Nursing Management of the Adult Patient with Neurological Alterations,Prepared by: Hikmet Qubeilat. RN,MSC.,Brain Needs,Blood flow Glucose Oxygen,Diagnostic Studies,Skull and Spinal Radiology CT (Computerized Tomography) MRI (Magnetic Resonance Imaging) PET (Positron Emission Tomography) EEG (Electroencephalogram) EMG (Electromyelogram) Cerebral Blood Flow Studies,Neurological Assessment,Level of Consciousness (LOC) Pupils Vital Signs (VS) Neuromuscular status Response to stimuli Posturing Glasgow Coma Scale (GCS),I. Neurological Disorders,The normal functioning of the CNS can be affected by a number of disorders, the most common of which are headaches, tumors, vascular problems, infections, epilepsy, head trauma, demyelinating diseases, and metabolic & nutritional diseases.,Headaches,Classified based on characteristics of the headache Functional vs. Organic type May have more than one type of headache History & neurologic exam diagnostic keys,Not always chronicbe careful,ONSET: Not reliable or diagnostic,HA: Essential History,Onset this particular headache Character of pain, severity and duration Associated symptoms Prior history, pattern Original onset: prior testing, treatment Other therapeutic regimens,Physical Exam,Neurologic examination Inspect for local infections, nuchal rigidity Palpation for tenderness, bony swellings Auscultation for bruits over major arteries,Organic vs. Traumatic vs. Functional: Diagnostics,CBC: underlying illness, anemia Chem panel: if associated vomiting, dehydrated CT scan: for focal neurological signs, sinus No LP for suspected ICP; association with brain herniation,Dont Miss It,Caused by subarachnoid hemorrhage from an aneurysm or head injury “Worse headache of my life” Changes in LOC, focal neurological signs Highly correlated with CVA Untreated, 50 % mortality,Headache Teaching Guide,Keep a calendar/diary Avoid triggers Medications (purpose, side effects) Stress reduction Dark quiet room, exercise, relaxation Regular exercise,Intracranial Pressure (ICP),Brain Components Skull is a rigid vault that does not expandIt contains 3 volume components: Brain tissue: (80%) or 2% of TBW Intravascualr blood: (10%) CSF: (10%),Intracranial Pressure (ICP) is the pressure exerted by brain tissue, blood volume & cerebral spinal fluid (CSF) within the skull. ICV = Vbrain + Vblood + Vcsf Normal ICP 10 to 15 mmHg Cerebral Perfusion Pressure (CPP) CPP = MAP ICP Normal CPP 70 to 100 mmHg Normal CSF 5 to 13 mmHg,Intracranial Pressure (ICP),Increased Intracranial Pressure (IICP) fluid pressure 15 mm Hg,IICP is a life threatening situation that results from an in any or all 3 components within the skull volume of brain tissue, blood, and / or CSF Cerebral edema: H2O content of tissue as a result of trauma, hemorrhage, tumor, abscess, or ischemia,Acute Coma,Levels of consciousness diminish in stages: Confusion: cant think rapidly and clearly Disorientation: begin to loose consciousness Time, place, self Lethargy: spontaneous speech and movement limited Obtundation: arousal (awakeness) is reduced Stupor: deep sleep or unresponsiveness Open eyes to vigorous or repeated stimuli Coma: respond to noxious stimuli only Light (purposeful), full coma (non-purposeful), deep coma (no response),19,Multiple Sclerosis,is a chronic autoimmune disorder affecting movement, sensation, and bodily functions. It is caused by destruction of the myelin sheath covering nerve fibres in the central nervous system (brain and spinal cord). Causes: 1. Autoimmune destruction. 2. Heredity. 3. Viruses. 4. Environmental factors.,20,Diagnostic Test:1. MRI.2. Physical examination.,21,* Early:1. Muscle weakness causing difficulty walking 2. loss of coordination or balance 3. numbness or other abnormal sensations 4. visual disturbances, including blurred or double vision,Clinical Manifestations:,22,* Late:1. Fatigue .2. Muscle spasticity and stiffness 3. Tremors. 4. Paralysis .5. pain .6. Vertigo. 7. Speech or swallowing difficulty .8. Loss of bowel and bladder control. 9. Sexual dysfunction .10. Changes in cognitive ability,23,Treatment:,1. Immunosuppressant drugs . These drugs include corticosteroids such as prednisone and methylprednisolone, the hormone adrenocorticotropic hormone (ACTH), and azathioprine. 2. Physiotherapy. 3. Occupational therapy.,24,Parkinsons Disease,is a progressive movement disorder marked by tremors, rigidity, slow movements (bradykinesia), and postural instability. It occurs when, for unknown reasons, cells in one of the movement-control centers of the brain begin to die. Causes: 1. Degeneration of brain cells in the area known as the substantia nigra, one of the movement control centers of the brain. 2. Drugs given for psychosis, such as haloperidol (Haldol) or chlorpromazine (Thorazine), may cause parkinsonism.,25,Clinical Manifestations,1. Tremors 2. Slow movements (bradykinesia), freezing in place during movements (akinesia). 3. Muscle rigidity or stiffness, occurring with jerky movements 4. Postural instability or balance difficulty occurs. 5. Masked face. 6. Depression 7. Speech changes 8. Problems with sleep 9. Emotional changes10. Incontinence. 11. Constipation. 12. Handwriting changes, 13. (dementia),