NCM 116j (Neuro) Main function of the CNS:

F.S.P - The central nervous system (CNS) controls

most functions of the body and mind. It
PERCEPTION consists of two parts: the brain and the
- It is a mental process by which the brain spinal cord. The brain is the center of our
selects, organizes and interprets these thoughts, the interpreter of our external
sensations. environment, and the origin of control over
COORDINATION body movement.
- movement of parts together: the skillful and Three functions of the CNS:
balanced movement of different parts, - The CNS comprises the brain, cerebellum
especially parts of the body, at the same and spinal cord. Remaining neurons, and
time. associated cells, distributed throughout the
body form the PNS. The nervous system
Neurologic Functions has three broad functions: sensory input,
● Receives stimuli or information from the information processing, and motor output.
internal and external environment over
varied, afferent or sensory pathways Cells in the Nervous System
● Communicates information between distant 1.) Neurons/Nerve Cells
parts of the body (periphery) to the CNS - It is an electrically excitable cell that
● Computes or processes the information communicates with other cells via
received at various reflex specialized connections called
● Transmits information rapidly over varied synapses.
efferent or motor - Neurons are cells within the nervous
system that transmit information to
Nervous system other nerve cells, muscle, or gland
cells.
Central Nervous System (CNS) 2.) Glial Cells
1.) Brain - It is also called glial cells (singular
gliocyte) or neuroglia, are
non-neuronal cells in the central
nervous system (brain and spinal
cord) and the peripheral nervous
system that do not produce electrical
impulses.

Lobes of the Brain

2.) Spinal Cord

1.) Parietal Lobe

- Processing
- Visual
Peripheral Nervous System - Information
2.) Frontal Lobe
1.) Somatic Nervous System - Thinking
- voluntary - Decision Making
2.) Autonomic Nervous System - Planning
- involuntary - Personality
a. SNS 3.) Occipital Lobe
b. PNS - Processing auditory information from
the brain
- Hearing
 4.) Temporal Lobe Cerebrospinal Fluid (CSF)
- Sensory - CSF : bathe, nourishes, cushion and
- Information protects the brain from jarring against the
skull
- Clear, Colorless, Odorless
Cerebellum (Hindbrain) - Appearance: halo sign
- It is responsible for coordination, balance, - Choroid Plexus: 125 to 150 ml/day
and posture. - Arachnoid Villi:
Spinal Cord - Pressure: 75-180 mmH20, 0-15 mmHg
- The spinal cord is a long, thin, tubular - Ventricles: lateral v, third v, fourth v.
structure made up of nervous tissue, which
extends from the medulla oblongata in the Diagnostic Exams
brainstem to the lumbar region of the
vertebral column. It encloses the central X-RAY
canal of the spinal cord, which contains - Uses electromagnetic radiation
cerebrospinal fluid. - Confirm skull fracture
- Main functions: - With radiation
a. To conduct reflexes below the neck.
b. To conduct messages from the skin CT Scan
and muscles to the brain. - Uses computerized special X-ray beam that
c. To conduct commands from the slices the image
brain to muscles of the trunk and - Identify tumors, aneurysm, hemorrhage,
limbs. hydrocephalus
- With radiation
The Cranial Nerves
MRI
- Uses magnetic field with radio frequencies
- Identify tumors, infarcts, vascular
abnormalities
- No radiation

Electroencephalogram (EEG)
- graphical recording of electrical impulses of
the brain from scalp by using sensors
- painless procedure
- lasts for 30 minutes
- lying down or sitting position
- Nursing Responsibilities:
a. Explain procedure, the cost
b. Review patient’s clinical record
c. Check patient’s medication history
for drugs that may interfere with test
result:
- antidepressants
- tranquilizers
- anticonvulsants
d. Avoid caffeine and other
e. Instruct patient to relax with eyes
closed and remain still
f. AFTER THE PROCEDURE:
- Wash hair, clean and dry hair

Lumbar puncture / Lumbar tap

- Needle is inserted in the lower back bones,
middle of L3 and L4, used to collect csf
- Lie on table in fetal position
- Doctor injects anesthetic to numb the lower
back
Electromyography (EMG) Muscular dystrophy (MD)
- It’s a test that measures and records the - a chronic disease damages skeletal
activity of contracting muscles in response muscles., a progressive weakness and loss
to electrical stimulation. of movement control, develops in childhood
- This test is use to help detect primarily affects boys. PT, & medications
neuromuscular abnormalities and muscle are used to control symptoms & improve
weakness. function
- During this test, one or more small needles
(also called electrodes) are inserted through
the skin into the muscle.

10 Conditions Diagnosed with an EMG

Myasthenia gravis
ALS Amyotrophic lateral Sclerosis - autoimmune disease that weakens skeletal
- a progressive neuromuscular disease. muscle, vision problems is the 1st symptom
Muscle weakness/disability & eventually and affects chewing swallowing and talking,
leading to breathing failure, unknown cause, tx include medications immune system
no cure but only to slow the damage of the therapies
nerve thru medication

Peripheral neuropathy
Carpal tunnel syndrome - damage to the nerves that run from the
- tingling and numbness in the hand and brain and spinal cord to all parts of the body,
fingers, compression of the wrist, an anti refers to nerves of the limbs, numbness
inflammatory drugs and exercise can relieve tingling & pain and DM is the main cause &
the symptoms some of autoimmune disease (tumors).

Polymyositis
- progressive muscle disorder, marked by
chronic muscle inflammation and weakness
Charcot Marie tooth disease (CMT) of both sides. Same no cure but only to
- inherited neurological disorder. Affects suppress the immune system with
motor and sensory nerves in the limbs, medications and reduce inflammation & PT
muscle weakness in the legs feet , foot
deformities, gait problems & affects arms &
hands at a later part(no cure/PT only)

Sciatica
- injury or pressure on the sciatic nerve, pain
on lower back, thighs, tingling weakness on
legs, common cause is herniated disc.
- Treated with PT to strengthen the back and
medication anti inflammatory or at times
surgery.
 Disorders of the Nervous System

Seizure
- is a sudden, uncontrolled discharges of
electricity in the brain cell
- Seizure are frequently a symptom of an
underlying pathology
Lambert-Eaton syndrome - Epilepsy: chronic recurrent seizures
- is a disorder of the communication between - Causes unknown in 75% of epilepsy cases
nerves and muscles. It causes fatigue and Etiology:
weakness. It most often affects the limbs - Normally neurons send out messages in
but can also cause problems with breathing, electrical impulses periodically. With
speaking and swallowing. seizures, many more neurons than normal
fire in a synchronous fashion in a particular
area of the brain
Causes:
- Tumors
- Metabolic: hypoglycemia, hypocalcaemia,
hyponatremia (HYPO)
- Infection: meningitis, encephalitis
- Encephalopathy: lead poisoning
- Congenital: hydrocephalus
Radiculopathy or pinched nerve
- Vascular: intracranial hemorrhage
- is a spinal nerve root injury. Nerve roots
3 stages of seizures
pass between the spinal vertebrae, where
1.) Stage 1: Beginning (AURA)
they can become pinched.
- Déjà vu (a sense that something has
happened before when in fact it
hasn’t)
- Jamais vu (a feeling that you’re
seeing something you know well for
the first time)
- Flashes of light/dark spots
- Mood changes
- Anxiety
Myelogram
- Nausea
- It uses x-rays and a special dye called
- Numbness
contrast material , injected at your back to
- Tingling of the limbs
visualize the spaces between the bones in
- Difficulty staying focus
your spinal column.
2.) Stage 2: Middle Phase (ICTUS/ICTAL)
- It finds tumor infections, problems with the
- Loss of awareness
spine such as bulging disc and arthritis.
- Memory lapse
- It's an invasive diagnostic test. Usually it is
- Feeling confused
done when spinal nerves are compressed
- Difficulty hearing
and it is not confidentially visualized on the
- Difficulty speaking or saying strange
MRI or CT scan.
words
- Twitching
Cerebral Angiography
- Loss of muscle control
- Injection of contrast through the femoral
- Racing heart
artery into the carotid arteries.
- Trouble breathing
3.) Stage 3: Ending Phase (POST – ICTAL)
Diagnostic and Laboratory Findings
- Confusion
● CT and MRI-hemorrhage, tumour, cysts,
- Lack of consciousness
oedema, brain atrophy
- Tiredness (fatigue)
● EEG-seizure, altered LOC
- Exhaustion
● CEREBRAL ANGIOGRAPHY-aneurysm,
- Headache
arteriovenous malformations
- Loss of bladder or bowel control
● LP-CSF analysis
- Frustration
● EMG-muscle weakness
- Thirst and Sore Muscles
 Types of seizures - NOTE: Nothing should be forced into the
1.) Partial mouth because this may occlude the airway.
- Simple - do not insert tongue blade
a. Seizure confined to one - Contrary to popular belief, it is not true that
hemisphere a person having a seizure can swallow his
b. NO loss of consciousness tongue.
c. Focal seizure: hand, arm, leg - Do not put anything in the person’s mouth.
- Complex Efforts to hold the tongue down can injure
a. Begin in focal area but the teeth or jaw.
spreads to both hemispheres Medications
b. Impairs consciousness, may - Anticonvulsant:
be preceded by aura a. Phenytoin (Dilantin)
c. Produce automatism (lip IM injection causes tissue irritations
smacking, grimacing, IV infusion causes hypotension,
repetitive hand movement) cardiac dysrhythmias, sinus
2.) Generalized bradycardia
- Petit mal/Absence Seizure b. Maintain serum drug levels
a. Minimal or no alteration in (therapeutic serum level:10-20
muscle tone mcg/ml)
b. brief LOC without movement - NOTE: if PHENYTOIN will be use, it will be
of the eyes, head and administered ONLY with NORMAL SALINE
extremities and administer it slowly
c. Regain of consciousness is - Barbiturates
rapid and lasts for 10-20 a. Amobarbital (Amytal)
seconds - status epilepticus
d. Not preceded by an aura b. Mephobarbital (Mebaral)
- Myoclonic - grand mal, petit mal
a. Sudden, brief, shock like c. Phenobarbital (Luminal)
involuntary contraction of one - grand mal, petit mal, status
muscle group epilepticus
- Tonic-Clonic (Grand Mal seizure) d. Primidone (Mysoline)
a. Violent spasm and stiffening - grand mal, psychomotor
total body seizure
b. Aura tonic (40 sec); clonic e. Carbamazepine (Tegretol)
next - tonic-clonic
- Atonic (Drop attack) f. Diazepam (Valium)
a. loss of muscle tone - status epilepticus
b. LOC maybe brief - Given 10-15 mins. to a
3.) Status Epilepticus maximum dose of 30 mg.
- Prolonged, repetitive seizures - 100 mg./24 hours (not
without recovery between attacks exceed)
- may result in complete exhaustion g. Lorazepam (Ativan)
and led to death - status epilepticus
- Last at least 30 minutes
What time of the day are seizures most
Diagnostic Tests for Seizure common?
- Blood studies - Most common seizure times and sleep
- LP: rule out infection stages
- CT scan & MRI - Nighttime seizures occur most often in the
- EEG: abnormal wave early morning around 5 a.m. to 6 a.m. and
occur least often shortly after falling asleep.
Nursing Management Some types of epilepsy, such as infantile
- Protect the patient/person from spasms, tend to cause seizures shortly after
INJURY-PROMOTE SAFETY waking.
- Promote patent AIRWAY
- Turn the client on the side Head Trauma
- Observe the seizure activity - Head trauma refers to any damage to the
- Provide privacy scalp, skull or brain caused by injury. Head
- Avoid any stimulus to the patient. injury may be classified in various different
 ways according to the type of injury, which
structures in the head are damaged or how
severe the trauma is.

Signs and Symptoms:

- Loss of consciousness from several minutes
to hours.
- Persistent headache or headache that
worsens.
- Repeated vomiting or nausea.
- Convulsions or seizures.
- Dilation of one or both pupils of the eyes. Predisposing Factors:
- Clear fluids draining from the nose or ears. - High blood pressure
- Inability to awaken from sleep. - Smoking
- Congenital
Types of Head Trauma: - Family history
- Concussions Assessment:
- Contusion - Rupture may be preceded by: severe
- Laceration (Hemorrhage) headache and pain in the eye
- epidural hematoma(skull & dura mater) - Seizure
- subdural hematoma(surface of the brain) - Nuchal rigidity
- subarachnoid hematoma(space that - Hemiparesis
surrounds the brain) - Decreasing Loss of consciousness
- Intracerebral hematoma - Increased ICP
- Compression of the brain (Fracture) - Diplopia, tinnitus, dizziness
Diagnostic Tests
Assessment: - Computerized tomography (CT) scan
- s/sx of increased in ICP - Cerebrospinal fluid test
- Signs of Basilar Head Injury - Magnetic resonance imaging (MRI)
- CSF leak from the ears and nose - Cerebral angiogram
- Raccoon’s Eye, Battle’s Sign Nursing Interventions
Raccoon’s Eye - Strict bed rest, HOB 30 degree, head
midline
- Deep breathing
- Prevent seizures
- Monitor V/S, NVS (GCS)
- I and O
- Avoid rectal temp
Battle’s Sign - Avoid coughing, sneezing, straining
- Maintain a quiet, darkened environment
Medications
- Osmotic diuretic
- Corticosteroids to prevent increased ICP
- Anticonvulsants to prevent seizure
- Stool softener to prevent straining
- CLIPPING, ENDOVASCULAR COILING—
CRANIOTOMY
Management:
- Care of client with increased in ICP Cerebrovascular Accident (CVA) / Brain attack/
- Monitor the client for the drainage from ears Stroke
and nose - Destruction of brain cells caused by
- Monitor the client for s/sx of meningitis, reduction in cerebral blood flow and oxygen
pneumonia, UTI Causes:
- Thrombosis
Cerebral Aneurysm - Embolism
- A cerebral aneurysm (also known as a brain - Hemorrhage
aneurysm) is a weak or thin spot on an
artery in the brain that balloons or bulges
out and fills with blood.
Stages of Development hemorrhage (ICH) and subarachnoid
1.) TRANSIENT ISCHEMIC ATTACK (TIA) hemorrhage (SAH).
- Warning sign of impending CVA
- Brief period of neurologic deficit
- blurred vision, diplopia
- Transient numbness, hemiparesis,
slurred speech, aphasia, vertigo\
- Last less than 30 seconds but no
more than 24 hrs with complete
resolution
2.) STROKE IN EVOLUTION:
- progressive development of strokes
symptoms ever a period of hours to
days
3.) COMPLETED STROKE:
- neurologic deficit remains
unchanged for 2-3 day period
Neglect Syndrome
CEREBROVASCULAR ACCIDENT (CVA)
- unaware of the affected side
- Interruption of cerebral blood flow (5
Cranial nerve impairment:
minutes/ more) - Cerebral Hypoxia - Death
- chewing, gag reflex, dysphagia, impaired
of neurons
tongue movement
- CVA due to thrombosis and embolism may
Cognitive impairment:
occur during SLEEP AND REST
- Impaired memory
- CVA due to HEMORRHAGE is associated
- Judgment
with ACTIVITIES and occur during WAKING
Diagnostic Tests
HOURS
- CT and brain scan: lesion
- EEG
Risk Factors:
- Cerebral Arteriography
- High blood pressure. This is the primary risk
Medications
factor for a stroke.
- THROMBOLYTIC : Alteplase,
- Diabetes.
Streptokinase, Urokinase
- Heart diseases. Atrial fibrillation and other
a. 3 to 4.5 hours the time symptom
heart diseases can cause blood clots that
first started
lead to stroke.
b. No anticoagulant for 24 hours after
- Smoking. When you smoke, you damage
tPA
your blood vessels and raise your blood
- ANTICOAGULANTs: Heparin, Warfarin,
pressure.
Aspirin
- A personal or family history of stroke or TIA.
- ANTIHYPERTENSIVE
- Age. Your risk of stroke increases as you
- STEROIDS
get older.
- ANTICONVULSANTS
- Race and ethnicity. African Americans have
NURSING INTERVENTIONS: ACUTE STAGE
a higher risk of stroke.
- Patent airway: Side lying, head elevated
- ET, mechanical ventilators
Two Major Types of Stroke
- Deep breath every 2 hrs
1.) Ischemic Stroke
- VS, NVS/GCS
- occurs when the blood supply to part
- Quiet restful environment
of the brain is interrupted or
- Maintain F/E IV, NGT
reduced, preventing brain tissue
- Proper positioning
from getting oxygen and nutrients.
a. HOB 30-45 degree
Brain cells begin to die in minutes. A
b. turn q 2 hours
stroke is a medical emergency, and
c. passive exercises
prompt treatment is crucial.
- Maintain adequate elimination
2.) Hemorrhagic Stroke
- Catheterize, stool softener, suppositories
- due to bleeding into the brain by the
Nursing interventions: Rehabilitative Stage
rupture of a blood vessel.
Hemiplegia:
Hemorrhagic stroke may be further
- Turn Q 2 hours
subdivided into intracerebral
- Prevent deformities:
- Support paralyzed arm on pillow
 - Elevate (prevent edema) Food high in Acetylcholine:
- Passive/Active exercises - Beef, beef liver.
- Safety: side rails, Canes, walkers, - Egg yolks.
wheelchair - Chicken breast.
APHASIA - Fish.
- RECEPTIVE: - Shiitake mushrooms.
a. Simple, slow directions - Potatoes.
b. One command at a time, pantomime - Legumes (beans, peanuts)
- EXPRESSIVE: - Milk
a. Listen and watch carefully : client Acetylcholine
speaks - Excitatory type of neurotransmitter
b. Anticipate needs - Released by stimulation of the vagus nerve
c. Allow sufficient time to answer and is important for the movement of the
d. Picture board muscle
- Essential to maintain muscle
Myasthenia Gravis strength/muscle tone
- Myasthenia gravis is a chronic autoimmune, Diagnostic Tests
neuromuscular disease that causes - Tension Test/Edrophonium HCL
weakness in the skeletal muscles. a. is a short acting anticholinesterase
- A neuromuscular disorder in which there is b. ONLY USED FOR DIAGNOSTIC
a disturbance in the transmission of PURPOSES
impulses from nerve to muscle cell at the c. HOW:
neuromuscular junction, causing extreme -Tensilon of 10 mg is administered
muscle weakness. via IV push
- Failure in the transmission of electrical -2 mg (Adults) is injected first
impulses to MUSCLE CELLS due to -if NO UNTOWARD REACTION
decreased supply of ACETYLCHOLINE at such as increased weakness,
the MYONEURAL JUNCTION. change in RR, nausea & abdominal
- Extreme muscle weakness especially cramps
during activity or exertion -then the remaining 8 mg is injected
- Characterized by remission and -If patient has MG, symptoms will be
exacerbation temporarily relieved (for 3-5 minutes)
Pathophysiology
- Decrease ACETYLCHOLINE
- Increase/Excess CHOLINESTERASE
Leading to impaired transmission of nerve
impulses to muscles at myoneural junction
Cause
- Unknown but can be autoimmune whereby
antibodies destroy acetylcholine receptor
site at the neuromuscular junction
Two peaks of onset
- Early onset for female
- Late onset for male
CSF analysis
- WOMEN: 15-35 YRS OLD
- reveals elevated cholinesterase levels
- MALE: OVER 40
Electromyography
- COMMON IN WOMEN
- In MYASTHENIA GRAVIS the amplitude of
Signs and symtoms
motor potentials decreases with each test
- PTOSIS (drooping of the eyes)
reflecting fatigue.
- Diplopia
Interventions:
- Expressionless face
- Anticholinesterase: blocks the action of
- Dysphagia
cholinesterase and increases levels of
- In severe case:
acetylcholine at neuromuscular junction.
a. Respiratory muscle weakness
- Neostigmine (Prostigmin)
Leading to Respiratory Arrest
- Pyridostigmine (Mestinon)
b. 15-20% of patient with MG have
- Promote comfort
THYMOMA
- Decrease symptoms (drugs)
- Anticholinesterase (long acting)
- Pyridostigmine bromide (mestinon)
 - Neostigmine (Prostigmine)
- Have antidote ready at bedside for Diagnostic Tests
cholinergic crisis-Atropine Sulfate - lumbar puncture: ↑protein, lymphocytes, IgG
Myasthenic Crisis - EMG: prolonged impulse conduction
- Abrupt onset: severe, general muscle - CT Scan, MRI: plaques: brain, spinal cord
weakness
- Inability to swallow, speak, dec. RR Nursing Interventions
Cause: - Promote optimum mobility
- undermed - Self-care activity, regular exercise (walking,
- Tensilon Test: improves swimming)
- avoid fatigue, infection
Cholinergic Crisis - Administer meds:
- Similar to MC plus S/E anticholinesterase: a. Corticosteroids, Beta interferon:
- Excess salivation, sweating, abd pain, N/V, reduce edema, alter immune
diarrhea, fasciculations response
Cause: b. Baclofen, Diazepam (Valium):
- Overdosage: spasticity
- Tensilon test: worsens c. Urecholine: urinary retention
- Urinary elimination: intermittent cath,
Nursing care in CRISIS: voiding sched, acid-ash diet
- Maintain TT or ET, Mechanical Ventilation - Bowel program
- Administer meds: - Safety: NO heating pads, position change
a. Myasthenic crisis: increase dose - There is no treatment for autoimmune
anticholinesterase drugs diseases, only palliative or supportive care
b. Cholinergic crisis: D/C
anticholinesterase drugs MG and MS
Factors of exacerbation
Multiple Sclerosis - Pregnancy
- Chronic, progressive degenerative disease - Fatigue
- Scattered demyelinization of CNS neurons - Infection
- Incidence: women - Trauma/Emotional stress
- CAUSE: unknown, autoimmune
Signs and Symptoms: Parkinson’s Disease
- Visual disturbances
a. BLURRED VISION is the INITIAL
SIGN of MULTIPLE SCLEROSIS
b. Diplopia
c. Scotoma
- Impaired sensation to touch, pain, pressure,
heat and cold
a. Tingling sensations
b. Paresthesia
c. Do not give hot packs to patients
with MS.because of decreased heat
sensitivity, heat application can
cause burns.
- Associated with decreased levels of
- Impaired motor activity
dopamine resulting from destruction of
- Weakness/fatigue 􀀀 spasticity 􀀀 paralysis
pigmented neuronal cells in the substantia
- Impaired cerebellar function
nigra in the basal ganglia.
- ATAXIA (unsteady gait)
- Affects older adults mostly, age 50-60 males
- Scanning speech
more often than females
- Bowel and Bladder dysfunction
Assessment
- Decrease Sexual Capacity
- Tremor at rest: bilaterally, pill-rolling
- Mood disorder
- Rigidity: cogwheel type, no arm swing,
CHARCOT’S TRIAD Sx of MULTIPLE
- Difficulty rising from sitting
SCLEROSIS
- Stooped posture: shufffling gait
- Intention tremors
- Cramped, small handwriting
- Nystagmus
- Increased salivation, drooling
- Scanning of speech
- Bradykinesia: slowness of movement
 - Masklike face, dec. blinking, lacrimation, - Absence deep tendon reflexes
monotone - Dysphagia
- excess sweat, constipation, dec sex
capacity Diagnostic Tests
Triad symptoms 1.) CSF: elevated protein
- RIGIDITY 2.) Electromyography (EMG): slowed nerve
- TREMORS conduction
- BRADYKINESIA Medical Management
Diagnostic Tests - Mechanical vent
- No specific test for disease - steroids, Opiates, analgesia
- Physical Examination - Atropine (bradycardia)
- Signs and Symptoms - Plasmapheresis
Nursing Intervention Nursing Interventions
- Increase mobility: - Maintain respiratory function
a. Physical therapy, Assistive devices a. HOB 45 deg
- Safety: b. Mechanical ventilation, O2, suction
a. Side rails, grab bars, no scatter rugs c. Chest physiotherapy, incentive
b. Sufficient time spirometry
- Read aloud, enunciate syllable clearly - Nutrition:
- Avoid constipation a. NPO, Pureed food, NGT
Medications b. Assess: gag, swallowing reflexes
- Levodopa (L-dopa): increases dopamine - Prevent immobility complications
a. w/ food, dark urine/sweat, avoid B6 a. Repositioning, massage, ice, heat
- Carbidopa-Levodopa (Sinemet): prevents - Improve Communication: Picture Board
breakdown of dopamine - Check individual muscle groups Q 2 hrs
- Bromocriptine (Parlodel): stimulate the - Assess Pain
release of dopamine and stop the
breakdown of dopamine in the brain Amyotrophic Lateral Sclerosis (ALS)
- Phenothiazines - Synonyms: Lou Gehrig’s Disease/ Charcot’s
- Pyridoxine Disease
- Reserpine - ALS: Progressive, incapacitating and fatal
- Monoamine Oxidase disease in which there is a degeneration of
- Marplan the MOTOR NEURONS.
- Parnate - Cause: Unknown
- Nardil Predisposing Factors:
Food - Male (50 to 60 years old)
- Vitamin B6 rich foods - Viral infection
- Tyramine rich foods - Possible familial or genetic component
Signs and Symptoms
Dopamine related symptoms are severely - progressive weakness, atrophy muscles:
exacerbated arms, legs, trunks
- At risk for aspiration and pneumonia - spasticity of the flexor muscles
- Excessive drooling increases - progressive respiratory
difficulties—diaphragmatic paralysis
Airway clearance is the priority - fasciculations
- Dysarthria
Peripheral Nervous System Disorders - Dysphagia
- Initial Signs
Guillian-Barre’ Syndrome (GBS, Landry’s a. WEAKNESS in the upper
Paralysis, Acute Idiopathic Polyneuropathy) extremities, shoulders, muscles of
- Symmetrical, bilateral ascending motor the neck and throat
paralysis b. Fasciculation
- Cause: autoimmune, viral infection and c. Fatigue
bacterial infection - Cardinal Signs
Assessment a. progressive muscle weakness
- Mild sensory changes: b. atrophy
- Clumsiness c. Fasciculation
- Progressive motor weakness As motor neurons die the muscle cells undergo
- Ascending, symmetrical, bilateral atrophic changes leading to paralysis:
death in 2 – 6 years. - droops, displacement mouth
- Loss corneal reflex (unable to close eye),
No known cure, no treatment, no preventive increase tearing, unable to wrinkle brow
measures - Pain behind ear

Diagnostic Tests
- EMG- to evaluate denervation and muscle
atrophy
- Pulmonary function test- to evaluate
respiratory function
- Muscle Biopsy- confirms changes is
muscle atrophy and loss of muscle fiber
Interventions
- First drug: Riluzole
- Promote respiratory functions
- Prevent complications of immobility:
Diversional activities, physical therapy
- Client and family with support
- Soft diet

Nursing Actions: Paralysis, Pain

Trigeminal Neuralgia (Tic Douloureux)
- Assess nerve function, facial exercise, moist
- Chronic disease of CN
heat
- Cause: unknown
- Meds: Prednisone, antiviral, analgesic
- Probably enlarged blood vessel (Superior
- Chew unaffected: Soft diet, avoid hot foods,
Cerebellar Artery) compressing the
mouth care
Trigeminal nerve.
- Eye care: dark glasses, artificial tears, eye
Assessment
patch
- PAIN:
a. brief and severe
Spinal Cord Injury
b. on one side of the face
- Paralysis below the level of injury
c. 100/day
- The higher the injury, the greater the loss of
- Triggers:
function
a. Cold
- Symptoms depend on the level and the
b. extreme temperature
extent of injury
c. Brushing
- Partial or complete disruption of nerve tracts
d. Chewing
and neurons resulting in
e. touching face
a. Paralysis
Medical Management
b. sensory loss
- ANTICONVULSANTS:
c. altered reflex activity
a. Carbamazepine (Tegretol)
d. autonomic nervous system
b. Phenytoin (Dilantin)
dysfunction
- NERVE BLOCK: Alcohol or Phenol
- Occurs most commonly in YOUNG ADULTS
- RHIZOTOMY- severing the nerve root
Causes
Nursing Interventions
Traumatic
- PAIN
- MVA
a. even room temperature
- Falls
b. avoid hot/cold food
- Contact sports
c. soft diet
- Industrial accidents
d. Chew unaffected side
- Gunshot
e. mouth care
- Stab wound
Non Traumatic
Bell’s Palsy (Idiopathic Facial Paralysis)
- Tumors
- UNILATERAL paralysis of facial muscles
- Hematomas
CN
- Aneurysms
- Cause: Autoimmune, Viral
- Congenital defects
Signs and Symptoms
- Loss of taste (tongue)
- Facial paralysis
- Loss of expression, side of face
Pathophysiology Possible Complications
INJURY - HEMORRHAGE & EDEMA - ISCHEMIA - 1.) SPINAL SHOCK/NEURAL SHOCK
NECROSIS and DESTRUCTION OF THE CORD - - is a period of flaccid paralysis and a
SIGNS & SYMPTOMS complete loss of reflexes
- s/sx:
Symptoms a. Absence of sweating
- Depends on the location and extent of BELOW the level of injury
damage b. Bowel/Bladder retention
c. Hypotension
QUADRIPLEGIA / TETRAPLEGIA (C1-C8 Injury) d. Bradycardia
- Paralysis of all four extremities e. Last for 4-6 weeks
- lesion ABOVE C6 causes respiratory 2.) AUTONOMIC HYPERREFL EXIA/Dysreflexia
paralysis due to lack of innervation to the - It causes hyperstimulation of the SNS.
diaphragm. Occurs clients with SCI ABOVE T6.
- phrenic nerve is located at the C4-C5 level - S/SX:
a. Severe headache
PARAPLEGIA-Thoracolumbar injuries (T1-L4 b. Blurring of vision
Injury) c. Hypertension
- causes paralysis of the lower half of the d. Bradycardia
body involving the legs. e. Sweating –above the injury
f. Pilomotor spasm (gooseflesh)-below
EXTENT OF INJURY the injury
Complete Cord Transection Management:
- Loss of movements and sensation below - Palpate the patient’s bladder because
the level of injury distended bladder is the common causes of
- Reflex activity may return to normal after Autonomic dysreflexia
spinal shock resolves and if blood supply to
cord is intact THE MOST DANGEROUS EFFECT OF
Incomplete Cord Transection AUTONOMIC HYPERREFLEXIA IS
- Varying degree of motor or sensory loss SEVERE HYPERTENSION…
below the level of the lesion depending on
which neurologic tract are damaged. Meningitis
- Inflammation of meninges
Nursing Interventions - Cause: Bacteria or Virus
Emergency Care a. Meningococcus
- Assess ABC b. Pneumococcus
- Do not move the client during assessment c. H. Influenzae
- Do not hyperextend the neck to open the d. Streptococcus
airway
- USE JAW THRUST MANEUVER. Encephalitis
- Immobilize the client in a position found until - Inflammation of the brain caused by a virus
help arrives. and bacteria.
- immobilizing the head & neck with a
CERVICAL COLLAR Assessment
- placed the client on a SPINAL BOARD - Dec LOC, headache, fever, vomiting,
- Have suction available to clear the airway photophobia, malaise
and prevents aspiration - Chills, Fever, poor sucking (infant)
- Perform a quick head-to-toe assessment - Meningeal irritation
- check for LOC - Nuchal rigidity Opisthotonos
- signs of trauma to the head and neck - (+) Kernig’s, (+)Brudzinski’s
- signs of motor & sensory impairment
Diagnostic tests
Medical Management - PE
- Horizontal turning frames (Stryker frame) - LP:
- Skeletal traction a. increase WBC, Protein
a. Gardner-Wells Tong b. decrease Glucose
b. Halo traction - Blood cultures: + org
- Surgery: Laminectomy, Spinal fusion
Nursing Management
Meningitis: Antibiotics, respiratory isolation for
- 24 hrs after start antibiotic
Encephalitis: Acyclovir (Zovirax)
fluids, I and O
Seizure prec: Elevate HOB 30 deg, quiet,dark room
- Antipyretic, analgesic, temp Q4 hrs, cooling
mattress, sponge bath
- Monitor VS, neuro checks(GCS)
- Prophylaxis:
Rifampin, Ciprofloxacin 500 mg single dose
Ceftriazone 250 mg IM