Care of the Patient With a Central Nervous System Disorder

1. Care of the Patient With a Central Nervous System Disorder Unit 1 Med-Surg 2

2. Central Nervous System Disorders • Know your terms! • A & P Review • Function • Divisions of the nervous system • Central nervous system • Peripheral nervous system • Autonomic nervous system • Sympathetic (adrenergic) • Parasympathetic (cholinergic) Med-Surg 2

3. Central Nervous System Disorders • 3 parts of the brain • Cerebrum • Cerebellum • Medulla • Spinal Cord • Protection for the CNS • Bones • Meninges • CSF Med-Surg 2

4. Central Nervous System Disorders • Basic Neurological Assessment • Level of consciousness • Vital signs • Pupillary response • Orientation • Motor function • Sensory performance Med-Surg 2

5. Central Nervous System Disorders • Glascow Coma Scale • Eye opening • Best verbal response • Best motor response Med-Surg 2

6. Central Nervous System Disorders • Care for a patient with a neurological deficit • Skin care • Eye care • Mouth care • Bladder and bowel care • Muscular care • Dietary care • Sensory and emotional care • Diagnostics Med-Surg 2

7. Central Nervous System Disorders • Increased Intracranial Pressure • Causes • Signs and symptoms • Treatment • Decerebrate posturing • Decorticate posturing Med-Surg 2

8. Central Nervous System Disorders • Seizures-sometimes called convulsions or epilepsy, are sudden, transient episodes of abnormal sensory, motor, autonomic, or psychic activity (or in combination). These are caused by a disorderly discharge of electrical impulses. • Causes • Types • Grand Mal • Status Epilepticus • Petit Mal-absence • Jacksonian-focal Med-Surg 2

9. Central Nervous System Disorders • Seizure Treatment • Teaching • Medications for Prevention • Dilantin (phenytoin) • Side effect of Dilantin • Luminal (phenobarbital) • Tegretol (carbamazepine) • Depakote (divalproex) • Zarontin (ethosuximide) • Depakene (valproic acid) • Klonipin (clonazepam) Med-Surg 2

10. Central Nervous System Disorders • Toxic effects of anticonvulsants • Skin rash, nervousness, drowsiness • Confusion, nausea and vomiting, fatigue • Ataxia, nystagmus, bone marrow depression • Nursing care • Airway • Protection • Precautions • Medications for Seizures • Valium and Dilantin Med-Surg 2

11. Central Nervous System Disorders • Seizure Treatment • Observation and documentation • Time and duration • Preconvulsant signs • LOC • Muscular activity • “A” incontinence • Sx of the seizure • Any injury • Postictal “A” Med-Surg 2

12. Central Nervous System Disorders • Seizure Treatment • Purpose of anticonvulsants • Nursing interventions • “A” seizures • “A” LOC • Patient safety • “A” oral cavity • Take with food or milk • Monitor CBC • Consider risk for osteomalacia • Monitor drug levels Med-Surg 2

13. Central Nervous System Disorders • CNS trauma • Head • Scalp injury • Skull fracture • Concussion • Cerebral contusion • Hematoma Med-Surg 2

14. Central Nervous System Disorders • Spinal cord • Spinal cord trauma • Signs and Sx • What is cord transection? • Autonomic Dysreflexia • Treatment • Immobilization/Traction • Assess for shock/further injury • Neuro assessments until stable • Medications • Pre and post op care for surgery • Assess for edema/loss of motor function • VS and I and O Med-Surg 2

15. Central Nervous System Disorders • Herniated Disc • Causes • Signs and Sx • Treatment • Bedrest • Medications • Physical therapy • Traction • Fluids • Activity • Good body mechanics Med-Surg 2

16. Central Nervous System Disorders • Daily care of spinal cord injury • Positioning • Temperature • Pain relief • Elimination • Diet • Autonomic dysreflexia • Rehabilitation Med-Surg 2

17. Central Nervous System Disorders • Skeletal Muscle Relaxants • Valium-diazepam (benzodiazepine) • Lioresal-baclofen • Flexeril-cyclobenzapine • Soma-carisoprodol • Robaxin-methocarbamol • Parafon Forte-chlozoxasone • Dantrium-dantrolene Med-Surg 2

18. Central Nervous System Disorders • Laminectomy • Pre-op care • Same as for most surgical patients • Educate regarding pain and muscle spasms • Post-op care • VS and airway • Observe dressing • “”A” for parasthesias • Ted hose • Encourage deep breathing • “A” for urinary retention • Positioning • Ambulation • Treat muscle spasms • Cervical injury? • Discharge teaching Med-Surg 2

19. Central Nervous System Disorders • Brain Abcess- infection from the bloodstream or middle ear that spreads to brain • Infectious Diseases of the CNS • Meningitis • Encephalitis • Guillain-Barre syndrome • Tetanus Med-Surg 2

20. Central Nervous System Disorders • Cerebrovascular Accident (CVA or Stroke) • Etiology • Hemorrhage or aneurysm-rupture of blood vessel in brain • Embolism-less common. An embolism becomes trapped in a small cerebral blood vessel. • Thrombosis-most common. Develops slowly as the blood vessel becomes occluded. Med-Surg 2

21. Central Nervous System Disorders • TIA (transient ischemic attack)-a temporary decrease in blood flow to the brain • Other Sx of stroke • 3 types of paralysis • Hemiplegia-3 stages • Flaccid • Spastic • Recovery • Paraplegia • Quadriplegia Med-Surg 2

22. Central Nervous System Disorders • Left cerebral hemisphere damage • Right side paralysis • Aphasia • Right cerebral hemisphere damage • Left side paralysis • Perceptual problems • Homonymous hemianopsia Med-Surg 2

23. Central Nervous System Disorders • Treatment for CVA • Airway • Positioning • Vital Signs • Neuro checks • Seizure precautions • Hydration • Anticoagulation • Reassurance • Treatment of aphasia • Treatment of dysphagia • Treatment of hemianopsia Med-Surg 2

24. Central Nervous System Disorders • Brain tumors • Degenerative diseases • Multiple Sclerosis (MS) • Myasthenia Gravis • Myasthenic Crisis • Cholinergic Crisis • Amyotrophic Lateral Sclerosis (ALS) • Huntington’s Chorea • Parkinson’s Disease Med-Surg 2

25. Central Nervous System Disorders • Miscellaneous Disorders • Neuralgia • Tic Douloureux (trigeminal neuralgia) • Bell’s Palsy • Headache End of Unit 1 Med-Surg 2