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Decreased HR and BP
Decresead RR
Diarrhea
Urinary Frequency
Seizures
II. SNS
a. Adrenergic Agents
1. Epinephrine (Adrenaline)
2. Note: Side Effects (SE) – normal drug expectancies
b. Beta-Adrenergic Agents (Beta-Blockers)
MEDICAL-SURGICAL NURSING 1. Propanolol, metoprolol, atenolol
2. Bronchospasm, Elicits decreased cardiac contractions,
Neurologic Nursing Treats HPN, AV conduction slows down (BETA)
3. Anti-HPN Management
________________________________________________________
Beta-blockers – ―-olol‖
ACE inhibitors – ―-pril‖
OVERVIEW OF THE STRUCTURE AND FUNCTION OF THE
Ca-Antagonist – nifedipine
NERVOUS SYSTEM
Transient headache and dizziness
Orthostatic hypotension
I. Divisions Assist in ambulation
a. CNS – brain and spinal cord
Pt. to rise slowly from sitting position
b. PNS – 12 pairs of cranial nerves and 31 pairs of spinal 4. BP = CO x PR
nerves 5. CO = HR x SV
1. Spinal nerves: 6. (N) HR = 60-100 bpm
Cervical – 8 7. (N) SV = 60-70 ml of H2O
Thoracic – 12 TOXIC SUBSTANCES THAT CAN PASS THE BLOOD-BRAIN
Lumbar – 5 BARIER: (BLACK)
Sacral – 5
Bilirubin – yellow pigment
Coccygeal - 1
Lead – Antidote: Ca+ EDTA
c. ANS – sympathetic and parasympathetic systems
Ammonia – cerebral toxin; present in hepatic encephalopathy (liver cirrhosis)
Carbon Monoxide – in Parkinson’s and Epilepsy
Ketones – cerebral depressant
III. CNS
a. Cells
1. Neurons
Excitability
Conductivity
Permanence
2. Neuroglia – majority of tumors arise from here; about
40% from astrocytes
Astrocytes – maintains integrity of BBB
Oligodendrocytes – production of myelin
Myelin sheath – insulates axons; for rapid impulse
transmission
Microglia – STATIONARY cells which carry on phagocytosis
(cell eating)
Sympathetic – flight or aggression response release of norepinephrine Ependymal cells – produces chemoattractants which
increase in all bodily activity except GI (constipation); adrenergic; concentrates bacteria
parasympatholytic response. b. Composition
1. 80% brain mass
REMEMBER: GIT is the least important area during stress
decreased blood flow in the area; Increased blood flow in the brain, CEREBRUM – divided into two hemispheres, the
heart and skeletal muscles left and right and is bridged by the corpus callosum
Mydriasis (―dilat‖-ation) Motor, sensory, integrative function
Dry mouth Lobes:
Increase in HR and BP
Frontal – controls higher cortical thinking,
Tachypnea personality development, motor activity,
Constipation contains BROCA’s are or the motor-speech
Urinary retention center. (Expressive Aphasia)
Occipital – vision
Parasympathetic – flight or withdrawal response release of Acetylcholine
decrease in all bodily activity except GI (diarrhea); chonlinergic/ vagal/ Parietal – appreciation and discrimination
sympatholytic response
of sensory impulses (pain, touch, pressure,
Meiosis
heat and cold)
Increased salivation
Temporal – hearing, short term memory, CI – Atlas; C2 – Axis
contains the general interpretative area— CSF – shock absorber,
cushions brain altered when there is obstruction in
CSF drainage
Wernicke’s aphasia
Insula (Island of Reil) – visceral function
HYDROCEPHALUS – posteriorly growth of the head d/t early closure of
(internal area) fontanels
NEUROLOGIC ASSESSMENT
F. Sensory Assessment
1. PAIN - Gingerbread test
100% very painful
75% tolerable pain
25% moderate pain
0% no pain
2. 10 % CSF 2. TOUCH – Stereognosis
3. 10% Blood Identifying familiar object placed on clients hands
Astereognosis – if patient cannot identify object;
MONROE KELLY HYPOTHESIS – the skull is a closed damage in parietal lobe
vault, any increase in one component will bring about increases 3. PRESSURE AND TOUCH – Graphesthesia
in ICP Identify numbers or letters written on client’s
NORMAL ICP IS 0-15 MMHG; NORMAL CSF: 120-250CC/DAY palm
NORMAL CSF OPENING PRESSURE: 60-150 MMHG Agraphesthesia if (-), damage to parietal lobe
NORMAL CSF CONTENTS: GLUCOSE, PROTEINS, WBCS
FORAMEN MAGNUM - The large openingin the basal part of the occipital
bone through which the spinal cord becomes
continuous with the medulla oblongata. G. Cerebellar Test
1. Romberg’s Test 2. Dysosmia – distorted sense of smell
3. Anosmia – absence of smell
Instruct patient to close eyes, assume a normal
anatomical position for 5-15 minutes; two nurses at
right and left side
Normal is (-)
If (+) ataxia
2. Finger-to-nose Test
3. Alternate Pronation and Supination
Dysmetria – inability of a client to stop a movement at a
desired point
H. DTRs
I. Autonomics
denominator – distance the person can see the letters
Abnormal findings
20/200 blindness
OD: oculus dexter
OS: oculus sinister
OU: oculus uritas
2. Visual Fields/Peripheral vision
Superiorly
Bitemporally
Nasally
CRANIAL NERVE ASSESSMENT Inferiorly
A. PREDISPOSING FACTORS
Levodopa (L-dopa) – short acting dopaminergic
1. Poisoning
Amantadine HCl (Symmetrel) – long acting
dopaminergic
Lead (ANTIDOTE: Ca EDTA – heavy metal antagonist)
Carbon Monoxide decreased capacity of Carbidopa (Sinemet) – long acting dopaminergic
SE: (GIT) anorexia, nausea and vomiting,
hemoglobin to carry oxygen cherry red skin color
2. Arteriosclerosis orthostatic hypotension, hallucination,
arrhythmia
3. Hypoxia – inadequate tissue perfusion
4. Encephalitis Contraindications: narrow angle closure
5. Drugs
glaucoma loss of peripheral vision tunnel vision
Reserpine (Serpasil)
halos in light; normal IOP = 12-21 mmHg
Has anti HPN properties
Promote safety when giving this drug
Also contraindicated in patient’s taking
MAOI’s (Avoid tryptophan and tyramine in
pts taking MAOI’s) C. CLINICAL MANIFESATION
1. PTOSIS – INITIAL SIGN
Administer with food or snack to lessen GIT irritation
Check palpebral fissure drooping of upper eyelids
Inform client that stools/urine maybe darkened 2. Double vision
RICH IN
INSTRUCT CLIENT TO AVOID FOODS VITAMIN B6- 3. Mask like facial expression
-PYRIDOXINE (Cereals, organ
meat, green leafy vegetables)
– reverses 4. Weakened laryngeal muscles dysphagia (difficulty of
therapeutic effect of levodopa swallowing, without food); odynophagia ang with food
Anti-cholinergics – relieves tremors 5. Hoarseness of voice
Relieves tremors
6. Respiratory muscle weakness respiratory arrest; prepare trache
Artane and Cogentin set at bedside
Mode of action: increases dopamine 7. Extreme muscle weakness especially during activity or
SE: SNS exertion in AM
Antihistamine – relieves tremors
Diphenhydramine HCl (Benadryl) D. DIAGNOSTICS
SE: 1. TENSILON TEST (EDROPHONIUM HCL)
Drowsiness – adult
Temporary relief of symptoms
CNS excitement and hyperactivity – children
Strengthens muscles temporarily
Dopamine Agonists – relieves tremors and rigidity
Pt, temporarily can open
5-10 minutes after admin
eyelids, increased muscle strength
Bromocriptine HCl (Parlodel) SE:
CNS Depression
E. NURSING MANAGEMENT
No OCP’s decreased effect
2. Maintain side rails to prevent injuries related to falls Airway
3. Prevent complications of immobility
Aspiration
4. Maintain good nutrition. Provide dietary intake that is Immobility
low in protein in AM and high protein at night to 1. Maintain patent airway and adequate ventilation
induce sleep Assist in mechanical ventilation
TRYPTOPHAN – induces sleep Assess PFT (decreased Vital Lung Capacity)
5. Assists in passive ROM exercises to prevent 2. Monitor Strictly VS, IO, NVS, motor grading scale
contractures. Q4h for proper body alignment. (muscle strength)
6. Increased OFI is encouraged and increased Fiber in the 3. Maintain side rails
diet for constipation 4. institute NGT feeding to prevent aspiration
7. Ambulate with assistance 5. prevent complications of immobility – q2 turning, q1
8. Assist in STEROTAXIC THALAMOTOMY for elderly
6. Administer meds as ordered
COMPLICATIONS: SUBARACHNOID HEMORRHAGE,
ENCEPHALITIS, CEREBRAL ANEURYSM Corticosteroids – for immunosuppression
Cholinergic/Anticholinergic agents
IV. MYASTHENIA GRAVIS (MG) – neuromuscular disorder
Mestinol (Pyridostigmine)
characterized by a disturbance in the transmission of impulses Neostigmine (Prostigmin)
from nerve to muscle cells at the neuromuscular junction (or Monitor for the two types of crisis
motor end plate – site of exchange of neurotransmitters)
IDIOPATHIC; DECENDING MUSCLE WEAKNESS Myasthenic Crisis Cholinergic Crisis
Causes: undermedication, stress, Cause: overmedication
infection
S/sx: (-) seeing, swallowing, speaking, S/sx: PNS, increased
breathing salivation aspiration
Tx: admin cholinergic agents as ordered Tx: anticholinergic agents,
atropine sulfate
7. Assist in
THYMECTOMY – removal of thymus which is believed to
produce autoimmunity
Plasmaparesis – filtering
of blood; removal of autoimmune
antibodies in the blood
8. Prevent complications respiratory arrest
9. Prepare trache set in pts with MG
A. Cause – IDIOPATHIC
E. DIAGNOSTICS
B. PREDISPOSING FACTORS
1. CAT scan
1. Autoimmune
2. Cerebral Arteriography – reveals site of lesion
2. antecedent viral infection
Informed consent
3. immunizations such as your flu vaccine
Allergies to seafood
C. CLINICAL MANIFESTATION
Post-dx: forced fluids and check for presence of hematoma
1. CLUMSINESS – INITIAL SIGN
2. Dysphagia
F. NURSING MANAGEMENT
3. Ascending muscle weakness paralysis
1. Maintain patent airway and adequate ventilation
4. Decreased DTRs
Assist in mechanical ventilation
5. Alternate hypertension and hypotension; MOST FEARED
Administer oxygen as ordered
COMPLICATION: ARRHYTHMIAS
2. Restrict Fluids
6. Autonomic changes
3. Elevate head of bed, 30-40 degrees to promote venous
Increased sweating and lacrimation
drainage
Increased salivation
4. Avoid activities that cause valsalva maneuver
Constipation
5. Prevent complications of immobility
Prevent
bed sores and hypostatic pneumonia TTS D. DIAGNOSTICS
q2
1. CSF Analysis : reveals elevated CHON and IgG
Use of egg crate mattress or water
bed Sand CSF is produced in the choroid plexus
bag/foot board to prevent foot lag
6. Institute NGT feeding
E. NURSING MANAGEMENT
7. ROM exercises q4h to prevent contractures and
promote proper body alignment 1. Maintain patent airway and ventilation
8. Alternative means of communication Assist in mechanical ventilation
2. Maintain side rails (paralysis)
Non verbal cues
3. prevent complications of immobility
Magic slate or picture board
4. institute NGT feeding
9. If positive for hemianopsia, approach client on
unaffected side 5. Administer medications as ordered
10. Administer meds as ordered Anticholinergics – Atropine Sulfate
Corticosteroids – to suppress immune response
Osmotic diuretics
Anti-arrhythmic agents
Mannitol (Osmitrol)
Corticosteroids
Lidocaine (Xylocaine)
Dexamethasone (Decadron) Bretyllium – Blocks norepinephrine
Mild Analgesics
Quinidines – anti-arrhythmic, anti-malarial
Codeine Sulfate
(Malaria –king of tropical diseases kaya ang
Thrombolytics meds ay queen = quinines) Common SE:
QUINCHONISM :
Streptokinase
Urokinase Female anopheles – malaria, night biting, lay
eggs in the morning
Tissue Plasminogen Activity Factor (TPAF)
Monitor for bleeding Female aegis egyptis – dengue, day biting,
lay eggs at night, 4 o’clock habit
Anti-coagulants as ordered.
Plasmodium falciparum – most dangerous form of
Heparin check PTT – if prolonged, indicates bleeding
malaria hemorrhage
give protamine sulfate when overdosed 6. Assist in plasmaparesis
7. Prevent complications
Coumadin check PT – if prolonged, indicates
ARRHYTHMIAS
bleeding vitamin K (aquamephyton) as antidote
RESPIRATORY ARREST
Given together because coumadin will take
effect after 3 days still VIII. CONVULSIVE DISORDERS
Loop-diuretics
A disorder of the CNS characterized by paroxysmal seizures
Lasix (okay to administer in DM pts but monitor CBG) with or without loss of consciousness, alternation in
sensation and perception, abnormal motor activity and
Anti-platelets changes in behavior; IDIOPATIHIC
ASA – anti-thrombotic
Febrile seizures are normal for children below 5 years only; can be
Contraindicated in dengue, ulcers and unknown outgrown
Febrile seizures in children >5 yo = abnormal
cause of headache potentiates bleeding
SEIZURE – first convulsive attack
EPILEPSY – series of seizure activity
11. Health Teaching
Avoid modifiable risk factors
Avoid / prevent complications: Sub-arachnoid hemorrhage
Diet modification: low saturated fat, sodium and caffeine
Rehabilitation for focal neurologic weakness
Importance of ffup care and strict compliance to medications
A. PREDISPOSING FACTORS Diazepam (Valium) – for status epilepticus
1. Head injury secondary to birth trauma Carbamazepine (Tegretol)
2. Lead poisoning
3. Genetics Also used for Trigeminal neuralgia (Tic Dolor)
4. Brain tumor Phenobarbitals (Luminal)
5. Nutritional and metabolic deficiencies 4. Institute seizure and safety precautions
6. Sudden withdrawal of anti-convulsive drugs Post-seizure:
Causes STATUS EPILEPTICUS O2 inhalation
DOC: diazepam, glucose Suction apparatus
7. Physical and emotional stress 5. Monitor and document the following
Onset and duration
B. TYPES OF SEIZURES Type of seizure
1. Generalized Duration of post-ictal sleep
increased length of sleep can
lead to status epilepticus
Grand Mal (Tonic-Clonic)
With or without an aura
6. Assist in CORTICAL RESECTION
Epigastric pain – initial sign of an aura (aura
is an initial sign of seizures) For a one year old client suffering grand mal seizures:
Visual auditory olfactory tactile NOT Mouthpiece Eh onte lang teeth ng one year old eh
sensory experience
Give pillows for the head (For banging of head
support
Epileptic cry
during seizure activity)
Fall
Loss of consciousness for 3-5 minutes
Tonic-clonic contractions
Direct symmetrical extension of extremities
Shaking/convulsive activity
Post-ictal sleep (unresponsive sleep)
Petit Mal (Absence Seizure)
S/sx:
Blank stare
Decreased blinking of the eyes
Twitching of the mouth and loss of
consciousness for 5-10 seconds
2. Partial Seizures
Jacksonian seizure (focal seizures) – characterized by
tingling and jerky movements
of index finger and thumb
spreads to shoulders
Psychomotor seizure (focal-motor seizures) – characterized
by:
Automatism – stereotype,
non-repetitive and non-
purposive behavior
Clouding of consciousness – not in contact with reality
Mild hallucinating sensory experience
3. Status Epilepticus – continuous uninterrupted seizure activity
that if left untreated may lead to hyperpyrexia coma
death
Increased electrical activity in brain increased metabolism
increased glucose and oxygen use, increased temperature
coma death
DOC: Valium, Glucose
C. DIAGNOSTICS
1. CT-SCAN – brain lesion d/t head trauma
2. EEG – hyperactivity of brain waves (all elevated)
Alpha, beta, delta, theta waves
D. NURSING MANAGEMENT
1. Maintain patent airway and promote safety before
seizure activity
Clear the site of sharps, harmful objects
Loosen clothing of the patient
Avoid use of restraints fractures
Maintain side rails
Turn head to side to prevent aspiration
Tongue guard is between mouth and teeth to prevent biting
of the tongue
2. Avoid precipitating stimulus
Bright/glaring lights
Noise
3. Administer medications as ordered
Phenytoin (Dilantin)
Gingival Hyperplasia
Use soft-bristled toothbrush
Ataxia
Nystagmus
Hirsutism