NCM_116 LECTURE

TOPIC: NEUROLOGIC SYSTEM

LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

NEUROLOGIC SYSTEM DEFINITION

 Controls motor, sensor, autonomic,
cognitive and behavioral activities
Two divisions:
• Central Nervous System
- Brain & spinal cord
- FUNCTION: to
coordinate to our
muscular system &
functions to the  BRAIN STEM
divisions of motor  Which connect cortex to
specifically somatic spinal cord
nervous system

• Peripheral Nervous System SPINAL CORD STRUCTURE

- external part of nervous
system (sensory
receptors, nerves,
ganglia and diff. flexes
- Cranial nerves, spinal
nerves and autonomic
nervous system.
• PNS DIVIDED INTO TWO:
 Sensory division-
• afferent
• perceived NEURON
stimulus  Basic function unit
 Motor division-  Can’t regenerate
• efferent  Composed of the following:
• how our body
react to stimulus
 subdivided :
• somatic nervous
system (involves
voluntary
contractions of
skeletal muscle) • Dendrites
• autonomic  Extension that carry
nervous system impulses toward the cell
(sympathetic and body.
parasympathetic 
)
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

• Axon
 Transmits impulses
away from the cell body
 Covering of axon myelin
sheath: to give
insolation to the actual
neuron; it helps to rapid
delivery of signals.

Types of Neurons
• Sensory Neurons
 also known as Afferent
Neurons
 transmit impulses from NEUROTRANSMITTERS
receptors to the CNS.  Communicate message from one
• Motor Neurons neuron to another or from a
 Also termed as Efferent neuron to a specific target tissue
Neurons  Potentiate, terminate, or
 Transmit module a specific action and
impulses from can either excite or inhabit
the central the target cell activity
nervous CLASSIFY INTO TWO:
system to the
effectors EXICITATORY: excited state; a large of
(muscles, production of an excitatory
glands) neurotransmitter, power up of
• Interneurons electrical signal of brain (seizures)
 Found entirely within INHIBITORY: our brain is in a
the central nervous depressed state
system.
 Specialized to transmit
sensory/ motor impulse
CENTRAL NERVOUS SYSTEM

 CEREBRUM
DIFFERENT NEURONS (when they get
attached to their target cells/ tissue)
NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

language
comprehension
• Occipital lobe
 Visual interpretation &
memory
 Brodmann area #17

BRODMANN’S AREA
- a region of the cerebral cortex, in the
• Frontal lobe human or other primate brain, defined by
 Larges lope its cytoarchitecture, or histological
 Major function: structure and organization of cells.
concentration,
abstract thought,
information
storage and
memory
function.
 Contains Broca’s area
(motor control of
speech)
 Generates the impulses
that bring about
voluntary movement
NOTE:
• Parietal lobe
 WERNICKE’S AREA 22,39,40
 Sensory function (language comprehension)
(primary somatosensory
“pag sira wernickes dika niya na
located to this area of
iinitindihan at all”.
the brain)
 BROCA’S AREA 44-45 motor
Touch, taste,
speech (speech formation)
temperature
“if sira ng broca’s ang tao ay
 This is where sensations
makakaintindi parin ng sinsabi mo
are felt
pero di niya ma express self niya”.
• Temporal lobe
 Sensory areas for
 CEREBELLUM
hearing and olfaction
• Controls fine movement,
 Plays a role in memory
balance, and position or
of sound and
proprioception (you will able to
understanding of
determine the position of your
language and music
body)
 Wernicke’s area:
 MEDULLA
NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

•Contains cardiac centers,  Production of hormones

respiratory centers,  Regulation of body
vasomotor centers & temperature
reflex centers (coughing,  Regulation of food and
sneezing, swallowing & fluid intake
vomiting)  Integration of the
• FUNCTION: It carries functioning of the
signals from the brain to autonomic nervous
the rest of the body for system
essential life functions  Directly connected to
the nervous (endocrine
like breathing, circulation,
& muscular system)
swallowing, and digestion.
 Production of
 PONS
hormones/ releasing
• Anterior to the cerebellum and
hormones.
superior to the medulla.
 THALAMUS
• Contains two
• Functions are primarily
respiratory centers
concerned with sensation.
(apneustic &
• Capable of suppressing minor
pneumotaxic)
sensations
responsible to
produce a normal
CORTICOSPINAL PATHAWAY
breathing rhythm
• FUNCTION: middle
portion of the
brainstem coordinat
es facial movements,
hearing and balance.
 MIDBRAIN
• Regulates visual reflexes,
auditory reflexes & righting
reflex
• DIVIDED INTO 3: thalamus,
pons and medulla oblongata.
• In our brain we have foramen
magnum (pinaka Malaki butas)
the hole in the base of the skull
through which the spinal cord
passes.

PERIPHERAL NERVOUS SYSTEM

 HYPOTHALAMUS  Cranial Nerves
o Functions: CRANIAL TYPE FUNCTION
NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

NERVE external ear,

I (olfactory) Sens Sense of smell pharynx,
ory larynx,
II (optic) Sens Visual acuity thoracic and
ory abdominal
III Moto Muscles that viscera;
(oculomotor) r move the eye parasympathe
and lid, tic innervation
pupillary of thoracic
constriction, and
lens abdominal
accommodati organs
on XI (spinal Moto Sternocleidom
IV (trochlear) Moto Muscles that accessory) r astoid and
r move the eye trapezius
V Mixe Facial muscles
(trigeminal) d sensation, XII Moto Movement of
corneal reflex, (hypoglossal) r the tongue
mastication
VI Moto Muscles that
(abducens) r move the eye  Spinal Nerves
VII (facial) Mixe Facial • Composed of 31 pairs
d expression  Cervical:8
and muscle  Thoracic: 12
movement,  Lumbar: 5
salivation and  Sacral:5
tearing, taste,  Coccygeal: 1
sensation in
 Autonomic Nervous System
the ear
-subdivision of motor division of
VIII Sens Hearing and
PNS.
(vestibulococ ory balance/equili
hlear) brium • Regulates the activities of the
IX Mixe Taste, organs.
(glossophary d sensation in • Primary responsibility:
ngeal) pharynx and Maintenance and restoration of
tongue, internal homeostasis.
pharyngeal
muscles Two major divisions
X (vagus) Mixe Muscles of  Sympathetic Nervous System
d pharynx,  Everything is fast except for GI
larynx, and  Those neurological ganglia
soft palate; nerves, plexuses which innervate
sensation in
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

the involuntary motor/ sensory tube

receptions Muscular Relax Contracted
 Fight and flight response sphincter
 Parasympathetic Nervous System s of
 Dominates during relaxed, non- digestive
system
stressful situations
Secretion Thin, watery Thick, viscid
of saliva saliva
salivary
Structure Parasympath Sympathetic glands
or active etic Effects Effect Secretion Increased -
Pupil of Constricted Dilated of
the eye stomach,
circulator intestine,
y system and
Rate and Decreased Increased pancreas
focus of Conversio Increased
heartbeat n of liver
Blood glycogen
vessels Constricted Dilated to
In heart Dilated glucose
muscles Constricted Genitourinary system
In Urinary Contracted Relax
skeletal bladder
muscles muscle
In walls
abdomin Sphincter Relaxed Contracted
al viscera s
and the
Muscles Relax; Contracted
skin
of the variable under some
Blood Decreased Increased uterus conditions,
pressure varies with
Respiratory System menstrual
Bronchiol Constricted Dilated cycle and
es pregnancy
Rate of Decreased Increased Blood Dilated
breathing vessels of
Digestive System external
Peristaltic Increased Decreased genitalia
moveme Integumentary System
nts of Secretion Increased
digestive of sweat
system Pilomotor Contracted
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

muscles (goose-flesh)  3=deep coma

Adrenal Secretion of Updated Glasgow Coma Scale: GCS-P
medulla epinephrine (2015)
and Eye Opening Spontaneous 4
norepinephri To sound 3
ne To pressure 2
No response 1
ASSESSMENT OF NUEROLOGICAL SYSTEM Non-testable NT
 Physical examination Verbal Oriented 5
• Categories: response
 Cerebral Function (LOC, Confused 4
mental status) Words 3
 Cranial nerve Sounds 2
 Motor function No response 1
 Sensory function Non-testable NT
 Reflexes Motor Obeys 6
response commands
CEREBRAL FUNCTION Localized pain 5
 Assess degree of wakefulness/ Withdrawal 4
alertness from pain
(Normal flexion)
 Note the intensity of stimulus to
Abnormal 3
cause a response
flexion
 Apply a painful stimulus over the (Decorticate)
nailbed with a blunt instrument Abnormal 2
 Ask question to assess orientation to extension
person, place & time (Decerebrate)
No response 1
*take note of other metabolic cause* Non-testable NT
Glasgow Coma Scale – indicator to do your Pupil Both pupils 2
ET TUBE. Reactivity unreactive
 Easy method of describing mental One pupil 1
status and abnormality detection unreactive
 Test three (3) areas: Neither pupil 0
 Eye opening unreactive
 Verbal response Note: For total GCS score, subtract pupil
 Motor response reactivity score from calculated GCS.
 Evaluation
Scores
 15=highest score; patient is fully
alert and oriented
 <7= comatose patient
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Inspect for conjugate movements

and nystagmus
 Problem: Dysconjugate gaze; gaze
weakness or paralysis; double vision
 Cranial nerves V (Trigeminal) – mixed
type of cranial nerve different
subdivision - afferent
CRANIAL NERVES  Instruct client to close his/her eyes
 Cranial nerves I (Olfactory)  Ask the patient to identify touch on
 With eyes closed, patient is asked to different parts of the face
identify familiar odors (cinnamon,  Ophthalmic, maxillary & mandibular
coffee)  While the patient looks up, light
 Each nose is tested separately touch a wisp of cotton against the
 Problem: anosmia = loss of sense of temporal surface of each cornea. A
smell blink reflex and tearing are normal
 Cranial nerves II (Optic) responses.
 Assess vision using a Snellen eye  Have the client clench and move the
chart jaw from side to side. Palpate the
 Assess visual fields masseter and temporal muscles,
 Perform ophthalmoscopic noting strength and equality.
examination  Problem: impaired or absent corneal
 Problem: hemianopia (loss of one- reflex, facial numbness and jaw
haft of the visual field, either weakness
unilateral or bilateral); decreased
visual acuity/blindness
 Cranial nerves III (Oculomotor) –
controls eye movement
 Test the eye movement towards the
nose
 Inspect for conjugate movements
and nystagmus
 Evaluate papillary size and test for Sensory – thru ophthalmic branch the one
papillary reactive to light that send stimulus.
 Inspect ability to open eyelids  Cranial nerves VI (Abducens)
 Problem: Dysconjugate gaze; Double  Test for Bilateral eye movement
vision; Dilated pupil; with or without  Inspect for conjugate movement
impaired papillary reaction to light  Problem: dysconjugate gaze; gaze
 Cranial nerves IV (Trochlear) - weakness or paralysis; double vision
 Test for upward eye movement  Cranial nerves VII (Facial) – efferent
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Ask the patient to frown, smile, and  Problem: weak or absent shoulder
wrinkle forehead shrug & inability to turn head to the
 Check for symmetry side
 Problem: facial weakness, inability  Cranial nerves XII (Hypoglossal)
to completely close the eyelids &  Ask the patient to stick out the
impaired taste tongue & move it from side to side
 Cranial nerves VIII (Vestibulocochlear)  Problem: difficult swallowing &
 Performing whisper/ watch-tick test slurred speech
 Test for lateralization (Weber test)
 Test for air & bone condition (Rinne
test)
 Assess standing balance with eyes
closed (Romberg test)
 Problem: decreased hearing/
deafness & impaired balance
 Cranial nerves IX (Glossopharyngeal)
 Assess patient’s ability to swallow
 Assess ability to discriminate
between sugar & salt on posterior
third of the tongue
 Problem: dysphagia & impairs taste LR 6
 Cranial nerves X (Vagus) SO 4
 Depress a tongue blade on the THE REST IS INERVATED BY THE
posterior tongue to elicit gag reflex OCULOMOTOR
 Note any hoarseness in voice
 Check ability to swallow
 Have the patient say “ah”
 Observed for symmetric rise of uvula
and soft palate
 Problem: weak or absent gag reflex;
Dysarthria (defective in speech due
to impairment of the muscles
essential to articulation);
Hoarseness
 Cranial nerves XI (Spinal Accessory)
ABNORMAL REFLEXES
 Ask the patient to turn head and
 v Positive Brudzinski Sign
shrug the shoulders against
 Client is supine position
resistance
 Head flexed to the chest
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 (+) pain, (+) resistance, (+) flexion of  Skull and spinal X-ray
hips & knees= (+) meningeal  Identify fracture, dislocation,
irritation compression, spinal cord problem
 v Positive Kernig’s Sign Nursing Care
 Client in supine position  Proved support for the confuse or
 Knees & hips are flexed combative patient
 Check for excessive pain and/or  Remove metal items
resistance  Maintain immobilization
 If present, (+) for meningeal  CT Scan
irritation  Used for diagnosing neurological
 Positive Babinski Reflex disorder of the brain or the spine
 Stroke the lateral aspect of the foot  Can detect:
 Normal: toes contract & draw  Hemorrhage
together  Cerebral atrophy
 Abnormal: toes fan out and draw  Tumors
back  Skull fractures
 Decorticate Position  Abscesses
Nursing Care
• Assess for iodine allergies
• Instruct to lie still on a movable
table
 Upper arms close to sides
• Inform patient there may be hot,
 Elbows, wrist and fingers flexed
flushed sensation & metallic taste in
 Legs extended with internal rotation
the mouth
 Feet are fixed
• Remove hairpins and other metallic
 Body parts are pulled into core of
object
the body
 Magnetic Resonance Imaging
 Posture of an individual with a lesion
 Used for diagnosis of degenerative
at or above the upper brain stem
diseases, intracranial and spinal
 Decerebrate Posture
abnormalities
 Not useful when looking for bony
abnormalities
 Electroencephalography (EEG)
 More dangerous  Graphic recording of electrical
 Upper and lower extremities are activity of the brain by several small
extended electrodes placed on the scalp
 Arms are internally rotated Nursing Care
 Damage in the area of the brain  Withhold medication that may
interfere with the result ü
DIAGNOSTIC TESTS Anticonvulsants
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Sedatives  Gas a pre-headache in which the

 Stimulants patient may experience visual
 Instruct adult client to sleep no disturbance, difficulty with speaking,
more than 5 hours the night before and/or numbness or tingling
 Cerebral Angiography 2) Common Migraine
 Injection of radiopaque substance  Does not have a pre-headache, but
into the cerebral circulation via the patient experience an
carotid, vertebral, femoral or immediate onset of a throbbing
brachial artery followed by x-ray headaches
 Used to visualized cerebral vessels Four Phase of Migraine
and detect: 1. Prodromal Phase
 Tumors  Symptoms that occur hour to days
 Aneurysm before a migraine headaches
 Occlusion  Depression
 Hematomas  Irritation
 Abscesses  Feeling cold
 Anorexia
NEUROLOGIC DISORDERS  Changes in activity level
HEADACHE  Increased urination
 Other term: Cephalgia  Diarrhea/constipation
 It is a symptom rather than a disease 2. Aura Phase
entity  Last less than 1 hour
Clinical Manifestation  Characterized by focal neurologic
 Pressure pain & tight feeling in the symptoms.
temporal area  Visual disturbance (light flashes &
 Nausea bright spots)
Classification  Numbness & tingling of the lips, face
1. Primary Headache or hands
 No organic cause can be  Mild confusion
identified  Slight weakness of an extremity
Migraine  Drowsiness & dizziness
 It is a complex of symptoms 3. Headaches Phase
characterized by periodic and  Several hours of throbbing
recurrent attacks of severe headaches
headache lasting from 4 to 72 hours  Photophobia
in adults.  N/V
 Throbbing, boring, viselike and  Duration of manifestation: 4 to 72
pounding pain hours
Types of Migraine: 4. Recovery Phase
1) Classic Migraine
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Also termed as  Contraindicated: Ischemic heart

Termination/Postdrome diseases (causes chest pain)
 Pain gradually subside 2. Naratriptan
 Muscles contraction in the neck 3. Rizatriptan
 Localized tenderness 4. Zolmitriptan
 Exhaustion 5. Almotriptan
Tension-Type
 Most common type of headaches Serotonin Receptor Agonists
 Chronic & less severe 1. Ondansetron
Cluster headaches 2. Granisetron
 Severe form of vascular headaches 3. Dolasetron
 Most frequent in men
Secondary Headaches Nursing Management
 Symptom associated with an organic  Goals:
cause (brain tumor aneurysm)  Enhance pain relief
Medication Management  Treat acute event of headache
 Abortive approach  Prevent recurrent episodes
 Best use in patient who have less  Provide comfort measures
frequent attacks  Quiet, dark environment
 Aimed at relieving or limiting a  Elevation of the head of the bed
headache at the onset or while it is to 30 degrees
in progress  Application of local heat /
 Preventive approach massage
 Used in patient who experience  Administration of analgesic
more frequent attacks at regular or agents
predictable intervals  Biofeedback / Stress reduction
 May have medical condition that  This helps the patient participate
precludes the use of abortive in the treatment of the
therapies headache and provides in the
 Anti-migraine Agents treatment of the headache and
 Cause vasoconstriction, reduce provides a sense of control over
inflammation and may reduce pain his or her illness
transmission  Exercise Programs
 Meditation
Triptans
1. Sumatriptan INCREASED INTRACRANIAL PRESSURE
 Most widely used  Increase in intracranial bulk due to
 Effective for the treatment of increase in any of the major
acute migraine & cluster intracranial components: brain, CSF,
headaches or blood.
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Normal: 0 to 10 mm Hp: 15 mm Hg  Assist in administering 100% oxygen

(upper limit of normal)  Prevent Valsalva Maneuver and the
Causes activities that may increase ICP
 Brain abscesses  Administer prescribed medications:
 Hemorrhage  Mannitol
 Edema  Corticosteroid
 Hydrocephalus  Anticonvulsant
Clinical Manifestations
 Early Manifestations CEREBROVASCULAR ACCIDENT
 Changes in LOC (earliest)  Refers to a functional abnormality of
 Pupillary changes (fixed, slowed the central nervous system (CNS)
response) that that occurs when the normal
 Slowing of speech Restlessness blood supply to the brat is
 Confusion disrupted.
 Increasing drowsiness  Transient Ischemic Attack
 Late Manifestations  Neurologic deficit typically lasting
 Decorticate less than 1 hour
 Decerebrate  Sudden loss of motor, sensory or
 Cushing’s Triad both functions
 Bradycardia Types:
 Hypertension  Ischemic Stroke
 Bradypnea  Caused by thrombus (common)
Diagnostic Tests and embolus
 CT Scan & MRI (most common) Types based on cause:
 Cerebral Angiography  Large artery thrombotic strokes
 Positron Emission Tomography (PET)  Due to atherosclerotic plaques in
Scan the large blood vessels of the
Complications brain.
 Brain Stem Herniation  Small penetrating artery
 Diabetes Insipidus  Thrombotic strokes affect
 SIADH one or more vessels
Medical Management  Most common type of
 Goals: ischemic stroke
 Decreasing cerebral edema  Cardiogenic embolic strokes
 Lowering the volume of CSF  Associated with
 CSF Drainage dysrhythmias usually atrial
Nursing Management fibrillation
 Maintain patent airway  Cryptogenic Stroke
 Elevate the head of the bed 30 to -  Hemorrhagic Stroke
15 degrees unless contraindicated.
NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Caused commonly by  Excessive alcohol

hypertension consumption
Types based on cause:  Clinical Manifestations
 Intracerebral Hemorrhage Cognitive Disturbance
 Most common in patients  Confusion / Altered LOC
with hypertension & cerebral Visual-Perceptual Disturbance
atherosclerosis  Homonymous
 Intracranial Aneurysm Hemianopsia (loss of half
 Dilation of the walls of a of the visual field)
cerebral artery that develops  Loss of peripheral vision
as a result of weakness in the  Double vision
arterial wall Motor Loss
 Arteriovenous Malformation  Hemiplegia (most
 This is due to an abnormality common)
in embryonal development  Hemiparesis
that leads to a tangle of  Loss/Decrease in deep
arteries and veins in the tendon reflexes
brain without capillary bed.  Ataxia
 Subarachnoid Hemorrhage Communication Loss
 Most common cause is a leaking  Dysarthria (difficulty in
aneurysm in the area of the speaking)
Circle of Willis or a congenital  Dysphasia (impaired
AVM of the brain speech)
 Diagnostic Tests  Apraxia (inability to
 CT Scan perform a previously
 MRI learned actions)
 Angiography  Expressive Aphasia
 Risk Factors  Unable to form words
 Hypertension (major risk that are
factor) understandable
 Atrial fibrillation  May be able to speak
 Hyperlipidemia in single-word
 DM responses
 Advanced Age (>55 y/o)  Receptive Aphasia
 Race (African-American)  Unable to
 Smoking comprehend the
 Asymptomatic Carotid spoken word
Stenosis  Can speak but may
 Obesity not make sense
 Global (Mixed) Aphasia
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Combination of both  Carotid Endarterectomy

receptive and (removal of an
expressive aphasia atherosclerotic plaque or
Sensory Loss thrombus from the
 Paresthesia carotid artery)
Emotional Deficits  For Severe Stenosis:
 Loss of self-control  Carotid Stenting
 Emotional lability  Nursing Management
 Decreased tolerance to  Prevent shoulder adduction
stressful situations  Ensure patent airway
 Depression  Give 100% 02 (decreases
 Withdrawal /CP)
 Fear, hostility & anger  Maintain a quiet, restful
 Feelings of isolation environment
 Comparison of Left & Right  Position: Lateral (initially):
Hemispheric Strokes Low fowlers with neck
Left Hemispheric Right Hemispheric aligned (stable)
Stroke Stroke  Monitor VS & GCS, pupil size
 Paralysis or  Paralysis or  Provide safety measures
weakness on weakness on (Hemianopsia)
right side of the left side of  Approach client on
the body the body unaffected side
 Right visual  Left visual field  Place personal
field deficit deficit
belongings. Foods on
 Aphasia  Spatial-
unaffected side
(expressive, perceptual
 Instruct/remind the
receptive, or deficits
global)  Increased patient to turn head in
 Altered distractibility the direction of visual
intellectual  Impulsive loss to compensate for
ability behavior and loss of visual field
 Slow, cautious poor judgement  Manage dysphagia
behavior  Lack of  Check gag reflex before
awareness of feeding client
deficits  Maintain calm, unhurried
 Medical Management approach
 Thrombolytic Therapy  Upright position
 Platelet-inhibiting  Place food in unaffected
Medications side of the mouth ü Offer
 For TIA and Mild Stroke: soft foods Give mouth
NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

care before and after MENINGITIS

meals  It is an inflammation of the lining
 Manage motor deficits around the brain & spinal cord
 Place objects within the Causes
patient reach on the non-  Bacteria (Neisseria meningitides)
affected side  Viruses
 Instruct the client to  Other microorganisms
exercise and increase the May reach the brain via
strength on the  Blood
unaffected side  CSF
 Encourage the client to  Direct extension from adjacent
provide range-of-motion (Fracture of frontal or facial bones)
exercises to the affected Clinical Manifestations
side  Headache and fever (initial
 Maintain body alignment symptoms)
in functional position as  Positive Kernig's sign
needed.  Positive Brudzinski's sign
 Manage verbal deficits  Photophobia
 Encourage patient to  Nuchal rigidity
repeat sounds of the
 Opisthotonus
alphabet
Diagnostic Test
 Explore the patient's
 Bacterial culture & Gram Staining of
ability to write as an
CSF & blood through lumbar
alternative means of
puncture
communication
Medical Management
 Speak slowly and clearly
 Vancomycin
 Explore the patient's
 Cephalosporins
ability to read as an
 Dexamethasone
alternative means of
 Fluid volume expanders
communication
Nursing Management
 Speak clearly in simple
 Administer large doses of antibiotics
sentences
IV as ordered
 Use gestures or pictures
 Enforce respiratory isolation for 24
when able
hours after initiation of antibiotic
 Manage cognitive deficits
medication"
 Reorient patient to time,
 Provide bed rest; keep room dark
place and situation
and 1 quiet
frequently.
 Administer analgesics for headache
 Provide familiar objects
ordered
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Maintain fluid and electrolyte  EEG

balance Medical Management
 Monitor vital signs and neurol  Anticonvulsants
assessment frequently  Antipyretics
 Diet: High calorie, high protein,  Analgesics
small frequent feeding  Sedatives Antiviral (Acyclovir)
 Monitoring daily body weight Nursing Management
 Prevent development of pressure &  Monitor vital signs
pneumonia  Perform neurological assessment
frequently
ENCEPHALITIS  Provide nursing care for confused /
 It is an acute inflammatory process unconscious client
of brain tissue  Comfort measures to reduce stress:
Etiologic Agents  Dimming the lights
 Herpes simplex virus (most  Limiting the noise
common)  Administering analgesics
 Fungi (Cryptococcus neoformans)  Injury prevention is key because of
 Arthropod-borne virus the potential for falls and seizures
Clinical Manifestations
 Headache & fever (most presenting SEIZURES
symptoms)  Sudden abnormal and excessive
 Nuchal rigidity electrical discharges from the brain
 Confusion that can change motor or autonomic
 Decreased level of consciousness function, consciousness or
 Seizures sensation.
 Sensitivity to light  Epilepsy — it is a chronic
 Ataxia neurological disorder characterized
 Abnormal sleep patterns by recurrent seizure activity
 Tremors  Status Epilepticus
 Hemiparesis  One or a series of grand mal
Complications seizures lasting more than 30
 Cognitive Disabilities minutes without waking
 Personality Changes intervals
 Motor deficits  Etiologic Factors
 Blindness  Idiopathic
Diagnostic Tests (genetic/developmental)
 CT Scan  Traumatic brain injury
 MRI  Infection
 Lumbar puncture  Vascular diseases
 Drugs
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Chemical poison  Lasts for 30 to 60 seconds

 Drug & alcohol withdrawal  Characterized by rigidity, fixed &
 Allergies dilated pupils, hands and jaws
Classifications of Seizures are clenched
1. Partial Seizures  Patient's breathing may
 Seizures beginning locally temporarily stop
 Repetitive purposeless behaviors  Urinary incontinence
(classic symptoms) Cyclonic
 Patient appears to be in a  Repeated shock like, often
dream-like state while picking at violent contractions in one or
his / her clothing, chewing or more muscle.
smacking his or her lips Diagnostic Tests
 Simple Partial  EEG (most useful test)
 Does not lose consciousness  CT Scan
 Symptoms confined to one  MRI
hemisphere Nursing Management
 Affectation of the motor change During Seizure
in posture), sensory  Remove harmful objects from the
(hallucinations), or autonomic patient's surrounding
(flushing / tachycardia)  Ease the client to the floor
 Lasts for less than 1 minute  Protect the head of the patient
 Complex Partial  Observe and note for the duration,
 Also termed as psychomotor parts of the body affected, behaviors
seizure before and after the seizure
 Consciousness is lost  Loosen constrictive clothing
 May last from 2 to 15 minutes  Do not restrain, or attempt to place
2. Generalized Seizures tongue blade or insert oral airway
 Entire cerebral cortex is involved After Seizure
Absence Seizures  Document the events during and
 Also referred to as petit mal after the seizure
seizure  Side-lying position (prevent
 Most often seen in children aspiration)
 Manifested by a period of staring  Suction equipment should be
for several seconds available
 Precipitated by stress,  Place bed in low position
hypoglycemia, fatigue,
hyperventilation. MYASTHENIA GRAVIS
Tonic-clonic  Defect in transmission of nerve
 Also termed as grand mal impulse at the myoneural junction
seizures
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Deficiency in acetylcholine due to  Place client in fowlers position

increased acetylcholine destruction  Offer thick fluids
Causes  Flex the neck during feeding
 Unknown (prevent aspiration)
 Autoimmune  Administer medication 20-30
Clinical Manifestations minutes before meals
 Diplopia & Ptosis (earliest)  Administer medication based on the
 Dysphonia (voice impairment) scheduled time
 Dysarthria  Protect from falls due to weakness
 Generalized weakness  Start meal with cold beverages to
 Respiratory paralysis (cause of improve ability to swallow
death)  Avoid exposure to infection Provide
Diagnostic Tests adequate rest and activity
 Tensilon Test (Edrophonium Myasthenic Crisis
chloride)  Caused by undermedication
 Fast-acting acetylcholinesterase  Increase BP & HR
inhibitor  Increase Secretions
 Positive (+) = resolved facial  Intervention: Give Neostigmine
muscle weakness & ptosis (5 Cholinergic Crisis
minutes)  Caused by overmedication
 Atropine sulfate = for  Weakness with difficulty of
edrophonium toxicity swallowing
 EMG  Intervention: Discontinue all
 Detects delay or failure of cholinergic drugs
neuromuscular transmission.
Treatment MULTIPLE SCLEROSIS
 Pyridostigmine (first line of therapy)  Degenerative disease
 Neostigmine  Demyelination of the nerve fibers
 Plasmapheresis (plasma exchange;  Chronic, slowly progressive
centrifugation of plasma in order to  Characterized by periods of
separate packed cells and plasma) remission and Exacerbation
 Thymectomy Causes
Medications to be AVOIDED  Unknown
 Muscle relaxant  Post viral infection
 Barbiturates Diagnostic Tests
 Morphine sulfate  MRI
 Tranquilizers  Electrophoresis (CSF)
 Neomycin  EEG
Nursing Interventions Clinical Manifestations
 Assess gag reflex before feeding  CHARCOT'S TRIAD
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Scanning speech  Warm packs (minimizes spasticity of

 Intentional tremors contractures)
 Nystagmus  Avoid hot baths (increases risk for
 Visual Disturbances burn injury)
 Blurring of vision  Swimming & stationary bicycling are
 Diplopia useful in treating muscle spasticity
 Patchy blindness  Strenuous exercises are to be
 Total blindness avoided (this may exacerbate
 Sensory Nerve Disturbances symptoms)
 Paresthesia  Instruct client to prevent cuts and
 Proprioception loss burns
 Pain  Eye patch for diplopia
 Cognitive Disturbance  Respiratory distress precautions
 Memory loss  Bowel and bladder program
 Decreased concentration
 Dementia GUILLAIN — BARRE SYNDROME
 Poor abstract reasoning  An autoimmune attack of the
 Cerebellum / Basal Ganglia peripheral nerve myelin
Involvement  Acute, rapid segmental
 Ataxia demyelination of peripheral nerves
 Tremors and some cranial nerves
 Weakness of muscle in throat  Neuromuscular disease
and face  More frequent in males
 Others: Causes
 Bowel & Bladder dysfunction  Unknown
 Importance  Post viral infection
 Muscle hypertonicity Diagnostic Tests
Management  EMG
Pharmacologic Therapy  CSF
 Interferon beta  ECG
 Methylprednisolone Clinical Manifestations
 Baclofen (medication of choice for  Diminished reflexes and muscle
spasticity) weakness that goes upward
 Steroids  Clumsiness (initial symptom)
Nursing Management  Paralysis of the diaphragm
Promoting physical mobility  Dysphagia
 Walking  Respiratory depression
 Use of assistive devices  Paresthesia
Others:  Paralysis of the ocular muscles
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Ataxia  Rigidity
Complications  Bradykinesia
 Respiratory failure  Postural instability
 Cardiac dysrhythmias Others
 Transient hypertension  Pill rolling (fingers)
 Orthostatic hypotension  Mask-like face
 Pulmonary embolism  Monotone speech
Medical Management  Drooling of saliva
 Plasmapheresis  Excessive and uncontrolled sweating
 Corticosteroids  Festinating gait
Nursing Management  Gastric and urinary retention
 Mostly supportive  Micrographia (very minute and
 Maintain adequate ventilation often illegible handwriting)
 Incentive spirometry  Dysphonia (abnormal voice quality
 Chest physiotherapy caused by weakness and
 Perform range-of-motion incoordination of speech muscles)
 Assess gag reflex before starting the
feeding Pathophysiology
 Monitor vital signs
 Check cranial nerve function Destruction of dopaminergic neuronal cells
 Administer corticosteroids to in the substantia nigra
suppress immune function
Depletion of dopamine stores
PARKINSON'S DISEASE
 It is a slowly progressing neurologic Degeneration of the dopaminergic pathway
movement disorder that eventually
leads to disability Imbalance of excitatory (acetylcholine) &
 Associated with decreased levels of inhibiting neurotransmitters in the corpus
dopamine striatum
Causes
 Idiopathic Impairment of extrapyramidal tracts
controlling complex body movement
 Degenerative
 Viral infection
Sign: Tremors, Rigidity Bradykinesia, Postural
 Head trauma
changes
 Use of anti-psychotic medications
 Excessive accumulation of oxygen
free radicals Diagnostic Tests
Clinical Manifestations  PET Scan
Cardinal Signs  Single Photon Emission Computed
 Tremors Tomography (SPECT)
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 It is a three-dimensional imaging  Provide warm baths and

technique that uses massage
radionuclides and instruments to  Increase fluid intake to prevent
detect single photons. constipation
Management  Aspiration Precaution
Pharmacologic Treatment  Provide semi-solid diet and thick
1. Anti-parkinsonian Drugs fluids
 Levodopa (most effective agent  Use of small electronic amplifier
and the mainstay of treatment) may lessen client's hearing deficit
 Carbidopa Health Teaching during Levodopa Therapy
2. Anti-viral Drugs Side Effects of Levodopa
 Amantadine  Nausea & vomiting
3. Dopamine Agonists  Orthostatic hypotension
 Bromocriptine  Insomnia
 Pergolide  Agitation
4. Antihistamines  Mental confusion
 Benadryl  Renal damage
 Phenindamine hydrochloride Drugs that block the effect of Levodopa
5. Anticholinergic Drugs  Phenothiazines
 Cogentin  Reserpine
 Artane  Pyridoxine (Vitamin B6)
 Akineton Foods to AVOID
Surgical Treatment Tuna
 Thalamotomy Pork
 Most common complications: Dried beans
Ataxia and Hemiparesis Salmon
 Pallidotomy Beef liver
 Involves destroying part of the
ventral aspect of the medial AMYOTROPHIC LATERAL SCLEROSIS
globus pallidus through electrical  Also termed as Lou Gehrig's Disease
stimulation in patients with  It is a progressive, degenerative
advanced disease condition that affects motor
 Pacemaker-like brain implants neurons responsible for the control
Nursing Management voluntary muscles.
 Improve client's mobility Causes
 Walking  Unknown
 Riding stationary bicycle  5-10% Genetically transmitted
 Swimming  Over-excitation of the
 Gardening neurotransmitter glutamate
Clinical Manifestations
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Fatigue  Promote measures to prevent

 Muscle weakness respiratory infection
 Cramps  Help client and family deal with the
 Fasciculation (spontaneous problem
contraction of the muscles)
 Dysphagia SPINAL CORD INJURY
 Difficulty of breathing  Injury to the spinal cord which
 Inappropriate emotional outburst of characterized by a decrease or loss
laughing and crying Constipation of sensory and motor functions
 Urinary urgency problem below the level of the injury.
Diagnostic Tests Causes
 Electromyography  Motor vehicle accidents
 Muscle biopsy  Gunshot
 MRI  Falls
 EEG  Sports injuries
 CSF Risk Factors
Medical Management  Young age
Glutamate Antagonist  Alcohol and drug abuse
 Riluzole  Male
Other drugs: Affectation
 Manage spasticity  Cl — C4 = Respiratory Depression
 Baclofen  C1 — C8 = Quadriplegia (with some
 Dantrolene arm and hand movement)
 Diazepam  T1 — T6 = Paraplegic, some trunk
Mechanical ventilation movement, legs paralyzed
Nursing Management  T7 — T12 = Paraplegic, good upper
 Maximize functional abilities back and abdominal strength, may
 Prevent complications of function well in wheelchair
immobility  Lumbar, Sacral & Coccygeal
 Promote self-care  Bowel, Bladder & Sexual
 Maximize effective Dysfunction
communication Diagnostic Tests
 Promote use of assistive devices  X-ray
 Ensure adequate nutrition  CT Scan
 Prevent respiratory complications  MRI
 Promote measures to maintain Complications
adequate airway  Spinal and Neurogenic Shock
 Promote measures to improve  Deep Vein Thrombosis
gas-exchange (02 therapy,  Pressure Ulcers
ventilatory assistance)  Orthostatic Hypotension
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Autonomic Dysreflexia  Profuse sweating

Management  Nasal congestion
 Respiratory function is the first  Piloerection
priority especially in cervical spinal  Bradycardia
cord injury.  Blurring of vision
 Immobilization (flat, firm surface) Management
 Cervical collar (if cervical injury is  Position the patient in sitting
suspected) position to decrease BP
 Transport client as a unit  Catheterization (bladder distention)
 Do not attempt to realign body parts  Check for fecal impaction
 Suctioning may be indicated, but  Monitor Blood pressure
used with caution  Administer anti-hypertensive agents
 Position change at least every two  DOC: Hydralazine (Apresoline)
hours
 Intermittent catheterization for ALZHEIMER'S DISEASE
bladder distention  Progressive, irreversible,
 Diet: High-calorie, High protein, degenerative neurologic disease
High-fiber  Begins with gradual losses of
 Anticoagulants cognitive function and disturbances
 Anti-embolism stockings in behavior and affect.
 Adequate hydration Etiology
 Bowel Training program (depending  Unknown/Idiopathic
on the affectation)  Viral / Bacterial infection
 Trisomy 21 (40 y/o)
AUTONOMIC DYSREFLEXIA  Decrease in the level of
 Life threatening complication that acetylcholine transferase activity in
occurs in patients with injuries the cortex and hippocampus
above the T6 level.
 Impairs the normal equilibrium
between the sympathetic and
parasympathetic divisions of the
Autonomic Nervous System.
Causes Pathophysiology
 Bladder distention (most common)
 Bowel impaction Cortical atrophy & loss of neurons
(parietal and temporal lobes)
 UTI
 Ingrown toenails Ventricular enlargement (because of
loss of brain tissue)
 Pressure ulcers
Clinical Manifestations Development of amyloid-containing
 Pounding headache neuritic plaques & neurofibrillary
tangles in cerebral cortex
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

touch)
Clinical Manifestations  Inability to write
Warning Signs Stage III  Complete dependency &
 Memory loss affecting ability to (Final) loss of language
function in job  Loss of bowel and
bladder control
 Difficulty with familiar tasks
 Progressive loss of
 Problems with language and
cognitive abilities
abstract thinking
Diagnostic Tests
 Disorientation, changes in mood and
 Cerebral biopsy (confirmatory)
personality
 Clinical examination
Stage
 MRI
Stage I  Appears healthy and
 CT Scan
(Early) alert
 Cognitive deficits are  Positron Emission Tomography
undetected  Single Photon Emission Computed
 Subtle personality Tomography
changes Medical Management
 Memory lapses and  Cholinesterase inhibitors
forgetfulness  For mild to moderate symptoms
 Seems restless and ü Enhances acetylcholine uptake
uncoordinated in the brain ü Donepezil (Aricept)
Stage II Memory deficits ü Rivastigmine (Exelon)
(Middle)  May lose ability to  Tacrine hydrochloride (Cognex)
recognize familiar  N-methyl-D-aspartate (NMDA)
places, faces and
Antagonist
objects
 Prevents over-excitation of
 May get lost in
familiar environment NMDA receptors in the brain.
 Impaired language  Memantine (Namenda)
 Difficulty with motor  Antidepressants
activity and object  Antipsychotics
recognition  Anti-anxiety
 Inability to carry out Nursing Management
ADLs Cognitive Function
 Impaired judgment  Provide a calm, predictable
 Sundowning: increased environment
agitation, wandering,  Speak in a quiet and pleasant
disorientation in the manner
afternoon and evening
 Use memory aids and cues
hours
 Astereognosis (inability  Encourage active participation
to identify objects by  Promote contact with reality
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

Safety  Provide simple recreational activities

 Remove all hazards Nutrition
 Avoid restraints (increases agitation)  Keep mealtime simple and calm
 Secure the doors from the house  One dish is offered at a time
 Supervise all activities at home (let  Cut food into small pieces
patient wear identification bracelet)  Provide familiar foods that look
Anxiety and Agitation Reduction appetizing and tastes good
 Provide constant emotional support  Provide adaptive equipment
 Keep the environment organized, necessary
familiar and noise-free
 Provide structured activities BELL'S PALSY
 Familiarize oneself with the patients  Unilateral inflammation of the
predicted responses to certain seventh cranial nerve
stressors  Produces unilateral facial weakness
Communication and paralysis
 Use clear, easy-to-understand  Rapid onset
sentences  May equally happen to both sexes
 Li  Adults (< 45 y/o)
Inflamed and edematous facial
s Cause
nerve
t  Unknown
Compression  Autoimmune
 Viral (Herpes Simplex / Herpes
Facial nerve damages Zoster)
 Bacterial infection
Occlusion of blood supply

Ischemic necrosis of the facial Pathophysiology

nerve
simple written instructions
 Patient may use nonverbal
communication
 Tactile stimuli (signs of affection)
Independence in self-care activities
 Simplify daily activities
 Collaborate with occupational
therapy
 Direct patient supervision
 Encourage patient to make decisions
Socialization
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

Clinical Manifestations  Age (25 to 55 years)

 Inability to close eye completely on  1:10, 0000
the affected side Cause
 Ptosis  Autosomal genetic transmission
 Pain around the jaw or ear Pathophysiology
 Unilateral facial weakness
 Ringing in the ear Degeneration of the corpus striatum
 Eating difficulty &caudal nucleus
 Taste distortion on the anterior
Progressive loss of normal movement and
portion of the tongue (affected side)
intellect
 Flat nasolabial fold
Diagnostic Tests Clinical Manifestations
 History and Physical Exam  Increased involuntary movements
 EMG  Cognitive progressive decline
Management  Impaired chewing & swallowing
Medications  Chorea
 Prednisone (7 to 10 days)  Dystonic posture
 Analgesics (pain control)  Dysarthria
 Antiviral drugs  Personality changes
Comfort measures  Depression
 Heat application on the involved  Psychosis
side  Hesitant speech & eye blinking
 Gentle massage Diagnostic Tests
 Electrical nerve stimulation  History and Physical Exam
Nursing Management  MRI
 Nutrition: Soft diet  CT Scan
 Instruct to chew on the unaffected  Genetic Testing
side Medical Management
 Avoid hot fluids/food  Thiothixene hydrochloride (chorea)
 Administer drugs as ordered  Haloperidol
 Artificial tears is recommended  Levodopa (rigidity)
(prevents corneal irritation) Nursing Management
 Facial exercise (grimacing; wrinkling,  Foster independence in ADL
whistling, puffing of the cheeks,  Reinforce the use of assistive
blowing out air) devices for ambulation as needed
 Aspiration precaution
HUNTINGTON'S DISEASE  Provide soft foods
 Progressive atrophy of basal ganglia  Give directions in a calm but firm
and some parts of cerebral cortex tone
 Provide safety environment
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Get emotional support from support

groups
 Seek genetic counselling

TRIGEMINAL NEURALGIA
 Other Term: Tic Douloureux
 It is a condition of the fifth cranial
nerve characterized by paroxysms of
pain in the area innervated by any of
the three branches
 Second and third branches of the Medical Management
trigeminal nerve (most common) Pharmacologic Therapy
 400 times more common in patients  Anti-seizure agents (Carbamazepine,
with Multiple Sclerosis (MS) Phenytoin)
 Men with MS > Women with MS  Alcohol or phenol injection of the
Causes Gasserian ganglion and peripheral
branches of the trigeminal nerve
 Chronic compression or irritation of
Surgical Treatment
trigeminal nerve
Microvascular Decompression of the
 Degenerative changes in the
Trigeminal Nerve
Gasserian ganglion
 With the aid of an operating
 Vascular pressure from structural
microscope, the artery loop is lifted
abnormalities encroaching on the
from the nerve to relieve the
trigeminal nerve, Gasserian ganglion
pressure, and a small prosthetic
or root entry zone
device is inserted to prevent
Clinical Manifestations
recurrence of impingement on the
 Intense recurring episodes of pain
nerve.
(sudden, jabbing, burning or
Radiofrequency Thermal Coagulation
knifelike)
 Percutaneous radiofrequency
 Episodes of pain begin and end
produces a thermal lesion on the
suddenly, lasting for few seconds to
trigeminal nerve.
minutes.
Percutaneous Balloon Micro-compression
 Unilateral pain
 Percutaneous balloon
Diagnostic Tests
microcompression disrupts large
 History of symptoms and direct
myelinated fibers in all three
observation of an attack
branches of the trigeminal nerve.
 CT Scan
Nursing Management
 MRI
Preventing Pain
 Recognize factors that may
aggravate facial pain
 NCM_116 LECTURE
TOPIC: NEUROLOGIC SYSTEM
LECTURER: DR. JEROMIE MENESES TRANSCRIBED BY: ALPHA ORTIZ

 Food that is too hot or too cold

 Jarring of the patient's bed or
chair
 Washing the face, combing hair
or brushing the teeth
 Providing cotton pads and
temperature
 Water for washing the face
 Rinse with mouthwash after eating
 Chew on the unaffected side
 Soft foods
Postoperative Care
 Sensory deficits
 Instruct not to rub the eye
 Assess the eyes for redness