Lecture Notes on Neurologic

Nursing
Prepared By: RONEL E. JAPON

II. SNS
a. Adrenergic Agents
1. Epinephrine (Adrenaline)
2. Note: Side Effects (SE) normal drug expectancies
b. Beta-Adrenergic Agents (Beta-Blockers)
1. Propanolol, metoprolol, atenolol
2. Bronchospasm, Elicits decreased cardiac contractions,
Treats HPN, AV conduction slows down (BETA)
3. Anti-HPN Management
Beta-blockers -olol
ACE inhibitors -pril
Ca-Antagonist nifedipine
Transient headache and dizziness
Orthostatic hypotension
Q Assist in ambulation
Q Pt. to rise slowly from sitting position
4. BP = CO x PR
5. CO = HR x SV
6. (N) HR = 60-100 bpm
7. (N) SV = 60-70 ml of H2O
TOXIC SUBSTANCES THAT CAN PASS THE BLOOD-BRAIN
BARIER: (BLACK)
Bilirubin yellow pigment
Lead Antidote: Ca+ EDTA
Ammonia cerebral toxin; present in hepatic encephalopathy
(liver cirrhosis)
Carbon Monoxide in Parkinsons and Epilepsy
Ketones cerebral depressant

MEDICAL-SURGICAL NURSING

Neurologic Nursing
________________________________________________________
OVERVIEW OF THE STRUCTURE AND FUNCTION OF THE
NERVOUS SYSTEM
I.

Decreased HR and BP
Decresead RR
Diarrhea
Urinary Frequency
Seizures

Divisions
a. CNS brain and spinal cord
b. PNS 12 pairs of cranial nerves and 31 pairs of spinal
nerves
1. Spinal nerves:
Cervical 8
Thoracic 12
Lumbar 5
Sacral 5
Coccygeal - 1
c. ANS sympathetic and parasympathetic systems

III. CNS

a.

Sympathetic flight or aggression response release of

norepinephrine increase in all bodily activity except GI
(constipation); adrenergic; parasympatholytic response.

b.

REMEMBER: GIT is the least important area during stress

decreased blood flow in the area; Increased blood flow in the brain,
heart and skeletal muscles
Mydriasis (dilat-ation)
Dry mouth
Increase in HR and BP
Tachypnea
Constipation
Urinary retention
Parasympathetic flight or withdrawal response release of
Acetylcholine decrease in all bodily activity except GI (diarrhea);
chonlinergic/ vagal/ sympatholytic response
Meiosis
Increased salivation
MS
1

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)
Ependymal cells produces chemoattractants
which concentrates bacteria
Composition
1. 80% brain mass
CEREBRUM divided into two hemispheres, the
left and right and is bridged by the corpus
callosum
Motor, sensory, integrative function
Lobes:
Q Frontal controls higher cortical thinking,
personality development, motor activity,
contains BROCAs are or the motor-speech
center. (Expressive Aphasia)
Q Occipital vision
Q Parietal appreciation and discrimination
of sensory impulses (pain, touch, pressure,
heat and cold)

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

Q
Q

Temporal hearing, short term memory,

contains the general interpretative area
Wernickes aphasia
Insula (Island of Reil) visceral function
(internal area)
Limbic System (Rhinencephalon) sense
of smell, libido or sexual urge control, long
term memory

CI Atlas; C2 Axis
CSF shock absorber, cushions brain altered when there is
obstruction in CSF drainage
HYDROCEPHALUS posteriorly growth of the head d/t early
closure of fontanels

Types of Cells:
Labile (regenerative) Epidermal, GIT, Respiratory, GUT
Stable regenerative but limited survival period: liver, pancreas,
salivary glands, kidneys
Permanent cardiac, neurons, osteocytes, retinal

NEUROLOGIC ASSESSMENT
I.

BASAL GANGLIA areas of gray matter

located deep within each cerebral hemisphere;
involved in the extrapyramidal tract; produces
DOPAMINE (controls gross voluntary movement)
MIDBRAIN (Mesencephalon) acts as a relay
station for sight and hearing particularly helps in
size and reaction of pupils and hearing acuity
N hearing acuity : 30-40dB
N pupil constriction: 2-3 mm
N pupil finding: PERRLA
Isocoria vs. Anisocoria
DIENCEPHALON (Interbrain)
Thalamus acts as a relay station for
sensation
Hypothalamus controls temperature, BP,
sleep and wakefulness, thirst, appetite
(satiety), some emotional responses like fear,
anxiety and excitement, controls pituitary
functions
BRAIN STEM
Pons (Pneumotaxic center) controls rate,
rhythm and depth of respiration
Medulla Oblongata lowest part; damage:
most life threatening; controls respiration,
HR,swallowing,vomiting,hiccups,
vasomotor center
CEREBELLUM smallest part; lesser brain;
balance, equilibrium, gait and posture.

COMPREHENSIVE NEUROLOGIC EXAM

A. Purpose
1. To know exact neuro deficit
2. To localize lesion
3. For rehabilitation
4. For guidance in nursing care
B. Survey of Mental Status
1. LOC
Conscious awake
Lethargy sleepy/drowsy/obtunded
Stupor only awakened by vigorous stimulation
General body weakness
Decreased body defenses
Coma
Light (+) to all painful stimuli
Deep (-) to all painful stimuli
PAINFUL STIMULATION
Deep Sternal Stimulation/Pressure
Orbital Pressure
Pressure on Great Toes
Nail bed pressure
Corneal/Blinking Reflex
Q Conscious wisp of cotton
Q Unconscious institute/drop of saline
solution (coma if positive reaction, deep
coma if negative)
2. Test of memory (consider educational background)
Short term memory (ask what the pt ate for
breakfast)
(+) anterograde amnesia temporal lobe
damage
Long term memory (ask birthday)
(+) retrograde amnesia damage to
Rhinencephalon (Limbic system)
C. Levels of Orientation (time, person and place)
D. CN Assessment
E. Motor Assessment

2.
3.

MS

F.

Sensory Assessment
1. PAIN - Gingerbread test
100% very painful
75% tolerable pain
25% moderate pain
0% no pain
2. TOUCH Stereognosis
Identifying familiar object placed on clients hands
Astereognosis if patient cannot identify object;
damage in parietal lobe
3. PRESSURE AND TOUCH Graphesthesia
Identify numbers or letters written on clients
palm
Agraphesthesia if (-), damage to parietal lobe

G.

Cerebellar Test

10 % CSF
10% Blood

MONROE KELLY HYPOTHESIS the skull is a closed

vault, any increase in one component will bring about increases
in ICP
NORMAL ICP IS 0-15 MMHG; NORMAL CSF: 120-250CC/DAY
NORMAL CSF OPENING PRESSURE: 60-150 MMHG
NORMAL CSF CONTENTS: GLUCOSE, PROTEINS, WBCS
FORAMEN MAGNUM - The large opening in the basal part of
the occipital bone through which the spinal cord becomes
continuous with the medulla oblongata.
2

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

H.
I.

1. Rombergs Test
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
DTRs
Autonomics

2.
3.

Dysosmia distorted sense of smell

Anosmia absence of smell

II. Glasgow Coma Scale

A. objective measurement of LOC;
B. quick neuro check
1. Motor 6
2. Verbal 5
3. Eye Opening 4
C. Normal: 14-15 conscious
1. lethargy 13-11
2. Stupor 10-8
3. Coma = 7
4. deep coma = 3
II. OPTIC
A. Sensory Vision
B. Tests
1. Test of Visual Acuity/Central or Distance Vision
Materials
Snellens Chart
Q Alphabet literate
Q E chart illiterate
Q Animal chart pedia, since shorter
attention span
20 feet distance (67 cm) 20 feet/6-7 m; constant
normal 20/20
numerator distance to snellen chart
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
Inferiorly
CRANIAL NERVE ASSESSMENT
I.
II.
III.
IV.
V.

VI.
VII.

Olfactory
Optic
Oculomotor
Trochlear (smallest) (down)
Trigeminal(largest)
(triCHEWminal)
Abducens (at the sides)
Facial

VIII.
IX.

Acoustic (Vestibulocochlear)
Glossopharyngeal

X.

Vagus (longest) (mavagal)

XI.
XII.

Accessory (shoulders)
Hypoglossal

I.

MS

Sensory
Sensory
Motor
Motor
Sensory,
motor
Motor
Sensory,
motor
Sensory
Sensory,
motor
Sensory,
motor
Motor
Motor

C.

Some
Say
Marry
Money
But

My
Brother
Says
Bad
Business
Marry
Money

OLFACTORY
A. Sensory smell
B. Use coffee, bar soap, vinegar, cigarette tar
C. Abnormal findings
Indication of:
Head trauma damaging the cribriform plate of
ethmoid bone where olfactory cells are located
Sinusitis give antibiotics to prevent meningitis
1. Hyposmia decreased sensitivity to smell
3

COMMON VISUAL DISORDERS

1. Glaucoma
40 yo, obese
hereditary
Loss of peripheral vision tunnel vision
Increased IOP (N = 12-21 mm Hg)
Signs and symptoms:
Headache
Nausea and vomiting
Halos around lights
Steamy cornea
Acute angle closure glaucoma most
dangerous, may lead to blindness
Diagnostics:
Tonometry increased IOP
Gonioscopy obstruction in anterior
chamber
Perimetry decreased visual fields
Drugs (for lifetime)
Timolol maleate
Pilocarpine drug of choice (miotic)
Epinephrine decrease in aqueous humor
CarbonicAnhydraseDiamox
(Acetazolamide)
Q Decrease in aqueous humor (maintains
IOP); promotes drainage
Q Monitor I/O

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

NO
ATROPINE:
may
lead to increased IOP
IgM
acute
infections
(mabilis)
IgE
allergic reactions
Surgery
IgD
Chronic infections (dalas)
Trabeculectomy
Peripheral iridectomy
Q Uveitis inflammation of the iris
Q Keratitis inflammation of the cornea

Cataract
Loss of central vision Glaring or hazy vision
Opacity of lens, milky white appearance of cornea,
decreased perception to colors
Due to aging
Prolonged UV rays exposure
Congenital disorder very rare
DM
Dx: Ophthalmoscopic examination
Tx: Mydriatics, cycloplegics (cyclogil) paralyzes
ciliary muscles
Surgery: lens extraction
ECLE partial removal of cataract
ICLE capsule included, total removal of
cataract
C. CLINICAL
MANIFESTATION
Retinal
Detachment most common complication
1.
disturbances
following
lens extraction
3. Visual
Blurring
of veil
vision
Curtain
like vision
Diplopia
Leads to blindness
Scotoma
spot)
Severe(blind
myopia
common cause
2. Impaired
sensation to touch,
pain,
pressure,
Emetropia
normal
refraction
ofheat
eyesand
cold Presbyopia loss of lens elasticity due to
Tingling sensation
aging
Paresthesia
(+) floaters d/t seepage of RBCs
Numbness
Surgery: Scleral Buckling, Diathermy (heat
3. Mood swings
application), Cryosurgery (cold application)
Euphoria sense of well-being
4. Impaired motor activity
Weakness
Macular degeneration degeneration of macula lutea
[Link]
Paralysis
(yellowish spots in center of retina)
Blackcerebellar
spots
5. Impaired
function
CHARCOT
Yellowish
S TRIAD
spots
: ataxia
in center
(unsteady
of retina
gait),
or the macula
nystagmus,
lutea intentional tremors
Scanning speech
6. Urinary retention or incontinence
III. OCULOMOTOR
7. Constipation
It innervates movt of EOMs
IV. TROCHLEAR
8. Decrease in sexual capacity
V. ABDUCENS
2.

D.

DIAGNOSTIC PROCEDURE
SR LT: reveals increased CHON
IO (trochlear)
1. CSF Analysis
and IgG
2. MRI LR
site and extent of demyelination MR
(Abducens)
IR

F.
A.
B.
C.

SO

NURSING MANAGEMENT: Palliative

1.
Administer
medications
as ordered
Normal
response
PEBRTLA/
PERRLA (isocoria)
Acute Exacerbation
Anisocoria
unequal pupils
ACTH(Adrenocorticotropic
Nystagmus
Rhythmical oscillation ofhormone)
the eyeballs,either
site in
of MS,
demyelination
pendularreduces
or jerky;edema
can beatseen
dilantin toxicity.
thereby preventing paralysis; compression of
spinal cord will lead to paralysis
VI. TRIGEMINAL largest cranial nerve with 3 branches; sensory
Baclofen (Lioresal), Dantrolene Na to reduce
and motor.
muscle spasticity
A. Ophthalmic branch
Interferons
B. Maxillary branch
Immunosuppressives
C. Mandibular branch
D. SensoryDiuretics
controls sensation of face and teeth, mucous
PROPHANTHELENE
BROMIDE (PRO-BANTHENE)
membrane
and corneal reflex
anti-cholinergic
for urinary incontinence
E. Motor Mastication
or chewing
2. Provide
for Relaxation
F. Trigeminal
Neuralgia
characterized by severe pain upon
biofeedback, yoga
chewing,DBE,
dysphagia
3. Retain
side extreme
rails
1. avoid
foods with
temperature
4. Prevent
complications
of immobility TTS Q2h, Q1 h
2. DOC:
carbamazepine
(Tegretol)
for elderly, 20 minutes only on affected side
5. Increase OFI, high fiber diet (for constipation), acidash in diet to acidify urine to prevent bacterial
VII. FACIAL
multiplication (cranberry juice, prunes, grape juice,
A. Sensory
anterior
2/3 orange
of tongue;
taste
without
vitamin
c, plums,
and identify
pineapple
juice.)
swallowing
6. Provide catheterization for urinary retention
B. Motor facial expression control
1. instruct patient to smile, frown or raise eyebrows
Bells palsy or (temporary) facial paralysis
damage to facial nerve caused by:
Forceps delivery - #1 cause
Autoimmune
Stress
MS

INCREASED INTRACRANIAL PRESSURE

Traumain the three intracranial components

Brought about byincrease
Nasolabial folds most evident sign of facial

symmetry
A. PREDISPOSING FACTORS
a. Head injury
b. Tumor
I.
ACOUSIC/VESTIBULOCOCHLEAR
c. Localized
abscesses
A.
Controls balance
or kinesthesia (position sense/ movement
[Link]
Cerebral
edemaof body in space)
correlation
e. 1.
Hydrocephalus
Organ of corti (true sense organ for hearing) for
f. Hemorrhage
hearing
[Link]
conditions organ in middle ear
Cochlea snail-shaped
Meningitis
[Link]
2. Conductive
Encephalitishearing loss
1.
2. Otitis Media
3. Menieres disease
B. SIGNS AND SYMPTOMS
a. Early signs
Archimedes
Principleor change
buoyancy
(pregnancyfetus)
1. Decreased
in LOC
[Link]
Law of Partial
Pressure
to confusion
Inertia -[Link]
Disorientation
4. Lethargy to stupor
5. Stupor to coma
GLOSSOPHARYNGEAL taste; posterior 1/3 tongue
II.
b. Late signs
VAGUS gag reflex, decreased vital signs, eyes constrict, mouth
III.
1. Changes in the vital signs
moist PNS
Elevated BP (SBP rising, DBP constant)
SPINAL/ACCESSORY controls 2 muscles:
IV.
N Pulse Pressure: 40 mmHG
A. Sternocleidomastoid (neck)
HR decreased
B. Trapezius (Shoulder)
RR decreased(Cheyne-Stokes
respiration:
HYPOGLOSSAL
tongue movement;
frenulumnormal
linguae
respiration
by periods of apnea)
V.
anchorsrhythmic
tongue (tongue
tied followed
short frenulum)
Elevated temperature
2. Headache, papilledema, projectile vomiting
3. Abnormal posturing- decorticate (flexion) damage to
corticospinal tract (spinal cord and cerebral cortex)
DISEASES
remember:DEMYELINATING
deCORDThreecate
OR decerebrate
(extension): upper brain stem damage pons, midbrain,
ALZHEIMERS
I.
cerebellum DISEASE - atrophy of the brain tissue
characterized
4. Unilateralby:
dilation of pupil (ANISOCORIA)
a. Amnesia
indicates uncal brain herniation; if bilateral dilatation:
b. Agnosia
(-) sense of smell
tentorial herniation
c. 5.
Apraxia
(-) purposive movements
possible seizures
[Link]
Cushings reflex (hypertension with bradycardia)
1. Expressive/Brocas problem in speaking
2. Receptive/Wernickes problem in understanding;
USUAL FOR ALZHEIMERS
3. o
Brocas
area inadequate
motor speech
center;
frontal
SHOCK
tissue
perfusion
4. o
Wernickes
area
general tissue
interpretative
area;
HYPOXIA
inadequate
oxygenation
temporal
e. ARICEPT drug of choice, given at HS
C. NURSING
MANAGEMENT
COGNEX
also given
1. maintain patent airway and adequate ventilation by:
prevention of hypoxia ( cerebral edema
increased ICP) and hypercarbia (CO2 retention)
cerebral vasodilation increased ICP
decreased tissue perfusion possible shock
Early signs of hypoxia
Restlessness
Agitation
Tachycardia
Late signs of hypoxia
Bradycardia
Extreme restlessness
Dyspnea
Cyanosis
Increased CO2 most potent respiratory
stimulant in the normal person (irritates medulla
oblongata)
Decreased O2 stimulates respiration in CRDS
Suctioning should only last for 10 -15 seconds and
application of suction should be done upon
withdrawal
of catheter
in a circular
PICKS Disease:
a form
of dementia
whereinfashion.
there is damage in the
frontoparietal area
2. SCLEROSIS
Assist in mechanical
ventilation
II. MULTIPLE
chronic,
intermittent disorder of
Elevate head
of bed
30-45ofdegrees
with of
neck
the [Link]
by white
patches
demyelination
thein neutral
position
when contraindicated
to promote venous
brain and spinal
cord. IDIOPATHIC,
AUTOIMMUNE
drainage
intake to 1.2-1.5 l per day (Forced fluids =
4. Limit fluid
A. INCIDENCE
RATE: 15-35 yo, females
2-3 L/day)
B. PREDISPOSING
FACTOR
Monitor VS, NVS,
I/O strictly
5.
1. Slow
growing
virus
Prevent
complications
of immobility
6.
2. Autoimmune

body
produces
antibodies which attacks
Prevent further increase in ICP
[Link] cells
Provide comfortable environment
3. REVIEW:
ANTIBODIES
Avoid use
of restraints fractures
IgG
passes
placenta
Keep
side rails
up (gestational)
IgA

found
in
bodily
secretions, colostrums
8.
54

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

9. Avoid valsalva maneuver

Straining of stools (give laxatives/stool softeners)
Excessive vomiting (give Metoclopramide (plasil)
anti-emetic)
Lifting of heavy objects
Bending or stooping
10. Administer medications as ordered
Osmotic Diuretics Mannitol (Osmitol)
cerebral diuresis
Monitor VS especially BP (SE: Hypotension
resulting from hypovolemia)
Monitor I/O qH
Given via side drip, fast drip to avoid
precipitate formation
Instruct client that a flushing sensation will
be felt as drug is introduced
Loop Diuretics via IV push Furosemide
BP
Monitor 1/0 q1, notify if <30cc/hr
IV push Lasix effect in 10-15 minutes,
max 6 hours; best given in AM to prevent
sleep interruption
Corticosteroids
Dexamethasone (decadron)
Q Steroids administered 2/3 in AM to
mimic diurnal rhythm
Hydorcortisone
Prednisone
Mild Analgesic
Codeine sulfate
Anti-Convulsant
Pheytoin (Dilantin)

SE: major depression suicidal ideation

Linked to Breast Ca development
Q SBE is done 7 days after menstruation
Q Breast Ca - #1 Ca in women
Q Cervical Ca - #2 Ca in women
1. multiple sex partners
2. early pregnancy
Q Ovarian Ca - #3 Ca in women
Q mammography lasts for 10-20 minutes
Methyldopa (Aldomet) has anti HPN properties
Haloperidol (Haldol) anti-psychotic
NEUROLEPTIC MALIGNANT SYNDROME
(NMS)
Q Tremors, tachycardia, tachypnea, fever
Phenothiazides anti-psychotic
PHENERGAN only anti-psychotic with antiemetic properties

B.

CLINICAL MANIFESTATION
1. PILL ROLLING TREMORS of the extremities first sx
2. Bradykinesia second sx
3. Rigidity (cogwheel type) third sx
4. Stooped posture, SHUFFLING GAIT, propulsive gait
5. Overfatigue
6. Mask-like facial expression, decreased blinking of the
eyelids
7. Difficulty in rising from sitting position
8. Quiet monotone speech
9. Mood lability depression suicide
10. Increased salivation, drooling type
11. Autonomic changes
Increased sweating and lacrimation
Seborrhea
Constipation
Decreased sexual capacity

C.

NURSING MANAGEMENT (palliative)

1. Administer medications as ordered
Anti-Parkinsonian Agents increase dopamine
relieves rigidity (CAPABLES!)
Levodopa (L-dopa) short acting
dopaminergic
Amantadine HCl (Symmetrel) long acting
dopaminergic
Carbidopa (Sinemet) long acting
dopaminergic
Q SE: (GIT) anorexia, nausea and vomiting,
orthostatichypotension,hallucination,
arrhythmia
Q Contraindications: narrow angle closure
glaucoma loss of peripheral vision
tunnel vision halos in light; normal IOP =
12-21 mmHg

Benadryl is given at HS because it causes drowsiness

Levothyroxine is given in AM to prevent insomnia

PARKINSONS DISEASE (degenerative disease) chronic

progressive disorder of the CNS characterized by degeneration of
the dopamine producing cells in the substantia nigra of the
midbrain and basal ganglia (areas of gray matter in both
hemispheres which is involved in the extrapyramidal tract)
IRREVERSIBLE, IDIOPATHIC

III.

A.

MS

PREDISPOSING FACTORS
1. Poisoning
Lead (ANTIDOTE: Ca EDTA heavy metal
antagonist)
Carbon Monoxide decreased capacity of
hemoglobin to carry oxygen cherry red skin
color
2. Arteriosclerosis
3. Hypoxia inadequate tissue perfusion
4. Encephalitis
5. Drugs
Reserpine (Serpasil)
Has anti HPN properties
Promote safety when giving this drug
6

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

2.
3.
4.

5.
6.
7.
8.

Q Also contraindicated in patients taking

MAOIs (Avoid tryptophan and tyramine in
pts taking MAOIs)
Administer with food or snack to lessen GIT
irritation
Inform client that stools/urine maybe
darkened
INSTRUCT CLIENT TO AVOID FOODS RICH IN
VITAMIN B6--PYRIDOXINE (Cereals, organ
meat, green leafy vegetables) reverses
therapeutic effect of levodopa
Anti-cholinergics relieves tremors
Relieves tremors
Artane and Cogentin
Mode of action: increases dopamine
SE: SNS
Antihistamine relieves tremors
Diphenhydramine HCl (Benadryl)
SE:
Q Drowsiness adult
Q CNS excitement and hyperactivity children
Dopamine Agonists relieves tremors and
rigidity
Bromocriptine HCl (Parlodel)
Q SE: CNS Depression
Q No OCPs decreased effect
Maintain side rails to prevent injuries related to falls
Prevent complications of immobility
Maintain good nutrition. Provide dietary intake that is
low in protein in AM and high protein at night to
induce sleep
TRYPTOPHAN induces sleep
Assists in passive ROM exercises to prevent
contractures. Q4h for proper body alignment.
Increased OFI is encouraged and increased Fiber in the
diet for constipation
Ambulate with assistance
Assist in STEROTAXIC THALAMOTOMY
COMPLICATIONS: SUBARACHNOID HEMORRHAGE,
ENCEPHALITIS, CEREBRAL ANEURYSM

MYASTHENIA GRAVIS (MG) neuromuscular disorder

characterized by a disturbance in the transmission of impulses
from nerve to muscle cells at the neuromuscular junction (or
motor end plate site of exchange of neurotransmitters)
IDIOPATHIC; DECENDING MUSCLE WEAKNESS

IV.

C.

CLINICAL MANIFESATION
1. PTOSIS INITIAL SIGN
Check palpebral fissure drooping of upper
eyelids
2. Double vision
3. Mask like facial expression
4. Weakened laryngeal muscles dysphagia (difficulty
of swallowing, without food); odynophagia ang with
food
5. Hoarseness of voice
6. Respiratory muscle weakness respiratory arrest;
prepare trache set at bedside
7. Extreme muscle weakness especially during activity or
exertion in AM

D.

DIAGNOSTICS
1. TENSILON TEST (EDROPHONIUM HCL)
Temporary relief of symptoms
Strengthens muscles temporarily
Pt, temporarily can open eyelids, increased muscle
strength 5-10 minutes after admin

E.

NURSING MANAGEMENT
Airway
Aspiration
Immobility
1. Maintain patent airway and adequate ventilation
Assist in mechanical ventilation
Assess PFT (decreased Vital Lung Capacity)
2. Monitor Strictly VS, IO, NVS, motor grading scale
(muscle strength)
3. Maintain side rails
4. institute NGT feeding to prevent aspiration
5. prevent complications of immobility q2 turning, q1
for elderly
6. Administer meds as ordered
Corticosteroids for immunosuppression
Cholinergic/Anticholinergic agents
Mestinol (Pyridostigmine)
Neostigmine (Prostigmin)
Q Monitor for the two types of crisis

Myasthenic Crisis
Causes:undermedication,stress,
infection
S/sx: (-) seeing, swallowing, speaking,
breathing
Tx: admin cholinergic agents as ordered

Cholinergic Crisis
Cause: overmedication
S/sx:PNS,increased
salivation aspiration
Tx: anticholinergic agents,
atropine sulfate

Monitor for BRITTLE CRISIS: characterized by severe respiratory

muscle weakness and exertioal discomfort. Prepare trache set.
7.

8.
9.

V.

MS

A.

INCIDENCE RATE
1. Women aged 20-40 years old

B.

PREDISPOSING FACTORS
1. Autoimmune
Involves release of CHOLINESTERASE an
enzyme which destroys Ach descending muscle
weakness

Assist in
THYMECTOMY removal of thymus which is
believed to produce autoimmunity
Plasmaparesis filtering of blood; removal of
autoimmune antibodies in the blood
Prevent complications respiratory arrest
Prepare trache set in pts with MG

MENINGITIS inflammation of the meninges of the brain and

spinal cord
Meninges 3fold membrane that covers the brain and
spinal cord
For support and protection
For blood supply
For nourishment
Dura mater - outermost
Subdural space between dura and arachnoid
Arachnoid mater - middlemost
Subarachnoid space where CSF circulates; location
where aspirate is taken during LT (puncture either bet l3-l4
or l4-l5 because it is above these areas where the spinal cord
terminates)
Pia mater gentle mater

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

VI.
A.

B.
C.

D.

E.

MS

ETIOLOGIC AGENTS
1. MENINGOCOCCUS MOST DANGEROUS
2. Pneumococcus
3. Streptococcus adult
4. Hemophilus influenzae pedia
MODE OF TRANSMISSION airborne transmission via
droplet infection
CLINICAL MANIFESTATION
1. Headache, photophobia, projectile vomiting
2. Fever, chills, anorexia, generalized body malaise,
weight loss
3. decorticate (deCORDthreecate) and or decerebrate
4. Possible seizure and increased ICP
5. Signs of meningeal irritation
Nucchal rigidity
Opisthotonus rigid arching of the head
(+) kernigs sign leg pain
(+) brudzinksis sign neck pain

DIAGNOSTICS
1. Lumbar puncture (lumbar or spinal tap)
Nursing management for before LT
Obtain informed consent
Explain procedure to client
Empty bowel and bladder for comfort
Encourage client to arch back to clearly
visualize spinal columns
Nursing management post LT
Flat on bed for 12-24 hours to prevent spinal
headaches and CSF leakage
Forced fluids
Check puncture site for any discoloration,
drainage and leakage to tissues
ASSESS FOR MOVEMENT AND SENSATION OF
EXTREMITIES (MOST IMPORTANT)
CSF analysis will reveal
Increased CHON and WBC
Decreased Glucose
Increased CSF opening pressure
Q N = 50-160 mmHg
(+) cultured microorganisms
These confirm presence of meningitis
2. CBC Reveals
Increased WBC

NURSING MANAGEMENT
1. Complete bed rest
2. Administer medications as ordered
Broad Spectrum Antibiotics
Penicillin alteration in the N flora of the
GI superinfection diarrhea
Analgesics
Antipyretics
3. Institute strict respiratory isolation after initiation of
antibiotic therapy
4. Institute ICP monitoring
5. Dim environment d/t photophobia
6. Monitor strictly VS, IO and NVS
7. Maintain F and E balance
8. Prevent complications of immobility: turn to sides q2
9. Health Teaching and D/C planning
Dietary intake increased in calories with small
frequent feedings (increase carbohydrates)
Prevent complications
HYDROCEPHALUS
HEARING LOSS (NERVE DEAFNESS)
Q Visit audiologist for audiometric screening
after resolution of meningitis
Rehabilitation for residual deficits
Mental retardation or delay and psychomotor
development
Singit lang to: pag post repair ng
myelomeningocoele checkup with
urologist baka na-hit ung bladder

CEREBROVASCULAR ACCIDENTS (Stroke, brain attack,

cerebral thrombosis, apoplexy) partial or total disruption in the
blood supply of the brain, usually in the MCA or ICA (2 largest
cerebral arteries)
A.

INCIDENCE RATE 2-3x higher in males than in females

B.

PREDISPOSING FACTORS
1. Thrombosis attached clot, #1 cause of stroke
2. Emboli detached/wandering thrombosis
Pulmonary embolism
Sudden sharp chest pain
Unexplained dyspnea
Tachycardia
Palpitation
Diaphoresis
Cerebral embolism
Headache
Dizziness
Disorientation
Change in LOC that may lead to coma
3. Hemorrhage

C.

RISK FACTORS
1. HPN
2. DM
3. Atherosclerosis MI
4. Valvularheartdisease,Mitral/post-cardiac
surgery/mitral valve replacement mlt CVA
5. Lifestyle
Smoking
Sedentary lifestyle
Obesity (more than 20% ideal body weight)
Diet rich in saturated fats
Hyperlipidemia genetic; (+) genes that easily
binds to cholesterol
Type A personality
Deadline driven person
Does several things at the same time
Feels guilty when not doing anything
Prolonged use of oral contraceptives
Macropil estrogen
Minipil progestin
Increases lipolysis breakdown of lipids
atherosclerosis HPN CVA

D.

CLINICAL MANIFESTATION
1. TRANSIENT ISCHEMIC ATTACK initial sign of CVA
Headache, dizziness, tinnitus, visual and speech
disturbances, paresis to plegia, increase in ICP
possible, cheyne-stokes respirations
2. Stroke in evolution progression of S/sx
3. Complete Stroke resolution phase characterized by
still dizziness and headache
Cheyne-stokes respirations
Anorexia
Nausea and vomiting
Dysphagia
(+) Kernigs and Brudzinksis
Focal Neurological Deficits
Plegia
Aphasia
Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

Q
E.

F.

Dysarthria speaking difficulty

Alexia reading difficulty
Agraphia writing difficulty
Homonymous hemianopsia loss of vision
field
Unilateral neglect

VII.

DIAGNOSTICS
1. CAT scan
2. Cerebral Arteriography reveals site of lesion
Informed consent
Allergies to seafood
Post-dx: forced fluids and check for presence of
hematoma
NURSING MANAGEMENT
1. Maintain patent airway and adequate ventilation
Assist in mechanical ventilation
Administer oxygen as ordered
2. Restrict Fluids
3. Elevate head of bed, 30-40 degrees to promote venous
drainage
4. Avoid activities that cause valsalva maneuver
5. Prevent complications of immobility
Prevent bed sores and hypostatic pneumonia
TTS q2
Use of egg crate mattress or water bed
Sand bag/foot board to prevent foot lag
6. Institute NGT feeding
7. ROM exercises q4h to prevent contractures and
promote proper body alignment
8. Alternative means of communication
Non verbal cues
Magic slate or picture board
9. If positive for hemianopsia, approach client on
unaffected side
10. Administer meds as ordered
Osmotic diuretics
Mannitol (Osmitrol)
Corticosteroids
Dexamethasone (Decadron)
Mild Analgesics
Codeine Sulfate
Thrombolytics
Streptokinase
Urokinase
Tissue Plasminogen Activity Factor (TPAF)
Q Monitor for bleeding
Anti-coagulants as ordered.
Heparin check PTT if prolonged,
indicates bleeding give protamine sulfate
when overdosed
Coumadin check PT if prolonged,
indicatesbleedingvitaminK
(aquamephyton) as antidote
Q Given together because coumadin will take
effect after 3 days still
Loop-diuretics
Lasix (okay to administer in DM pts but
monitor CBG)
Anti-platelets
ASA anti-thrombotic
Q Contraindicated in dengue, ulcers and
unknown cause of headache potentiates
bleeding

VIII.

GUILLAINE-BARRE SYNDROME (GBS) CNS disorder

characterized by bilateral, symmetrical, polyneuritis leading to
ascending muscle weakness/paralysis.
A.
B.

Cause IDIOPATHIC
PREDISPOSING FACTORS
1. Autoimmune
2. antecedent viral infection
3. immunizations such as your flu vaccine

C.

CLINICAL MANIFESTATION
1. CLUMSINESS INITIAL SIGN
2. Dysphagia
3. Ascending muscle weakness paralysis
4. Decreased DTRs
5. Alternate hypertension and hypotension; MOST FEARED
COMPLICATION: ARRHYTHMIAS
6. Autonomic changes
Increased sweating and lacrimation
Increased salivation
Constipation

D.

DIAGNOSTICS
1. CSF Analysis : reveals elevated CHON and IgG
CSF is produced in the choroid plexus

E.

NURSING MANAGEMENT
1. Maintain patent airway and ventilation
Assist in mechanical ventilation
2. Maintain side rails (paralysis)
3. prevent complications of immobility
4. institute NGT feeding
5. Administer medications as ordered
Anticholinergics Atropine Sulfate
Corticosteroids to suppress immune response
Anti-arrhythmic agents
Lidocaine (Xylocaine)
Bretyllium Blocks norepinephrine
Quinidines anti-arrhythmic, anti-malarial
(Malaria king of tropical diseases kaya ang
meds ay queen = quinines) Common SE:
QUINCHONISM :
Q Female anopheles malaria, night biting, lay
eggs in the morning
Q Female aegis egyptis dengue, day biting,
lay eggs at night, 4 oclock habit
Q Plasmodium falciparum most dangerous
form of malaria hemorrhage
6. Assist in plasmaparesis
7. Prevent complications
ARRHYTHMIAS
RESPIRATORY ARREST

CONVULSIVE DISORDERS
A disorder of the CNS characterized by paroxysmal
seizures with or without loss of consciousness, alternation in
sensation and perception, abnormal motor activity and
changes in behavior; IDIOPATIHIC
Febrile seizures are normal for children below 5 years only;
can be outgrown
Febrile seizures in children >5 yo = abnormal
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

MS

Abejo

Lecture Notes on Neurologic Nursing

Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor

A.

B.

PREDISPOSING FACTORS
1. Head injury secondary to birth trauma
2. Lead poisoning
3. Genetics
4. Brain tumor
5. Nutritional and metabolic deficiencies
6. Sudden withdrawal of anti-convulsive drugs
Causes STATUS EPILEPTICUS
DOC: diazepam, glucose
7. Physical and emotional stress

5.

TYPES OF SEIZURES
1. Generalized
Grand Mal (Tonic-Clonic)
With or without an aura
Q Epigastric pain initial sign of an aura (aura
is an initial sign of seizures)
Q Visual auditory olfactory tactile
sensory experience
Epileptic cry
Q Fall
Q Loss of consciousness for 3-5 minutes
Tonic-clonic contractions
Q Direct symmetrical extension of extremities
Q Shaking/convulsive activity
Post-ictal sleep (unresponsive sleep)

2.

3.

MS

4.

Diazepam (Valium) for status epilepticus

Carbamazepine (Tegretol)
Also used for Trigeminal neuralgia (Tic
Dolor)
Phenobarbitals (Luminal)
Institute seizure and safety precautions
Post-seizure:
O2 inhalation
Suction apparatus
Monitor and document the following
Onset and duration
Type of seizure
Duration of post-ictal sleep increased length of
sleep can lead to status epilepticus
Assist in CORTICAL RESECTION

6.
For a one year old client suffering grand mal seizures:
NOT Mouthpiece Eh onte lang teeth ng one year
old eh
Give pillows support for the head (For banging of
head during seizure activity)

Petit Mal (Absence Seizure)

S/sx:
Q Blank stare
Q Decreased blinking of the eyes
Q Twitching of the mouth and loss of
consciousness for 5-10 seconds
Partial Seizures
Jacksonianseizure(focalseizures)
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
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
Q Use soft-bristled toothbrush
Ataxia
Nystagmus
Hirsutism

10

Abejo