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Increased Intracranial Pressure (pg. 666)The cranium consists of 1. Brain tissue 2. Blood3. Cerebrospinal fluid (CSF)If one or more of these increases significantly without a decrease in one or the

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Слайд 1Chapter 43: Central and Peripheral Nervous System Disorders

Chapter 43: Central and Peripheral Nervous System Disorders

Слайд 2Increased Intracranial Pressure (pg. 666)
The cranium consists of
1. Brain

tissue
2. Blood
3. Cerebrospinal fluid (CSF)
If one or more

of these increases significantly without a decrease in one or the other two, ICP becomes elevated.
Increased Intracranial Pressure (pg. 666)The cranium consists of 1. Brain tissue 2. Blood3. Cerebrospinal fluid (CSF)If

Слайд 4Increased Intracranial pressure
The skull cannot expand so a tumor, cerebral

edema, brain abscess, or bleeding compresses the brain and causes

increased intracranial pressure (ICP)
As pressure increases, the cerebral blood flow decreases and PCO2 increases causing cerebral edema which increases the ICP even more
Increased Intracranial pressureThe skull cannot expand so a tumor, cerebral edema, brain abscess, or bleeding compresses the

Слайд 5Increased Intracranial Pressure
If not recognized, the brainstem will herniate thru

the foramen magnum
brainstem controls vital signs so death will occur

Increased Intracranial PressureIf not recognized, the brainstem will herniate thru the foramen magnumbrainstem controls vital signs so

Слайд 6ICP
Signs and symptoms develop rapidly or slowly
If slow it may

be over looked
Keep check on baseline and observe closely
change in

LOC is usually earliest sign
alterations may be difficult to determine
ICPSigns and symptoms develop rapidly or slowlyIf slow it may be over lookedKeep check on baseline and

Слайд 7Level Of Consciousness
Confusion, restlessness, disorientation and drowsiness may or may

not be a symptom of impending change in LOC
Report sudden

change to Dr stat
Change in LOC is one of the earliest signs of ICP
Level Of ConsciousnessConfusion, restlessness, disorientation and drowsiness may or may not be a symptom of impending change

Слайд 8Headache
Pain is usually intermittent--if constant condition usually grave
coughing, sneezing, straining

at stool increases headache
lying in bed with head elevated reduces

ICP and headache
HeadachePain is usually intermittent--if constant condition usually gravecoughing, sneezing, straining at stool increases headachelying in bed with

Слайд 9Vomiting and ICP
Commonly occurs without warning of nausea and without

a relationship to eating
projectile in nature

Vomiting and ICP Commonly occurs without warning of nausea and without a relationship to eatingprojectile in nature

Слайд 10Papilledema
Papilledema (edema of optic nerve caused by obstruction of venous

drainage due to ICP
Can be seen only with an ophthalmoscope
Affects

pupillary response to light.
Normal pupil response to strong light is rapid constriction. In IICP the response is sluggish or nonexistent (fixed)

PapilledemaPapilledema (edema of optic nerve caused by obstruction of venous drainage due to ICPCan be seen only

Слайд 11Posturing
Decorticate--arms flexed--problem with cervical spinal tract or cerebral hemisphere
Decerebrate--arms extended

(more serious as brainstem damage, problems within midbrain or pons
see

page 660 for picture
PosturingDecorticate--arms flexed--problem with cervical spinal tract or cerebral hemisphereDecerebrate--arms extended (more serious as brainstem damage, problems within

Слайд 13Symptoms of ICP
Change in LOC
headache
vomiting
papilledema
vital signs--temp rises, b/p rises and

pulse pressure widens
pupils sluggish or fixed
decorticate or decerebrate position

Symptoms of ICPChange in LOCheadachevomitingpapilledemavital signs--temp rises, b/p rises and pulse pressure widenspupils sluggish or fixeddecorticate or

Слайд 14Vital signs
Temp rises, B/P rises and pulse pressure widens. These

3 s/s are called Cushing’s triad. A late sign in

IICP.
Pulse may increase at first but later becomes slow (40-60) and bounding
resp rate is irregular or cheyne-stokes (shallow, rapid, then decreases and then apnea)
Vital signsTemp rises, B/P rises and pulse pressure widens. These 3 s/s are called Cushing’s triad. A

Слайд 15Medical and surgical management
Osmotic diuretics (mannitol, glycerol); steroids to reduce

cerebral edema
If clot then it is removed;
surgery for depressed skull

fx, tumor or bleeding…fix the cause stat
Medical and surgical managementOsmotic diuretics (mannitol, glycerol); steroids to reduce cerebral edemaIf clot then it is removed;surgery

Слайд 16Medical & surgical management
Restrict fluids, lumbar punctures to remove CSF

and hyperventilation via ventilator to cause resp alkalosis which constricts

cerebral arteries and reduces ICP
Medical & surgical managementRestrict fluids, lumbar punctures to remove CSF and hyperventilation via ventilator to cause resp

Слайд 17Medical Management
May order:
insertion of foley
NG tube for gastric decompression or

feedings
Stool softener to prevent straining
Histamine antagonist (Pepcid) to prevent stress

ulcers
Cooling blankets if hyperthermia


Medical ManagementMay order:insertion of foleyNG tube for gastric decompression or feedingsStool softener to prevent strainingHistamine antagonist (Pepcid)

Слайд 18Normal ICP In the Ventricles
Norm: 1 to 15
Moderate ↑:

15 to 40
High: > 40 mm Hg
Although the ICP

varies, a rise of 2 mm HG from a previous measurement is cause for concern.

Normal ICP In the Ventricles Norm: 1 to 15Moderate ↑: 15 to 40 High: > 40 mm

Слайд 19Nursing care ICP
Teach to remain quiet in bed and not

to turn in bed without help
avoid ROM until ICP normal

and Dr orders
suction only when absolutely necessary…gently remove secretions with gauze
give oxygen before suctioning
Nursing care ICPTeach to remain quiet in bed and not to turn in bed without helpavoid ROM

Слайд 20Nursing Care ICP
ICP can affect temp regulation so cooling blanket

may be needed
Neuro assessment should be done q 30 min
Avoid

extreme flexion of hip because this increases intraabdominal, ICP and intrathoracic pressure
Nursing Care ICPICP can affect temp regulation so cooling blanket may be neededNeuro assessment should be done

Слайд 21Nursing Care ICP
A neurologic flow sheet that includes the Glasgow

Coma Scale or Ranchos Los Amigos Scale and ICP pressure

measurement (see chapter 42) is used to establish a data base and record
Intake and output and daily weights are recorded to monitor the fluid and nutritional status of the client.
Nursing Care ICPA neurologic flow sheet that includes the Glasgow Coma Scale or Ranchos Los Amigos Scale

Слайд 22Nursing Care ICP
Laboratory findings such as serum electrolyte levels and

arterial blood gas measurements are analyzed to detect fluid, electrolyte,

and acid-base complications, or to evaluate the effectiveness of medical management.
Bowel sounds are present in all quad’s and palpated to determine if there is distention.
Bowel elimination patterns are monitored.
Nursing Care ICPLaboratory findings such as serum electrolyte levels and arterial blood gas measurements are analyzed to

Слайд 23Nursing Care ICP
Keep head straight and head of bed slightly

elevated
If a basal skull fx and ICP may be kept

flat but in no case must the head be allowed to be lower than body
Reduce noise and bright lights, limit movement, space activity
Nursing Care ICPKeep head straight and head of bed slightly elevatedIf a basal skull fx and ICP

Слайд 24Activities That increase ICP
Coughing
range of motion exercises
sneezing
hip flexion of 90

degrees or greater
vomiting
suctioning

Activities That increase ICPCoughingrange of motion exercisessneezinghip flexion of 90 degrees or greatervomiting suctioning

Слайд 25Activities that increase ICP
Straining to have a BM (valsalva maneuver
holding

breath
digging heels into bed to help in repositioning
turning in bed

without help
Activities that increase ICPStraining to have a BM (valsalva maneuverholding breathdigging heels into bed to help in

Слайд 26Nursing Care ICP
Hourly I&O may be done
If steroids given, monitor

glucose as ordered
test stools for blood
assess bowel and bladder elimination

and prevent straining
complete care given until ICP normal
monitor temp q 4 hours & prn
Nursing Care ICPHourly I&O may be doneIf steroids given, monitor glucose as orderedtest stools for bloodassess bowel

Слайд 27Nursing Care ICP
Monitor I&O…fluids may be restricted to reduce cerebral

edema and prevent vomiting and coughing which raise pressures
calculate IV

fluids so given over 24 hours
nutrition may be total parenteral nutrition (TPN)
assess skin turgor and electrolytes
Nursing Care ICPMonitor I&O…fluids may be restricted to reduce cerebral edema and prevent vomiting and coughing which

Слайд 28Infectious & Inflammatory Disorders
Meningitis
Encephalitis
Gullian-Barre Syndrome
Poliolmyelitis
Brain Abscess

Infectious & Inflammatory DisordersMeningitisEncephalitisGullian-Barre SyndromePoliolmyelitisBrain Abscess

Слайд 29Meningitis (Covering of the Brain) pg 669
Inflammation of meninges (three

membranes that cover the brain-dura, arachnoid, & pia mater)
May affect

cerebral cortex and decrease blood flow to the brain
Meningococcus, strept, staph and pneumococcus most common cause (contagious—meningococcal)
Reaches brain by the bloodstream or ear or sinus infection
Meningitis (Covering of the Brain) pg 669Inflammation of meninges (three membranes that cover the brain-dura, arachnoid,

Слайд 31Meningitis
Most adults with bacterial meningitis recover without permanent neurologic damage

or dysfunction.
When complications do occur, they usually are serious.

MeningitisMost adults with bacterial meningitis recover without permanent neurologic damage or dysfunction.When complications do occur, they usually

Слайд 32Meningitis S/S
Fever, nuchal rigidity (pain and stiffness of neck); inability

to place chin on chest
nausea and vomiting, photophobia, headache, restlessness,

irritability and seizures
severe may cause opisthotonus (arching of back and neck hyperextended
Meningitis S/SFever, nuchal rigidity (pain and stiffness of neck); inability to place chin on chestnausea and vomiting,

Слайд 33Kernig’s Sign
Positive Kernig’s sign ( inability to extend the

leg when the thigh is flexed on abdomen

Kernig’s Sign Positive Kernig’s sign ( inability to extend the leg when the thigh is flexed on

Слайд 34Brudzinsi’s Sign
Brudzinski’s sign--flexion of neck produces flexion of knees

and hips

Brudzinsi’s Sign Brudzinski’s sign--flexion of neck produces flexion of knees and hips

Слайд 35Diagnostic findings: Meningitis
Lumbar puncture done
if bacterial meningitis the CSF is

cloudy and pressure is elevated, glucose is decreased, protein is

elevated and WBC & RBCs are elevated
Cultures are done
If culture negative then it is viral in nature
Diagnostic findings: MeningitisLumbar puncture doneif bacterial meningitis the CSF is cloudy and pressure is elevated, glucose is

Слайд 37Medical Management
IV fluids, antibiotics, anticonvulsants are used to treat
sulfonamide

given to people who are exposed
observe for altered LOC, signs

of airway obstruction and cardiac arrhythmias
Medical Management IV fluids, antibiotics, anticonvulsants are used to treatsulfonamide given to people who are exposedobserve for

Слайд 38Encephalitis (Brain Inflammation) pg 676
Infectious disease of CNS characterized by changes

in both white and gray matter of spinal cord and

brain
Extensive nerve cell destruction may occur

Encephalitis (Brain Inflammation) pg 676 Infectious disease of CNS characterized by changes in both white and gray

Слайд 39Encephalitis (brain inflammation)
Symptoms similar to meningitis
Caused by bacteria, fungi, or

virus
cause virus: Polio, herpes, measles, mumps, chickenpox, mono, hepatitis,,St. Louis

virus and Eastern and Western equine virus

Encephalitis (brain inflammation)Symptoms similar to meningitisCaused by bacteria, fungi, or viruscause virus: Polio, herpes, measles, mumps, chickenpox,

Слайд 40Encephalitis
occurs after a viral infection elsewhere (measles or vaccinations)
Poisoning by

drugs and chemicals, such as lead, arsenic, or Carbon monoxide,

may closely resemble encephalitis clinically!!!

Encephalitisoccurs after a viral infection elsewhere (measles or vaccinations)Poisoning by drugs and chemicals, such as lead, arsenic,

Слайд 41Encephalitis
Onset of viral is sudden with fever, severe headache, stiff

neck, vomiting and drowsiness
lethargy is a prominent symptom and coma

and delirium may occur
Tremors, seizures, spastic or flaccid paralysis, irritability
EncephalitisOnset of viral is sudden with fever, severe headache, stiff neck, vomiting and drowsinesslethargy is a prominent

Слайд 42Encephalitis
Muscle weakness, incoordination, incontinence and visual disturbances (photophobia, involuntary eye

movement, double or blurred vision may occur
speech changed, increased ICP

and shock
EncephalitisMuscle weakness, incoordination, incontinence and visual disturbances (photophobia, involuntary eye movement, double or blurred vision may occurspeech

Слайд 43Encephalitis--brain inflammation
Lumbar puncture done…CSF pressure elevated but fluid clear
EEG has

slow wave forms
treatment supportive only as viral
Total care, LOC, vital

signs monitored
Encephalitis--brain inflammationLumbar puncture done…CSF pressure elevated but fluid clearEEG has slow wave formstreatment supportive only as viralTotal

Слайд 44Encephalitis
Mild cases are common and may go unrecognized
complications and deaths

are more common in infants and elderly
usually recover in 2-3

weeks unless severe
EncephalitisMild cases are common and may go unrecognizedcomplications and deaths are more common in infants and elderlyusually

Слайд 45Guillain-Barre’ syndrome Pg.677
Rare, inflammatory condition involving the CNS that causes

rapid weakness and loss of sensation.
History of recent infection (esp.

resp tract); recent surgery or vaccinations
also seen in malignancy and Lupus.
The affected nerves become inflamed and edematous.
Mild to severe ascending muscle weakness or paralysis develops.
Guillain-Barre’ syndrome Pg.677Rare, inflammatory condition involving the CNS that causes rapid weakness and loss of sensation.History of

Слайд 46Guillain-Barre’ Syndrome
May be autoimmune response to viral infection
Takes approx 1

month to start improving and may take 1 year or

longer to recover
Muscle weakness or paralysis can occur and be permanent.
Immobility complications kills (pneumonia & infection)
Guillain-Barre’ SyndromeMay be autoimmune response to viral infectionTakes approx 1 month to start improving and may take

Слайд 47Guillain Barre’ Syndrome
Weakness, tingling, and numbness in arms and legs

may be 1st symptoms
Weakness usually starts in legs and moves

to arms and face
may affect the muscle of respiration
Muscle weakness may be followed by paralysis.
chewing, talking, and swallowing become difficult if cranial nerves involved

Guillain Barre’ SyndromeWeakness, tingling, and numbness in arms and legs may be 1st symptomsWeakness usually starts in

Слайд 48Medical Management Guillian Barre’
Plasmaphoresis removal of plasma from the blood

and reinfusion of the cellular components with saline, has been

shown to shorten the course of the DX. If performed within the first 2 weeks.
If the respiratory muscles are involve, endotracheal intubation & mechanical ventilation become necessary.
Difficulty chewing—may need IV fluids, gastric feedings, or TPN
Medical Management Guillian Barre’Plasmaphoresis removal of plasma from the blood and reinfusion of the cellular components with

Слайд 50Nursing Management
Monitory respiratory status/distress
Use IS
R/T incapacitated by immobility, provide meticulous

skin care and change position every 2 hours.
Give passive ROM

q 2 hours


Nursing ManagementMonitory respiratory status/distressUse ISR/T incapacitated by immobility, provide meticulous skin care and change position every 2

Слайд 51Brain abscess Pg. 678
A collection of pus caused by a

bacterial infection in the brain—if untreated it can be fatal!!
Causes:

infection that spreads from an infected skull (osteomyelitis, mastoiditis, sinusitis)
infection spreads thru bloodstream or trauma
Brain abscess Pg. 678A collection of pus caused by a bacterial infection in the brain—if untreated it

Слайд 53Brain abscess
May occur from infection of teeth, sinus, middle ear,

or from an infection in other organs.
common after endocarditis, pulmonary

or abdominal infection, or intracranial surgery
fever, headache, ↑ IICP s/s, seizures, muscle weakness, paralysis and lethargy
Brain abscessMay occur from infection of teeth, sinus, middle ear, or from an infection in other organs.common

Слайд 54Brain abscess
Risk increases with head injury, illness that lowers resistance

(esp. diabetes) recent infection (esp around eye, nose, or face)

Iv drug users and immuno-suppressed
Brain abscessRisk increases with head injury, illness that lowers resistance (esp. diabetes) recent infection (esp around eye,

Слайд 55Brain abscess
I&O fluids may be restricted as over-hydration may cause

cerebral edema
antibiotics usually given 4 to 6 weeks; craniotomy may

be needed
seizure precautions; pad side rails, decrease stimuli
Brain abscessI&O fluids may be restricted as over-hydration may cause cerebral edemaantibiotics usually given 4 to 6

Слайд 56General Nursing Care for Inflammatory Disorders
Swallowing may be affected---give PO

drugs slowly…no narcotics
REPORT sudden increase in headache
Dr. must order ROM

but turn and give skin care….cooling blanket may be needed for temp
General Nursing Care for Inflammatory DisordersSwallowing may be affected---give PO drugs slowly…no narcoticsREPORT sudden increase in headacheDr.

Слайд 57Nursing Care for Inflammatory Disorders
Monitor vitals…complete care
neuro checks…use Glasgow Coma

scale
Seizure precautions—insert a padded tongue blade in the mouth ONLY

IF THE TEETH ARE NOT TIGHTLY SHUT!!
lung sounds and suction PRN******caution it raises ICP
elevate head of bed 30 degrees
keep oral airway at bedside
Nursing Care for Inflammatory DisordersMonitor vitals…complete careneuro checks…use Glasgow Coma scaleSeizure precautions—insert a padded tongue blade in

Слайд 58Neuromuscular disorders PG 678
Involves the nervous system and indirectly affects

the muscles
Multiple Sclerosis
Myasthenia Gravis
Amyotrophic lateral sclerosis (Lou Gehrig)

Neuromuscular disorders PG 678Involves the nervous system and indirectly affects the musclesMultiple SclerosisMyasthenia GravisAmyotrophic lateral sclerosis (Lou

Слайд 59Multiple sclerosis PG 678
Chronic, progressive disease of the peripheral nerves.
Onset

in young adult and early middle life (20 to 40)
May

be autoimmune
people in colder climates at higher risk

Multiple sclerosis PG 678Chronic, progressive disease of the peripheral nerves.Onset in young adult and early middle life

Слайд 60Multiple sclerosis
Permanent degeneration as patchy destruction of myelin sheath of

nerve fibers of brain and spinal cord
Impulses cannot go thru

without myelin so muscles become paralyzed
scar tissue replaces myelin (sclerotic)
Multiple sclerosisPermanent degeneration as patchy destruction of myelin sheath of nerve fibers of brain and spinal cordImpulses

Слайд 61Multiple sclerosis
Myelin sheath swells (exacerbation) when it is deteriorating
when swelling

goes down then there is a remission
may go for years

without symptoms
each exacerbation causes the symptoms to last longer and more severe

Multiple sclerosisMyelin sheath swells (exacerbation) when it is deterioratingwhen swelling goes down then there is a remissionmay

Слайд 62Multiple sclerosis
Weakness of arms and legs may progress to paraplegia
may

be incontinent
visual disturbances may eventually progress to blindness
infection and emotional

upsets may cause exacerbations
NO CURE
Multiple sclerosisWeakness of arms and legs may progress to paraplegiamay be incontinentvisual disturbances may eventually progress to

Слайд 63Multiple sclerosis
Intellectual functioning may be impaired late in disease
loss of

memory, impaired judgment
shallow breathing can cause pneumonia (most common cause

of death)
may live 20 years with the disease
Multiple sclerosisIntellectual functioning may be impaired late in diseaseloss of memory, impaired judgmentshallow breathing can cause pneumonia

Слайд 64Drugs for MS
Lioresal and Dantrium--muscle spasticity and rigidity
Antibiotics, urinary infectives,

tranquilizers for mood swings
Ditropan---urinary incontinence
Urecholine for retention
Steroids

Drugs for MSLioresal and Dantrium--muscle spasticity and rigidityAntibiotics, urinary infectives, tranquilizers for mood swingsDitropan---urinary incontinenceUrecholine for retentionSteroids

Слайд 65Nursing
Sensory impairment: be careful with hot, cold, avoid injury
REST, conserve

energy
Polyunsaturated fate, linoleic acid--found in sunflower oil may help

NursingSensory impairment: be careful with hot, cold, avoid injuryREST, conserve energyPolyunsaturated fate, linoleic acid--found in sunflower oil

Слайд 66Myasthenia Gravis pg 681
Disorder of muscles, with increasing fatigue and

weakness as muscles are used
Fatigue appears to be caused by

a defect in nerve impulses from nerve endings to muscles
Receptor sites destroyed
Thought to be autoimmunne
Myasthenia Gravis pg 681Disorder of muscles, with increasing fatigue and weakness as muscles are usedFatigue appears to

Слайд 67Myasthenia Gravis
Most common symptoms are ptosis of eyelids, difficulty chewing

and swallowing, diplopia, voice weakness, masklike facial expressions and weakness

of arms and legs
May affect respirations

Myasthenia GravisMost common symptoms are ptosis of eyelids, difficulty chewing and swallowing, diplopia, voice weakness, masklike facial

Слайд 68Myasthenia Gravis
Diagnosed by giving IV Tensilon which relieves symptoms in

a few seconds if it is Myasthenia
Chest x-ray may show

tumor of thymus

Myasthenia GravisDiagnosed by giving IV Tensilon which relieves symptoms in a few seconds if it is MyastheniaChest

Слайд 69Myasthenia gravis
Treatment is Mesitonon or Myelelase
Atropine is antidote for mestinon

and other anticholinesterase drugs
Thymus gland may be surgically removed as

it may cause destruction of nerve endings
Myasthenia gravisTreatment is Mesitonon or MyelelaseAtropine is antidote for mestinon and other anticholinesterase drugsThymus gland may be

Слайд 70Mestinon or Mytelase
Observe for drug overdose….abdominal cramps, clenched jaws, muscle

rigidity
Give drug at exact intervals to maintain therapeutic blood levels
Watch

for resp distress if drugs not affective
May aspirate as cannot swallow
Mestinon or MytelaseObserve for drug overdose….abdominal cramps, clenched jaws, muscle rigidityGive drug at exact intervals to maintain

Слайд 71Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682
Progressive, fatal neuro disorder of

unknown cause
Degeneration of motor neurons of CNS which causes wasting

and weakness of muscles
Fasciculations (twitching) and difficulty speaking or swallowing
Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682Progressive, fatal neuro disorder of unknown causeDegeneration of motor neurons of CNS

Слайд 72Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682
Periods of inappropriate laughter or

crying
Causes resp failure and total paralysis
No specific tests or treatment
Care

is supportive…may need help with ADLs
Will become total care

Amyotrophic Lateral Sclerosis--Lou Gehrig’s Disease 682Periods of inappropriate laughter or cryingCauses resp failure and total paralysisNo specific

Слайд 73Cranial Nerve disorders Pg. 683
Trigeminal Neuralgia (Tic douloureux)
Bell’s palsy
Temporomandibular Disorder

(TMD)

Cranial Nerve disorders Pg. 683Trigeminal Neuralgia (Tic douloureux)Bell’s palsyTemporomandibular Disorder (TMD)

Слайд 74Trigeminal Neuralgia (Tic douloureux) pg 683
Painful condition that involves the

5th cranial nerve—which has 3 major branches: mandibular, maxillary &

ophthalmic.
This sensory and motor nerve is important to chewing, facial movement, and sensation.
Trigeminal Neuralgia (Tic douloureux) pg 683Painful condition that involves the 5th cranial nerve—which has 3 major branches:

Слайд 75Trigeminal Neuralgia (Tic douloureux) pg 683
Attacks can be initiated by

slight stimulus such as cold, heat, light touch and air,

vibration of music, a passing breeze, a temperature change
Trigeminal Neuralgia (Tic douloureux) pg 683Attacks can be initiated by slight stimulus such as cold, heat, light

Слайд 76Trigeminal Neuralgia
The pain is described as sudden, severe, and

burning
It ends as quickly as it began, usually lasting a

few seconds to several minutes.
The cycle is repeated many times a day
During a spasm, the face twitches and the eyes tear.
Trigeminal Neuralgia The pain is described as sudden, severe, and burningIt ends as quickly as it began,

Слайд 77Trigeminal Neuralgia
Analgesics, surgery on nerve root or branches
post op there

is no feeling in the area
corneal reflex (blinking) may be

gone so need eye drops and shield
Trigeminal NeuralgiaAnalgesics, surgery on nerve root or branchespost op there is no feeling in the areacorneal reflex

Слайд 78Trigeminal Neuralgia
Slightest stimulus may start attack (vibration from music, breeze,

temp change
they avoid washing face, shaving
forehead over eyebrow is a

common trigger spot so avoid touching face
Do not jar the bed

Trigeminal NeuralgiaSlightest stimulus may start attack (vibration from music, breeze, temp changethey avoid washing face, shavingforehead over

Слайд 79Trigeminal Neuralgia
Post-op eating may be a problem as may bite

tongue without knowing it
food gets caught in mouth and swallowing

is difficult as they lose sensation after nerve cut
small sips, inspect mouth for breaks in mucus membranes
Trigeminal NeuralgiaPost-op eating may be a problem as may bite tongue without knowing itfood gets caught in

Слайд 80Trigeminal Neuralgia (Tic Douloureux)
Chew on opposite side
Avoid hot and cold

foods and use mouth rinses after eating
dental appointment to check

for problems as no sensations from cavity or abscess
Trigeminal Neuralgia (Tic Douloureux)Chew on opposite sideAvoid hot and cold foods and use mouth rinses after eatingdental

Слайд 81Trigeminal Neuralgia
Dilantin and tegretol used to reduce pain as analgesics

not too successful
narcotics may be given
Dentist should be seen as

may be caused by dental deformities
Trigeminal NeuralgiaDilantin and tegretol used to reduce pain as analgesics not too successfulnarcotics may be givenDentist should

Слайд 82Bell’s Palsy
7th cranial nerve—responsible for movement of the facial muscles
facial

nerve usually affects one side

Bell’s Palsy7th cranial nerve—responsible for movement of the facial musclesfacial nerve usually affects one side

Слайд 83Bell’s Palsy
causes weakness and paralysis of facial muscles and eyelid
facial

pain, pain behind ear, numbness
diminished blink reflex
ptosis of eyelid, tearing

of affected side

Bell’s Palsycauses weakness and paralysis of facial muscles and eyelidfacial pain, pain behind ear, numbnessdiminished blink reflexptosis

Слайд 84Bell’s Palsy
Speech and chewing difficulty may occur
Must rule out CVA,

tumor
no specific test
Prednisone, analgesics, electrotherapy to prevent atrophy of facial

muscles
most show improvement in a few weeks

Bell’s PalsySpeech and chewing difficulty may occurMust rule out CVA, tumorno specific testPrednisone, analgesics, electrotherapy to prevent

Слайд 85Bell’s palsy
If ptosis and blinking reflex affected must wear eye

patch
corneal ulcerations and infection of eye may develop
eye shield at

night
antibiotic ointment in eye
eye assessment needed
Bell’s palsyIf ptosis and blinking reflex affected must wear eye patchcorneal ulcerations and infection of eye may

Слайд 86Temporomandibular Disorder pg 685
TMD is a cluster of symptoms that

are localized at and about the jaw.
TMD caused by

arthritis of mandibular joint, malocclusion of teeth, and excessive movement of jaw at time of endotracheal intubation in general anesthsesia

Temporomandibular Disorder pg 685TMD is a cluster of symptoms that are localized at and about the jaw.

Слайд 87TMD S/S
Jaw pain, headache, tinnitus, ear pain
clenching of jaw,

inability to open mouth
Clicking of the jaw when the joint

is moved, or the jaw can lock, which interferes with opening the mouth

TMD S/S Jaw pain, headache, tinnitus, ear painclenching of jaw, inability to open mouthClicking of the jaw

Слайд 88TMD S/S
Pronounced spasm and tenderness of the masseter and

temporalis muscles
Dental x-rays help with diagnosis

TMD S/S Pronounced spasm and tenderness of the masseter and temporalis musclesDental x-rays help with diagnosis

Слайд 89TMD Medical Management
Treatment is referred to a dentist
Analgesics are prescribed
Custom-fitted

mouth guard is worn during sleep

TMD Medical ManagementTreatment is referred to a dentistAnalgesics are prescribedCustom-fitted mouth guard is worn during sleep

Слайд 90TMD Medical Management
TENS (transcutaneous electrical nerve stimulation), injection of a

local anesthetic to relieve muscle spasm, and ice water oral

irrigations are also used to reduce and relieve discomfort.
Surgery is available if conservative methods are ineffective
TMD Medical Management TENS (transcutaneous electrical nerve stimulation), injection of a local anesthetic to relieve muscle spasm,

Слайд 91Extrapyramidial disorders pg 686
Parkinson’s disease
Huntington’s disease
One primary characteristic is abnormal

movement.

Extrapyramidial disorders pg 686Parkinson’s diseaseHuntington’s diseaseOne primary characteristic is abnormal movement.

Слайд 92Parkinson’s
Usually begins after age 50
early signs include stiffness, tremors of

hands, pill rolling and difficulty performing movement
Tremors decrease with voluntary

movement
Parkinson’sUsually begins after age 50early signs include stiffness, tremors of hands, pill rolling and difficulty performing movementTremors

Слайд 93Parkinson’s
Intention tremor: when tremors increase during voluntary movement…may be seen

in some patients
Later, tremors of head, mask-like expression, stooped posture
Monotonous

speech and shuffling gait

Parkinson’sIntention tremor: when tremors increase during voluntary movement…may be seen in some patientsLater, tremors of head, mask-like

Слайд 94Parkinson’s
Have difficulty turning or redirecting forward motion
arms seldom swing while

walking
rigidity develops more than tremors
reflexes and power of contraction are

not affected but speed and movement are

Parkinson’sHave difficulty turning or redirecting forward motionarms seldom swing while walkingrigidity develops more than tremorsreflexes and power

Слайд 95Parkinson’s
Levodopa and cogentin are drugs of choice
physical therapy…in extreme cases

surgery done to destroy part of the thalamus so excessive

muscle contraction decreased
fetal tissue transplanted in brain has helped some patients

Parkinson’sLevodopa and cogentin are drugs of choicephysical therapy…in extreme cases surgery done to destroy part of the

Слайд 96Parkinson’s
Symptoms usually begin on one side and may take 15

years to spread bilaterally
late symptom is drooling and problems with

swallowing
eyes may roll up or down and stay in that position for days
Parkinson’sSymptoms usually begin on one side and may take 15 years to spread bilaterallylate symptom is drooling

Слайд 97Huntington’s Disease pg. 689
Hereditary, degeneration of basal ganglia and cerebral

cortex
Causes mental apathy, emotional disturbances, choreiform movement (uncontrollable withering and

twisting of body) grimacing

Huntington’s Disease pg. 689Hereditary, degeneration of basal ganglia and cerebral cortexCauses mental apathy, emotional disturbances, choreiform movement

Слайд 98Huntington’s
Treatment is supportive, no cure
tranquilizers and antiparkinsonian drugs to relieve

choreiform movements
late in the disease, may have hallucinations, delusions, impaired

judgment, and becomes totally dependent
Huntington’sTreatment is supportive, no curetranquilizers and antiparkinsonian drugs to relieve choreiform movementslate in the disease, may have

Слайд 99Huntington’s
1/2 children of affected parent will develop the disease but

will not find out about it until well past child

bearing age
must have disease to transmit trait
most do not develop disease until between age 30 to 50
Huntington’s1/2 children of affected parent will develop the disease but will not find out about it until

Слайд 100Huntington’s
Personality changes (obstinanacy, moodiness and lack of interest
Inappropriate behavior may

start before the involuntary jerky, irregular choreic movements
gait is wide

paced and prancing (ST. vitus dance)
Huntington’sPersonality changes (obstinanacy, moodiness and lack of interestInappropriate behavior may start before the involuntary jerky, irregular choreic

Слайд 101Huntington’s chorea
Difficulty chewing and swallowing, speech difficulty, intellectual decline
loss of

bowel and bladder control
severe depression may lead to suicide
paranoia is

common
Huntington’s choreaDifficulty chewing and swallowing, speech difficulty, intellectual declineloss of bowel and bladder controlsevere depression may lead

Слайд 102Nursing care extrapyramidial 43-2 pg 690
Offer fluids hourly
I&O, keep suction

available to prevent aspiration
soft diet, allow time to chew, cut

food into small bites
may need to feed in later stages
skin care,
maintain self care as long as possible
Nursing care extrapyramidial 43-2 pg 690Offer fluids hourlyI&O, keep suction available to prevent aspirationsoft diet, allow time

Слайд 103Nursing Care extrapyramidial
Avoid stress, fatigue
bowel and bladder incontinent retraining program

may be helpful early, not too effective late
Prone to injury,

assist when ambulating or getting up…may climb over rails or wander
observe frequently
Nursing Care extrapyramidialAvoid stress, fatiguebowel and bladder incontinent retraining program may be helpful early, not too effective

Слайд 104Seizure disorders pg 692
Abnormal electrical discharge of neurons
can be focal

or generalized
idiopathic (no known cause
causes---high fever, electrolyte imbalance, uremia, hypoglycemia,

hypoxia, brain tumor
Seizure disorders pg 692Abnormal electrical discharge of neuronscan be focal or generalizedidiopathic (no known causecauses---high fever, electrolyte

Слайд 106Seizure disorders
Epilepsy is a permanent, recurrent seizure disorder
causes include brain

injury at birth, head injury, metabolic disorders or idiopathic
convulsive disorder

and seizure disorder the same
Seizure disordersEpilepsy is a permanent, recurrent seizure disordercauses include brain injury at birth, head injury, metabolic disorders

Слайд 107Seizure disorders
Too much electrical discharges from nerve cells in the

brain
Different types: partial or focal--from a localized area, cause specific

symptoms and may spread to entire brain
lasts from seconds to about one minute
Seizure disordersToo much electrical discharges from nerve cells in the brainDifferent types: partial or focal--from a localized

Слайд 108Seizure disorder
Jacksonian: begins at one place and spreads to another

in an orderly fashion
psychomotor and psychosensory: seizure with hallucinatory sights,

sounds and odors
mumbles and non-sense words, smacking lips
Seizure disorderJacksonian: begins at one place and spreads to another in an orderly fashionpsychomotor and psychosensory: seizure

Слайд 109Seizures
Generalized seizure: Entire brain involved; can last several minutes, loss

of consciousness
absence; brief change of consciousness lasting 1 to 10

seconds, mostly children
blank stare, mouth arm or eyelid movement, vacant stare, Petit mal
SeizuresGeneralized seizure: Entire brain involved; can last several minutes, loss of consciousnessabsence; brief change of consciousness lasting

Слайд 110Generalized seizure
Myoclonic: brief involuntary muscular jerks of extremities or body
Tonic-clonic:

Grand mal--emotional changes, aura (seconds or minutes before), epileptic cry,

loss of consciousness
tonic-stiffness and rigidity
Generalized seizureMyoclonic: brief involuntary muscular jerks of extremities or bodyTonic-clonic: Grand mal--emotional changes, aura (seconds or minutes

Слайд 111Seizure--Grand mal
Clonic phase; alternating spasms and relaxations---thrashing and jerking
breathing is

spasmodic
frothing saliva, jaws clenched, incontinence
labored breathing and cyanosis
lasts 2 to

5 minutes
Seizure--Grand malClonic phase; alternating spasms and relaxations---thrashing and jerkingbreathing is spasmodicfrothing saliva, jaws clenched, incontinencelabored breathing and

Слайд 113Grand mal seizure
Postictal stage: consciousness is regained, does not remember

seizure
confused, difficulty speaking, headache
fatigue, soreness and may sleep for hours

Grand mal seizurePostictal stage: consciousness is regained, does not remember seizureconfused, difficulty speaking, headachefatigue, soreness and may

Слайд 114During a seizure
Turn to side to keep airway patent and

to prevent aspiration of saliva and vomitus
suction PRN
remove pillow, bedding

and clothing that can obstruct breathing
loosen restrictive clothing
During a seizureTurn to side to keep airway patent and to prevent aspiration of saliva and vomitussuction

Слайд 116During a Seizure
Protect from injury…do not forcibly restrain arms, legs

or head
stay with patient
Give privacy…clear onlookers

During a SeizureProtect from injury…do not forcibly restrain arms, legs or headstay with patientGive privacy…clear onlookers

Слайд 118After a seizure
Keep bed flat; turn to side until awake

and responding
keep room lighting dim and noise to a minimum
Take

vitals stat and q 30 minutes until awake
inspect lips, tongue, oral cavity for injury
change linen if incontinent
After a seizureKeep bed flat; turn to side until awake and respondingkeep room lighting dim and noise

Слайд 120Nursing
Observe closely and chart activity before and after
turn on side--prevent

aspiration, protect from injury
do not restrain, do not force objects

in mouth
Stay with patient
take vitals after a seizure
NursingObserve closely and chart activity before and afterturn on side--prevent aspiration, protect from injurydo not restrain, do

Слайд 121Nursing
Assess for injury, allow to rest, report activity, time elapsed

and client reaction
pad side rails
good mouth care--gingival hyperplasia
dilantin levels
give meds

on schedule
NursingAssess for injury, allow to rest, report activity, time elapsed and client reactionpad side railsgood mouth care--gingival

Слайд 123Status Epilepticus
Several tonic-clonic seizures without consciousness returning
this is an emergency
may

be from stopping seizure meds
life threatening

Status EpilepticusSeveral tonic-clonic seizures without consciousness returningthis is an emergencymay be from stopping seizure medslife threatening

Слайд 125Medications for seizures
Dilantin
phenobarbital
Tegretol
Zarontin
depakene
Valium drug of choice to stop status epilepticus

Medications for seizuresDilantinphenobarbitalTegretolZarontindepakeneValium drug of choice to stop status epilepticus

Слайд 126Brain Tumor pg. 697
Can result in death even if benign
They

take up space and block flow and absorption of CSF

so cause ICP to occur
headache, vomiting and papilledema is common
headache usually early in AM and becomes more severe as tumor grows
Brain Tumor pg. 697Can result in death even if benignThey take up space and block flow and

Слайд 127Brain tumor
Projectile type vomiting without nausea, speech difficulty, double vision,

paralysis
Causes brain stem herniation so resp rate deeper, labored, periodic…temp

usually rises but B/P stays stable
Brain tumorProjectile type vomiting without nausea, speech difficulty, double vision, paralysisCauses brain stem herniation so resp rate

Слайд 128Brain Tumor
Keep as pain free as possible
IV fluids and TPN

may be needed--keep I&O
encourage mobility as long long as possible…assist
radiation

& chemotherapy causes oral lesions…keep mouth moist, give sips of water

Brain TumorKeep as pain free as possibleIV fluids and TPN may be needed--keep I&Oencourage mobility as long

Слайд 129Brain Tumor
Chemotherapy, radiation and surgery used to treat
craniotomy (incision thru

skull) or craniectomy (part of skull removed) done, laser beams

or radioisotopes inserted into tumor also done

Brain TumorChemotherapy, radiation and surgery used to treatcraniotomy (incision thru skull) or craniectomy (part of skull removed)

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