTICS Intraventricular catheter – measures ICP
– device surgically inserted into the brain.
Subarachnoid (subdural) bolt (or screw)
Intraparenchymal bold (fiberoptic)
Epidural sensor (least invasive)
MANIFESTATIONS SYMPTOMS SIGNS
Increased ICP
• Any change in level of consciousness (loss of consciousness,
lethargy, confusion, seizures)

• Any change in sensory–motor function (slowed reflexes, slowed

response time, restlessness, ataxia (slurred speech, stumbling,
falling, and incoordination), aphasia, slowed speech)

• Headache, which becomes progressively worse, or is aggravated

by movement

• Change in eye signs or vision (change in pupil size, unequal pupils,

slowed or no response to light, inability to follow examiner’s finger,
difficulty seeing)

• Change in vital signs (pulse <60 or >100, increased blood

pressure, widening of pulse pressure, increased or lowered body
temperature)

• Change in respirations or evidence of respiratory distress (occurs

late—caused by pressure on brain stem)

•Increased ICP, recorded on a monitoring device

• Nausea and vomiting (especially, projectile vomiting)
• Urinary incontinence
• Bulging fontanels (in infant); elevation of bone segments
• Sudden changes in condition
• Leakage of cerebrospinal fluid (CSF) (clear yellow or pinkish) from
nose or ear
TREATMENT - ICU for close monitoring
- Medication such as Mannitol (Osmitrol) – osmotic diuretic to lower ICP
- Surgical Intervention
Ventriculostomy – used to drain CSF to relieve pressure
CONSIDERATIONS - Send CSF to lab for analysis
KEY NOTES Dura – outer membrane of the meninges – protects the brain
CSF – acts as shock absorber
Serious symptoms can appear up to several days after a head injury. Observe the
 client carefully.

DISORDER HERNIATION OF THE BRAIN

DEFINITION Displacement of a portion of the brain
- Upward
- Downward
- Lateral pushing of a portion of the brain through an opening (foramen
magnum)
CAUSES - Increased ICP
KEY POINTS Coup-contrecoup – damage occurs both at and opposite to the site of impact
(Coup) – the brain may be hit on one side and then bounce (rebound) off the
other side of the skull (Contrecoup).

DISORDER CONCUSSION
DEFINITION - Is the result of any blow to the head. It may not damage any brain
structures.
MANIFESTATIONS SYMPTOMS SIGNS
- Severe headaches
- Blurred vision
TREATMENT - See a physician immediately for a thorough neurologic examination.

DISORDER SKULL FRACTURES

TYPES OPEN – Potentially expose the brain to - Less likely to produce rapid elevation in
external microorganisms which could lead to ICP. The fracture allows for some brain
meningitis or encephalitis. swelling

CLOSED

SIMPLE - Results in significant risk for increased

ICP and meningitis
DEPRESSED – Caused by a severe blow to the - Brains speech center, may be impaired
head. The fracture breaks the bone and forces until the pressure is relieved.
the broken edges to press against the brain.

COMMINUTED(Fragmented) `

BASILAR FRACTURE – fracture at the base of

the skull. It may injure the nerves entering the
spinal cord or interfere with CSF circulations. It
can tear the dura.
DIAGNOSTICS - CSF Test + test for CSF is known as halo sign
MANIFESTATIONS SYMPTOMS SIGNS
Rhinorrhea – leakage of CSF from the nose
Otorrhea – leakage of CSF from the ear
Periorbital ecchymosis (raccoon’s eyes)
Periauricular ecchymosis (Battle’s sign)
KEY NOTES - Basilar skull fracture is especially dangerous because of potential damage to the vital
centers that control BP and Respiration
DISORDER HEMATOMA
DEFINITION - Refers to a blood clot within the skull
TYPES EPIDURAL - Accumulation of blood,
HEMATOMA usually from the
temporal artery, between
the dura and the skull.
Common in children.
Mechanism of injury is
typically a blow to the
side of the head.
One or both of person’s
pupils may be dilated. Usually
unconscious immediately
after the injury, lucid for a
brief period then unconscious
again as blood accumulates in
the epidural space and causes
pressure. Most common in
children.

INTRACRANIAL - Caused by hemorrhage

HEMATOMA and edema that result
from bleeding within the
skull. Cause – rupture of
delicate blood vessels
owing to HTN or cerebral
aneurysm. Ruptured
blood vessels within the
brain are one cause of
CVAs.

SUBDURAL - Typically slow forming. Symptoms vary with size and

HEMATOMA Caused by an location. The person may feel
accumulation of blood, drowsy or lose consciousness,
usually from a torn vein with seizures, paralysis, and
on the brain’s surface. muscle weakness. Speech
may be affected; confusion is
common. Symptoms may not
appear for days or even
weeks after the accident
CAUSES - HTN
- Trauma
KEY NOTES - Any type of cranial hematoma, ICP may dangerously elevate.
DISORDER PENETRATING HEAD INJURIES
DEFINITION - The degree of damage depends on the penetrating object’s velocity and
location.

High Velocity – bullet = more damage

Low Velocity – stab wound = lesser damage

MANIFESTATIONS SYMPTOMS SIGNS

- Severe headaches
- Blurred vision
MEDICAL/SURGICAL Neurologic evaluation
TREATMENT - GCS – Broad indicator of the severity of brain injury

- Eye Opening 1-4

- Motor Response 1-6
- Verbal Response 1-5

- Highest possible score = 15

- Lowest possible score = 3
- Coma state = 6-8

- Methods to limit swelling and damage caused by increased ICP

- Osmotic diuretic
- Immediate neurosurgery to prevent death
- Tying off blood vessel and cleaning debris and accumulated blood clots.
- Burr holes – made in the skull
- Intraventricular catheter may be inserted to relieve increased ICP by
draining CSF or blood.
NURSING CONSIDERATIONS Patient should remain absolutely quiet, with Complete bed rest
Observe for signs of increased ICP
- Headache
- Dizziness
- Visual Impairment
- Hearing Loss
- Nausea
- Clear or bloody drainage from the ears, nose, or mouth.
- Projectile (forceful vomiting)
Observe changes in BP and pupils
Monitor LOC frequently
Note personality or behavior changes
See a physician immediately if he/she has any recurring symptoms
Teach family about these symptoms – patients may be unable to detect
deterioration of functioning.
DISORDER NEOPLASM
OTHER NAME - Brain tumors
AFFECTED GROUP - All age groups
TYPES - Benign
- Malignant
DIAGNOSTICS - Neurologic assessment and history
- CT scan
- EEG
COMPLICATIONS - Severe brain damage
- Death
- Neurologic deficits
MANIFESTATIONS SYMPTOMS SIGNS
- Headache - Sudden projectile vomiting
- Visual abnormalities - Increased ICP
- Numbness - Twitching in the arm
- Personality changes
- Memory and reasoning impairment
- Severe respiratory difficulties
TREATMENT - Regular follow-up is essential after treatment for any brain tumor.
- Surgery – Craniotomy
- Chemotherapy
- Radiation therapy
NURSING CONSIDERATIONS - Follow routine pre-op preparation
- Head or a portion of it may need to be shaved
- Shaved hair is put into a paper bag and labeled. This hair can be used later
for a wig or hair-piece, it the client desires.
- Inform client before doing so
- Informed consent must be signed
- The physician will inform the client if he or she is to remain awake during a
craniotomy.
- Mild sedative may be given to relax the client, while allowing him or her to
respond to various stimuli applied to parts of the brain during surgery.
KEY NOTES - Only a small percentage of brain tumors are malignant.
- As brain tumors grow, signs and symptoms progressively worsen
- Craniotomy – surgical entry into the skull (cranium)
- Craniectomy – procedure that removes a portion of skull bone.