Chapter 14
Care of the Patient with a Neurological
Disorder
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Care of the Patient with a
Neurological Disorder
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The nervous system is responsible for
communication and control within the body
It is the body’s link with the environment and
allows the interpretation of information and
appropriate action to occur
Two main structural divisions
– central
– peripheral
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Neural Pathway Involved in the
Patellar Reflex
(Figure 14-3)
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Effects of Aging on the Nervous
System

Loss of brain weight and loss of neurons
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Often an altered sleep/wakefulness ratio
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Decrease ability to regulate body
temperature
Decrease in the velocity of nerve impulses
Blood supply to the spinal cord is decreased,
resulting in decreased reflexes
Normal changes are not the same as senility,
organic brain disease, or Alzheimer’s disease
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Prevention of Neurological Problems

Some neurological problems can be prevented by
modifying lifestyle factors, similar to risk factors for
cardiovascular disorders:
– Avoidance of drug and alcohol use
– Safe use of motor vehicles
– Safe swimming practices – no diving in shallow water
– Safe handling and storage of firearms
– Use of hardhats in dangerous construction areas
– Use of protective padding as needed for sports
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Laboratory and Diagnostic
Examinations

Assessment of the neurologically impaired
patient includes a variety of lab and
diagnostic exams
Variety of
blood tests
ABGs
Cerebrospinal
fluid
Brain scan
MRI
Lumbar
puncture
Positron emission
tomography
(PET)
Angiogram
Electromyogram (EMG)
CT scan
Electroencephalog
ram (EEG)
Myelogram
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Increased Intracranial Pressure

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Increase in the volume of one of the contents of the
cranium (blood, brain, blood vessels, or cerebrospinal)
results in increased intracranial pressure (ICP)
because the cranial vault is rigid and will not expand
Classic signs
– Restlessness
– Disorientation
– Headache
– Contralateral hemiparesis
– Visual changes including blurring and diplopia
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Nursing Intervention for ICP
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Elevate the head of the bed to 30-45 degrees to
promote venous return
Place the neck in a neutral position to promote venous
drainage
Position the patient to avoid flexion of the hips, waist
and neck
Instruct the patient to avoid isometric or resistive
exercises and Valsalva’s maneuver

Have a Foley catheter in place

Perform suctioning only as necessary

Administer oxygen and use a hypothermia blanket as
necessary
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Neurological Disorders
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Epilepsy – caused by sudden, excessive
and disorderly electrical discharges of the
brain
Stroke – most common disease – caused by
thrombus, embolus, or hemorrhage
Degenerative diseases:
– Multiple sclerosis – unknown cause
– Parkinson’s disease – damage or loss of
dopamine-producing cells
– Alzheimer’s disease – unknown cause
– Myasthenia gravis – lower motor neuron
characteristics
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Vascular Problems

Cerebrovascular accident (CVA) – “stroke”
causes ischemia of the brain tissue
– Cerebral thrombosis – caused by
atherosclerosis
– Cerebral embolism – a thrombus from the
endocardial layer of the heart
– Cerebral hemorrhage – bleeding into the
brain or the suarachnoid space
– Transient ischemic attack (TIA) -
episodes of cerebrovascular insufficiency with
temporary dysfunction
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Neurological Disorders
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Guillain-Barre syndrome – inflammation
and demyelination of the peripheral nervous
system
Meningitis – caused by bacteria or viral
agents
Encephalitis – caused by a virus –
sometimes fatal
Tumors and cancers – surgery treatment
of choice
Spinal cord trauma – usually caused by
accidents, results in partial or full paralysis
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Nursing Diagnoses

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Autonomic dysreflexia
Communication, impaired
verbal
Coping, compromised
family
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Disuse syndrome, risk for

Falls, risk for

Grieving

Infection, risk for

Knowledge, deficient
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Memory, impaired
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Mobility, impaired physical

Nutrition: less then body
requirements, imbalanced
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Pain, acute; Pain, chronic
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Self-care deficit
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Swallowing, impaired
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Thought process, disturbed

Tissue perfusion (cerebral),
ineffective
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