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Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_P_I_E
PATHOPHYSIOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Huntington’s Disease
Myasthenia Gravis
Guillian-Barre ’ Syndrome
Meningitis
Parkinson’s Disease
PHARMACOLOGY
--Decrease ICP
--Disease /
Condition
Specific Meds
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary

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Progressive
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Degenerative
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No Cure
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Affects nerve fibers in the brain and spinal cord
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Most common neurological cause of debilitation in young people (ages20 - 40)
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Probably autoimmune disease
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Antibodies and white blood cells attack the proteins in the neuron’s myelin sheath
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Inflammation and injury to the sheath and ultimately to the nerves that it surrounds
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Multiple areas of scarring…
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Hardening ( Sclerosis ) of nerve fibers...usually in spinal cord, brain stem and optic nerves
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More women than men
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More common in Caucasians
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Children of parents with MS have a higher rate of incidence (15 – 50% depending on data source)
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Geographic location --- Cold climate…?
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Based on the presence of CNS lesions that are disseminated in time and space (neurologic dysfunction in more than 2
Because no single test is totally reliable
, diagnosis
MRI (visualize plaques)
CSF analysis (increases protein and slight increase
WBCs) monitors)
(define extent of disease and
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"Turbo FLAIR" MRI
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Because different nerves are affected at different times, MS symptoms often worsen
(exacerbate), improve, and develop in different areas of the body
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This disease is unpredictable and varies in severity
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Intermittent damage to myelin… intermittent severity
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Scarring and sclerosis of nerve fibers usually in the spinal cord, brain stem, and optic nerves…
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Fatigue
Muscle Spasticity
Muscle Weakness
Dysarthria
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Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of extremities)
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Lhermitte's sign (Electrical sensation down the spine on neck flexion)
Dysphagia Tinnitis
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Uhthoff’s Sign (Exertion or Heat causes sudden exacerbation of S&S)
Numbness, tingling (Paresthesia) Pain
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Bowel, bladder and sexual dysfunction
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Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)
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"Slurred" speech
Speaking softly or barely able to whisper
Slow rate of speech
Rapid rate of speech with a "mumbling" quality
Limited tongue, lip, and jaw movement
Abnormal intonation (rhythm) when speaking
Changes in vocal quality ("nasal" speech or sounding "stuffy")
Hoarseness
Breathiness
Drooling or poor control of saliva
Chewing and swallowing difficulty
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Emotionally labile
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Depression (suicide increased 7.5%, usually in first 5 years)
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MS can progress steadily… or cause acute attacks ( exacerbation ) followed by partial or complete reduction in symptoms ( remission )
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Returns to baseline + recovery
85%
Increasing severity
… maybe minor plateaus or remissions
10-20%

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Control symptoms
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Prevent complications
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Provide adaptive devices to increase mobility and self-care
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A vonex IM
Weekly (interferon beta – 1a)
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B etaseron SQ
Daily (interferon beta 1b)
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C opaxone SQ
Daily
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R ebif SQ given 3 x week
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Baclofen / Dantrium (for spasms)
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NSAIDS (for flu-like side effects and pain)
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Analgesics
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Corticosteroids (limit severity by modulating immune response which decreases inflammation)
Antidepressants (like Prozac)
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Beta blockers for tremors (like Inderal)
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Anticonvulsants for parethesia (like Tegretol)
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Anticholinergics for bladder dysfunction (Pro-Banthine)
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Bacterial infections (lung, bladder)
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Disturbed thought processes
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Impaired bladder & bowel function
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Contractures
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Seizures
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Impaired mobility / speech / swallowing
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Sensory & visual impairment
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In some people, MS is a mild illness, but, for others, it results in permanent disability
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Most patients have a normal lifespan
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