MEDICAL SURGICAL NURSING 2ND SEMESTER

ADHARA 2023
NEUROLOGIC DISORDERS
May13
AY 2021-2022

3RD YEAR NURSING

07
T

TABLE OF CONTENTS C. Intracranial Pressure (ICP) Regulation

1 Anatomy & Physiology of the Nervous System a. Components of Intracranial Pressure
A. Neurons D. Intracranial Pressure Autoregulation
B. Nerve cells Mechanisms
C. Nerve impulse a. Pressure autoregulation
D. Glial cells b. Metabolic Autoregulation
E. Central Nervous System c. Cerebral Autoregulation
a. Brain d. Monroe-Kellie Doctrine/Theory
i. Cerebrum E. Increased Intracranial Pressure
ii. Diencephalons and hypophysis a. Causes
iii. Cerebellum b. Signs of Increased ICP
iv. Brainstem c. Collaborative Management
b. Spinal cord d. Increased ICP in Infants
i. Sensory tracts F. Meningitis
F. Peripheral Nervous System a. Causes
G. Autonomic Nervous System b. Epidemiology
H. Blood supply c. Predisposing Factors
I. Blood brain barrier d. Diagnostic Test
J. Protective structures e. Signs and Symptoms
K. Skull f. Nursing Diagnosis
L. Spine CSF g. Collaborative Management
2 Assessment of Neurologic System h. Nursing Interventions
A. Health History G. Altered Level of Consciousness
B. Physical Assessment a. Level of Consciousness
C. Diagnostic Tests b. Causes of Altered LOC
D. History c. General Nursing Interventions
E. Physical Examination H. Guillain Barre Syndrome (GBS)
a. Vital Signs a. Pathophysiology of GBS
b. Mental Status b. Classification of GBS
c. Head, Neck and Back c. Risk Factors\
d. Cranial Nerves d. Signs and Symptoms
e. Motor System e. Complications of GBS
f. Sensory Function f. Laboratory Examination
g. Reflexes g. Nursing Diagnosis
h. Autonomic Nervous System h. Medical Management
F. Common Diagnostic Aids for Neurologic i. Nursing Interventions
Functions 5 Chronic NS Disorders
3 Nursing Management: Biobehavioral Intervention A. Seizure
A. Movement and Proprioception B. Epilepsy
a. Progressive muscle relaxation a. Irreversible Factors
b. Exercise b. Precipitating Factors
c. Movement therapy c. Theoretical Mechanism/
B. Cognitive Interventions Pathophysiology of Seizures
a. Sensory information C. Epilepsy
b. Imagery D. Generalized Seizures
c. Decisional control E. Partial Seizures
d. Reminiscence a. Diagnostic Examinations
C. Sensory Intervention b. Management
a. Therapeutic touch c. Pharmacotherapy
b. Music d. Medical Management
c. Massage e. Nursing Diagnosis
d. Biofeedback f. Nursing Management
D. Other Interventions F. Parkinson’s Disease
a. Causative Factors
4 Nervous System Disorders
b. Pathophysiology
A. Acute Nervous System Disorders
c. Medical Management
B. Chronic Nervous System Disorders
d. Collaborative Management

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e. Nursing Interventions ○ astrocytes

G. Multiple Sclerosis (MS) ○ oligodendrocytes
a. Causes ○ ependymal cells
b. Pathophysiology of MS ○ microglia
c. Signs and Symptoms ○ schwann cells
d. Diagnostic Tests
e. Medical Management CENTRAL NERVOUS SYSTEM
f. Nursing Interventions ● Brain
H. Myasthenia Gravis ● Spinal Cord
a. Etiologic Factors
b. Epidemiology
BRAIN
c. Pathophysiology
d. Assessment Findings
e. Laboratory Examination Cerebrum
f. Nursing Diagnosis ○ reasoning
g. Medical Management ○ function intellectually
h. Nursing Interventions ○ express personality
I. Alzheimer’s Disease ○ mood
a. Causes ○ interact with the
b. Signs and Symptoms ○ environment
c. Late Clinical Manifestations ● It has two hemispheres and divided into frontal lobe,
d. Laboratory Examination temporal lobe, parietal lobe, occipital lobe
e. Nursing Diagnosis
f. Medical Management Frontal Lobe
g. Nursing Interventions ● high level cognitive functioning
Book Recommendation ● memory storage
● influences somatic motor control
ANATOMY & PHYSIOLOGY OF THE NERVOUS SYSTEM ○ Expects paralysis or twitching
● controls voluntary eye movements
NEURONS ● controls motor of speech in Broca's area - paano
● The basic anatomical and functional units of the siya magsalita
nervous system ○ Slurring of speech
● Three parts
○ cell body - integrates all the signals to the..
○ axon - conduct an electrical signal Temporal lobe
○ dendrites - from the axon accepts the impulses ● the primary auditory receptive areas
from the environment and sensory impulses ● auditory association area (Wernicke's area) -
interpreting speech
NERVE CELLS ● Note: If the problem is on the temporal lobe have
● are separated by a synaptic cleft; neurotransmitters different means of communication such as drawing
are secreted into the cleft by one neuron to stimulate to gives instructions
the dendrites of another neuron
● Synaptic cleft: a space that separates two neurons.
It forms a junction between two or more neurons and Parietal lobe
helps nerve impulse pass from one neuron to the ● holds the primary sensory cortex and sensory
other. association areas
○ size, shape, weight, texture and consistency
NERVE IMPULSE ○ process the visual - spatial information
● conduction of the nerve impulse is initiated when a ○ spatial orientation
stimulus is sufficient to create an action potential
● it is then sent down the axon by depolarization Occipital lobe
● visual center for the eyes
GLIAL CELLS
● controls both eye reflexes
● supportive structures of the nervous system that
nourish, support and protect the brain neurons ● interpretation of sight
● they the source of primary tumors of the nervous
system DIENCEPHALONS AND HYPOPHYSIS
● Note: First line of protective structure of the brain ● located at the bottom of the cerebrum near the
● Types of GLIAL CELLS midbrain

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● thalamus and pituitary gland
● temperature control, water metabolism, pituitary
secretion, visceral and somatic activities, visible
physical expressions in response to emotions,
sleep-wake cycle, food getting reflex
CEREBELLUM
● muscle synergy and coordination
● maintains balance through feedback loops
BRAINSTEM
● is an integration system that also controls basic
functions
● midbrain, pons, medulla
● RAS for alertness
● substantia nigra (a problem in sensation if
damaged?)
SPINAL CORD
● elongated mass of nerve tissue that runs most of the
length of the vertebral column
● 7 cervical, 12 thoracic, 5 lumbar 4 sacral
● Sensory tract (dorsal roots)
● Motor tracts (ventral roots)
SENSORY TRACTS
● Carry afferent impulses from the periphery to dorsal
root ganglia
● Two types of sensory fibers
○ General somatic fibers
○ General visceral efferent fiber
PERIPHERAL NERVOUS SYSTEM
● 31 pairs of spinal nerves, 12 pairs of cranial nerves,
and the autonomic nervous system
● each pair of spinal nerves has dorsal and ganglion
roots that exit the spinal cord by way of an
intervertebral foramina that corresponds with the
spinal level, these nerves carry input between
specific areas called dermatomes and the spine
AUTONOMIC NERVOUS SYSTEM
● collection of motor nerves that regulate activities of
the viscera, smooth muscles and glands to maintain
a stable internal environment
● sympathetic nervous system
○ active during stress
○ increases heart rate, bp and vasoconstricts
peripheral blood vessels
BLOOD SUPPLY
● the brain uses only glucose for its energy supply
● lack of glucose for 5 minutes results in irreversible
brain damage
● brain receives 750 ml/min of blood or 15-20% of the
resting cardiac output
● blood flow rates for specific sites correspond directly
with the rate of metabolism
ADHARA 2023
BLOOD BRAIN BARRIER
● refers to a network of endothelial cells in the wall of
the capillaries and astrocyte projections in close
proximity that do not have pores between them
● molecules must enter the brain by active transport,
endocytosis and exocytosis, which create a highly
selective barrier that guards the entrance to the
neurons
● the barrier is very permeable to water, oxygen,
carbon dioxide, other gases, glucose and lipid
soluble compounds
PROTECTIVE STRUCTURES
● MENINGES - cover the brain and spinal cord to
protect and support
○ Dura - tough membranous tissue that surrounds
and extends into the brain tissue that provides
important landmarks such as falx cerebri and
tentorium cerebelli
○ Arachnoid membrane - lies below the dura and
is a network of delicate, elastic tissue that
contains blood vessels of varying sizes
○ Pia mater - vascular membrane that covers the
entire brain with tiny vessels that extend into the
gray matter of the brain
● within the meninges there are potential spaces
(epidural, subdural, subarachnoid)
SKULL
● Bony structure of the head that includes 8 fused
cranial bones and 14 facial bones
● the cranium encloses the brain in a protective vault
● the foramen magnum is the large hole at the base of
the skull through which the spinal cord runs
SPINE
● Flexible column that encloses the spinal cord
CSF
● clear, odorless solution that fills the ventricular
system and subarachnoid space
● shock absorber
● it has electrolytes, protein, oxygen, carbon dioxide
dissolved in solution
● In between L4-L5 kinukuha extracted
PAHINGA MUNA ADHARA
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7. Reflexes
8. Autonomic Nervous System

ASSESSMENT OF NEUROLOGIC SYSTEM
HEALTH HISTORY
● Guides the physical examination
● Some complaints require complete neurologic exam
while others may be focused on certain anatomical
parts or system
PHYSICAL ASSESSMENT
● Inspection, Palpation, Percussion, Auscultation
● Intended to detect abnormalities in neurologic
functioning
1. VITAL SIGNS
● Neurologic disorders can cause life-threatening
changes in vital signs.
● CUSHING'S TRIAD/RESPONSE: Indicates Inc. ICP
○ Elevated SBP
○ Widened Pulse Pressure
○ Bradycardia
● Certain structures of the NS can affect these
cardinal signs: Hypothalamus? Pons? Medulla
Oblongata?
2. MENTAL STATUS
Includes examination of the following:
2.1 LOC
○ Most important part of the Assessment
○ Most sensitive indicator of changes in neurologic
status
○ Refers to arousal and wakefulness level
○ GLASGOW COMA SCALE: an assessment tool
designed to note trends in a client's response to
stimuli in terms of (1) eye opening, (2) verbal
response, (3) motor response.

DIAGNOSTIC TEST 2.2 Orientation

● Invasive ○ Orientation to (1) Time, (2) Place, (3) Person
● Non-invasive ○ Orientation to event or situation
○ To Person: usually not lost, except in dementia
HISTORY ○ To Time: usually lost at first
● Biographical and Demographic Data
● Current Health 2.3 Memory
● Chief Complaint ● Assessment of memory deficits
● Clinical Manifestations ● LONG-TERM MEMORY
○ Pain? ○ Past Health history?
○ Dizziness? ○ Historical dates?
○ Sensory Complaints? ○ Birthdate? Names of Family Members?
○ Motor Complaints? ● SHORT-TERM MEMORY
○ Loss of Consciousness or Alterations in Mental ○ Recent Events: "What brings you here?", "What
Status did you eat for breakfast?"
● ROS ● ABILITY TO LEARN
● Past Medical History ○ Three words to remember. (?)
● Past Surgical History
● Allergies 2.4 Mood and Affect
● Medications ● Is the client's affect appropriate with the situation?
● Dietary Habits ● Ask the client to describe how he or she feels; then
● Social History observe facial expression
● Family Health History
2.5 Intellectual Performance
PHYSICAL EXAMINATION ● Consists of fund of knowledge and calculation ability
● Ask commonly known places, people, current
Sequence for P.E.:
events, reversed serials 7's or 3's, simple addition
1. Vital Signs
and subtraction
2. Mental Status (including language and
communication)
2.6 Judgment and Insight
3. Head, Neck and Back
● Includes reasoning, abstract thinking,
4. Cranial Nerves
problem-solving and client's perception of the
5. Motor System (including Coordination and Gait)
situation
6. Sensory Function
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● Are the answers logical?
● Do they relate to the question?
● Explaining a proverb; What to do in situations
2.7 Language and Communication
● EXPRESSION
○ Speech flow? Choice of words? Speech for
articulation problems? Written expression?
Following simple verbal commands?
● COMPREHENSION OF SPOKEN LANGUAGE
○ Ability to follow commands
● COMPREHENSION OF WRITTEN LANGUAGE
○ Ability to read several words or sentences and
explain them
○ Read a command and perform the command
3. HEAD, NECK, AND NECK
INSPECTION
● Head size, shape and contour, and symmetry
● RACOON'S SIGN/ EYES
○ Periorbital ecchymosis and occasional CSF
drainage from nares
○ Indication: Anterior basilar skull fracture
● BATTLE'S SIGN
○ Ecchymosis over the mastoid process behind
the ears
○ Indication: Middle Fossa basilar skull fracture
● Assess SPINE and Back for Symmetry, skin tags,
lipomas
PALPATION
● Palpate skull for nodules or masses
● N: Skull is smooth and firm
● ABN: Areas of bogginess or depression
PERCUSSION
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● Percuss over spinous process: Pain? Tenderness?
AUSCULTATION
● Auscultate major neck and other vessels: BRUITS?
4. CRANIAL NERVES
● Importance of CN Assessment: (1) CN III through
CN XII reflect function of the brain stem (2)
Protective reflexes (?)
● Problems in CN:
A. Failure to receive stimuli
B. Failure to respond to stimuli
C. Combination of A and B
● NOTE: Some abnormal findings are not clinically
significant. ANOSMIA? ANISOCORIA? Surgeries?
5. MOTOR SYSTEM
5.1 Muscle Size: Symmetry? Atrophy? Hypertrophy?
5.2 Muscle Strength: Flexion? Extension? Grading?
5.3 Muscle Tone:
● HYPOTONICITY: Muscles are soft, flabby, flaccid
● HYPERTONICITY: Rigid, Resistant to movement,
Spastic
5.4 Muscle Coordination
● Rapid Alternating Movement
● Point-to-point testing
● Truncal balance
5.5 Gait and Station: Able to stand still? Walk in tandem
in a straight line? Proprioception?
5.6 Movement: Chorea? Tremors? Spasms?
Bradykinesia?
6. SENSORY FUNCTION
6.1 SUPERFICIAL SENSATION:
● Sharp and Dull Sensation? Light touch?
Temperature?
6.2 MECHANICAL SENSATION
● Vibration: Tuning Fork
● Proprioception: Location
6.3 DISCRIMINATION
● Ability to integrate and interpret sensory stimuli in
the parietal lobe
● STEREOGNOSIS - ability to perceive and recognize
the form of an object in the absence of visual and
auditory information, by using tactile information to
provide cues from texture, size, spatial properties,
and temperature, etc
● GRAPHESTHESIA - ability to recognize symbols
when they're traced on the skin. “Graph” means
writing and “esthesia” means sensing.
● EXTINCTION PHENOMENON - neurological
disorder that impairs the ability to perceive multiple
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stimuli of the same type simultaneously. EXERCISE

● TWO-POINT DISCRIMINATION - Two point ● Active and passive ROM, ambulation, exercise to
discrimination is the ability to discern that two nearby increase muscle strength and general exercise to
objects touching the skin are truly two distinct points, promote well being
not one. ● Classified as: isotonic, isometric, or isokinetic or as
aerobic and anaerobic
7. REFLEXES
● SUPERFICIAL (CUTANEOUS) REFLEXES MOVEMENT THERAPY
○ Abdominal, Plantar, Corneal, Pharyngeal, ● It is closely aligned to exercise
Cremasteric, Anal Reflexes ● One of the movement therapy is dance
● DEEP TENDON (MUSCLE STRETCH) REFLEXES ● It places emphasis on the holism of the human being
○ Biceps, Triceps, brachioradialis, patella, and
ankle jerk
COGNITIVE INTERVENTIONS
● Other Normal reflexes: Reflex Salivation, Light
reflex or Pupillary Reflex ● The common goal is to provide patient with a sense
● Abnormal Reflexes: BABINSKI's reflex of control over situation
● GRADING REFLEX ACTIVITY ○ Sensory information
○ 0 = no response; always abnormal. ○ Imagery
○ 1+ = a slight but definitely present response; ○ Reminiscence
may or may not be normal. ○ Decisional control
○ 2+ = a brisk response; normal.
○ 3+ = a very brisk response; may or may not be SENSORY INFORMATION
normal. ● To provide the person with an objective description
○ 4+ = a tap elicits a repeating reflex (clonus); of what the person will see, feel, hear, smell, and
always abnormal. taste in a specific situation

COMMON DIAGNOSTIC AIDS FOR NEUROLOGIC IMAGERY

FUNCTIONING ● It has been used extensively as an intervention for
● Computed Tomography (CT) Scan pain control
● Magnetic Resonance Imaging (MRI) ● It is defined as the formation of a mental
● Lumbar Puncture (LP) representation of an object that is usually perceived
● Myelogram only through the senses
● Cerebral Angiography
● Electroencephalography (EEG) Electromyography
(EMG) DECISIONAL CONTROL
● Positron Emission Tomography (PET) Scan ● This intervention provides the patient with the
opportunity to choose among courses of action
NURSING MANAGEMENT: Biobehavioral Interventions ● It has to be clear to the patients that they are
allowed to make these choices but do not have to do
so
MOVEMENT AND PROPRIOCEPTION
● Promoting mobility and preventing problems REMINISCENCE
associated with immobility
● It can be used to help orient people who are
● It promotes wholeness, improves self-concept, and
confused, to orient close head injury patients with
decreases stress
short term memory loss, to assist younger people
○ Progressive muscle relaxation
who are facing death to reconcile past problems and
○ Exercise
to improve feelings of self-worth
○ Movement therapy
● It is defined as a planned strategy to help a person
recall past events, feelings, and thoughts so that the
PROGRESSIVE MUSCLE RELAXATION person can better adapt to the present time
● This technique involves the tensing and then
relaxing of successive muscle groups SENSORY INTERVENTIONS
● The person learns to discriminate between feelings
● This may be used for stimulation, communication,
experienced when the muscle group is tensed and
healing, re-learning and stress reduction
then relaxed
○ Therapeutic touch
● Physiologic benefits: decreased oxygen
○ Music
consumption, metabolism, RR, HR, muscle tension,
○ Massage
PVC, BP
○ Biofeedback
● Reduces overall anxiety

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THERAPEUTIC TOUCH
● It is process by which it is postulated that energy is
transmitted from one person to another for the
purpose of potentiating the healing process of one
who is ill or injured

FOUR STEPS of THERAPEUTIC Touch

● Centering
○ The nurse first relaxes and directs attention
inward
● Assessment
○ The nurse moves her hands held several inches
away over the patient's body to determine
differences in the quality of energy flow in the
patient

MUSIC THERAPY
● It is used as an adjunct with other interventions such
as imagery, exercise and meditations
● Music can be used both to calm and to stimulate
patients

MASSAGE
● Massage produces effects on multiple body systems
● Manipulation of the skin causes it to become more
and sebaceous excretion is enhanced
● It improves movement of the musculoskeletal
system by reducing edema, loosening and stretching
contracted tendons and aiding in the reduction of
soft tissue adhesions

BIOFEEDBACK
● Has been used to manipulate functions related to the
autonomic, peripheral and central nervous systems
● Any technique that uses instrumentation to provide a
person with immediate and continuous signals
concerning body functions of which that person is
not normally conscious (Katkin and Goldband 1980

OTHER INTERVENTIONS
● Humor
● Timing
● Hope
● Presence

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NERVOUS SYSTEM DISORDERS engorgement

● IF BP FAILS, vasodilation improves blood supply
(for nourishment)
ACUTE NERVOUS SYSTEM DISORDERS
● Altered Level of Consciousness
METABOLIC AUTOREGULATION
● increased ICP
● Inflammatory conditions: Meningitis ● Cerebral blood vessels also dilate and constrict in
● Guillain Barre Syndrome response to CO2 and O2 levels in the blood
● The following trigger vasodilation:
READING ASSIGNMENTS: ○ Hypercapnia (PaCO2 > 50)
● Amyotrophic Lateral Sclerosis ○ Hypoxemia (PaO2 of 50)
● Cerebrovascular Disorders: ○ Hyperthermia (increased waste product by inc.
○ Cerebrovascular Accident/Stroke metabolic activity)
○ Cerebral Aneurysm ● Yawning: to eliminate excess CO2, para magising
nerves ng utak (an example of how metabolic
autoregulation works)
CHRONIC NERVOUS SYSTEM DISORDERS
● Seizures
CEREBRAL AUTOREGULATION
● Parkinson’s Disease
● Multiple Sclerosis ● Compensated
● Myasthenia Gravis ○ CSF regulation
● Alzheimer’s disease ○ Cerebral blood flow reduction
○ Skull expansion
READING ASSIGNMENTS: ● Uncompensated
● Huntington’s Diseases ○ A rapid, extreme, or sustained increase in ICP
● Cranial Nerve Disorders: can quickly overwhelm them and the brain loses
○ Trigeminal Neuralgia its ability to compensate
○ Bell’s Palsy
MONROE KELLIE DOCTRINE/THEORY
INTRACRANIAL PRESSURE (ICP) REGULATION ● The relationship of intracranial pressure to volume of
● In an adult, the skull forms a non-distensible, the intracranial contents
essentially closed container filled by brain tissue, ● Vic = Vbrain + Vcsf + Vblood
blood, and cerebrospinal fluid (CSF). ● An increase in any one of the contents of cranium
● Intracranial pressure (ICP) is the force exerted by usually is accompanied by a reciprocal change in the
these three components within the skull. volume of the others

COMPONENTS OF INTRACRANIAL SPACE INCREASED INTRACRANIAL PRESSURE

CAUSES
BRAIN TISSUE 80% ● INCREASED BULK OF THE BRAIN:
● Neurons ● 500-700 mL ○ Space occupying lesions such as tumor,
● Glial cells ● 700-900 mL abscess, edema
● ECF ● 100-150 mL ○ Obstruction in blood supply such as thromboses,
Embolism, aneurysm, or AVMs
BLOOD 10% ○ CSF flow obstruction due to brain tumor, CSF
● Blood Volume ● 100-150 mL overproduction due to tumors in the choroid
plexus
CSF 10%
● CSF Volume ● 100-150 mL
SIGNS OF INCREASED ICP
● Restlessness - initial sign
INTRACRANIAL PRESSURE AUTOREGULATION ● HA, N/V, Diplopia
MECHANISMS: ○ Headache is due to traction on pain-sensitive
● PRESSURE Autoregulation brain structures and on CN
● METABOLIC Autoregulation ○ Vomiting (may be projectile) - pressure on the
● CEREBRAL Autoregulation medulla oblongata
● MONROE-KELLIE Doctrine ○ Diplopia - pressure on the CN VI control the
lateral rectus of the eye
PRESSURE AUTOREGULATION ● Decreased LOC - affectation in the ARAS.
● Maintains CCP regardless of systemic BP fluctuation ● VS changes = Cushing's triad
● If BP RISES, compensatory vasoconstriction of
cerebral arterioles protect the brain from blood ● Vital Sign Changes:

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○ Elevate Systole = inc. cardiac contractility promotes CSF drainage)

○ Dec. or Normal Diastole
○ Widening pulse pressure => 40 mmHg
○ Pulse rate is SLOW
○ Body temperature is elevated or Subnormal
● Pupillary Changes:
○ Anisocuria due to CN III compression
○ Pinpoint = pons affectation
○ Fixed, Dilated = compression; respiratory
arrest= brain stem
● Papilledema
○ Compression of the optic nerve
○ "CHOKED DISC"
○ Assessed using ophthalmoscope
● LATERALIZING SIGN
○ Contralateral loss of motor function due to
decussating motor fibers at the level of the
medulla oblongata
● BRAIN STEM FUNCTION Impairment
○ DOLL'S EYE sign- compression
○ Decortication = above the midbrain
involvement;
○ Decebration = brainstem involvement; naka E
yung hands
○ Oculovestibular test = Caloric ice water test
● No external stimuli
● Flat: neutral pagdaloy ng dugo (this is to
decrease venous return= to decrease
ICP)
B. Keep BP stable at a desired pressure to
maintain cerebral perfusion
● Maintain pressure autoregulation
C. Vasodilators??
● Assess first. This should also be used in
moderation because with increased
usage, nakakaopen ito ng arteries ng
brain which could lead to increased ICP.
Giving this medication depends on the
situation of the patient.
II. Maintaining optimal O2 for patent airway and
adequate ventilation
A. Induced Hypocapnia - thru a brown bag
B. Positioning - one unit at a time
C. Suctioning - PRN, avoid unnecessary
suctioning
D. Monitor ABG results
E. Prevent Aspiration - NPO
III. Maintain adequate cardiac output
A. Maintain cardiac stability = monitor BP
B. Treat shock, blood loss, F & E imbalance
● Monitor I&O
● lf with cerebral edema = restrict fluids
(but binibigyan ng ice chips sa lips, for
dry mouth)

IV. Correct blood abnormalities

A. Treat Anemia, polycythemia vera thru diet and
BT as necessary

V. Reduction of brain bulk

A. Hyperosmolar Agents
● MANNITOL= (0.75 -1.5g/ kg initially
then 0.25 - 0.35g/kg every 4-6 hours)

B. Diuretics
● FUROSEMIDE (LASIX) - loop acting
● Osmotic diuresis: hinuhugot excess
fluids sa brain tissue tas nililipat sa
● ALTERATIONS: circulation
● Sensory Function ● Mannitol and furosemide should be
● Motor Function given together
● Language and Speech (wernickes and broca’s area ● RN: should strictly monitor I&O
are affected; should give alternatives on how to
communicate with patient like drawing) C. Steroids
● Bowel and Bladder (stool softeners are given; ● To decrease cerebral edema
lactulose; mostly catheterized due to altered bladder ● DEXAMETHASONE = (10mg IV then 5
elimination) mg IV every 6 hours)

COLLABORATIVE MANAGEMENT D. External and Internal Decompression

I. Increase cerebral blood flow and perfusion E. Barbiturates
A. Strict bed rest - flat or minimally elevated (15 ● Sedative drugs to avoid seizure attacks
to 30 degrees, maximum of 45 degrees = F. Withdrawal of CSF
● VENTRICULOPERITONEAL Shunt:
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siliconized catheter sa skull which drains ● Reduce environmental

excess fluids ● stimulation, maintain a quiet room, use low
● OMAYA TAP RESERVOIR: similar to soothing voice
heplock IV port sa skull which (1)
directly gives medications and (2) INCREASED ICP IN INFANTS
withdraws excess fluids ● Signs and Symptoms:
● It is important to prevent infection during ○ Bulging Fontanels
these two procedures ○ Cranial Suture separation
○ Increased head circumference
VI. Monitor NVS ○ High-pitched cry
● BP, Temperature, RR, LOC, Sensation and ○ Interventions for adult may be used if applicable
perception, or COMPOSURE
MENINGITIS
C Consciousness: monitor LOC of the patient. ● It is an inflammation of the meningeal tissues
Para malaman if may compression of covering the brain
brainstem. Especially the ARAS ● This usually starts as an infection of the
nasopharynx or tonsils
O Oxygenation: Baka kasi compressed na si
medulla and thalamus both of which play a CAUSES
role in the breathing reflex of the patient. ● Bacterial, Mycobacterial infection
Assess for breathing pattern and signs of ● Head trauma (penetrating head wound)
secretion. Suction as necessary. ● Viral neisseria meningitis
● Streptococcus pneumonia
M Motor: Assess motor strength because this ● Haemophilus influenzae
is another sign for a neurologic deficit or ● Fungal or Protozoal Infection (less common)
increased ICP.
EPIDEMIOLOGY
P Pupillary response: use of penlight. Para
malaman na kung ano yung orientation gn ● Occur during winter or spring month
pupils: dilated? pinpoint? ● Prevalent in crowded places
● Prognosis is poorer in infants and elderly clients
O Oculomotor: Assess eye movement
because this has something to do with the PREDISPOSING FACTORS
compression of the brainstem. Assess for ● URTI
six cardinal gazes of the patient. ● Otitis media
● Mastoiditis
S Signs and symptoms: check for cushings ● Sickle cell anemia
triad: BP, HR, and pulse rate. Check for any ● Recent neurosurgical procedures
signs like racoon eyes, etc. ● Head trauma
● Immunological defects
U Urine output: Monitor I&O
DIAGNOSTIC TEST
R Reflexes: brachial, triceps and patellar ● LP shows: Increased CSF pressure
(kahit tatlong lang toh) ● CSF analysis:
○ (+) Meningococcal gram stain and culture in
E Evaluation: to check for any discrepancies CSF or in blood
or any deviations. ○ Cloudy, milky white CSF, high protein
○ Depressed CSF glucose
VII. Limit surgery if necessary ● Normal CSF: Clear, odorless: 100-150 mL
● CXR: reveals pneumonitis or lung abscess,
VIII. Removal of the cause tubercular lesions
● CBC: Leukocytosis
IX. Reduction in cerebral blood flow
● Artificial Ventilation SIGNS AND SYMPTOMS
○ Reducing the pCO2 to 25 to 30 mmHg ● High or subnormal temperature
○ Head Elevation accelerates venous ● Headache
return. ● Neck Pain
X. Monitor NVS ● Stiffness
● Avoid Valsalva Maneuver ● Convulsion/ Chills
● Treat fever with TSB and antipyretics ● Malaise
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● Lethargy
disorganized response to pain
● Mental Confusion
● Vomiting
Deep Coma: Absence of response to even the
● Opisthotonos (arching of back)
most painful stimuli
● (+) Kernig's sign
● (+) Brudzinski sign
● NOTE: To assess LOC, utilize GCS. Please refer to
NURSING DIAGNOSIS hand out.
● Hyperthermia
● Risk for Injury CAUSES OF ALTERED LOC
● Decreased Intracranial adaptive capacity ● Primary brain injury or disease:
○ Trauma
COLLABORATIVE MANAGEMENT ○ Vascular Disease
● Antimicrobial therapy: Penicillin G, ○ Infections
● Ampicillin, Tetracycline ○ Neoplasms
● Osmotic diuretics: Mannitol ○ Seizures
● Anticonvulsants: Phenytoin (Dilantin), Phenobarbital ● Systemic Conditions
(Luminal) ○ Metabolic encephalopathies
● Analgesics/ Antipyretics ○ Hypoxic encephalopathy
● Isolation precautions ○ Toxicity
● NVS and CVP monitoring ○ Physical causes
● Patient education ○ Deficiency states (e.g. malnutrition)
○ Transmission of infection
● Bed rest GENERAL NURSING INTERVENTIONS
● IVF administration 1. Maintain Stimulation
○ If indicated ● Speak to patient before touching
● Oxygen Therapy, ET and Mechanical ventilators 2. Maintain nutrition
● Administer Enteral feeding: NGT or gastrostomy
NURSING INTERVENTIONS feeding
● Assess neurologic function often 3. Maintain elimination
● WOF deterioration of patient's condition ● Administer stool softeners, suppository as
● Suction only if necessary ordered; adequate fluids
● Hyperoxygenate with 100% oxygen 4. Maintain circulation
● Position patient carefully ● Change position at regular basis
● Darken room 5. Maintain normal body temperature
● Relieve HA with non- narcotic agent such as aspirin ● Relieve hyperthermia/ hypothermia
or acetaminophen 6. Promote safety
● Assess allergic reactions for aspirin and ● Raise side rails at all times
acetaminophen 7. Promote Activity
● Change of positions (every 2 hours unless
ALTERED LEVEL OF CONSCIOUSNESS (LOC) contraindicated), ROM exercises, gradual
ambulation
8. Maintain skin integrity
LEVEL OF CONSCIOUSNESS ● Render hygienic measures; apply lotion; use
protective devices
Level Description 9. Maintain good hygiene
● Render bed bath, hair shampoo, oral care, nose
I Conscious, cognitive, coherent (3 C's) and eye care, perineal care
10. Support family
II Confused, Drowsy, Lethargic, Obtunded, ● Involve family members in the care of the client;
somnolent help them explore their concerns, thoughts and
feelings
III Stuporous; responds only to noxious, strong,
or intense stimuli e.g. sternal pressure, GUILLAIN BARRE SYNDROME (GBS)
trapezius pinch, pinch at nail base or ● Also known as Infectious Polyneuritis, Acute
supraorbital area idiopathic polyneuritis
● An auto-immune attack of the peripheral nerve
IV Light Coma: Response is only by grimace or myelin (an insulator)
withdrawing limb from pain, primitive or ● An acute rapidly progressive and potentially FATAL
form of polyneuritis
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MED SURG 丨2ND SEM 丨LESSON 7 丨NEUROLOGIC DISORDERS

● Weaken and often paralyzes extremities and ● Swine influenza

respiratory muscle ● Viral illnesses
● Hodgkin’s disease (autoimmune disorder)
PATHOPHYSIOLOGY OF GBS ● Systemic lupus erythematosus
Exposure to virus
↓ SIGNS AND SYMPTOMS OF GBS
Body produces myelinotoxic antibodies (cell-mediated ● Chief Sign: Flaccid Paralysis
process or humoral immune response) ● Ascending weakness and paralysis: leg affected
↓ first
Destruction of myelin cell insulating nerve fibers ● If cranial nerve is involved: facial weakness, difficulty
↓ talking, chewing and swallowing
S/sx occur within 4 - 21 days after the infection ● Loss of proprioception
↓ ● Diminished DTR
● Diminished breath sounds and respiratory
Paralysis of Paralysis of Paralysis of Paralysis of
congestion
the foot the legs the bladder the lungs
● Hypo or hypertension
● Arrhythmias
● Sinus tachycardia or bradycardia
● POTENTIAL RESPIRATORY FAILURE!

COMPLICATIONS OF GBS

COMPLICATIONS PREVENTIVE MEASURES

Thrombophlebitis Anti-embolic stockings

Pulmonary Embolism Prevent turning

Bed Sores Provide cushion

Contractures Passive ROM

Muscle Wasting ROM exercises

Because this syndrome causes inflammation and
degenerative changes in the posterior and anterior nerve Aspiration SAP; stay with client during
roots, MOTOR and SENSORY losses occur feeding
SIMULTANEOUSLY!
Respiratory Infection Maintain aseptic technique,
Suction PRN
CLASSIFICATION OF GBS
1. ASCENDING Cardiac Disorders Monitor V/S
● Starts from the feet then legs going up
2. DESCENDING
● Usually starts from the hands going down LABORATORY EXAMINATION
3. MILLER FISHER VARIANT TYPE ● CSF protein level is INCREASED but the WBC
● Abnormal muscle coordination, paralysis of the remains normal in the CSF
eye muscles and absence of the tendon ● EMG: repeated firing of same motor unit instead of
reflexes wide spread sectional stimulation
● Starts from head and affects muscle eyes ● Nerve conduction velocity studies: Decreased
4. PURE MOTOR TYPE nerve conductor velocity
● Deficits in motor function only ● Pulmonary function test: Decreased vital capacity,
● No sx/x of altered sensation or perception decreased tidal volume
paralysis ● ABGS: Decreased PaO2, Increased PaCO2,
CAUSES metabolic acidosis
● Post infection polyneuritis of UNKNOWN origin
commonly follows viral infection NURSING DIAGNOSIS
● Ineffective breathing pattern
RISK FACTORS ● Risk for aspiration
● Surgery - previous operation ● Impaired physical mobility
● Rabies ● Ineffective airway clearance
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● Altered sensory pattern ● A disorder marked by a disturbed electrical rhythms

in the central nervous system
MEDICAL MANAGEMENT ● A problem in the SYNAPSES of the neurons
● ICU admission ● Epilepsy is a disorder marked by disturbed
● Mechanical ventilation electrical rhythms in the central nervous system.
● TPN and IVF
● Plasmapheresis (common treatment)
● IV Immunoglobulin

NURSING INTERVENTIONS
1. MAINTAIN RESPIRATORY FUNCTION
● Chest physiotherapy
● Incentive spirometry
● Mechanical ventilator

2. ENHANCE PHYSICAL MOBILITY

● Support pralyzed extremities
● Provide passive range of motion exercise
● Prevent CVT and pulmonary embolism
● Padding over bony prominence

3. PROVIDE ADEQUATE NUTRITION

● IVF
● Parenteral nutrition
● Assess frequently return of gag reflex IRREVERSIBLE FACTORS
A. Structural brain damage
4. IMPROVE COMMUNICATION ● Head Trauma
● Use other means of communication ● Degenerative disease
● Brain Tumor
5. DECREASE FEAR AND ANXIETY ● Genetic Disease
● Provide referrals ● CVD: Stroke, Heart Attack, Blocked NT
● Answer questions ● Infections: Meningitis
● Provide diversional activities ● Febrile seizures
B. Idiopathic
6. MONITOR AND MANAGE COMPLICATIONS
● DVT, Urinary retention, pulmonary PRECIPITATING FACTORS
embolism, respiratory failure ● Emotional Stress
● Fatigue
CHRONIC NS DISORDERS ● Loss of sleep
● Seizures/Epilepsy ● Menstrual periods
● Parkinson’s Disease ● Fever
● Multiple Sclerosis ● Other Illnesses
● Myasthenia Gravis ● Specific Sensory Stimuli/ Activities
● Alzheimer’s Disease ● Failure to take medications

READING ASSIGNMENTS: THEORETICAL MECHANISM/PATHOPHYSIOLOGY OF

● Huntington’s Disease SEIZURES
● Cranial Nerve Disorders A. Disturbance in the excitatory and inhibitory synapses
○ Trigeminal Neuralgia impinging in the epileptic neuron
○ Bell’s Palsy B. Presence of different degrees of epileptic neurons
within the epileptic focus
SEIZURE C. Chemical and structural alteration within and outside
● A physical manifestation of paroxysmal and the epileptic focus
abnormal electrical firing of neurons in the brain D. Alterations in enzymes and neurotransmitter
● A problem of the NEURON substances within the brain
↓
EPILEPSY Lower seizure Threshold of a specific neuron
● A group of syndromes characterized by recurring ↓
seizures Stimulate epileptic activity (excessive discharge of
hypersynchronous electrical activity of a neuron)
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↓
Interictal discharge Kindling phenomenon
↓ ↓
LOCAL SEIZURES GENERALIZED SEIZURE

NOTE:
● I neuron can become local seizure
● 1-2 neuron can be a generalized seizure and
epilepsy

EPILEPSY
RECURRING SEIZURES MAY BE CLASSIFIED AS:
I. GENERALIZED SEIZURES
● cause a generalized electrical abnormality
within the brain
II. PARTIAL SEIZURES
● a these seizures arise from a localized part
of the brain and cause specific symptoms
III. STATUS EPILEPTICUS
● medical emergency which may affect the
respiratory status of a client
● Lasts for more than an hour: This is why
inoorasan dapat mga seizures.
PARTIAL SEIZURES
GENERALIZED SEIZURES I. Simple partial seizure - typically limited to one
1. General Tonic-Clonic seizure (Grandmall cerebral hemisphere
Jacksonian)
● characterized by loss of consciousness and II. Complex partial seizure - begins with an aura,
alternating movements of the extremities then with impaired consciousness, with
● (1) Pre ictal, (2) Ictal phase, (3) post ictal purposeless behaviors like lip-smacking,
2. Absence Seizure (Petit mal) chewing movements
● common in children, begins with a brief
change in the LOC, indicated by blinking DIAGNOSTIC EXAMINATIONS
rolling of eyes and blank stares I. History
3. Myoclonic seizure ● complete description of seizure activity
● Characterized by brief, involuntary muscular ● Precipitating factors
jerks of body extremities ● Presence or absence of warning and nature of
● Muscle contracts all over the body like warning
tetany ● Post -ictal experience?
4. Akinetic (Atonic) seizure ● Seizure activity? What body part Frequency?
● general loss of postural tone and a
temporary loss of consciousness - a drop II. Laboratory studies for blood chemistry and;
attack electrolytes
● No aura
III. Dx Studies
● CT Scan
● Cerebral Angiography
● EEG: Definitive test
● MRI
● Lumbar Tap

MANAGEMENT
● Goal: Obtain maximum control of seizure with
minimal side effects

PHARMACOTHERAPY
1. Anticonvulsants
● Determine DOC: type of seizure? SE of medication?
Preference of px?

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● Most commonly Phenytoin, Phenobarbital and CAUSATIVE FACTORS

Carbamazepine ● Unknown
● Ethosuximide and Valproic acid for absence seizure ● Potential factors:
2. Serum Drug Level determination ○ Genetics,
● Below therapeutic level: Unable to control seizure ○ Atherosclerosis
● Above therapeutic level: Toxic side effects ○ Free radical stress
3. Side effects category ○ Viral infection
A. Dose related: involve CNS; eg. Disturbance ○ Head trauma and
in coordination and in mental function ○ Environmental factors
B. Idiosyncratic allergic & metabolic: affected
organs outside CNS; eg. Liver toxicity PATHOPHYSIOLOGY OF PARKINSON’S DISEASE
Destruction of pigmented neuronal cells in the
MEDICAL MANAGEMENT substantia nigra in the basal ganglia
1. ANTIEPILEPTIC DRUGS ↓
2. SURGERY - removal of epileptic focus Decreased levels of dopamine
● Criteria should be considered ↓
● Types: Clinical symptoms do not appear until 60% of the
a. Cortical resection surgery neurons have disappeared
b. Stereotactic surgery
c. Hemispherectomy

NURSING DIAGNOSIS
● Potential for Injury r/t involuntary movements
during seizure activity as manifested bruises,
bleeding tongue, cuts or other injury
● Altered thought process r/t post -ictal confusions
as manifested by disorientation and memory
difficulty
● Ineffective Individual coping r/t adjustment to
diagnosis of epilepsy as manifested by grief, fear,
role disturbance and altered self-concept

NURSING MANAGEMENT
● Observe & document time of onset and duration of
seizure
● Note activity of patient at the time of onset
● Note if there's a focal onset to the seizure
● Record detailed description of the sequence of
events
● Note autonomic changes
● Observe & note laterality of movement
○ Eye deviations?
○ Head Turning?
○ Extension of a limb during seizure?

POST SEIZURE CARE

● Maintain oral mucosa and support joints
● Check ROM
● Provide hydration
● Document before, after and during seizure
● Suction PRN after seizure
● Orient client to TPP

PARKINSON’S DISEASE DIAGNOSTIC TEST

● A slowly progressing neurologic movement ● CT scan is normal
disorder associated with dopamine deficiency ● EEG reveals minimal slowing of brain activity
● The degenerative idiopathic form is the most
common form SIGNS AND SYMPTOMS
● Tremor: resting, pill-rolling

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● Rigidity: cog-wheel, lead-pipe

● Bradykinesia: Abnormally slow movement
● Dementia, depression, sleep disturbances and
hallucinations
● Excessive sweating, Paroxysmal flushing Orthostatic
hypotension
● Mask like facial expressions
● Shuffling gait
● joint stiffness
● Dyskinesia

PARKINSON'S TRINITY: pill-rolling, cogwheel (parang

robot), and bradykinesia

NURSING DIAGNOSIS
● High risk for injury

MEDICAL MANAGEMENT
● Anti-parkinsonian drugs:
○ Levodopa, Carbidopa
● Anticholinergic therapy
○ Antiviral therapy to reduce tremors and rigidity
■ Amantadine
○ Dopamine Agonists
■ Bromocriptine (most promising and
favorite med) and Pergolide
■ Ropirinole and Pramipexole

COLLABORATIVE MANAGEMENT
● Mono Amine Oxidase Inhibitors (MAOI)
● Antidepressants
● Antihistamine

NURSING INTERVENTIONS PATHOPHYSIOLOGY OF MS

● Improve mobility
● Enhance Self- care activities Sensitized T cells will enter the brain
● Improve bowel elimination ↓
● Improve nutrition
Promote antibody production
● Enhance swallowing
● Encourage the use of assistive devices ↓
Myelin sheath damage
MULTIPLE SCLEROSIS (MS) ↓
● An auto-immune mediated progressive Plaques of sclerotic tissues appear on the demyelinated
demyelinating disease of the CNS axons
● The myelin sheath is destroyed and replaced by ↓
sclerotic tissue (sclerosis) Neuronal transmission interruption
↓
CAUSES Most commonly areas affected
● Unknown
● Multiple factors ● Optic nerves and chiasm
○ Viral infection ● Cerebrum
○ Environmental factors ● Cerebellum
○ Geographic location ● Spinal Cord
○ Genetic predisposition
● Common in WOMEN ages 20 to 40 (due to
hormonal imbalances)
SIGNS AND SYMPTOMS
● Visual problems such as diplopia, blurred vision and
nystagmus
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MED SURG 丨2ND SEM 丨LESSON 7 丨NEUROLOGIC DISORDERS
● Motor dysfunction: mono/quadriplegia
● Fatigue, sensory impairment
● Mental changes like mood swings, depression
● Spasticity, ataxia
DIAGNOSTIC TESTS
● MRI (Primary diagnostic study)
● CSF (Immunoglobulin G)
MEDICAL MANAGEMENT
● Interferons
● Immunomodulators
● Corticosteroids
● BACLOFEN (for muscle spasms)
● NSAIDS (for pain)
● Antidepressants
NURSING INTERVENTIONS
1. Promote physical mobility
● Exercise
● Schedule activity and rest periods
● Warm packs over the spastic area
● Swimming and cycling are very useful
2. Prevent injuries
● Wide stance walking
● Use of walking aids
● Wheelchair
3. Enhance bladder and bowel control
● Set a voiding schedule
● Intermittent bladder catheterization
● Use of condom catheter
● Adequate fluids, dietary fibers and bowel
training program
4. Manage speech and swallowing difficulties
● Careful feeding, proper positioning, suction
machine availability
● Speech therapist
5. Improve Sensory and Cognitive function
● Vision- use eye patch for diplopia
● Obtain large printed reading materials
● Offer emotional support
● Involve the family in the care
6. Strengthen coping mechanism
● Alleviate the stress
ADHARA 2023
● Referral to the appropriate agencies
7. improve self-care abilities
● Modify activities according to physical strength
● Provide assistive devices
8. Promote sexual functioning
● Refer to sexual counsellor
MYASTHENIA GRAVIS
● A sporadic, but progressive weakness and
abnormal fatigability of striated muscles which
are exacerbated by exercise and repetitive
movements
● Autoimmune disorder that impairs transmission of
nerve impulses
ETIOLOGIC FACTORS
● Autoimmune disease
● Thymoma
EPIDEMIOLOGY
● Women suffer at an earlier age and are more
affected
PATHOPHYSIOLOGY
Acetylcholine receptor antibodies interfere with
impulse transmission
↓
Follows an unpredictable course of periodic
exacerbations and remissions
ASSESSMENT FINDINGS
● Gradually progressive skeletal muscle weakness
and fatigue
● Weakness that worsens during the day
● Ptosis, diplopia and weak eye closure
● Blank, mask-like facies
● Difficulty chewing
● Difficulty swallowing
● Respiratory difficulty
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MED SURG 丨2ND SEM 丨LESSON 7 丨NEUROLOGIC DISORDERS

○ Amyloid plaques in the brain

○ Oxidative stress
○ Neurochemical deficiencies

LABORATORY EXAMINATION
● EMG
● TENSILON TEST
● CT scan
● Serum anti-AchReceptor antibodies

NURSING DIAGNOSIS
● Ineffective Airway Clearance
● Impaired Swallowing
● Ineffective breathing pattern

MEDICAL MANAGEMENT
● Anticholinesterase drugs:
○ MESTINON
○ Pyridostigmine and Neostigmine
● Corticosteroids
● Immunosuppressants
● Plasmapheresis (hinihiwalay ang plasma from
antibodies)
● Thymectomy

NURSING INTERVENTIONS
SIGNS AND SYMPTOMS
● Administer prescribed medication as scheduled
● Forgetfulness
● Prevent problems with chewing and swallowing
● Recent memory loss (test for recall sa three words)
● Promote respiratory function
● Difficulty learning
● Encourage adjustments lifestyle to prevent fatigue
● Deterioration in personal hygiene
● Maximize functional abilities
● Inability to concentrate
● Prepare for complications like (Reading Assignment)
Myasthenic crisis and Cholinergic crisis
● Prevent problems associated with impaired vision LATE CLINICAL MANIFESTATIONS
resulting from ptosis of eyelids ● Difficulty in abstract thinking
● Provide client teaching ● Difficulty communicating
● Promote client and family coping ● Severe deterioration in memory, language and motor
function
ALZHEIMER’S DISEASE ● Repetitive action - perseveration
● Personality changes
● A progressive neurologic disorder that affects the
brain resulting in cognitive impairments
LABORATORY EXAMINATION
CAUSES ● Neurologic examination
● PET scan
● Unknown
● EEG, CT and MRI
● Potential factors:
● Other tests to rule out Vitamin B deficiencies and
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MED SURG 丨2ND SEM 丨LESSON 7 丨NEUROLOGIC DISORDERS

hypothyroidism
● Autopsy is the most definitive

NURSING DIAGNOSIS
● Altered thought process
● High risk for injury

MEDICAL MANAGEMENT
Drug therapy
● Drugs to treat behavioral symptoms -
antipsychotics (d/t presence of hallucinations but
not psychiatric in nature yung sakit ni patient)
● Anxiolytics
● Donepezil (Aricept): acetylcholinesterase inhibitors
● Tacrine: centrally acting cholinesterase inhibitor

NURSING INTERVENTIONS
● Support patient's abilities
● Provide emotional support
● Establish an effective communication system
with the patient and family
○ Use short simple sentences, words and gestures
○ Maintain a calm and consistent approach
○ Attempt to analyze behavior for meaning
● Protect the patient from injury
○ Provide a safe and structured environment
○ Requests a family member to accompany client
if he wanders around
○ Keep bed in low position
○ Provide adequate lightning
○ Assign consistent caregivers
● Encourage exercise to maintain mobility
● FIVE A'S OF DEMENTIA
○ AMNESIA
○ ANOMIA
○ APRAXIA (misuse of objects)
○ AGNOSIA: May ipapakita na orange, pero di
madescribe ni patient kung ano yung object,
kaya mag-iimbento siya ng bagong bagay, “Yan
ay bola”
○ APHASIA: Patient is unable to communicate.
Nakakalimutan na ang simple sentences.
Parang may language disorder si patient.
Mayroong mga salita na yung patient lang may
alam “Aalis ako, kunin mo yung kurkur”
● Apply moist heat to reduce pain
● Massage the face to maintain muscle tone
● Give frequent mouth care
● Protect the eye with an eye patch.
Eyelid can be taped at night
● Instruct to chew on unaffected side
● Always orient the patient to reality. Pero wag
makipagtalo. Use a calm approach. Patience.

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