PATHO/PHARM II and HUMAN NEEDS II

Neurological Content - Chapter Highlights

Chapters 55-60

The attached chapter highlights was developed to allow the student the opportunity to integrate concepts
taught in NUR 3421 and NUR 3317. These highlights focus on important concepts the student must
know. It is highly recommended that the student use the chapter highlights as a study tool for class and
exam preparation.

CHAPTER 55 - NURSING ASSESSMENT: NERVOUS SYSTEM

-Read and review the A & P of nervous system. Most of this chapter is a review of the information that you
covered in previous anatomy and assessment classes.
-Assessment techniques—review thoroughly with attention to:
Appearance, speech, affect, motor function
Level of ADL’s—you need to note if there have been any changes for patient in ability to perform
ADL’s. This may be the first sign that patient is having problems related to neurological function.
-Cranial nerve assessment (review your previous Health Assessment notes for the various techniques used to
assess each cranial nerve). You must know each cranial nerve, its function (motor, sensory, or both), and how to
assess and evaluate the function of each cranial nerve. The Lewis Evolve website has several video clips
demonstrating the evaluation of the various cranial nerves. You may also use your Health Assessment Videos as
a review.
-Read and review the diagnostic evaluations of nervous system in Table 55-7 and Table 55-8. Remember that
lumbar puncture (LP) to evaluate CSF is contraindicated whenever patient has increased ICP or infection at the
site of puncture. Review other specific diagnostic tests and pre- and post-procedure interventions to teach
patients.

CHAPTER 56 - NURSING MANAGEMENT: ACUTE INTRACRAINIAL PROBLEMS

-Clinical manifestations of ICP= note changes in LOC, VS, ocular signs, motor function, and presence of
headache and vomiting
-Eye assessment: know implications of various changes in pupils (fixed, pinpoint, ovoid, etc.) What is
papilledema and what does it indicate?
-Level of consciousness (LOC)—very important as the first indication that central neurological function has
declined
-Glasgow coma scale (Table 56-5)= score of 15=normal neurological functioning
(fully alert patient)
3=deep coma state
(8 or less usually indicates coma)
{Remember Glasgow starts with G and high number (H) = normal or high LOC)}
-LOC—review positioning changes r/t change in ICP and implications to nervous system status:
Decorticate (flexor) = indicate interruption of voluntary motor tracts in cerebral cortex
Decerebrate (extensor) =indicate disruption in motor fibers in brainstem and mid-brain
-Know the appearance of each position (Fig. 56-5)
-Review ICP monitoring indications and measuring techniques
-Remember: 1st step in management of ICP is ensuring adequate oxygenation
-Review drug therapy in management of ICP: mannitol, corticosteroids, barbiturates and timing of use for each.
Need for antacids with which meds?
-Review ventilation and suctioning interventions that must be used in patients with increased ICP
-Use of barbiturate coma in patients when their ICP cannot be otherwise controlled. When is it used and how
does it work?
Head Injury:
-Closed head injury vs. open head injury
-Head trauma defined? Prognosis?
-Know extent of ICP in injuries and dangers of brain herniation
-Know the differences between epidural hematoma, subdural hematoma, and intracerebral hematoma
-Clinical manifestations of each?
-Assessment priorities?
-Client education for minor head injury. Also, differences for moderate to severe head trauma (must know long-
term effects that these patients and families will encounter)

Brain Tumors:
-Review differences in primary or secondary
-Classification of tumors?
-Non-surgical management techniques (chemotherapy, radiation therapy)
-Surgical care: Stereotactic surgery (when is this used? Advantages? When is radiosurgery used?
-Know post-operative care needs and especially the proper positioning after certain surgical techniques
-Health teaching and referrals for patient and family includes what info???

Meningitis:
-Viral vs. Bacterial
-Classic symptoms= nausea, vomiting, headache and fever. What about nuchal rigidity???
-Diagnostic assessments used? Remember important to do blood culture, LP for CSF prior to starting
antibiotics but start antibiotics before results of cultures received
-Interventions=monitor/record neuro status, V/S, vascular assessment
-Review Table 56-16 thoroughly to note differences/similarities in cerebral inflammatory conditions

Encephalitis:
-What is it and cause?
-S/S and treatment (same or different from that of meningitis?)

Brain Abscess:
-What is it and what causes it?
-Manifestations?
-Non-surgical and surgical interventions? Medications used, burr holes

CHAPTER 57 - NURSING MANAGEMENT: STROKE

Stroke= Brain Attack:

-Medical emergency!
-Know different types of strokes
-Key features of different strokes and TIA’s
-Know differences between left and right hemispheric strokes (differences in language, behavior, memory,
hearing and vision)
-Know what effects the visual changes have on patients’ ability to perform in daily living. Also, review changes
in communication, affect, intellectual function, spatial/perceptual alterations, elimination
-Non-surgical management: Review thoroughly use of intracranial monitoring and its time of use, nursing
considerations for care of patient (i.e. Nurse should avoid clustering activities. Why???), observations and
assessments to do of patient, etc.
-Review interventions for disturbances in sensory perception, unilateral neglect, impaired communication,
swallowing, and incontinence. Know how to assess for swallowing ability, how to assess if nutrition is
adequate, how to best treat incontinence.
-What is the ultimate goal of rehab for stroke patients?
-Be sure to assess self-esteem and coping issues of patients and families

CHAPTER 58 - NURSING MANAGEMENT: CHRONIC NEUROLOGIC PROBLEMS

-Cluster headaches and tension headaches—review differences from migraines in diagnosis and treatment.

-Migraine headaches- review etiology and assessment

-Review treatment—especially preventive therapy (for example, use of beta blockers, SSRI’s, antidepressants)

-Review and know differences between types of seizures.

-Complications of seizures:
status epilepticus- know what it is, causes, and treatment
psychosocial effects- review

-Seizure prevention techniques=

Medication as prescribed
Balanced diet, proper rest and stress reduction
Diary or log of seizure activity
Caution with driving & employment activities

-Nursing diagnoses with seizure disorders and epilepsy

-Common drug therapy (anti-epileptics)

-Know seizure precautions and seizure management---know how to prevent aspiration, documentation required,
do NOT use restraints or padded tongue blades (and know WHY NOT!)

Multiple Sclerosis
-Review diagnosis, s/s, and treatment
-Remember symptoms are vague and occur intermittently over months/years
-Remember no effect on pregnancy or L & D but greatest risk of exacerbation during postpartum period

Parkinson’s disease:
-Key features (note Figure 58-9)
-Diagnosis made on clinical findings. NO specific diagnostic test---(CSF may show decrease in dopamine but
otherwise normal usually) What is ultimate confirmation of PD?
-Treatment - especially use of levodopa and carbidopa
-Note important aspects of care r/t ambulation, injury prevention and nutrition (i.e. Methods to prevent
aspiration and promote swallowing to enhance nutritional state)

Myasthenia Gravis:
-What is it?
-Know the causative and risk factors?
-Key features
-Review Tensilon testing very thoroughly and know how to interpret results. -Also, know antidote for Tensilon!
-Classic presentation of MG? Subjective and objective behavior?
-Non-surgical management: what assistance is needed by patient? May need help with ADL’s.
-Drug therapy:
Drugs used and know the drugs to be avoided!
Complications? What is myasthenia crisis? Cholinergic crisis? Differences? Know the characteristics
of each (Table 58-19)
-Surgical management: know especially the post-op interventions and complications to assess for in patients
-What about use of plasmaphoresis & IV IGG?

ALS(Lou Gehrig’s disease):

-Symptoms???
-Cure? Interventions for treatment?

Huntington disease:
-Definition= remember it is genetically transmitted
-S/S especially choreiform movements (writhing, twisting movements in limbs, body, and facial muscles)
-What causes these movements and is patient able to stop them?
-No cure!
-Goals of nursing management?

CHAPTER 59 - NURSING MANAGEMENT: ALZHEIMER’S DISEASE, DEMENTIA, AND

DELIRIUM

Dementia:
-Clinical manifestations (Table 59-1; 59-2; 59-3): Review thoroughly
-Prevention measures?

Alzheimer’s disease: same as dementia??? Table 59-5; 59-6; 59-7

-Chemical changes? Etiology?
-Note changes in cognition, behavior/personality, self-care skills. Table 59-4
-Review effects on patient with change in routine or environment????
-Risk for injury and caregiver role strain?
-What is sundowning? Nursing interventions that may help?

CHAPTER 60 - NURSING MANAGEMENT: PERIPHERAL NERVE AND SPINAL CORD

PROBLEMS

Trigeminal neuralgia: (also called tic douloureux)

-Causes and manifestations
-Treatment: non-surgical and surgical
-Use of microvascular decompression-what is done, where do the effects occur?
-Nursing diagnoses (ie. imbalanced nutrition, impaired oral mucous membranes, social isolation) and
interventions required?

Bell’s Palsy:
-Which cranial nerve?
-Cause?
-Treatment?
-Remember importance of privacy and reassurance to patient and family of good chances for recovery
Guillain-Barre’ syndrome:
-Cause???
-Stages?
-Symptoms—especially ascending weakness, paresthesias, and paralysis in patient with ascending GBS!!!
-Pt with descending GBS – difference in symptoms?
-Two biggest complications? Remember need for constant monitoring
-Nursing diagnoses?
-Priority interventions? Respiratory assessment to perform? Indications for elective intubation? Cardiac
interventions? Eye care? Nutritional needs?
-Treatment with plasmaphoresis or IV dose of high-dose immunoglobulin? Know when to use each and need
for good hydration and renal function with IV immunoglobulin

Botulism
-symptoms?
-when do s/s appear?
-treatment steps?
-prevention techniques?

Tetanus
-s/s?
-prevention best
-DT booster every 10 years for adults
-Know when to give DT sooner than every 10 years

Spinal Cord Injury:

-Review types, degree, and areas of injury
-Assessment and first priority!!!
-Spinal shock=when it occurs, signs/symptoms, and resolution???
-Neurogenic shock= differences from spinal shock?
-Know clinical manifestations- cardiovascular, respiratory, urinary, gi, skin, metabolic needs?
-Emergency management – Review Table 60-3
-Autonomic dysreflexia =what is it, what causes it, why is it a neurological emergency, and what is the
treatment?
-Non-surgical treatment= know assessment priorities, body alignment requirements and rationale for treatments
-Surgical treatment (i.e. Decompression laminectomy) what is done and why?
-Interventions to promote airway management and patency?
-Interventions to prevent problems from immobility?
-Bowel training?

Spinal cord tumors

-Review diagnosis, S/S and treatment

These are just major highlights of the chapters. All of the information in these chapters is important so read all
of the chapters thoroughly. It is a large amount of data but is so important. We will cover some additional
information in class and in the power point slides that I give you.

Hope these highlights help!!