Care of Patient with neurological Disorder ( NUR 475) 2015 - 2016 DR. Samah Mohammed

Out lines Introduction. Definition of nervous system. Structure of neuron. Path physiology. Neurological disorder. Nursing management.

INTRODUCTION Three of the top 15 causes of death in 2007 were neurologic in nature. Prevalence: number of people in a given population with a particular disease Incidence: number of people diagnosed with a particular disorder in a one-year period 3

Nervous System Nervous system defined as:- Allows for communication between cells through sensory input, integration of data, and motor output. 2 cell types: neurons and neuralgia 2 divisions: Central nervous system (CNS): Brain and spinal cord. Peripheral nervous system (PNS): Nerves and ganglia (cell bodies). 4

Structure of the Nervous System Each neuron contains: Cell body: with nucleus. Dendrites : fibers that receive messages from other neurons. Axons : fibers that send messages to other neurons. 4. Axon Terminals: Transmit information 5

Neurons and Impulse Transmission Synapses: slight gap between each cell. Neurotransmitters: connects synapse to next cell. Relay electrically conducted signals 6

Nervous System Organization 1. Central Nervous System (CNS) Spinal Cord – simple decisions & information transmission. Brain – “complex” decisions. 2. Peripheral Nervous System (PNS) Somatic Nervous System: the nerves that convey messages from the sense organs to the CNS and from the CNS to the muscles and glands (voluntary movement). Autonomic Nervous System: neurons that control the heart, the intestines, and other organs (involuntary movement). Sympathetic : increases ( HR, RS, B/P) acts in emergency as fear and anxiety. Parasympathetic: decrease (HR, RS, B/P) acts in rest as diet, and elimination.

Central Nervous System (CNS) Brain Lobes Occipital lobe: scans through images. Temporal lobe: attaches image to name. Frontal lobe: controls voluntary motion. Parietal lobe: perceives touch and pain. 1.Cerebrum : largest part of human brain. - Responsible for: Thought Language Senses Memory Voluntary movement 8

The CNS: Brain 3.Brain Stem : connects brain to spinal cord 2. Cerebellum : at base of brain -Responsible for: Muscle coordination Balance Posture 3.Brain Stem : connects brain to spinal cord -Responsible for: Breathing Swallowing, Heartbeat, and Blood pressure

Spinal cord 8 Cervical 12 Thoracic 5 Lumbar 5 Sacral 1 Coccygeal The Spinal Cord: part of the CNS found within the spinal column. The spinal cord communicates with the sense organs and muscles below the level of the head. 31 pairs & their branches carries messages to & from the spinal cord Both sensory and motor nerves 8 Cervical 12 Thoracic 5 Lumbar 5 Sacral 1 Coccygeal

Peripheral Nervous System

Common Neurologic disorder There are many types of disease as:- Intracranical pressure, cerebra – vascular disorder. Stroke, Headache, Coma, Dementia. Seizures, Multiple Sclerosis. Cerebral Palsy, Alzheimer’s Disease. Hydrocephalus, Epilepsy. Peripheral Neuropathy. CNS Infections/Inflammation. Cranial Nerve Disorders. Parkinson’s Disease. 12

General Diagnostic Studies Skull and Spinal Radiology. CT (Computerized Tomography). MRI (Magnetic Resonance Imaging). EEG (Electroencephalogram). Cerebral Blood Flow Studies. CBC (complete blood count). Other test.

Common Types OF Headaches Head /ache defined as: Pain of head. 1. Tension headaches: Stress causes residual muscle contractions. Pain is generally felt on both sides of the head. Usually a dull ache or a squeezing pain. 2. Migraine headaches: Caused by changes in the size of blood vessels at the base of the brain. Pain is generally unilateral and focused. Types of headache

Common Types of Headaches 3. Cluster headaches Begins as minor pain around one eye and spreads to one side of the face. 30–45 minutes each 4. Sinus headaches Inflammation /infection within sinus cavities. Pain is located in superior portions of the face. May be accompanied by postnasal drip, sore throat, and nasal discharge.

Management of Headaches Maintain life style as diary food. Medications (purpose, side effects) Stress reduction Dark quiet room, relaxation Regular exercise Treat for trauma or injury if present. Ask what medications patient has taken for pain management: Ketofen and Morphine. Medication for nausea and vomiting Oxygen as needed.

Intracranial pressure Intracranial Pressure (ICP) defined as: is the pressure do by brain tissue, blood volume & cerebral spinal fluid (CSF) within the skull. Normal ICP is 0-15 mmHg (averages 10-15) Brain, Blood, Cerebral Spinal Fluid are factors of ICP. When ICP increases, blood perfusion to brain decreases.

Signs & symptoms LOC = decrease awareness of self & environment, confused, drowsiness, restlessness hypoxia and acidosis. Motor cortex: hemiparesis. Cushing’s Triad: decrease pulse, Elevation of blood pressure , and slow deep respirations (Life threatening signs) Headache--increases in severity with coughing, sneezing, Abnormal reflexes, vomiting Pupil changes ( dilated pupil)

Nursing Management 1. Monitor vital signs. 2. Maintain patent airway. ( used intubation) If patient is not incubated, put the patient on his one side to decrease the possibility of airway obstruction. 3. Be aware that stimulation of coughing when suctioning increases intracranial pressure and may precipitate seizure activity. 4. Administer medications as ordered and antibiotic.

Nursing Management Elevate head of bed (30º) ( semi flowers position to Promotes return of venous blood. Fluids will be restricted to reduce intracranial pressure. Accurate intake and output must be records. Protect patient from injury should as bed side rails. Secure a tongue blade to the head of the bed for easy access. Maintain normal body temperature.

Stroke Stroke defined as: Disruption of blood flow in brain May be leading to death. Hemorrhage: bleeding in brain, blood vessel ruptures can be from traumatic injury to blood vessel or “aneurysm” weakening of blood vessel wall, balloon like And rupture. Causes: infections, toxins, Smoking, developmental abnormality.

Stroke Nursing Management Signs and symptoms: Headache. Sudden blindness. Sudden unilateral Paresthesia. 4. Difficulty thinking. 5. Seizures. 6. Coma. 7. Hypertension. Nursing Management Administer fluids as needed. Elevate the patient’s head 30 Ensure airway is clear. Watch for seizures. Monitor blood pressure Monitor vital signs.

Nursing Assessment of Neurologic Function 1. Health history: Note speech, behavior, coordination, alertness, LOC. 2. Chief complaint and history of present illness: Document what complain the patient to seek medical attention Describe any injuries. If patient has pain, note the onset, severity, location, and duration. 3. Past medical history: Head injury, seizures, diabetes mellitus, hypertension, heart disease, and cancer Record dates and types of immunizations

Nursing Assessment of Neurologic Function 4. Family history: Have immediate family members had heart disease, stroke, diabetes mellitus, cancer, seizure disorders? 5.Review of systems: Fatigue or weakness, headache, dizziness, changes in vision / hearing, drainage from ears or nose, neck pain or stiffness, vomiting, bladder or bowel function, sexual dysfunction, fainting, tremors, paralysis, in coordination, numbness, memory problems, mood changes.

Nursing diagnosis of neurological disorder Ineffective airway clearance related to decreased protective reflexes (cough, gag) Ineffective cerebral tissue perfusion related to the effects of increased ICP. Knowledge defect related to disease. Fatigue and restlessness related to complication of disease. Activity introlance related to complication of disease.

Surgical Measures Surgery 1. Craniotomy: Surgical opening of the skull 2.Craniectomy: Excision of a segment of the skull 3.Cranioplasty: Any procedure done to repair a skull defect