What causes Increased intercranial pressure?

_

Traumatic Brain injuries from concussion

ruptured cerebral aneurysm

stroke

obstructions in the circulation of CSF

infectious disorders of the nervous system such as a meningitis and encephalitis

Client present w/

Drowsiness, Difficult to awaken

restlessness

confusion

irritability

Glasgow Coma Scale>13

Personality changes

sluggish or unequal pupil response

weakness in arms or legs

slow or slurred speech

Dull headache, especially upon awakening

vomiting without nausea

Early signs of Increased Intracranial Pressure

What are some Late signs of Increased Intracranial Pressure

Unresponsive

Glasgow Coma Scale<12

Decreased response to painful stimuli

Decorticated or Decerebrated posturing

Increased weakness or Hemiparesis

Dilated Pupil(s)

Seizures

Cushing triad: Bradycardia, elevated systolic blood pressure w/wide pressure, irregular breathing

loss of gag or corneal reflexes

period of apnea

What is the First sign of ICP before any other?

Decreased Level of Consciousness (LOC)

Can be accompany by lethargic, stupors, semi-comatose, to comatose.

Confusion restlessness and periodic disorientation accompany decreased LOC

What is Papilledema?

Swelling of the optic nerve

Client present w/

Pulse rate that increase initially but then decrease

Systolic BP rise w/a widening pulse pressuse

Cushing Triad

What is done to DX's underlying causes of ICP?

Skull radiography

CT, MRI

Lumbar Puncture

Cerebral angiography

Medical TX's for ICP

Decreasing ICP by relieving the cause

Maintain BP, Prevent Hypoxia

Mechanical Ventilator

Client head maintain at midline of 30

True or False

Shivering and seizures can cause increase ICP?

True

What can be given when ICP can't be reduce?

Sedation w/ Barbiturates and propofol (helps with seizure)

Nursing MNGT's for ICP client?

Gather history of leading up to injury for client of witness, or technician,

Medical History

LOC/VS

assist with head -to toe exam

neurologic assessment q 30-60 min

obtain current and daily WT, I's and O's,

monitor electrolytes and ABG's

evaluate bowel sound and elimination

note evidence of seizures

Nursing care plan 37-1 610-612

Nursing care plan 37-1 610-612

What is meningitis?

Inflammation of the meninges caused by various infections microorganism

Bacteria, Viruses, fungi, or Parasites

What are the pathogens that causes Meninges?

Bacteria (meningococci and streptococci)

Viruses (HSV, Mumps, Enteroviruses)

What space so the microorganism travel through?

Subarachnoid

Client present w/

Headache

Fever

nuchal rigidity (stiff neck not able to place chin on chest)

N/V

Photophobia (aversion or sensitivity to light)

Restlessness

irritability

seizure

small to large petechiae( rug burn appearance)

Maculopapular rash (viral)

Meningitis

Severe irritation of Meninges causes hyperextension of head and arching of the back?

Opisthotonos

1. Inability to extend the leg when the thigh is flexed on the abdomen

Positive Kernig sign

Positive Brudzinski Sign

flexion of the neck produces flexion of the knee and hips

• What DX's is use for Meningitis?

Lumbar Puncture (on CSF) Cloudy (Bacterial)

Elevated CSF, Decrease Glucose concentration, Elevated Protein level

WBC and RBC are elevated

C&S to determine Bacterial causative

Viral C&S negative

CT, Blood culture, CBC rule out other poss. disorders

What medical management are done to treat Meningitis?

Hand Hygiene

Local Health department is notified of all cases

IV fluids

antimicrobial therapy (bacterial)

Penicillin, Cephalosporin, Rifampin (turn secretion orange) Ciprofloxacin, azithromycin or a IM dose of cefriaxone

What vaccine is recc for all college and universities ?

Meningococcal meningitis

Haemophilus influenzae type b reduce the acquistion of bacterial meningitis

What is encephalitis

Inflammatory process affecting the CNS

What is the most common cause of Encephalitis?

Vector-borne viral infections

(St. Louis, western equine, eastern equine, West Nile)

Transmit by Ticks and Mosquitoes

Client present w/

Sudden fever

severe headache

stiff neck

vomiting

drowsiness

Insect bite on physical exam

Worsen infection

tremors, seizures, Spastic or Flaccid paralysis, Irritability and Muscle Weakness, Lethargy, delirium or coma, incontinence and visual disturbances involuntary eye movement, double or blurred vision

Viral encephalitis

What diagnostic procedure is done to Dx's encephalitis

Lumbar puncture CSF elevated Fluid is Clear

West Nile blood or CSF show rise in IGM antibodies

EEG Slow waveforms

MRI, CT to rule out other etiologies

What medical Management is use to treat encephalitis?

antipyretics

anticonvulsants

anti-inflammatory drugs and analgesics

what are nursing intervention for encephalitis?

Monitor VS and LOC frequently

Consult PCP if Indwelling catheter for urinary incontinence or urinary retention

Measure I's and O's (sign Fluid volume deficit) electrolyte imbalance

assess Bowel elimination to deter if stool softener or enema is needed

• Pay attention to surveillance reports concerning the incidence of birds infected with West Nile virus or St. Louis virus in your community.
• Avoid being outdoors during peak mosquito biting times, such as early evening.
• Wear clothing that covers as much skin as possible when outdoors.
• Apply insect repellant containing permethrin or DEET to clothing and exposed skin.
• Repair or replace windows and door screens.
• Place netting around strollers and infant carriers.
• Empty outdoor items frequently that may hold standing water.
• Transport discarded tires to a location for waste management.
• Clear gutters of debris that may obstruct the drainage of rainwater

Measures to Control Exposure to Mosquitoes

What is Guillain-Barré syndrome?

acute postinfectious polyneuropathy, polyradiculoneuritis) affects the peripheral nerves and the spinal nerve roots.

What is the cause of GBS Guillain–Barré syndrome?

exact cause of the disorder is unknown,

Is believed to be an autoimmune reaction

History of recent surgery

recent vaccination for viral disease(FLU)

What are the different types of Guillaun-Barre syndrome GBS?

• Acute inflammatory demyelinating polyradiculoneuropathy is most common (muscle weakness lower extremities and moves upward)
• (Viral) Miller fisher syndrome begin 1-4wks after infection begin with weakness in eye muscle and progressed down

Client present w/

Weakness, numbness and tingling in the arm and leg(painful the 1st symptoms)

Paralysis, weaken Muscle

If Cranial nerve involve (Chewing talking and swallowing difficult)

Guillaun-Barre syndrome

What procedures are us to Dx's Guillaun-Barre syndrome

Lumbar puncture reveal Elevated CSF, Protein level and Pressure

Electrophysiological test marked slow conduction of nerve impulses

What are some Medical Management for Guillaun-Barre syndrome

• Plasmapheresis (remove plasma from the blood and reinfusion of the cellular components w/saline shorten the course of DX.)
• Administer IV immune globulin May enhance improvement
• Supportive treatment( gabapentin, amitriptyline or opioid to relieve discomfort
• Endotracheal intubation and mechanical ventilation
• IV fluids, gastric tub feeding or Parenteral Nutrition (PTN)

Nursing intervention for client with Guillaun-Barre syndrome

observe the client for respiratory distress

spirometer to evaluate the clients ventilation capacity

assess for pneumonia

check VS and lung sound frequently

provide meticulous skin care position change q2hours

help client perform active and passive exercises to prevent muscle atrophy

What is a Brain abscess?

Collection of purulent material in the brain

What causes a brain abscess?

Infection in the middle ear, sinuses or teeth or infection or organs

After intracranial surgery or head trauma

secondary to such disorders Bacterial endocarditis, bacteremia, Pulmonary or abdominal infection

The client is present with/

Increased ICP, Fever, headaches,

neurologic changes ( paralysis seizures, muscle weakness, lethargy)

Brain Abscess

What is done to DX's Brain Abscess?

Elevated WBC

CSF by lumbar confirms DX( risk for herniation of brain stem)

CT, MRI and Skull radiography are safer techniques for diagnosing and locating the abscess

What medical management for Brain Abscess?

Antimicrobial therapy once dx confirmed.

Craniotomy done to drain abscess

Cerebral edema and seizure treated with drug therapy

Control fever, mechanical ventilation, IV fluids and nutritional support

Nursing management for brain abscess

Assess frequently for altered LOC

change in sensory and motor functions

Sign of ICP monitors VS frequently

measures fluids I's and O's for overhydration that can leaded to Cerebral edema

What is Multiple Sclerosis?

Chronic progressive dx of the Peripheral nerves

What cause a client to have MS?

Trigger by a defective genes

Why is MS characterized by demyelinating dx

Cause permanent degeneration and destruction of myelin

Client present w/

Pressure ulcers, cachexia, deformities, and contractures develop

Pneumonia by limited activity

Shallow breathing and general Debility cause death

1st is fatigue and strain

blurred vision, diplopia( double vision)

Nystagmus weakness, clumsiness and numbness and weakness and tingling of an arm or leg .

intention tremor and slurred, hesitant speech, mood swings are commonParaplegis Bowel or bladder incontinence

Multiple Sclerosis

What Dx's are done to confirm multiple Sclerosis?

Lumbar puncture for CSF reveal increased WBC count

Electrophoresis of CSF reveal abnormal immunoglobulin G bsnd

CT MRI my or may not be discolsed lesion in the brains white matter

True or false

There is a cure for MS?

False there is no cure for MS, nor a single treatment that relieves all symptoms

What are medical management for MS?

Keep client functional as long as possible

Current research for promoting nerve regeneration

Medication use 1st dx's modifying drug Interferon beta-1a(avonex) Interferon beta-1b(betaseron), fingolimod(Gilenya)

Newer Drugs Immunosuppressive Alemtuzumab, Natalizunba, teriflunomide inhibit neurodegeneration

baclofen and dantrolene for muscle spasticity and rigidity

antibiotic for infection

tranquilizer alleviate mood swings

Oxybutynin and Botulinum toxin manage urinary incontienence

bethanechol use to relieve urinary retention

anti-inflammatory action of corticosteroids relieve symptoms and hastens remissions

What are some nursing management for clients with MS?

Assess the client current physical and emotional status new developments or changes to previously assess

identifies the client visual problem emphasize that these may diminish when a remission occurs

listen to clients speech (rec. language board or assistive devices)

assess weight regularly blenderization of food in swallowing is impaired

Manage constipation with high fiber food and fluids

provide instruction concerning drug therapy

What is Myasthenia Gravis?

Neuromuscular disorder characterized by severe weakness of on or more groups of skeletal muscles

Most common in women

What are some causes of Myasthenia Gravis?

Cause is unknow

believed to be autoimmune in nature

The client is present w/ is what?

Muscle weakness

Ptosis(drooping of eyelids) most common

difficulty chewing, swallowing, diplopia, voice weakness,

Masklike facial expression, Weakness of the extremities

Respiratory system is affected

Myasthenia Gravis

The client present w/ is what?

Increase muscle weakness

respiratory distress

decreased tidal volume

difficulty talking, swallowing and chewing

Myasthenic Crisis

How do you Dx's Myasthenia Gravis?

IV administration of edrophonium (tensilon) relieve muscle weakness in a few seconds then dissipate in about 5 min

elevated acetylcholine receptor antibody titer

Chest radiography show enlargement of thymus(thymoma)

Electromyography measures the electrical potential of muscles

What are some medical and surgical management for client with Myasthenia Gravis?

Administer Anticholinesterase (Pyridostigmine bromide) mestinon, (neostigmine) prostigmin or (ambenonium Chloride) mytelase facilitate normal neurotransmission

surgical removal of thymus gland

for client who don't response to therapy Prednisone or other immunosuppressant (azathioprine) Imuran TID a week

Myasthenic Crisis w/severe respiratory distress requires intubation and mechanical ventilation

What are some nursing management for client with Myasthenia Gravis?

Provide periods of rest

support ventilation by elevating the head of the bed and suction secretion w/difficulty in swallowing

make effort to understand the client when speech is compromises

demonstrates patience and empathy

administer medication at exact times to maintain therapeutic blood level

observe for signs of drug overdose (abd cramps, clenched jaws, muscle rigidity)

What is Amyotrophic Lateral Sclerosis (Lou Gehrig disease)?

Progressive and fatal neurologic disorder

Common in men than women

What cause of Amyotrophic lateral sclerosis?

Cause is unknown

Client Present w/ is what ?

Progressive muscle weakness and wasting of arms, legs and truck

Muscle Fasciculations (twitching)

If brain stem is affected (speaking and swallowing becomes difficult)

Inappropriate laughing and crying

Respiratory failure and total Paralysis (Terminal stages)

Amyotrophic Lateral Sclerosis (Lou Gehring Disease)

How is ALS DX's ?

Difficult to diagnose in the early stage No specific diagnostic test

Electromyography validated weakness in the affected muscles

What are some medical management for ALS?

no specific treatment, death occurs several years after Dx

encourage remain active as long as possible

Mechanical ventilation when ALS affect muscles of respiration

treated with riluzole slow progression and delay need for Trachestomy

What are some nursing management for client with Amyotrophic lateral Sclerosis?

Comprehensive assessment and plan of care on client basis problems

Provide assist with walking, bathing, shaving and dressing

teach family required skills ( suctioning, how to administer feeding tubes and catheter care

Client and family teaching for client with ALS

Medication schedule, adverse effects of medications
Dietary and feeding suggestions
Agencies that can help with or give home care
Sources of financial assistance
Exercises to prevent muscle atrophy
Positioning and good skin care
Techniques for preventing skin breakdown

Nursing process for client with chronic neuromuscular disorder 621-622

Nursing process for client with chronic neuromuscular disorder 621-622

What is Trigeminal Neuralgia (Tic Douloureux)?

Painful condition that involves the 5th cranial nerve

3 major branches ( Mandibular maxillary and ophthalmic)

for Chewing facial movement and sensation

What is the cause of Trigeminal Neuralgia Nerve pain?

Unknown

Suggested it could be related to compression of the trigeminal nerve root

Client present w/ is what?

sudden pain, severe and burning

Pain ends as quick as it begins

repeat many time a day

face twitches and eye tear during spasm

Trigeminal Neuralgia

What is done to DX's Trigeminal Neuralgia?

Skull radiography, MRI or CT are preformed to rule out other pathologies

DX's is base on symptoms

What medical treatment for Trigeminal Neuralgia?

Supportive and symptomatic

opioids

Anticonvulsants (phenytoin) Dilantin and (Carbamazepine) Tegretol reduce pain

Check toxicity level

Dentist referral correction of dental Malocclusion (relieve some cases)

What are surgical management for trigeminal Neuralgia?

Surgical division of sensory root of trigeminal nerve provides permanent relief

Nursing process for client with Trigeminal Neuralgia 623-624

Nursing process for client with Trigeminal Neuralgia 623-624

Client and Family Teaching for Trigeminal Neuralgia

Inspect the mouth daily for breaks in the mucous membrane.
Take small sips or bites of food and concentrate on chewing and swallowing if surgery has been performed.
Chew on the opposite side.
Avoid eating hot foods.
Use mouth rinses after eating.
Keep regular dental appointments because the warning pain of a cavity, abscess, or other dental problem may be mistaken for neuralgia.

What is Bell Palsy?

involves the 7 cranial nerve that originates in the pons

What causes Bell Palsy?

Unknown, But viral link it suspected

Client is present w/is what?

Symptoms develop in few hour to over 1-2 days

Facial pain, pain behind the ear numbness, diminished blink reflex

Ptosis of eyelid ,Tearing on the effected side

Speaking and chewing become difficult

Bell Palsy

What is done to DX's Bell Palsy?

No specific diagnostic tests

Based on symptoms and visual examination to the face.

Electromyography (EMG) Determine if any residual nerve and muscle activity

MRI or CT scan rule out other etiologies

What medical treatment is use for Clients w/ Bell palsy?

Short-term high dose Corticosteroid therapy w/ prednisone Reduce nerve inflammation and edema

Antiviral acyclovir, Famciclovir or valacyclovir inhibit viral replication and shorten symptoms

B complex vitamin

Facial reanimation Improve facial movement and appearance

Nursing process for client with Bell palsy 625

Chew on unaffected side, protect eye with eye patch

Nursing process for client with Bell palsy 625

Chew on unaffected side, protect eye with eye patch

What is the cause of Parkinson Disease?

Deficiency of Dopamine

The imbalance between dopamine and acetylcholine result in movement disorder

Client present w/ is what?

Stiffness, pill-rolling tremor fine tremor, hand tremor

Bardykinesia Slowness preforming spontaneous movement

Masklike expression, stooped posture Hypophonia (low volume of speech) difficulty swallowing saliva and food, Weight loss occurs

Shuffling gait Arms are rigid While Walking

Foward lean

Parkinson Disease

Nutrition notes for client with Parkinson Disease?

High fiber crushed bran added to hot cereal and fiber-fortified supplement

prevent constipation w/fluids prunes and prune juice stimulate peristalsis

Taking levodopa should avoid high intake of protein decreasses it effectiveness

High protein diet for client with weight loss

Client present w/

affect the jaw tongue and larynx, speech is slurred and chewing and swallowing become difficult

Rigidity can lead to contractures

Salivation increases accompanied by drooling

Cogwheel rigidity muscles ( stop and go motion)

Late stage Parkinson Diseases

What diagnosis is use for Parkinson Disease?

Typical symptoms and neurologic examination

Medical treatment for Parkinson Disease?

Aim to prolong independence

Drug Selegiline( Eldepryl) Levodopa (larodopa) levodopa-carbidopa (sinemet) Amantadine (symmetrel) Bromocriptine (parlodel) Apomorphinr (apokyn) Benztropine (cogentin)

Rehabilitation measures physical therapy occupational therapy client family education and counseling

Surgical management for clients with Parkinson Disease

Deep Brain Stimulation implantation of the neurostimulation Pacemaker for the brain

Gene therapy

Transplant of fetal dopamine neurons

Nursing Management for client with Parkinson Disease are

Managing Client drug Therapy

Levodopa associated with periods of break through or end of dose wearing off

apomorphine help relieving the above

Help with walking OT and PT

small meals, difficult swallowing

37-2 and 37-1 some meds look at safety B6

What is Huntington disease?

Hereditary disorder of the CNS

The client present with

mental apathy and emotional disturbance

Choreiform movements, grimacing difficulty chewing and swallowing, speech difficult, intellectual decline and loss of bowel and bladder control

Severe depression

Huntington disease

How is Huntington disease diagnostic?

Base on the symptoms and family history

PET scan shows CNS changes

Genetic testing can predict which member will develop the disease

What are some medical management for Huntington's

Treatment is supportive , No cure

Tranquilizers and antiparkinson drug relieve choreiform, movements in some clients

No drug available TO HALT THE MENTAL DETERIORATION

Genetic counseling before a pregnancy is advised

nursing management for client with Huntington's disease

Help with ADL's were the client can do.

encourage client to lead a normal life,

Demonstrates how to use both hands to hold drink, use a straw to drink and wear slip on shoes

Increase risk for acquired infections especially if the client is catheterized

What is a seizure?

Safety for client on meds 37-2 and 37-3

brief episode abnormal electrical activity in the brain

Convulsion symptom of a seizure (spasmodic) contractions of muscles

Epilepsy chronic recurrent pattent of seizure

What causes seizure in a client?

Idiopathic

High fever

electrolyte imbalances

uremia

Hypoglycemia

hypoxia

brain tumor

drug abuse and Alcohol withdrawal

Client present with/

Motor symptoms

No LOC

seizure last less than 1 minute

uncontrolled jerking of body part (finger, mouth, hand or foot)

Sensory Symptoms

Hallucinatory Sight, sounds and odors, mumbling, and use of nonsense word

Partial Seizures

True or False Generalized seizure involves the entire brain?

True

Client present after a seizure that last for several second to several minutes and lose of consciousness is ?

Generalized Seizure

What are Absence seizure

Brief loss of Consciousness or Cognition during which physical activity ceases

Client present in the with

Stares blankly

the eyelids flutter

the lips move and slight movement of the head and leg occurs

lasting on for a few seconds

Absence Seizures

Misidentified as a learning disability

Client present with

brief activity of sudden excessive jerking of the arms leg or entire body and fall to the ground

Myoclonic seizures

Tonic-clonic seizure are also called

Grand Mal seizures

What is Preictal Phase?

happen before a seizure that could be vague emotional changes, depression, anxiety and nervousness.

Lasting for minutes of hours before a seizure

What is a Aura?

Sensation that occurs immediately before the seizure.

Sensory( Hallucinatory or odor or sound) or weakness or numbness

always the same

When and what is the epileptics cry?

Epileptics Cry after the aura and it is the spasm of the respiratory muscles of the throat and glottis

after Cry the client will have LOC (tonic-Clonic phase)

Muscles contract rigidly in Clonic phase

Contraction and relaxation of muscle, jerking movement and thrashing of the arms and legs, skin cyanotic and breathing spasmodic

Saliva mixed with air (Frothing at the mouth

Jaws tight clenched, biting of the tongue and inner cheek my occur, urinary and fecal incontinence is common

Clonic phase last for 1 min or more

What is Postical phase?

Period following the seizure client has Headache, Fatigue, Deep, sleep Confusion, Muscle soreness

What is status epilepticus?

After a tonic-Clonic a client does not regain consciousness between seizure.

If not treated Death can occur

Can be brought in by anticonvulsant abrupt stopping. Must be withdrawn gradually

What is Atonic seizure and Akinetic ?

LOC briefly and falls to the ground, recovery rapid (atonic)

Similar client may or may not fall and recovery rapid

What is done to DX's a Atonic Seizure?

Neurologic exam

EEG performed

CT, MRI, Serology and serum Electrolyte levels Confirm DX and determining cause of seizure

If EEG required if 1st on normal if epilepsy is suspected

What are medical management for client with seizure disorders?

Client need to have a current and updated medical list

• Anticonvulsant drugs use Phenytoin, Phenobarbital, Cabamazepine, Ethosuximide, Valproic acid, Felbamate, Gabapention and Fosphenytoin injection
• To terminate Epilepticus IV lorazepam, Diazepam, Midazolam. Alterated drug are IV fosphenytoin valproic acid or levetiracetam
• If seizure continue for 40 mins or more Thiopental or propofol my be required

Drug Therapy 37-2 633-634

Drug Therapy 37-2 633-634

What are some surgical Management for clients with seizures?

Surgery only if client does not response to drug or the seizures are severe

Surgeon must consider if part of brain will cause neurologic dysfunction( paralysis) or loss of speech

What are nursing interventions for clients with seizures?

See nursing process for client p636

Medical history and if they have seizures and treatment regimen

identifies client who may be prone to seizure

Promote safety (suction, oral airway, and oxygen equipment at the bedside, padded siderails and head board bed lowest position

administered and reinforces drug compliance

event of seizure

position client on side loosen restrictive clothing

airway keep patient, suction and oxygen if need

inspected for injuries to tongue, teeth, and buccal cavity

If incontinent clean the client and change linen

Document situation that lead up to seizure duration of seizure and parts of body involved, VS, Oxygen

Anticonvulsants impair vitamin D metabolism

Leads to calcium imbalance, rickets or osteomalacia if supplemental vitamin D is not given

Childrens who seizures are not well control need

High Fat diet

What is a brain tumor?

Growth of abnormal cells within the cranium

What causes a brain tumor?

Congenital

Genetic factors

Viral infection

exposure to radiation

head trauma

immunosuppression

Client present with

Headache (most common in the Morning), vomiting, papilledema

Vomiting without Nausea or warning

seizure develop,

behavior and mood changes speech difficulty, paralysis and double vision

Brain tumor

What is done to diagnosis Brain tumor in a client?

CT scan, MRI, Brain scan, and Cerebral angiography show Tumor's size and location

What are medical management for client that has a brain tumor?

Brain tumor Treat by surgery, radiation therapy, Chemotherapy,

Metastatic tumors some are inoperable, radiation therapy and Chemotherapy the only treatment choices

if cant do surgery are keep comfortable and free from pain as possible

to destroy or slow down tumor growth (intra-arterial or intrathecal)

symptomatic drug includes Corticosteroids and osmotic diuretics reduces cerebral edema, analgesics, anticonvulsants and antibiotics

What are surgical interventions for clients with Brain tumors?

Craniotomy incision through skull

Craniectomy excision of part of the skull

What is a Gamma-Knife radiosurgery?

Noninvasive procedure for treating deep brain tumor or that conventional surgery can only partially remove

Laser procedure

Outpatient basis or 24 hour inpatient stay involves more than one procedure

Headaches, minor nausea after treatment , Temporary hair loss my occur if tumor is close to surface

What are some nursing interventions for client with brain tumor?

Medication regimen
Appointments for chemotherapy or radiation therapy
Adverse effects of chemotherapy or radiation and techniques for managing them
Nutritional support
Home care considerations
Rehabilitation (exercises, physical therapy)
Referrals to support services for physical, emotional, and financial assistance