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)

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

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

CNS Infections Meningitis Encephalitis

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

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

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

Increased ICP: Monitoring Three methods Intraventricular Cerebral tissue Subdural or subarachnoid space Catheters inserted through burr holes Catheters  Transducer  Monitor (p. 1137 Figure 48.3) Require aggressive nursing care

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

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

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

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

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

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

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

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?

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.