1. Central Nervous System Disorders Unit II Syllabus
Welcome to MS Nervous System Unit II
CNS Infections & Inflammatory disorders (activity)
Increased Intracranial Pressure (PP presentation)
Headaches (PP, activity)
Traumatic Brain Injury (Worksheets)
Brain Tumors & IC Surgery (PP Presentation)
Spinal Disorders & Injuries (PP presentation)
(Activities 1-3 included in this PP with additional handouts)

2. Central Nervous System Disorders
What structures do central CNS disorders involve?
The CNS is the control center of the body
CNS disorders can cause symptoms in any part of the body

3. CNS Infections Infectious agents can enter the CNS and alter function
Two main CNS infections: meningitis & encephalitis
Objectives
Complete the CNS activity
Discuss pathophysiologies, S&S, diagnostic tests & treatments associated with meningitus & encephalitis

4. CNS Infections
Meningitis Encephalitis

5. Increased Intracranial Pressure (ICP)
ICP = pressure exerted within the cranial cavity.
Three components within the cranium affect ICP:
Normal ICP:
Common causes: intracranial hemorrhage, head trauma, increased amounts of CSF, tumors

6. Increased Intracranial Pressure (ICP)
????Critical Thinking Question????
Hyperventilation is known to trigger constriction of cerebral blood vessels. What affect will this have on ICP?

7. Increased ICP: Signs & Symptoms
Early S&S
Irritability & restlessness
Nuchal rigidity, headache & vomiting
Decreased level of consciousness
Sluggish pupil reactions
Late S&S
Vital sign changes
Cushing’s response (Cushing’s triad)
Widened pulse pressure
Fixed and dilated pupils

8. Increased ICP: Monitoring
Three methods
Intraventricular
Cerebral tissue
Subdural or subarachnoid space
Catheters inserted through burr holes
Catheters  Transducer  Monitor (p Figure 48.3)
Require aggressive nursing care

9. Increased ICP: Monitoring
Class activity: Identify structures A-D

10. Increased ICP: Monitoring
Intraventricular Monitoring
Placement = lateral ventricle
Allows for both pressure monitoring & drainage of CSF
P. 1137, figure 48.3
Disadvantages: Clotting of catheter
Infection

11. Increased ICP: Monitoring
Subarachnoid Bolt & Intraparenchymal (Brain Tissue) Monitoring
P. 1137, figure 48.4 (subarachnoid monitoring)
Allows for pressure monitoring
Can not remove CSF
Disadvantages: Clotting of catheters
Infection

12. Increased ICP: Nursing Considerations
Keep HOB elevated 30 degrees
Administer stool softeners, antitussives, & antiemetics
Minimize suctioning
Nonnarcotic medications are prefered
Avoid neck flexion
Avoid hip flexion
Space activities
Provide quiet environment

13. CNS Disorders: Headache
Three types of Headaches
1) Tension
2) Migraine
a) classic
b) common
3) Cluster

14. CNS Disorders: Headaches
Most headaches are transient and are not serious
Headaches are a common symptom of other neurological disorders
When headaches are persistent or recurrent, they should be evaluated
Diagnosis is based on symptoms and diagnostic procedures are utilized to rule out other disorders

15. Headaches: Class Activity
Type/
classification
Cause
Symptoms
Management/
Treatments
Tension
Develop gradually, locations and intensity vary. Described as tight, steady aching , & pressure
Migraine
Classic
Common
Prodromal phase
Immediate onset
Dietary restrictions, quiet environment nifedipine, propranolol, amitriptyline, ergot (Cafergot) , sumatriptan (Imitrex)
Cluster
Vascular disturbance, stress, anxiety, emotional disturbances

16. Closure/Review: CNS Infections, ICP, & Headaches
What are early symptoms of increased ICP?
Define widened pulse pressure
Are opioid analgesics frequently used with neurological disorders? Why or why not?
Describe Brudzinski’s & Kernig’s sign.
What is the cause of tension headaches? What interventions are utilized with these?
What is the pathophysiology of meninigitis?

17. Closure/Review: CNS Infections, ICP, & Headaches
What type of headache may be preceded by an aura? Describe an aura.
Describe the pathophysiology of encephalitis
Describe the therapeutic effect of nifedipine as it relates to migraine headaches.
Describe the therapeutic action of sumatriptan (Imitrex) when utilized for the treatment of migraine headaches.