medical surgical nervous system disorder.pptx

medical surgical nervous system disorder

1. Nervous System disorders Nursing Management of the client with disruption of nervous system By;- Ibrahim A( BsN ) 1/8/2024 Ibrahim A(BsN) 1

2. Assessment A Neurologic assessment includes a patient history, general physical examination, and thorough neurologic examination. An important principle underlying neurologic assessment is: maximum stimulation for maximum response. Common manifestations of neurologic dysfunction include motor, sensory, autonomic, and cognitive deficits. 1/8/2024 Ibrahim A(BsN) 2

3. Assessment cont … Computed tomography (CT) scan is a structural imaging study that uses a computer-based X-ray to provide a cross-sectional image of the brain. Lumbar Puncture Obtaining CSF for examination (microbiologic, serologic, cytologic, or chemical analysis). Assess eye opening (level of responsiveness): Eye opening = arousal 1/8/2024 Ibrahim A(BsN) 3

4. Assess cognitive function : A. Orientation 1. Person, place, and time 2. Where are you, why are you here B. Speech 1. Inability to express self 2. Difficulty speaking 3. Inability to understand spoken language Assess motor function : -Voluntary movement -Reflexive movement 1/8/2024 Ibrahim A(BsN) 4

5. CEREBROVASCULAR ACCIDENT (STROKE, BRAIN ATTACK) Stroke, cerebrovascular accident (CVA), or brain attack is the disruption of blood supply to the brain. Cause Ischemic (more than 70% of strokes) Hemorrhagic (associated with greater morbidity and mortality). 1/8/2024 Ibrahim A(BsN) 5

6. Clinical Manifestations Numbness (paresthesia), weakness (paresis), or loss of motor ability ( plegia ) on one side of the body. Difficulty in swallowing (dysphagia). Loss of half of a visual field (hemianopsia), double vision, photophobia. Altered cognitive abilities and psychological affect. Self-care deficits. Diagnostic Evaluation CT scan to determine cause and location of stroke. 1/8/2024 Ibrahim A(BsN) 6

7. Management Maintain airway, breathing, oxygenation, circulation. Diuretic treatment to reduce cerebral edema. Calcium channel blockers, nimodipine , to reduce BP, promote vasodilatation, and prevent cerebral vasospasm. Anticoagulation after hemorrhage is ruled out. Treatment of poststroke depression with antidepressants. 1/8/2024 Ibrahim A(BsN) 7

8. Complications Aspiration pneumonia Deep vein thrombosis, pulmonary embolism Poststroke depression Dysphagia in 25% to 50% of patients after stroke 1/8/2024 Ibrahim A(BsN) 8

9. Nursing Assessment Assess for voluntary or involuntary movements, tone of muscles, presence of deep tendon reflexes. Assess mental status, sensation. Monitor bowel and bladder function/control. Monitor effectiveness of anticoagulation therapy. Assess for skin breakdown, contractures, and other complications of immobility. Impaired Physical Mobility related to motor deficits 1/8/2024 Ibrahim A(BsN) 9

10. Nursing diagnosis Disturbed Thought Processes related to brain injury Impaired Verbal Communication related to brain injury Self-Care Deficit: Bathing, Dressing, Toileting related to hemiparesis/paralysis Imbalanced Nutrition: Less Than Body Requirements related to impaired self-feeding, chewing, swallowing Impaired Urinary Elimination related to motor/sensory deficits Disabled Family Coping related to illness, and care giving burden 1/8/2024 Ibrahim A(BsN) 10

11. Goal Optimizing Cognitive Abilities Nursing intervention Be aware of the patient's cognitive alterations, and adjust interaction. Participate in cognitive retraining program: reality orientation (rehabilitation). Be aware that depression is common and therapy should include psychotherapy and pharmacological agents 1/8/2024 Ibrahim A(BsN) 11

12. Nursing intervention cont … Attaining Bladder Control Insert indwelling bladder catheterization during acute stage. Strengthening Family Coping Teach stress management techniques, such as relaxation exercises. Provide information about stroke and expected outcome. Teach family that stroke survivors do show depression in the first 3 months of recovery. 1/8/2024 Ibrahim A(BsN) 12

13. Evaluation: Expected Outcomes Oriented to person, place, and time Brushing teeth, putting on shirt and pants independently Feeds self two-thirds of meal Voids on commode. 1/8/2024 Ibrahim A(BsN) 13

14. Encephalitis Encephalitis is inflammation of the brain. Usually occurs when the cerebral hemispheres, brainstem, or cerebellum is infected by a microorganism. Complications of encephalities include epilepsy, parkinsonism, behavioral and personality changes, and mental retardation. A comatose state may last for days, weeks, or months after the acute infectious state. Causes Most cases of encephalitis are related to viruses, and the most common cause is herpes simplex Virus 1/8/2024 Ibrahim A(BsN) 14

15. Clinical Manifestations Fever, headache, and neck rigidity (stiff neck). Altered mental status; confusion in older patients. Signs of meningeal irritation include nuchal rigidity and positive Brudzinski's and Kernig's signs. To elicit Brudzinski's sign, place the patient supine and flex the head upward. 1/8/2024 Ibrahim A(BsN) 15

16. Resulting flexion of both hips, knees, and ankles with neck flexion indicates meningeal irritation. To test for Kernig's sign, once again place the patient supine. Keeping the bottom leg straight, flex the other hip and knee to form a 90-degree angle. Slowly extend the upper leg, resulting in pain and spasm of the muscle. Resistance to further extension can be felt. 1/8/2024 Ibrahim A(BsN) 16

17. Diagnostic Evaluation Complete blood count to detect an elevated leukocyte count in bacterial and viral meningitis. Blood cultures are obtained to indicate the organism. 1/8/2024 Ibrahim A(BsN) 17

18. CSF evaluation for pressure and leukocytes. In acute bacterial meningitis, the CSF may indicate elevated pressure and elevated leukocytes. In viral encephalitis, the CSF may indicate normal/moderately elevated pressure, few elevated leukocytes. Most patients are given I.V. antibiotics until the laboratory findings determine the type of meningitis (e.g., viral, bacterial). 1/8/2024 Ibrahim A(BsN) 18

19. However, cultures should be taken before initiating antibiotics. To manage inflammation, dexamethasone (Decadron) or another corticosteroid is given I.V. This steroid should be used before or with the first dose of antibiotics 1/8/2024 Ibrahim A(BsN) 19

20. Complications Seizures occur in 20% to 30% of patients. Increased ICP may result in cerebral edema, decreased perfusion, and tissue damage. Severe brain edema may result in herniation or compression of the brain stem. 1/8/2024 Ibrahim A(BsN) 20

21. Goal Reducing Fever Nursing Interventions Administer antimicrobial agents on time to maintain optimal blood levels. Monitor temperature frequently or continuously, and administer antipyretics as ordered. Institute other cooling measures, such as tepid sponging. 1/8/2024 Ibrahim A(BsN) 21

22. Nursing Diagnoses Hyperthermia related to the infectious process and cerebral edema Risk for Imbalanced Fluid Volume related to fever and decreased intake Ineffective Tissue Perfusion (cerebral) related to infectious process and cerebral edema Acute Pain related to meningeal irritation Impaired Physical Mobility related to prolonged bed rest 1/8/2024 Ibrahim A(BsN) 22

23. Goal Maintaining Fluid Balance Nursing intervention Prevent I.V. fluid overload, which may worsen cerebral edema. Monitor intake and output closely. Goal Reducing Pain 1/8/2024 Ibrahim A(BsN) 23

24. Nursing intervention Administer analgesics as ordered; monitor for response and adverse reactions. Darken the room if photophobia is present. Assist with position of comfort for neck stiffness. Elevate the head of the bed to decrease ICP and reduce pain. 1/8/2024 Ibrahim A(BsN) 24

25. Traumatic Brain Injury Traumatic brain injury (TBI), also known as head injury, is the disruption of normal brain function due to trauma-related injury. The goal of treatment is to prevent secondary brain injury by providing supportive care. 1/8/2024 Ibrahim A(BsN) 25

26. Classification Mild (GCS 13 to 15, with loss of consciousness to 15 minutes) Moderate (GCS 9 to 12, with loss of consciousness for up to 6 hours) Severe (GCS 3 to 8, with loss of consciousness greater than 6 hours) 1/8/2024 Ibrahim A(BsN) 26

27. Glasgow Coma Scale 1/8/2024 Ibrahim A(BsN) 27

28. Clinical Manifestations Disturbances in consciousness: confusion to coma Headache, vertigo Restlessness Respiratory irregularities Cognitive deficits (confusion, aphasia, reading difficulties, writing difficulties, acalculi, memory deficits such as amnesia and difficulty learning new information) Pupillary abnormalities Diagnostic Evaluation CT scan to identify and localize lesions, edema, bleeding. 1/8/2024 Ibrahim A(BsN) 28

29. Management Assess and maintain patent airway. Intubate for GCS less than 8 (comatose) Placement of nasogastric tube with intubation to prevent aspiration Administer oxygen as needed. 1/8/2024 Ibrahim A(BsN) 29

30. Management cont … Treat asymptomatic anemia with iron supplements. Antibiotics to prevent infection with open skull fractures or penetrating wounds Surgery to evacuate intracranial hematomas, debridement of penetrating wounds, elevation of skull fractures, or repair of CSF leaks. Treatment of hyponatremia (due to cerebral salt wasting) by monitoring daily fluid status, fluid restriction, oral salt replacement, and I.V. saline 0.9%. 1/8/2024 Ibrahim A(BsN) 30

31. Complications Infections: neurologic(meningitis, ventriculitis) Increased intra cranial pressure (ICP). Posttraumatic seizure disorder Permanent neurologic deficits: cognitive, motor, sensory, speech Death Nursing Interventions Maintain a patent airway. Monitor respiratory rate, and depanth. 1/8/2024 Ibrahim A(BsN) 31

32. Seizure Disorders Seizures (also known as epileptic seizures and, if recurrent, epilepsy) are defined as a sudden alteration in normal brain activity. Seizures are thought to result from disturbances in the cells of the brain that cause uncontrolled electrical discharges.. 1/8/2024 Ibrahim A(BsN) 32

33. Classification 1. Simple partial seizures without impairment of consciousness. 2. Complex partial seizures have an impairment of consciousness. 3. Generalized seizures have a loss of consciousness with convulsive or non convulsive behaviors. 4. Simple partial seizures can progress to complex partial seizures, and complex partial seizures can secondarily become generalized 1/8/2024 Ibrahim A(BsN) 33

34. Etiology Trauma to head or brain resulting in scar tissue or cerebral atrophy Tumors Cranial surgery Drug toxicity, such as theophylline. CNS infection 1/8/2024 Ibrahim A(BsN) 34

35. Clinical Manifestations Impaired consciousness Disturbed muscle tone or movement Disturbances of behavior, mood, sensation, or perception Disturbances of autonomic functions 1/8/2024 Ibrahim A(BsN) 35

36. Diagnostic Evaluation CT scan to identify lesion that may be cause of seizure Management Pharmacological Phenobarbital:2-6 mg/kg/day Phenytoin:4-12 mg/kg/day divided BID to TID. Carbamazepine:10-40 mg/kg/day divided BID 1/8/2024 Ibrahim A(BsN) 36

37. Nursing Management Nursing Diagnoses Ineffective Tissue Perfusion (cerebral) related to seizure activity Risk for Injury related to seizure activity Ineffective Coping related to psychosocial and economic consequences of epilepsy 1/8/2024 Ibrahim A(BsN) 37

38. Goal Maintaining Cerebral Tissue Perfusion Nursing Intervention Maintain a patent airway until patient is fully awake after a seizure. Provide oxygen during the seizure if color change occurs. Stress the importance of taking medications regularly. Monitor patient for toxic adverse effects of medications. Monitor liver functions for toxicity due to medications. 1/8/2024 Ibrahim A(BsN) 38

39. Status epilepticus Status epilepticus (acute, prolonged, repetitive seizure activity) is a series of generalized seizures without return to consciousness between attacks. The term has been broadened to include continuous clinical and/or electrical seizures lasting at least 5 minutes. Status epilepticus is considered a serious neurologic emergency. It has high mortality and morbidity (permanent brain damage, severe neurologic deficits 1/8/2024 Ibrahim A(BsN) 39

40. Predisposing factor: medication withdrawal Fever Metabolic or environmental stresses Alcohol withdrawal Sleep deprivation. 1/8/2024 Ibrahim A(BsN) 40

41. Nursing Interventions Establish airway, and maintain blood pressure (BP). Administer oxygen there is some respiratory depression associated with each seizure, which may produce hypoxia of brain. Administer I.V. Diazepam [Valium]) slowly to ensure effective brain tissue and serum concentrations. If initial treatment is unsuccessful, general anesthesia may be required. 1/8/2024 Ibrahim A(BsN) 41

42. Preventing Injury Place the bed in a low position. Do not put anything in the patient's mouth during a seizure. Place the patient on side during a seizure to prevent aspiration. Provide a helmet to the patient who falls during seizure. 1/8/2024 Ibrahim A(BsN) 42

43. Headache Syndromes Headaches are one of the most common complaints of people seeking health care. Pain in the head is a symptoms of underlying pathology. Headaches is divided into two categories: 1. Primary headache disorders, which include Migraine Tension-type headache Cluster headache 2. Secondary headache disorders. 1/8/2024 Ibrahim A(BsN) 43

44. Path physiology and Etiology Primary Headaches Diagnosis is generally based elimination of other pathology such as stroke, intracranial bleed, or brain tumor. Migraine headache consists of initial vasospasm followed by dilation of intracranial and extracranial arteries; occurs in about 10% of population Caused by hyperactivity to the neurotransmitter serotonin; familial predisposition. 1/8/2024 Ibrahim A(BsN) 44

45. Tension headache is due to irritation of sensitive nerve endings in the head, jaw, and neck from prolonged muscle contraction in the face, head, and neck. Precipitating factors include fatigue, stress, poor posture. Cluster headache release of increased histamine results in vasodilatation -Usually unilateral, recurring . 1/8/2024 Ibrahim A(BsN) 45

46. Secondary Headaches Headache due to a neurologic or systemic disease. Mass lesion (tumor, abscess) Intracranial infection (bacterial/viral/fungal meningitis or encephalitis) Inflammation Cerebrovascular disease ( intracranial hemorrhage) Increased intracranial pressure Low-pressure headache (post lumbar puncture, trauma induced) Sinus infection, viral infection such as influenza, systemic illness 1/8/2024 Ibrahim A(BsN) 46

47. Clinical Manifestations Migraine: gradual onset of severe unilateral headache, may become bilateral. Nausea, vomiting, and photophobia may accompany moderate to severe headache Worsened by activity May last 4 to 72 hours and greatly impair activities. Migraine head ache may be triggered in women by hormonal fluctuations (menses, pregnancy), excess or lack of sleep, and change in eating habits. 1/8/2024 Ibrahim A(BsN) 47

48. Tension/muscle contraction : Persistent pain and pressure in the back of the head and neck, across forehead; may be tender points of head or neck. Not aggravated by activity, but may be worsened by noise and light. No nausea and vomiting, but may be associated with anorexia. 1/8/2024 Ibrahim A(BsN) 48

49. Cluster headache: sudden, sharp, burning, unilateral pain Always involving facial area from neck to temple, and often occurs during the evening or night; more frequent in men. -Associated with unilateral excessive tearing, redness of the eye, and stuffiness of nostril on affected side, facial swelling, flushing, and sweating. 1/8/2024 Ibrahim A(BsN) 49

50. Diagnostic procedure CT scan to rule out lesions, hemorrhage, and chronic sinusitis Erythrocyte sedimentation rate and other blood studies to help determine inflammatory process with temporal arteritis 1/8/2024 Ibrahim A(BsN) 50

51. Management Pharmacologic Treatment Medications are intended to reduce the frequency, severity, and duration of the headache. Aspirin, acetaminophen, for mild to moderate pain of tension, sinus, or mild vascular headaches. Antihistamines and decongestants may be effective for sinus headaches. Occasionally, opioid analgesics, muscle relaxants, and antianxiety agents may be needed for severe pain. 1/8/2024 Ibrahim A(BsN) 51

52. Nursing Interventions Reduce environmental stimuli: light, noise, and movement to decrease severity of pain. Apply warm, moist heat to areas of muscle tension. Teach progressive muscle relaxation to treat and prevent tension headaches. Alternately tense and relax each group of muscles for a count of five, starting with the forehead and working downward to the feet. Relaxation of just head and neck may also be helpful if time is limited. 1/8/2024 Ibrahim A(BsN) 52

53. Disorders that cause paralysis Hemiplegia Loss of muscle control & sensation on one side of the body (L or R) Cause: most frequently stroke Also intracranial tumor or hemorrhage S/S: weakness of half of the face, aphasia, etc . 1/8/2024 Ibrahim A(BsN) 53

54. Paraplegia Paraplegia refers to loss of motion and sensation in the lower extremities and all or part of the trunk. Cause Damage to the thoracic or lumbar spinal cord or to the sacral root. 1/8/2024 Ibrahim A(BsN) 54

55. Quadriplegia Quadriplegia refers to the loss of movement and sensation in all four extremities and the trunk. Cause: Associated with injury to the cervical spinal cord. 1/8/2024 Ibrahim A(BsN) 55

56. Paraplegia & Quadriplegia Both conditions most frequently follow trauma such as falls, injuries, and gunshot wounds, But they may also be the result of spinal cord lesions (tumor), infections and abscesses of the spinal cord. Signs and symptoms of Paraplegia & Quadriplegia : loss of bowel & bladder control Sexual dysfunction. Low blood pressure and pulse 1/8/2024 Ibrahim A(BsN) 56

57. Management of the Quadriplegic or Paraplegic Patient Nursing Interventions Rehabilitation care: Nursing care is one of the key factors determining the success of the rehabilitation program. The main objective is for the patient to live as independently as possible in the home and community. Increasing Mobility 1/8/2024 Ibrahim A(BsN) 57

58. Exercise Programs The unaffected parts of the body are built up to optimal strength to promote maximal self-care. The muscles of the hands, arms, shoulders, chest, spine, abdomen, and neck must be strengthened in the paraplegic patient because he or she must bear full weight on these muscles to ambulate. To strengthen these muscles, the patient can do push-ups when in a prone position. Extending the arms while holding weights 1/8/2024 Ibrahim A(BsN) 58

59. Exercise Programs cont … Squeezing rubber balls promotes hand strength. The sooner muscles are used, the less chance there is muscle atrophy. Weight-bearing also reduces the possibility of renal calculi and enhances many other metabolic processes. Ambulation using crutches requires a high expenditure of energy. Wheelchairs provide greater independence and mobility. Every effort should be made to encourage the patient to be as mobile and active as possible. 1/8/2024 Ibrahim A(BsN) 59

60. Intervention for clients with peripheral Nervous system disorder CRANIAL NERVE DISORDERS BELL'S PALSY Bell's palsy is an acute peripheral facial paralysis of the seventh cranial nerve (facial) unilaterally. It is typically a self-limiting process that usually improves in 3 to 6 months. Cause Cause is unknown. Possible etiologies include: Vascular ischemia, and autoimmune. Virus 1/8/2024 Ibrahim A(BsN) 60

61. Clinical Manifestations Facial muscles weak throughout forehead, cheek, and chin; Can affect speech Diminished taste from anterior two-thirds of tongue. Inability to close eye Painful eye sensations Photophobia 1/8/2024 Ibrahim A(BsN) 61

62. M anagemen t Corticosteroid therapy initiated early to decrease inflammation (e.g., prednisone 1 mg/kg/day for 10 to 14 days, followed by a tapering dose). Eye care to maintain lubrication and moisture if unable to close. May need to be patched during sleep. Surgery to anastomose facial nerve to other cranial nerve. Complications Corneal ulceration Impairment of vision 1/8/2024 Ibrahim A(BsN) 62

63. Nursing Intervention Patch eye to keep shut at night as directed. Inspect eye for redness or discharge. Advise patient to report eye pain immediately. Administer or teach patient to administer corticosteroids to reduce inflammation. Teach patient to apply moist heat to face. Perform or teach patient to perform facial massage. 1/8/2024 Ibrahim A(BsN) 63

64. Parkinson's Disease Parkinson's disease is a chronic, progressive neurologic disease affecting the brain centers responsible for control and regulation of movement. Population older than age 60 is affected by Parkinson’s disease. Cause A deficiency of dopamine Underlying etiology may be related to a virus; toxicity from pesticides, herbicides or repeated head injuries. 1/8/2024 Ibrahim A(BsN) 64

65. Signs and Symptoms Bradykinesia (slowness of movement), loss of spontaneous movement and delay in initiating movements. Tremor. Rigidity in performance of all movements. Rigidity is always present but increases during movement. May lead to sensations of pain, especially in the arms and shoulders. Poor balance when moving. May lead to falls. Sleeplessness, salivation, sweating, dizziness. Depression, dementia. 1/8/2024 Ibrahim A(BsN) 65

66. Management Pharmacologic Anticholinergics to reduce transmission of cholinergic pathways, which are thought to be overactive when dopamine is deficient. These medications are most effective in controlling tremor. Levodopa, a dopamine precursor. 1/8/2024 Ibrahim A(BsN) 66

67. Complications Dementia Aspiration Injury from falls 1/8/2024 Ibrahim A(BsN) 67

68. Nursing Interventions Improving Mobility Encourage the patient to participate in daily exercise, such as walking, or gardening. Encourage the patient to take warm baths and receive massages to help relax muscles. Instruct the patient to take frequent rest periods to overcome fatigue and frustration. Assess safety in environment to reduce risk of falls. 1/8/2024 Ibrahim A(BsN) 68

69. END THANKS FOR YOUR ATTENTION 1/8/2024 Ibrahim A(BsN) 69