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DISTURBANCES
INCREASE INTRACRANIAL
PRESSURE
Excessive, prolong increased ICP
anorexia of brain cells & cellular death
Extradural hematoma
Results from tear in the wall of skull; blood
collects in the extradural space separating
dura from the skull
Nursing Care
Establish an airway
Check for presence of shock
Check for evidence of spinal injuries
Observe for scalp and skull injuries
Prevent infection
Rest
Observe for CSF leakage
Improve cognitive functioning (orient)
SPINAL CORD INJURIES
Fracture or displacement of 1 or more
vertebrae damage to SC & nerve roots
neurologic deficits & altered
perception/ paralysis or both
Thoracic injury
Paraphlegia
Bladder distention and impacted rectum
Flaccid paralysis at first but becomes spastic
Autonomic dysreflexia (above T6 & in cervical
lesions)
Types of Injury
Lumbar Injury
Flaccid paralysis of LE, bladder &
rectumculate (loss of sympathetic tone)
S2-S4 injury damages sympaha & para
Injury above S2 (+)erection but unable
to eja
Spinal Tumors
Same symptoms but development is
slower
Signs and Symptoms
General
Loss of sensation below level of injury
Inability to move
EARLY SYMPTOMS OF SHOCK
Early symptoms of shock:
f. Absence of reflexes below level of the
lesion
g. Flaccid paralysis (below level of injury)
h. Inability to perspire in affected parts
i. Hypotension
Signs and Symptoms
LATE SYMPTOMS OF SHOCK
Reflex hyperexcitability (spastic
paralysis)
State of diminished reflex excitability
(flaccid paralysis)
Inability to perspire in affected parts
Urinary retention
Management
Maintain vertebral alignment
Bed rest with supportive device (bed
board)
Bed rest with total immobilization
Traction
Surgery
Straight alignment of spine
Log rolling from mattress
Keep back straight
Mechanical ventilation if needed
DEGENERATIVE DISEASES
MULTIPLE SCLEROSIS
Chronic, slowly progressive, non-
contagious
Breakdown of myelin or demyelination of
the NS
Affects the white matter of CNS
Incidence
Greater in cold environment
Common in age group 20-40 years
Clinical course extends over 10 – 20
years
Signs and Symptoms
Spastic weakness of extremities
Nystagmus
Intentional tremors- motor weakness in
coordination
Scanning speech
Visual disturbance
Euphoria & emotional hyperexcitable
N/V
Bladder & bowel incontinence
Ataxia
Anesthesia/numbness
Paralysis
Medications
Corticosteroids
Immunosuppressants
Baclofen
Carbamazepine
Propranolol
Betanechol
Oxybutinin Chloride
MYASTHENIA GRAVIS
Nueuromuscular weakness characterized
by marked weakness & abnormal fatigue
of voluntary muscles
Muscles supplied by bulbar nuclei are
commonly involved
Clients with MG have high incidence of
thymus abnormalities & frequently have
SLE
Nursing Management
Monitor respiratory status
Maintain suction & “E” equipments at
bedside
Monitor speech and swallowing
Instruct client to avoid stress, infection &
fatigue
Pathophysiology
Defect in transmission of nerve impulses
at the myoneuronal junction
Signs and Symptoms
Muscle involvement usually progresses
from ocular to facial, proximal muscles,
respiratory muscles
No muscle atrophy
With periods of exacerbation &
remissions
Muscles generally strongest in the
morning
Diagnosis
Tensilon test in which an injection of
Edrophonium is given
Tensilon test determine if myasthenic
crisis or cholinergic crisis
Inc muscle strength myasthenic crisis
Weakness become severe cholinergic
crisis (atrophine Sulfate)
Management
Anticholinesterase
b. Neostigmine/Pyridostigmine
c. Tensilon
Side effects: related to the effects of increased
Ach
Excessive dose– cholinergic crisis
give atrophine sulfate 30 mins before
meals with milk
h. Steroids
i. Avoid: Streptomycin; Kanamycin and
Neomycin
Cholinergic crisis
Produced by excessive dosage of
anticholinesterase
May cause generalized weakness,
presence of fasciculations & tightness,
dysphagia & respiratory weakness,
excessive salivation, sweating abdominal
cramps, diarrhea
Symptoms worse with Tensilon
Myasthenic crisis
Acute exacerbation of disease due to
rapid unrecognized progression of
disease, failure of medications,
infections, fatigue
S/Sx: weakness, dysphagia,
restlessness,
Tensilon relieves symptoms
Mgt: thymectomy, respiratory support
GUILLAIN-BARRE
SYNDROME
Disorder in which a person’s immune
response attacks the myelin sheath
Clinical syndrome of uknown cause
ivolving the PNS & CN
Paresthesia, muscle weakness or
paralysis
Pathophysiology
Anti-ganglioside antibodies highly
associated with C. jejuni infection–
attack the normal ganglioside found in
peripheral neuaral tissues at the nodes
of Ranvier--- ineffective transmission of
impulses
Signs and Symptoms
Paresthesia of LE
Muscle weakness of legs- progress to
ascending paralysis involving the trunk,
upper extremities and facial muscles
(complete paralysis)
Difficulty chewing, swallowing & talking
(CN involvement)
Loss of sensation & sphinceter
disturbance of bladder & rectum
Management
Support respiration
Watch for breathlessness, shallow
irregular breathing
Assist in Mechanical ventilator
Minitor for dysphagia
Monitor for cardiac arrhythmias
Prevent Cx of immobility
Physical therapy to prevent tightening of
muscles & to preserve joint & muscle
function
Corticosteroids
Management
Plasmapharesis
HUNTINGTON’S DISEASE
Genetically transmitted degenerative
neurologic disease characterized by
abnormal movements, intellectual
decline & emotional disturbance
Men & women equally affected
30- 40 years
Autosomal dominant (chromosome 4)
Pathophysiology
D striatum in degeneration of basal
ganglia GABA, Ach, substance P
relative inc concentration of other NT
(dopa & NE) excessive movement in
HD
Signs and Symptoms
Emotional disturbance (suspicious,
negative, irritable, mental deterioration
procedes abnormal movements
Depression, psychosis
Temper outburst
Decline in cognition, dementia,
incontinence
Rapid, jerky choreiform movements
Signs and Symptoms
Behivioral & personality changes
Weight loss, anorexia, insomnia,
malaise, dizziness
Early: progressive memory loss, visual
impairment & dysphagia
Progressive dementia
Mycoclonus (twitching)
Rapid deterioration– 90% fatal