Nervous Nle Intensive

Disorders of the
Nervous System
Prepared by:Jem Sombilla RN,CNN,MAN

National/International Lecturer
NEUROLOGIC DISORDERS
Anatomy and Physiology
FUNCTIONS:
1.Sensory Input(internal and external stimulus)

2.Integration(Brain and Spinal Cord)
3.Mental Activity
4.Control Muscles and Glands(SNS/PNS)
5.Homeostasis(Hypothalamus)
DIVISIONS OF NERVOUS SYSTEM
CNS PNS
CARDIOVASCULAR DISORDERS
CENTRAL NERVOUS SYSTEM
BRAIN FUNCTIONS:
1.Cerebrum
 Frontal Lobe(Brocas Area)
 Parietal Lobe
 Temporal Lobe(Wernicks
Area)
 Occipital Lobe
2.Cerebellum-little brain
BRAIN FUNCTIONS:
3.Brainstem
3.1Diencephalon
 Thalamus -most sensory inputs
 Hypothalamus -homones, ANS control
 Epithalamus -sleep wake cycle(concsist of pineal gland)
3.2 Midbrain -movement of body and head/visual-auditory

reflexes
3.3 Pons
3.4 Medulla
Oblongata NEUROLOGIC DISORDERS
RIGHT BRAIN LEFT BRAIN
SPINAL CORD
 Composed Ascending and Descending pathways
 Center for reflex acts
Origin of ANS:
 Craniosacral segment(origin of PNS)
 Thoracolumbar segment(origin of SNS)
 Damage of spinal cord will lead to paralysis
PROTECTIVE STRUCTURES OF CNS
1.Cranium
-composed of 8 bones
-with junctions called sutures
2.Vertebral column
(7-C,12-T,L-5-S,5,C-4)
3.Meninges
 Pia Mater
 Arachnoid
 Dura Mater
4.CSF-cushions/protect the brain
-Regulate ICP
5.BBB(Blood Brain Barrier)
PERIPHERAL NERVOUS SYSTEM
1.CRANIAL NERVES 12-PAIRS

2.SPINAL NERVES: 31-PAIRS
8 cervical
12 thoracic
5 lumbar
5 sacral
1_coccygeal
31
3.AUTONOMIC NERVOUS SNS

SYSTEM PNS
CRANIAL NERVES
CRANIAL NERVES
AUTONOMIC NERVOUS SYSTEM
ORGAN SYSTEM SYMPATHETIC PARASYMPATHETIC
1.HEART(BV)
3.LUNGS(AIRWAY)
4.EYES
5.G.I
ORGAN SYSTEM SYMPATHETIC PARASYMPATHETIC
6.G.U
7.SKIN AND SWEAT
8.SECRETIONS:
GASTRIC AND
SALIVARY
9.LIVER
INCREASE ICP
(INTRACRANIAL PRESSURE)
INCREASE ICP
Main Problem Increase Bulk of the Brain
Signs and Restlessness-initial sign of increase
Symptoms: ICP
Headache
N/V-pressure at the medulla
oblongata(vomiting may be projectile)
Altered LOC
Diplopia(double vision)-due to pressure
on cranial nerve V1(Abducens)
Cushings Triad
INCREASE ICP
Signs and  Hypo or Hyperthermia

Symptoms:  Anisocuria(unequal pupil)
 Pinpoint pupil
 Fixed,dilated pupils
 Papilledema
 Dolls eye sign
 Decortication(abnormal flexion)
 Decerebration(abnormal extension)
INCREASE ICP
INCREASE ICP
MANAGEMENT:
1.Reduce ICP:
Position:Semi Fowlers
Avoid Factors that Increase ICP:
-Straining/Valsalva Manuever
-Bending on Waist
-Coughing/Sneezing
-Heavy lifting
2.Treat Cerebral Hypoxia
 Oxygen Therapy
INCREASE ICP
MANAGEMENT:
3.Medications
 Diuretics
-Mannitol(osmotic diuretic)
-Furosemide(loop diuretic)
Anti-Inflammatory(Steroids)
-Decadron(Dexamethasone)
Q AND A:INCREASE ICP
Tissue plasminogen activator (t-PA) is considered
for treatment of a patient who arrives in the
emergency department following onset of symptoms
of myocardial infarction. Which of the following is a
contraindication for treatment with t-PA?
a.Worsening chest pain that began earlier in the
evening.
b.History of cerebral hemorrhage.
c.History of prior myocardial infarction.
d.Hypertension.
Q AND A:INCREASE ICP
ANSWER:B :
CEREBROVASCULAR ACCIDENT
(CVA/STROKE)
(CVA/STROKE)
Main Problem  Disruption of blood and oxygen supply
to the brain tissue.
Commonly  Middle Cerebral Artery(MCA)
affected site:
Risk Factors:  Smoking
 HPN/Heart Problem
 DM
 Family History
 Aneurysm
 Atherosclerosis
(CVA/STROKE)
TYPES: CAUSES
1.ISCHEMIC STROKE
 Thrombotic
 Embolic
2.TIA-Transient Ischemic
CLOT
Attach
3.HEMORRHAGIC -RUPTURED ANEURYSM
STROKE Common cause:HYPERTENSION
Diagnostic Exam:
 CT SCAN/MRI
 TPA(for ischemic
stroke only)
(CVA/STROKE)
SIGNS AND SYMPTOMS:
F-acial Drooping
A-rm weakness/numbness(hemiparesis/plegia)
S-lurred Speech
A-phasia(Receptive and Expressive)
H-emianopsia(loss of half of visual fields)
I-ncrease ICP
(CVA/STROKE)
(CVA/STROKE)
(CVA/STROKE)
Left CVA Right CVA
Right Hemiplegia Left hemiplegia
Right visual defect Left visual field defect
Aphasia Spatial-perceptual field defect
Altered intellectual Increased distractability(poor
activity attention span)
Slow,cautious Impulsive behaviour,poor
behavior judgement, lack of awareness
of deficit
(CVA/STROKE)
Management for ICP Care for Hemianopsia
VS and LOC(GCS) Approach:unaffected side

Oxygen of visual field
Mannitol Scanning Technique
Dexamethasone
Anticonvulsant
Seizure Precautions
(CVA/STROKE)
Supportive care Care for Aphasia
Nutrition(TPN,enteral Short Phrases, simple

feedings) details
Activity(Turning,PROM) Use Gestures
 Elimination( I and O ) Ask question one at a
time
 Rehabilitation of the Communication
client Response Board(paper)
(CVA/STROKE)
Thalamic Syndrome
 Divert/Distract
(CVA/STROKE)
Q AND A:(CVA/STROKE)
A 61 year old male client is admitted to the hospital with
a right sided CVA.The nurse is aware that the most
common cause of the CVA is thrombosis.The nurse
provides instruction to the family about the
homonymous hemianopsia.The nurse should instruct
the client on measures to overcome the deficit by:
a.Place his personal items or object in his impaired
field of vision
b.Approach the client to affected to turn the head to
scan the lost visual field
c.Remind the client to turn the head to scan the lost of
visual field
d.Stop the client from wearing eye glasses
ANSWER:C
A 61 year old male client is admitted to the

hospital with a right sided CVA.The nurse is
aware that the most common cause of CVA is:
a.Embolism
b.Hemorrhage
c.Cerebral arterial spasm
d.Thrombosis
ANSWER:D
SEIZURE DISORDERS
SEIZURE DISORDERS
STAGES CHARACTERISTIC TIME/DAY
S
1.PRODROMAL  Symptoms prior to  Few days before seizure
seizure(days
before seizure)
2.AURA  Warning signs  Seconds or min before
before seizure seizure
3.ICTUS  Actual Seizure  1-3 mins(time?)

 5 mins and above(status
epilepticus-emergency)
4.POST ICTUS  After  Hours or days(tonic
seizure/recovery clonic)
 Immediate(absence)
SEIZURE DISORDERS
TYPES CHARACTERISTICS TIME
1.GENERALIZED SIZURE
(whole brain)
a.Tonic-  Most common  1-3 mins(timer)
Clonic  (+) Aura  5 mins and above(status
(grand mal) epilepticus-emergency
reponse)
b.Absence  Common:Pedia  Seconds

(Petit-Mal)  Hallmark:Staring
c.Atonic  Without Muscle  Immediate

(Drop Attack) Tone(standing
suddenly fall)Px:Head
SEIZURE DISORDERS
TYPES CHARACTERISTICS TIME
2.FOCAL SIZURE
(partial/specific area of the brain)
Other Name: Jacksonian Seizure
a.Simple Partial Patient is aware Less than

(Focal Onset Aware) (+) Aura 2 mins
b.Complex Partial Unaware

(Focal Impaired Automatism(lip
Awareness) smacking)
SEIZURE DISORDERS
OTHER TYPES OF SEIZURE

 Psychomotor Seizure
Febrile Seizure
-common under 5 yr.old
Status Epilepticus
SEIZURE DISORDERS
DIAGNOSTIC TEST:
1.EEG
Preparation:
 Wash the hair (before and after)-to remove
oils/sprays, paste.
 avoid stimulants, depressants(24hrs)
SEIZURE DISORDERS
MANAGEMENT:SEIZURE PRECAUTIONS
1.SAFETY:
oxygen /suction
padded bedrails
bed lowest position
pillow
remove restrictive clothing
2.DURING SEIZURE
Lay down with pillow under head/lap
Do not restrain
Do not insert anything in the mouth
Time seizure
Note characteristics/NEURO assessment
SEIZURE DISORDERS
MANAGEMENT:SEIZURE PRECAUTIONS
3.MEDICATION:
Anticonvulsants:
 Barbiturates(Phenobarbital
Action:Stimulates GABA receptors
 Hydantoins:Phenytoin/Dilantin
S/E:Ginigival Hyperplasia
NI:Oral care
C.I:No to antacids/milk(decrease absorption)
 Diazepam or Lorazepam(fast acting for status
epilepticus)
S/E:Very Drowsy,TOLERANCE(not as effective)
Q AND A:SEIZURE DISORDERS
A client is experiencing the tonic phase of

the grandma seizure.After protecting the
clients head,which of the following is the
nurse expected to do first?
a.Monitor VS especially the RR
b.Place a padded tongue blade in the
pateinst mouth
c.Provide mechanical ventilation
d.Turn patient to his side
Q AND A:SEIZURE DISORDERS
ANSWER: D
HEAD TRAUMA
HEAD TRAUMA
Concussion-jarring of the brain
Contusion-bruising of the brain tissue
SIGNS AND SYMPTOMS:
Signs of Basilar Head Injury:
-Battles sign(post auricular ecchymosis-at the mastoid
process behind the ear)
-Raccoon Eyes-peri orbital ecchymosis
-Rhinorrhea and Otorrhea
-Increase ICP
Note:CSF leak causes high risk for meningitis

HEAD TRAUMA
HEAD TRAUMA
HEAD TRAUMA
MANAGEMENT:
Manage Increased ICP
 Monitor CSF leak(test the fluid for glucose)
Material: Gauze pad
Result:(+ )CSF Leak:Halo or ring sign-yellowish ring
encircles the blood.
HEAD TRAUMA
HEAD TRAUMA
SURGERY:
1.Burr Hole(Trephine)
2.Craniotomy
3.Craniectomy
4.Cranioplasty
HEAD TRAUMA
HEAD TRAUMA
Q AND A:HEAD TRAUMA
A patient has returned to the neurosurgery unit after
her craniotomy operation.Which of the following orders
in the chart the nurse question?Select all that apply.
1.Administer oxygen at 2lpm
2.Give dexamethasone 4mg every 6 hours
3.Infuse IVF at 150ml/hr
4.Place the head in flexion
5.Elevate the head of the bed at 30 degrees
6.Encourage visitors for the client
7.Do some exercise like head rotation
8.Give stool softener as ordered
Q AND A:HEAD TRAUMA
ANSWER:3,4,6,7,
MENINGITIS
MENINGITIS
CHARACTERISTIC Inflammation of the
Meninges(Covering layer of the
brain)
CAUSES: BACTERIAL:
 Streptococcus pneumonia
 Neisseria Meningitides
VIRAL:
 Enteroviruses(most common –
spread through respiratory
secretions)
 Arboviruses
 HIV
 Herpes simplex virus
MENINGITIS
DIAGNOSTIC TEST:
Lumbar culture
Specimen:CSF
Normal:
Glucose:50-80mg/dl(decreased-infection)
Protein-20-50mg/dl(increased-infection)
Pressure-75-180mmH2O or 0-14mmhg
Result:
CSF glucose –decreased
CSF protein- elevated
CSF Color :turbid/purulent
MENINGITIS
SIGNS AND SYMPTOMS:
Nuchal rigidity(neck stiffnes)
Kernigs sign
Brudzinskis sign
Flu like Symptoms
Increased ICP
MENINGITIS
MENINGITIS
MANAGEMENT:
1.Prevent Transmission: DROPLET precautions
2.Non Stimulating Environment
Bed rest
Darkened room
Cool cloth over the eyes
3.Seizure Precautions
4.Manage the ICP
5.Medications:
 Antibiotics IV(ampicillin, penicillin, cephalosphorins)
Codeine for headache
Acetaminophen or aspirin-fever NEUROLOGIC DISORDERS
Q AND A:MENINGITIS
The nurse receives a report at the beginning of a shift
about a client with suspected Meningitis.Which
assessment data on the client, the nurse expects to
find: Select all that Apply.
1.Opisthotonus Posture
2.Brudzinskis Sign
3.Episodes of seizure
4.Hydrocephalus
5.Herberdens nodules
6.Kernigs sign
7.Exophtalmus
8.Photophobia
9.Nuchal Rigidity NEUROLOGIC DISORDERS
Q AND A:MENINGITIS
ANSWER:1,2,3,4,6,8,9
SPINAL CORD INJURY
SPINAL CORD INJURY
CAUSE: Trauma
EFFECTS: Paralysis
Loss of :
-Reflexes
-Sensory function(afferent fibers
involved)
-Motor function(efferent fibers
involved)
Autonomic dysfunction
SPINAL CORD INJURY(SCI)
SIGNS AND SYMPTOMS:
CERVICAL SCI-most fatal THORACIC SCI
 Quadriplegia  Paraplegia
 Respiratory Paralysis  Poor control of upper
trunk
 Bowel and Bladder  Bowel/Bladder retention
Retention
Complication:
Autonomic Dysreflexia
-Injury above T6
SIGNS AND SYMPTOMS:
LUMBAR SCI SACRAL SCI
 Paradriplegia If Injury is above S2:
 Bowel and Bladder  (+) Erection
Retention  (-) Ejaculation
If injury is between S2-S4:
 (-) Erection
 (-) Ejaculation
 Paraplegia:
Male:Impotence
Female:(-) Orgasm,but capable to
bear a child
 .B and B Incontinence
COMPLICATIONS:
1.SPINAL SHOCK 2.AUTONOMIC
DYSREFLEXIA
Complete Loss of ALL Hyperstimulation of SNS
reflexes
Flaccid Paralysis DOC:
1.Hexamethonium
Chloride(a ganglionic
blocking agent)
2.Nitroprusside(vasodilator)
Q AND A:SCI
A client is being assessed by a nurse in the
emergency after suffering from a driving accident 3
hours earlier. It was revealed that the client ahs
fracture of the C4.Although the client is breathing
independently ,he has no muscle tone and no
movement below the area of injury. The nurse
recognizes and is aware that the client:
a.Will have paralysis in all 4 extremities
b.Has been suffering a complete SCI
c.Is going through a spinal shock
d.Ha sustained an upper motor neuron injury
Q AND A:SCI
ANSWER:C
Q AND A:SCI
The dietitian has recommended a client with SCI to
decrease the total intake of calcium per day.When the
client ask the nurse about it,which of the following
responses would give the most accurate information?
a.”Dairy products would probably contribute to weight
gain”
b.”Excessive dairy products intakes makes
constipation more common”.
c.”Immobility promotes calcium absorption from
intestines”
d.”Bone demineralization will occur due to lack of
weight bearing”.
Q AND A:SCI
ANSWER:D
PARKINSONS DISEASE
NEUROTRANSMITTERS
Excitatory Inhibitory
Acetylcholine GABA(Gamma Amminobutyric
Acid)
Dopamine Glycine
Glutamate
Norepinephrine
Serotonin
PARKINSONS DISEASE
CHARACTERISTIC:
PROBLEM:  Decrease Dopamine

 Imbalance between Dopamine vs
Acetylcholine
ETIOLOGY/RISK  Unknown
FACTORS  Older(60)
 Trauma
PARKINSONS DISEASE
SIGNS AND SYMPTOMS
1.Tremors(initial sign)
Pill-rolling tremors
2.Cogwheel rigidity
3.Bradykinesia/Akinesia
4.Other Symptoms:
Shuffling, festinating gait- tip toe walking
Flattened affect(mask like facial expression)
Stooped posture
Monotonous voice
Dysphagia/Fatigue NEUROLOGIC DISORDERS
PARKINSONS DISEASE
MANAGEMENT:
1. SAFETY-Priority
Soft diet for dysphagia
Firm bed to prevent contractures
Upright Position-prevent aspiration
Increase fluid intake
2.MEDICATIONS:
1.Dopaminergic
DOC:Carbidopa with levodopa(Sinemet)
Levodopa-a precursor of dopamine can cross the BBB
Carbidopa- reduces destruction of levodopa.
Note: Dopamine cannot cross the BBB
NLE Tips(AVOID):
 Vit.B6(Pyrodoxine)-it decrease effect of drugs
PARKINSONS DISEASE
2.Dopamine Agonist 3.MAOI-B
Action:stimulates Action:Increase dopamine

dopamine receptors by stopping MAO Activity
Parlodel(Bromocriptine Rasagiline(Azilect)
Mesylate)
PARKINSONS DISEASE
4.Anticholinergics 5.Antiviral Drugs
Action: Action:
to reduce rigidity stimulates dopaminergic
activity in CNS
Artane(Trihexyphenidyl) Symmetrel(Amantadine
Cogentin(Benztropine) Hcl)
Akineton(Biperiden)
S/E:Dry Mouth/Urinary
Retention
C.I:Glaucoma-increase IOP
NI:Sugar less candy,ice chips
-Encourage to Void
Q AND A:PARKINSONS DISEASE
Which of the following is the common

early sign of Parkinson's disease as
gathered by the nurse conducting the
history?
a.Gait Changes
b.Slow Movement
c.Freezing movement
d.Tremors in one of the upper limbs
Q AND A:PARKINSONS DISEASE
ANSWER:D
NEUROMUSCULAR DISORDERS
DISORDERS PROBLEM BULBAR COMMON
SIGNS SYMPTOMS
1.MG
2.GBS
3.MS
4.ALS
DISORDERS PATTERN COMMON DOC:
OF SYMPTOM
PARALYSIS S
1.MG
2.GBS
3.MS
4.ALS
MG VS.GBS
NEURONS
Neuron
-basic structural and functional unit of nervous system
NEURONS-MUSCLE
NEURONS-NEURONS
HOW DOES MG DEVELOP?
HOW DOES MG DEVELOP?
NEUROTRANSMITTER
Note: Transmission across synapse is

essentially a chemical process .
Synaptic transmission is both excitatory
or inhibitory.
MG VS.GBS
MYASTHENIA CHARACTER GUILLAINE BARRE
GRAVIS(MG) ISTICS SYNDROME(GBS)
Decrease MAIN Damage Myelin Sheath of
Acetylcholine PROBLEM PNS Neurons
Autoimmune ETIOLOGY  Autoimmune
 G-I Infection
(Campylobacter
Infection)
 R-espi Infection(Swine
Flu)
 E-PSTEIN BARR
Virus/HIV
MG VS.GBS
MYASTHENIA CHARACTER GUILLAINE BARRE
GRAVIS(MG) ISTICS SYNDROME(GBS)
SIGNS/
 Ptosis SYMPTOMS  Paresthesia/Numbness
 Dysphagia (feet)
 Dysarthria  Dysphagia/Constipation
 Dyspnea  Dyspnea
 Fatigue  Speech Problem
 Snarl  ANS:Cardiac dysrhythmias
smile(mask like)  Elevated protein level in
the CSF
Muscle Weakness MAIN Muscle Weakness

PROBLEM
MG VS.GBS
MYASTHENIA CHARACTERI GUILLAINE BARRE
GRAVIS(MG) STICS SYNDROME(GBS)
DESCENDING PARALYSIS ASCENDING
AIRWAY- PRIORITY AIRWAY-Respiratory

Respiratory Failure
Failure
Myasthenic COMPLICATION
Crisis
Cholinergic
Crisis
MG VS.GBS
MYASTHENIA GUILLAINE BARRE
GRAVIS(MG) SYNDROME(GBS)
1.Tensilon Test D 1.EMG(Electromyography)
(Endrophonium Test) I 2.Lumbar Puncture
 short acting A NI:
cholinergic G Before:Empty the bladder
 Dose:2mg first then N During:Lateral
8mg-IV O Recumbent(knees-up to
 Result(+)-improve in S abdomen/chin to chest)
muscle strength(only T After:Flat
for 3-5 mins) I Increase OFI
C Result:
Protein-Increase
WBC-Normal
MG VS.GBS
MYASTHENIA GRAVIS(MG) GUILLAINE BARRE
SYNDROME(GBS)
MANAGEMENT:
1.Improve Swallowing: 1.Symptomatic
Gag reflex /Supportive Management
Meds: 20-30 mins before
Cold Beverage 2.Promote adequate
2.Promote adequate ventilation
ventilation
3.Avoid trigger(infections) 3.Bed Side :Intubation
4.Rest Set/MV/Suction(acute
satge)
MEDICAL MANAGEMENT:
MG VS.GBS
1.Acetylcholinesterase 1.Immunoglobulin Therapy
Inhibitors/Cholinesteras Action:from donor-to STOP
e Inhibitors antibodies that are damaging
Prostegmin(Neostigmine) the nerves
Mestinon(Pyridostigmine) 2.Plasmapahresis
Best Time:Before Meals Action: remove antibodies
(better absorption) that are attacking the myelin
NLE Tip: sheath
 Observe for signs of
cholinergic and
myesthenic crisis
 Antidote:Atrophine
MG VS.GBS
MYASTHENIA GUILLAINE BARRE
GRAVIS(MG) SYNDROME(GBS)
MEDICAL MANAGEMENT:
2.Glucocorticoids
3. Plasmapharesis
4.Thymectomy
Myasthenic Crisis Cholinergic Crisis(PNS)
MG VS.GBS
-undermedication/delayed -excessive medications
medication S/Sx:
S/Sx:  LIKE:PARASYMPATHETIC
 LIKE:SYMPHATETIC STIMULATION
STIMULATION  BP(Decrease)
 BP(Increase)  HR(Decrease)
 HR(Increase)  Increase secretions:
 Severe Muscle Weakness:  Sweating/lacrimation
 (-)Gag/Cough/Swallowing  Diarrhea/Abd.cramps
Reflex  Severe Muscle Weakness:
 Respiratory failure  Dysphagia, chewing/speakin
 Bowel or bladder incontinence  Respiratory Failure
Interventions: Interventions:
DOC:Acetylcholinestaerase DOC:Atrophine 1mg IV
Inhibitor/Cholinergic D/C Cholinergic drugs
Drugs(Neostigmine) Provide adequate ventilator
Provide adequate ventilator support
support NEUROLOGIC DISORDERS
MG VS.GBS
QUESTION: HOW WILL YOU KNOW IF THE PATIENT

IS EXPERIENCING MYASTHENIC CRISIS OR
CHOLINERGIC CRISIS?
Q AND A:MG
A client is diagnosed with MG is given an

anticholinesterase drug therapy. This is to
distinguish cholinergic crisis from myasthenic
crisis.Which of the following symptoms is not
present in cholinergic crisis?
a.Improved muscle strength after tensilon injection

b.Increased Weakness
c.Diarrhea
d.Increased Salivation
Q AND A:MG
ANSWER:A
Q AND A:GBS
The pediatric ward nurse ask the client who ahs
GBS to cough every now and then.She also
assesses clients speech for decreased muscle
volume and clarity.Which of the following is the
underlying rationale for doing those two
assessments?
a.To determine regression to an earlier
developmental phase
b.To deteremine increase ICP
c.To determine involvement of facial and cranial
nerves
d.To determine inflammation of larynx and epiglotis
Q AND A:GBS
ANSWER:C
MULTIPLE SCLEROSIS(MS)
MULTIPLE SCLEROSIS(MS)=MYELIN SHEATH(MS)
Characteristic: Damage Myelin Sheath of
CNS/PNS Neurons
ETIOLOGY: UNKNOWN
Autoimmune
RISK FACTORS: Women(20-40 years old)
EBV
DIAGNOSTIC TEST: MRI
Lumbar Puncture
Result:(+)Oligoclonal
bands(protein)Increase
Indication:Inflammation
SIGNS AND SYMPTOMS
Ataxic Gait(Uncoordinated Movement)
+Romberg Signs(cerebral lesion)
Lhermittes Sign(Electric Shock Sensation)
Vision:Blurry,double vision
Elimination:Incontinence or Retention
Emotions:Fatigue,depressed mood
 Charcoats Triad:
S-canning Speech(repetition the first syllable of each word)
I-ntention tremors
N-ystagmus
MANAGEMENT:
PRIORITY:SAFETY
Patch the eye alternately -diplopia
 Diet-high in fiber,fluids
 Avoid hot baths(heat increases weakness)
 Speech and PT
MEDICATIONS:
1.STEROIDS:
 Prednisone
2.BLADDER ISSUES
 Anti Cholinergic:Oxybutynin(Incontinence)
 Cholinergic:Bethanecol(Retention)
3.FATIGUE
 Amantadine
 Modafinil:CNS Stimulant
4.SPASM
 Baclofen
 Diazepam
MEDICATIONS
5.TREMORS:
Propanolol
Isoniazid(Infection related tremors)
Q AND A:MS
A client is given health teaching by the nurse
regarding the management of MS.Which of the
following instructions should be included in the care
plan?Select all that apply.
1.Take daytime rest /naps
2.Avoid eating vegetables and fruits
3.Avoid hot baths or showers
4.Set a regular time for elimination
5.Limit fluid intake to 1l/day
6.Eat a diet high in fiber like papaya and pineapple
7.Elevate the toilet seat for easy access
8.Space out drinking fluids
Q AND A:MS
ANSWER: 1,3,4,6,7,8
AMYOTROPHIC LATERAL
SCLEROSIS(ALS)
AMYOTROPHIC LATERAL
SCLEROSIS(ALS)
Characteristic: Degeneration of Motor Neuron
Increase glutamate
OTHER NAME: Lou Gehrigs Disease
ETIOLOGY: UNKNOWN
RISK Family History/Genetics

FACTORS: (2-3 out of 100,000 individuals)
AMYOTROPHIC LATERAL
SCLEROSIS(ALS)
SIGNS/SYMPTOMS:
Dysphagia(1st sign-initial sign)
Dysarthria
Spasticity
Fasciculations(twitching)
Muscle weakness and atrophy
Respiratory difficulty
AMYOTROPHIC LATERAL
SCLEROSIS(ALS)
MANAGEMENT
Supportive and Symptomatic
Promote respiratory function
Gastrostomy feeding
Avoid aspiration
Assist with ADL
Provide emotional support to the client and family
 Medication:
RILUZOLE(Glutamate Antagonist)
Action:Inhibit Glutamate Release
 Slow progression of disease
Q AND A:ALS
A client is suspected with Amyotrophic Lateral
Sclerosis which is a debilitating disease. Which of the
following assessment findings does the nurse expect.
Select all that apply.
1.RR of 45
2.Dysarthria
3.Tremors when resting
4.Drooping of the eyelids
5.Weakness of the extremities
6.Substantial Memory loss
7.Facial Fasciculation
8.Fatigue while talking
Q AND A:ALS
ANSWER: 1,2,5,7,8
BELLS PALSY
VS.
TRIGEMINAL NEURALGIA
BELLS PALSY CHARACT TRIGEMINAL
ERISTICS NEURALGIA
CRANIAL CRANIAL CRANIAL NERVE 5
NERVE 7 NERVES -SENSORY NERVE
-MOTOR AFFECTED
NERVE
 Infection(herp ETIOLOGY  CNS Problem
es near the  Trauma
ear)  Stroke
 Trauma
BELLS PALSY CHARACTE TRIGEMINAL
RISTICS NEURALGIA
 FACIAL SIGNS/ FACIAL
PARALYSIS: SYMPTOMS PAIN:LIPS,GUMS,NOSE
1 side of FACE Excruciating
 Ptosis Recurrent
 Inability to : Stabbing
 Raise Eyebrow Pain aggravated by:
 Frown,  Cold(washing the face)
 Smile  Chewing
 Close the  Hot or cold foods and
eyelids fluids
 Puff out cheeks  Touch of wind on the
face.
BELLS PALSY MANAGEMEN TRIGEMINAL
T
NEURALGIA
1.Facial N Avoid TRIGGERS:
exercises U 1. hot or cold
2.Protect the R foods/beverages
eyes from S 2. liquid and soft foods
dryness I 3.Chewing: unaffected
3.Chewing: N side
unaffected side G
INTERVENT
IONS
BELLS PALSY MANAGEME TRIGEMINAL
NT NEURALGIA
1.Steroids MEDICAL 1.Lioresal(Baclofen)
2.Analgesics 2.Valium(Diazepam)
SURGERY 1.Alcohol injection of

the nerve
2.Neurectomy
ALZHEIMERS DISEASE
ALZHEIMERS DISEASE
CHARACTERISTIC:  degenerative disorder of the cerebral
cortex resulting to microscopic
plaques.
 Progressive loss of memory
 5th leading cause of death among
adult 65 and above
ETIOLOGY:  UNKNOWN
RISK FACTORS:  Age
 Heredity
PROBLEM:  MEMORY LOSS:
Recent Memory(1st)
Remote Memory(Intact)
 CONFUSION
ALZHEIMERS DISEASE
MANAGEMENT:
 Prevent  Orient
Injury  Close supervision
(safety is the  Remove hazards(toxic
priority) drugs ,dangerous electrical appliance)
Promote  Exercise:walking with an escort
Activity  Mental Stimulation:
 Listening to music, coloring, watching
TV
 Simple games or activities
ALZHEIMERS DISEASE
MANAGEMENT
 Promote Sleep  Wander in a safe place until
he/she becomes tired
 Prevent shadows in the room
 Avoid Agitation  Avoid scolding, embarrassing,
and Violence arguing
 Approach the client slowly and
calmly
 Remove from stressful
environment
ALZHEIMERS DISEASE
MANAGEMENT
Minimize  Call the client by name
confusion and  Orient the client frequently
Disorientation  Ask only one question at a time
 Place a calendar and clock in a
visible place
 Provide structured/ROUTINE
activities
 Allow the client to reminisce
(remote memory may remain intact
for a long period of time)
 Allow time for the client to
complete a task
ALZHEIMERS DISEASE
MANAGEMENT
 Prevent Sundown  Turn lights on before it becomes dark
Syndrome
 MEDICATION 1.Acetylcholinesterase Inhibitors:

 Aricept
 Razadyne
 Tacrine
 DR.G
1.D-onepezil
2.R-ivastigmine
3.G-alantamine
2.NMDA(N-Methyl D-aspartate)
 Namenda
Q AND A:ALZHEIMERS DISEASE
A patient with Alzheimers disease has a self care
deficit linked to his cognitive impairement.Which is a
priority to include in the nursing care plan for a
patient who is experiencing difficulty processing and
completing complex task?
a.Repeating the instructions until the patients follow
them
b.Requesting the patient to do one step of the task at
a time
c.Demonstrating on how to do for the patient
d.Maintaining structure and routine for the patient
ANSWER:B
Alzheimer’s disease is the secondary diagnosis of a
client admitted with myocardial infarction. Which
nursing intervention should appear on this client’s
plan of care?
a.Perform activities of daily living for the client to
decease frustration.
b.Provide a stimulating environment.
c.Establish and maintain a routine.
d. Try to reason with the client as much as possible.
ANSWER:C

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Disorders of the

Prepared by:Jem Sombilla RN,CNN,MAN

1.Sensory Input(internal and external stimulus)

 Epithalamus -sleep wake cycle(concsist of pineal gland)

3.2 Midbrain -movement of body and head/visual-auditory

1.CRANIAL NERVES 12-PAIRS

3.AUTONOMIC NERVOUS SNS

7.SKIN AND SWEAT

Signs and  Hypo or Hyperthermia

VS and LOC(GCS) Approach:unaffected side

Nutrition(TPN,enteral Short Phrases, simple

A 61 year old male client is admitted to the

3.ICTUS  Actual Seizure  1-3 mins(time?)

b.Absence  Common:Pedia  Seconds

c.Atonic  Without Muscle  Immediate

a.Simple Partial Patient is aware Less than

b.Complex Partial Unaware

OTHER TYPES OF SEIZURE

A client is experiencing the tonic phase of

Note:CSF leak causes high risk for meningitis

PROBLEM:  Decrease Dopamine

Action:stimulates Action:Increase dopamine

Which of the following is the common

Note: Transmission across synapse is

Muscle Weakness MAIN Muscle Weakness

AIRWAY- PRIORITY AIRWAY-Respiratory

QUESTION: HOW WILL YOU KNOW IF THE PATIENT

A client is diagnosed with MG is given an

a.Improved muscle strength after tensilon injection

RISK Family History/Genetics

SURGERY 1.Alcohol injection of

 MEDICATION 1.Acetylcholinesterase Inhibitors:

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