Central Nervous System: Brain

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Central Nervous System Brain
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Neurologic Assessment Mental Status

• Level of Consciousness (LOC)
• Orientation
• Memory
• Remote
• Long-term
• Recall (recent)
• Immediate (new)
• Attention
• Language and copying
• Cognition

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Neurologic Assessment

• Cranial nervew
• Sensory function
• Pain and temperature
• Touch
• Abnormal sensory findings
• Motor function
• Muscle strength
• Cerebral/brainstem integrity
• Abnormal motor findings

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Neurologic Assessment Cerebellar Function

• Coordination
• Gait and equilibrium
• Rombergs sign
• Proprioceptive awareness
• Reflex activity
• Deep tendon reflexes (DTRSs)
• Cutaneous reflexes
• Babinskis sign
• Abnormal reflex findings

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Neurologic Assessment Cerebellar Function

• Rapid neurologic assessment
• Response to painful stimuli
• Level of consciousness
• Pupil assessement

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Glascow Coma Scale (GCS)

• Eye opening
• Spontaneous 4
• To sound 3
• To pain 2
• Never 1
• Motor Response
• Obeys commands 6
• Localizes pain 5
• Normal flexion 4
• Abnormal flexion 3
• Extension 2
• Nil 1

• Verbal response
• Oriented 5
• Confused conversation 4
• Inappropriate words 3
• Incomprehensible sounds 2
• None 1
• The highest possible score is 15

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Neurologic Disorders of the Brain

• Epilepsy
• Meningitis
• Parkinsons
• Alzheimers

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Epilepsy

• Chronic disorder recurrent, unprovoked seizure
  activity
• Due to brain or CNS irritation
• Seizures abnormal, sudden, excessive discharge
  of electrical activity
• Epileptic
• Primary/idiopathic
• Secondary underlying brain lesion

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Epilepsy

• Seizures
• Nonepileptic
• Metabolic disorders
• Acute alcohol withdrawal
• Electrolyte disturbance (hyperkalemia, water
  intoxication, hypoglycemia
• Heart disease
• Risk Factors can trigger seizure activity
• Increased physical activity
• Emotional stress
• Excessive fatigue
• Alcohol, caffeine, or certain foods or chemicals

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Types of Seizures

• Generalized
• Tonic-clonic (f.k.a. grand mal)
• Tonic
• Clonic
• Absence (f.k.a. petit mal)
• Myoclonic
• Atonic (akinetic) (f.k.a. drop attack)
• Partial (focal)
• Complex partial
• Simple partial

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Seizure Interventions

• Nonsurgical management
• Drug therapy
• Seizure precautions
• Seizure management
• Preictal phase
• Postictal phase
• Acute seizures
• Status epilepticus
• Vagal nerve stimulation
• Surgical management

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Meningitis

• Inflammation of arachnoid/pia mater of brain,
  spinal cord and CSF
• Most often due to bacterial and viral organisms
• Enters CNS through blood stream at the
  blood-brain barrier
• Direct routes
• Penetrating trauma -- ruptured cerebral abcess
• Surgical procedure -- otorrhea/rhinorrhea
• Exudate may spread to cranial/spinal nerves
  neurologic deterioration

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Meningitis Bacterial

• Occurs most often in fall and winter with URIs
• Organisms
• Streptococcus pneumonae
• Neisseria meningitidis
• Haemophilus influenzae
• Risk factor cigarette smoking
• Occurs in areas of high population density
• Predisposing conditions

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Meningitis

• Viral
• Aseptic meningitis
• Sequela to viral illnesses measles, mumps,
  herpes simple/zoster
• Inflammation over cerebral cortex/white
  matter/meninges
• Patho varies depending on virus
• Fungal
• Cryptococcus neoformans most common in clients
  with AIDS
• Headaches, nausea, vomiting, decline in mental
  status

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Meningitis Assessment

• Meningeal irritation
• Nuchal rigidity
• Kernigs sign
• Brudzinski refles
• Increased intracranial pressure
• Hydrocephalus/cerebral edema
• Herniation of brain/death
• Seizure activity
• SIADH
• Vascular dysfunction

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Meningitis Interventions

• Neurologic assessment
• Monitoring for complications
• Septic emboli -- Coagulation disorders
• Shock -- Prolonged fever
• Septic complications (bacterial endocarditis)
• Drug therapy
• Broad spectrum antibiotics -- Steroids
• Hyperosmolar agents -- Anticonvulsants
• Prophylaxis with rifampin for close contacts

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Parkinsons Disease

• (Paralysis agitans) second most common neurologic
  degenerative disease
• Cardinal symptoms
• Muscle rigidity
• Bradykinesia
• tremor
• Genetic defect of chromosome 4
• Occurs most often in people over 50
• Widespread degeneration of substantia nigra
  decreased dopamine

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Parkinsons Disease (continued)

• Decreased dopamine decreased ability to refine
  voluntary movement
• Imbalances between excitatory and inhibitory
  neuronal activity
• Increased excitation of neurons prevents
  controlling/initiating voluntary movements
• Stages 1 - 5

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Parkinsons Disease Assessment

• Early symptoms fatigue, slight tremor, problems
  with manual dexterity
• Rigidity
• Cogswheel
• Plastic
• Lead pipe
• Masklike facial expression
• Wide-open, fixed, staring eyes
• Difficulty chewing and swallowing
• Uncontrolled drooling
• No specific diagnostic tests

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Parkinsons Disease Interventions

• Nonsurgical management
• Drug therapy
• Exercise/ambulation
• Self-care
• Nutrition
• Communication
• Psychosocial support
• Surgical management
• Stereotactic pallidotomy
• Thalamotomy
• Deep brain stimulation (DBS)
• Fetal tissue transplant

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Alzheimers Disease

• Chronic, progressive, degenerative disease
• Manifestations
• Loss of memory, judgment, and visuospatial
  perception
• Changes in personality
• Progressive cognitive impairment
• Severe physical deterioration
• Structural/chemical changes in the brain
• Exact cause unknown

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Alzheimers Disease (continued)

• Theories/risk factors
• Genetics
• Chemical imbalances
• Environmental agents
• Immunologic changes

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Alzheimers Disease Nursing Diagnoses

• Chronic confusion
• Risk for injury
• Compromised family coping
• Disturbed sleep pattern
• Impaired verbal communication
• Imbalanced nutrition
• (Self-care deficit)