1. Chapter 14 Care of the Patient with a Neurological Disorder
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2. Care of the Patient with a Neurological Disorder
The nervous system is responsible for communication and control within the body
It is the body’s link with the environment and allows the interpretation of information and appropriate action to occur
Two main structural divisions
central
peripheral

3. Neural Pathway Involved in the Patellar Reflex
(Figure 14-3)

4. Effects of Aging on the Nervous System
Loss of brain weight and loss of neurons
Often an altered sleep/wakefulness ratio
Decrease ability to regulate body temperature
Decrease in the velocity of nerve impulses
Blood supply to the spinal cord is decreased, resulting in decreased reflexes
Normal changes are not the same as senility, organic brain disease, or Alzheimer’s disease

5. Prevention of Neurological Problems
Some neurological problems can be prevented by modifying lifestyle factors, similar to risk factors for cardiovascular disorders:
Avoidance of drug and alcohol use
Safe use of motor vehicles
Safe swimming practices – no diving in shallow water
Safe handling and storage of firearms
Use of hardhats in dangerous construction areas
Use of protective padding as needed for sports

6. Laboratory and Diagnostic Examinations
Assessment of the neurologically impaired patient includes a variety of lab and diagnostic exams
Variety of blood tests
ABGs
Cerebrospinal fluid
Brain scan
MRI
Lumbar puncture
Positron emission tomography (PET)
Angiogram
Electromyo-gram (EMG)
CT scan
Electroencephalogram (EEG)
Myelogram

7. Increased Intracranial Pressure
Increase in the volume of one of the contents of the cranium (blood, brain, blood vessels, or cerebrospinal) results in increased intracranial pressure (ICP) because the cranial vault is rigid and will not expand
Classic signs
Restlessness
Disorientation
Headache
Contralateral hemiparesis
Visual changes including blurring and diplopia

8. Nursing Intervention for ICP
Elevate the head of the bed to degrees to promote venous return
Place the neck in a neutral position to promote venous drainage
Position the patient to avoid flexion of the hips, waist and neck
Instruct the patient to avoid isometric or resistive exercises and Valsalva’s maneuver
Have a Foley catheter in place
Perform suctioning only as necessary
Administer oxygen and use a hypothermia blanket as necessary

9. Neurological Disorders
Epilepsy – caused by sudden, excessive and disorderly electrical discharges of the brain
Stroke – most common disease – caused by thrombus, embolus, or hemorrhage
Degenerative diseases:
Multiple sclerosis – unknown cause
Parkinson’s disease – damage or loss of dopamine-producing cells
Alzheimer’s disease – unknown cause
Myasthenia gravis – lower motor neuron characteristics

10. Vascular Problems
Cerebrovascular accident (CVA) – “stroke” causes ischemia of the brain tissue
Cerebral thrombosis – caused by atherosclerosis
Cerebral embolism – a thrombus from the endocardial layer of the heart
Cerebral hemorrhage – bleeding into the brain or the suarachnoid space
Transient ischemic attack (TIA) - episodes of cerebrovascular insufficiency with temporary dysfunction

11. Neurological Disorders
Guillain-Barre syndrome – inflammation and demyelination of the peripheral nervous system
Meningitis – caused by bacteria or viral agents
Encephalitis – caused by a virus – sometimes fatal
Tumors and cancers – surgery treatment of choice
Spinal cord trauma – usually caused by accidents, results in partial or full paralysis

12. Nursing Diagnoses Autonomic dysreflexia Communication, impaired verbal
Coping, compromised family
Disuse syndrome, risk for
Falls, risk for
Grieving
Infection, risk for
Knowledge, deficient
Memory, impaired
Mobility, impaired physical
Nutrition: less then body requirements, imbalanced
Pain, acute; Pain, chronic
Self-care deficit
Swallowing, impaired
Thought process, disturbed
Tissue perfusion (cerebral), ineffective