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Neurological 7

  1. Nursing interventions
    1. Provide care of the client with increased intracranial pressure 
      1. seizure precautions 
      2. seizure care 
      3. care of the client on ventilator 
      4. care of the client undergoing surgery
    2. Maintain balanced nutrition and fluids
    3. Help with ADL as indicated
    4. Prevent complications of immobility
    5. Monitor neuro vital signs
    6. Give medications as ordered
    7. Provide emotional support with appropriate referrals
    8. Manage pain within guidelines
  2. Brain Tumors
  3. Growth of tissue within skull
    1. May be cancerous or benign
    2. Classified according to tissue type
    3. May be primary or metastatic
  4. Findings
    1. Depend on size and location of tumor
      1. frontal lobe: personality changes - classic, focal seizures, visual disturbances, hemiparesis, aphasia
      2. occipital lobe: visual hallucinations, focal seizures
      3. temporal lobe: headache, seizures
      4. parietal lobe: visual losses, seizures
      5. cerebellum: coordination or mobility difficulties
    2. Increased intracranial pressure
  5. Diagnostics
    1. History and physical exam
    2. CT scan
    3. Magnetic resonance imaging (MRI)
  6. Management
    1. Expected outcomes: remove the tumor, and minimize harm to the nervous system
    2. Depends on location and size of tumor
    3. Treatment for associated increased intracranial pressure
      1. surgery
      2. craniotomy to remove tumor
      3. stereotactic laser surgery
      4. radiation therapy for malignancy
    4. Medications for malignant tumors: chemotherapy
  7. Nursing interventions
    1. Provide:
      1. care of the client with increased intracranial pressure 
      2. care of the client undergoing
        1. surgery
        2. radiation therapy
        3. chemotherapy
      3. seizure precautions 
      4. seizure care 
      5. balanced nutrition and fluid
    2. Facilitate emotional support with referrals to support groups
  8. Peripheral Nerve and Cranial Nerve Disorders
  9. Trigeminal neuralgia (tic douloureux)
    1. Syndrome of paroxysmal facial pain
      1. middle age and older adults
      2. affects cranial nerve five (trigeminal nerve)
      3. etiology unknown
      4. involves one side only
      5. triggered by harmless events such as a breeze, hot or cold liquids
    2. Findings
      1. intense facial pain lasting about one to two minutes along the nerve branches
      2. extreme facial sensitivity
    3. Diagnostics: history and physical exam
    1. Management
      1. expected outcome: to relieve pain
      2. anticonvulsants: carbamazepine (tegretol), phenytoin (dilantin)
      3. surgery
        1. minor
        2. major - microvascular compression: move arterial loop away from posterior trigeminal root
    2. Nursing interventions
      1. help clients to name trigger points with identification of triggering incidents
      2. recommend restful environment with scheduled rest
      3. provide balaned nutrition
      4. care of the client undergoing surgery
      5. teach client
        1. medications and side effects
        2. to avoid triggering agents
        3. to chew on the opposite side of the mouth
        4. to avoid drafts
        5. to avoid very hot or cold foods
  10. Facial nerve paralysis (bell's palsy)
    1. Definition/etiology
      1. disorder of cranial nerve seven (facial nerve)
      2. involves one side only; unilateral
      3. etiology unknown
    2. Findings often occur suddenly over ten to 30 minutes
      1. ptosis
      2. cannot close or blink eye with excessive tearing
      3. flat nasolabial fold
      4. impaired taste
      5. lower face paralysis
      6. difficulty eating
    3. Diagnostics: history and physical exam
    4. Management
      1. expected outcome: to restore cranial nerve function
      2. medications
        1. prednisone
        2. analgesics
      3. local comfort measures: heat, massage and electrical nerve stimulation for muscle tone
      4. alternative actions: reiki, massage, imagery
    1. Nursing interventions
      1. provide balanced nutrition: soft diet
      2. administer drugs as ordered
      3. teach client
        1. to chew on opposite side
        2. how to use protective eye wear during risk periods
        3. effects of steroids
        4. the use of eye drugs or ointment to protect the eye from corneal irritation
        5. that once findings disappear their return may occur especially in times of high stress
  • In multiple sclerosis, early changes tend to be in vision and motor sensation; late changes tend to be in cognition and bowel control.
  • Peripheral nerves can regenerate, but nerves in the spinal cord are thought to not be able to regenerate.
  • During a seizure, do not force anything into the client's mouth.
  • A major problem often associated with a left-sided CVA is an alteration in communication.
  • Clients with CVAs are at a greater risk for aspiration. Initially these clients must be evaluated to determine if dysphagia is present.
  • The rate, rhythm and depth of a client's respirations are more sensitive indicators of increases in intracranial pressure than blood pressure and pulse.
  • When caring for a comatose client, remember that the hearing is the last sense to be lost.
  • After a CVA clients often have a loss of memory, emotional lability and a decreased attention span.
  • Communication difficulties of a client with a CVA usually indicate involvement of the dominant hemisphere, usually left, and is associated with right sided hemiplegia or hemiparesis.
  • The client with myasthenia gravis will have more severe muscle weakness in the evening due to the fact that muscles weaken with activity - described as progressive muscle weakness - and regain strength with rest.