NEUROLOGIC DISORDER

(Medical Surgical Nursing)

OVERVIEW OF NERVOUS SYSTEM
1. CNS vs PNS
2. Neurotransmitter
3. Lobes of the brain
4. Meninges
5. Cranial Nerves
6. Spinal Nerves
CNS: Brain and Spinal Cord
PNS: Cranial Nerves and Spinal Nerves
• Brain
• SC
Afferent (Sensory) Efferent (Motor)
2 Division:
1. Somatic (Voluntary)
2. Autonomic (Involuntary )
 Parasympathetic (Rest and Digest) Sympathetic (Fight or Flight)

BP : Decreased Increased
HR: Decreased Increased
RR: Decreased Increased
Eyes: Miosis Mydriasis (Pupil dilation)
Production of Saliva: Wet Dry
Skin: Decreased Increased
Bladder: Increased Decreased
Bowel: Increased Decreased
Bronchi: Bronchoconstriction Bronchodilation: DOC: Anaphylactic
Shock and Status Asthmaticus.
Epinephrine 1mg Wheezing:, Absence
breath sounds
Neurotransmitter
1. Serotonin: happy hormones (Depression), calm and relax
2. Acetylcholine (Ach): muscle contraction, (Myasthenia Gravis)
3. Dopamine: Inhibitory Neurotransmitter, produced in the substantia nigra
(Basal Ganglia)
Increase Dopamine : Schizophrenia (+) (Delusion, Hallucination)
Decrease Dopamine: PD (Parkinson’s Disease)
4. GABA (Gamma Aminobutyric Acid) - Inhibitory Neurotransmitter
Decrease: Anxiety and Seizure
5. Norepinephrine: SNS
LOBES OF THE BRAIN

1. Frontal – Memory, Thinking, Motor,

Judgement, concentration, Broca’s Area:
2. Parietal- Sensory and Interpretation
3. Temporal –Hearing, Memory, Balance
4. Occipital - Vision
MENINGES
Epidural Space
1. Dura Mater
Subdural Space
2. Arachnoid
Subarachnoid Space: Absorb
CSF: Choroid Plexus
3. Pia Mater
PERIPHERAL NERVOUS SYSTEM (PNS)
1. Cranial Nerves
CN I (Olfactory Nerve): Smelling (Sensory)
CN II (Optic Nerve): Visual Acuity (Snellen Chart) 20/20 (Sensory)
CN III (Oculomotor): Eye movement (Motor)
CN IV (Trochlear): Eye movement (Motor)
CN V (Trigeminal) : (Both), mastication, Facial Sensation, Corneal Reflex
CN VI (Abducens): Eye movement (Motor)
CN VII (Facial Nerve): Facial Expression, Salivation, Facial Movement
CN VIII (Vestibulocochlear, Acoustic, Auditory) : Hearing and Balance
CN IX: (Glossopharyngeal): Gag reflex, swallowing,
CN X: Vagus Nerve (Decreased RR, BP, HR), Swallowing, Voice
CN XI: Accessory (Movement trapezius and sternocleidomastoid)
CN XII: Hypoglossal (Tongue Movement)
Spinal Nerves: 31 Pairs
1. Cervical Nerve (8 pairs)- innervates head, shoulder, arms, neck,
diaphragm
C4 : connected diaphragm (Phrenic Nerve), Respiratory Arrest
2. Thoracic Nerve (12 pairs) – Chest, Back, Thorax and Abdomen
3. Lumbar Nerve: (5 pairs) – Lower extremities
4. Sacral (5 pairs): Control lower extremities, BOWEL, BLADDER, SEXUAL
5. Coccygeal Nerve (1 pair) – Lower extremities
INCREASED ICP
INCREASED ICP
Increase pressure in the brain, affecting the perfusion (blood
supply).

Monro – Kellie Hypthesis (Triad, Doctrine)

1. CSF –
2. Blood –
3. Brain Tissue –

Normal ICP: 5 – 15 mmHg, >20 mmHg,

: Ventriculostomy (Draining Blood or CSF, ICP)
CPP (Cerebral Perfusion Pressure): Amount of perfusion in the
brain
Normal: 60 – 100 mmHg
Formula: MAP – ICP
MAP: Mean Arterial Pressure (Amount Perfusion in the body
system)
MAP: D(2) + S/3: BP: 80/40: 53
ICP: 25
MAP: 70 – 100mmHg
CAUSES:
1. Infection : Meningitis, Encephalitis
2. Brain Tumor:
3. CVA – Hemorrhagic Stroke
4. Hydrocephalus – CSF buildup in your brain tissue
5. TBI (Traumatic Brain Injury) –
S/Sx:
6. Earliest Sign: ALOC (Confused, Agitated, Restless)
7. Late Sign: Cushing’s Triad (Widened Pulse Pressure/Increased Systolic BP, Bradycardia,
Bradypnea)
8. Cheyne Stokes : Rapid breathing to apnea
9. Seizure
10. Abnormal Posturing (Decorticate and Decerebrate)
11. (+) Babinski Reflex – Upper motor lesion/injury
12. Optic Nerve Damage : Pressure, Blurry vision, decreased visual acuity
MGT.
- To decrease the ICP
1. Avoid activities that will increase the ICP
- No coughing, increase intrathoracic pressure: Cough Suppressant/Anti-
tussive(Codein, Dexthromerthorphan (Benilyn DM), Butamirate (Sinecod Forte)
- No vomiting: Anti-emetics (Ondansetron, Metochlopramide), we inject the drug
SIVP, Tardive dyskenia
- No bearing, No straining, No Valsava Maneuver (Constipated): Laxatives,
Docusate Sodium (Colace), Lactulose (Cephulac)
- Head of Bed (30 degrees), midline (Avoid turning their head side to side)
- No flexion in the hips (Increase intraabdominal pressure)
- Sneezing
- No suctioning,
2. Monitor GCS (Glascow Coma Scale)
3 (EVM)- 4, 5, 6
• Eye Opening:
1. Spontaneous: 4
2. Sounds: 3
3. Pain: 2
4. Unresponsive: 1
• Verbal Response:
1. Oriented: 5
2. Confused: 4
3. Inappropriate words: 3
4. Incomprehensible sounds: 2
5. Unresponsive: 1
• Motor Response
6 = Able to follow commands
5 = Localized pain
4 = Failed to locate the pain, withdraw
3 = Decorticate Posturing
2 = Decerebrate Posturing
1 = Unresponsive
15= highest score
<8 = coma
3 = lowest score
3. Ventriculostomy = bore hole, we need to monitor signs of infection,
4. NO LUMBAR PUNCTURE/TAP: BRAINSTEM HERNIATION
5. Mannitol: Osmotic Diuretics
6. Corticosteroids: Dexamethasone
7. Anti-hypertensive
8. Anticonvulsant (Phenytoin, mouth care, gingival hyperplasia, WOF: Bone marrow
suppression, WOF: Rash (Steven Johnson Syndrome)
• Valproic Acid
• Levetiracetam
• Lamotrigine
• Gabapantine
• Carbamazepine
• Oxcarbazepine
Barbiturates:
1. Phenobarbital
2. Amubarbital
3. Secobarbital
Benzodiazepines
4. Diazepam (Valium)
5. Lorazepam
6. Clonazepam
7. Midazolam
8. Alprazolam
9. Chlordiazepoxide
10. Oxazepam
Antidote: Flumazenil
A 24-year-old male with a traumatic brain injury is admitted to the
ICU. The nurse observes the following: GCS score of 9, unilateral
dilated pupil, heart rate 48 bpm, and irregular respirations.
Intracranial pressure is measured at 25 mmHg. Which is the nurse’s
priority action?
A. Increase the head of the bed to 90 degrees
B. Administer IV mannitol as prescribed
C. Prepare the patient for an MRI scan
D. Encourage deep coughing and suctioning
A nurse is caring for a patient 6 hours post-craniotomy. The patient is
restless, has unequal pupils, and a blood pressure of 170/60 mmHg.
ICP monitor reads 28 mmHg. Which action should the nurse take first?
A. Administer prescribed hydralazine IV for hypertension
B. Reassess ICP after elevating the head of the bed to 30°
C. Notify the neurosurgeon immediately
D. Check if the patient received sedatives in the last hour
SEIZURE
SEIZURE
Increase electrical activity in the brain.
2 Neurotransmitter:
1. Glutamate: Excitatory, High
2. GABA: Inhibitory, Low
Causes:
3. Infection: Meningitis or Encephalitis
4. Hyperthermia
5. Brain Tumor
6. Hypoglycemia
7. Alcohol- Alcohol Withdrawal (Benzodiazepines)
8. Increased ICP
9. Acid-Base Imbalance
10. Hypoxia
Epilepsy: twice or more in 24 hours
Time: 1-2 mins, >5 mins (emergency), Status Epilecticus
Stages:
1. Prodromal Stage: symptoms before the actual event happen (Seizure)
- GI disturbances (VANDA) Vomiting, Anorexia, Nausea, Diarrhea, Abdominal
Pain), Anxiety, Depression
2. Aura : Warning Signs (blurry vision, dizziness, weird taste (metallic), smell,
anxiety
3. Ictus = During Seizure
= Measure the time, Side lying, place pillow, restraint (cause
trauma/injury), Do not put anything on the mouth (Cause injury), Remove
any object around the patient
4. Post-ictal= after seizure (headache, disorientation/confused, drowsy, dizzy)
Types:
1. Generalized (All lobes affected)
A. Tonic-Clonic (Grand Mal)
Tonic: Increased Tonicity of the muscle/stiff/rigid
Clonic: Rapid involuntary jerky movements
B. Absence Seizure (Petit- Mal)
- Common pediatrics
C. Atonic (Drop Attack)
- Loss muscle tonicity, brain
2. Focal (Partial)
A. Simple Partial: Aware
B. Complex Partial: Unaware, Lip smacking
Medical and NSG. MGT
- Correct the cause
1. Implement Seizure precaution:
• O2 and E-cart
• Pillow
• Padded the rails (to prevent injury)
• Bed in low position
• No Restrictive cloth
• During Seizure:
• Time the episode
• Place pillow under the head
• Position them into side lying (to drain secretions)
• Don’t restraint
• Remove any object around the patient
• Do not put anything on the mouth
After seizure:
• Reorient the patient
• Assess the level of consciousness (GCS)
• Notify the doctor
• EEG (Electroencephalogram) = analyze brain waves
Before:
1. Informed Consent
2. Painless
3. Advised to wash and apply shampoo their hair
4. Hold anticonvulsant
5. No caffeine (stimulant)
6. No need to NPO
3. Avoid stress, anxiety or triggers
4. Anticonvulsant (Phenytoin, Levetiracetam, Valproic acid)
Therapeutic Level: 10-20mcg/dL
5. Barbiturates (stimulates GABA production)
6. Benzodiazepines
A nurse enters the room and finds a client with a known seizure disorder
actively seizing in bed. Which action should the nurse take first?
A. Place a tongue blade to prevent aspiration
B. Restrain the client to prevent injury
C. Turn the client to the side and protect the head
D. Call the healthcare provider immediately
A client who had a generalized tonic-clonic seizure is now in a
postictal state, drowsy and confused. Which intervention is the
priority?
A. Perform a full neurologic assessment
B. Administer a stat dose of lorazepam
C. Maintain side-lying position and monitor airway
D. Insert a peripheral IV line
 CEREBROVASCULAR
ACCIDENT (CVA) AKA:
STROKE
CEREBROVASCULAR ACCIDENT
(CVA) AKA: STROKE
MYASTHENIA GRAVIS
A patient with myasthenia gravis develops sudden muscle weakness,
abdominal cramps, excessive salivation, and blurred vision after
receiving an additional dose of pyridostigmine due to worsening
fatigue. The nurse suspects a cholinergic crisis.
What is the priority nursing intervention?
A. Administer atropine sulfate as prescribed
B. Encourage the patient to ambulate to improve circulation
C. Increase the dose of pyridostigmine
D. Teach the patient to perform deep-breathing exercises
A patient with myasthenia gravis is prescribed corticosteroids post-
thymectomy. The patient expresses concern about side effects and asks
why steroids are necessary.
What is the best explanation the nurse can give?
A. “Steroids help suppress the immune system to reduce muscle
weakness.”
B. “Steroids will increase your muscle strength immediately.”
C. “Steroids help your body heal the surgical wound faster.”
D. “Steroids prevent infections after surgery.”
A patient with multiple sclerosis is receiving methylprednisolone during
an acute exacerbation. The nurse is monitoring for side effects. Which
of the following findings should be reported to the provider
immediately?
A. Mild leg edema
B. Elevated blood glucose of 148 mg/dL
C. New-onset fever and productive cough
D. Report of metallic taste in the mouth
A patient with multiple sclerosis asks the nurse what lifestyle changes
can help reduce relapses. Which recommendation is most
appropriate?
A. “Avoid physical activity to prevent fatigue.”
B. “Practice stress management and avoid overheating.”
C. “Eat a low-protein diet to reduce inflammation.”
D. “Get daily sun exposure to help with energy levels.”