Adult II Nursing
Neurological Nursing
NEUROLOGICAL NURSING
Introduction:
The care of a neurological patient may be complex. Successful nursing care
requires preparation, sound clinical skills, and systematic approach to the
nursing process
1. Nervous System:
1. Regulates system
2. Controls communication
3. Coordinates Activities of body system
Divisions
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Central nervous system ( CNS) : brain and spinal cord –interprets
incoming sensory information and sends out instruction based on past
experiences
Brain:
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Cerebrum-Largest part of brain:outer layer called cerebral cortex
composed of dendrites and cell bodies : controls mental processes:
highest level of functioning
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Adult II Nursing
Neurological Nursing
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Cerebellum: controls muscle tone coordination and maintains equilibrium
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Diencephalon:Consist of two major structures located between cerebrum
and midbrain
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Hypothalamus: regulates the autonomic nervous system: controls blood
pressure: hepls maintain normal body temperature and appetite: controls
water balance and sleep
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Thalamus: acts as a relay station for incoming and outgoing nerve
impulses:produces emotions o pleasantness and unpleasantness
associated with sensations
Brainstem:
Connects the cerebrum with the spinal cord
 Midbrain- relay center for eye and ear reflexes
 Pons- connecting link between cerebellum and rest of nervous system
 Medulla oblongata- contains center for respiration, heart rate, and
vasomotor activity
Spinal Cord:
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Inner column composed of gray matter, shaped like a H, made up of
dendrites and cell bodies: outer part composed of white matter, made up
of bundles of axons called tracts
 Functions: sensory tract conducts impulses to brain motor tract conducts
impulses from brain: center for all spinal cord reflexes
Protection for CNS:
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Bone- vertebrae surround cord: skull surrounds the brain
Meninges: three connective tissue membranes that cover the brain and
spinal cord
1. Dura mater: white fibrous tissue: outer layer
2. Arachnoid: delicate membranes: middle layer : contains subarachnoid
fluid
3. Pia mater: inner layer contains blood vessels
Cerebrospinal Fluid: acts as a shock absorber: acts in exchange of
nutrients and waste materials
Peripheral nervous system (PNS): Cranial and spinal nerves extending
out from brain and spinal cord---carry impulses to and from brain and
spinal cord. Caries voluntary and involuntary impulses
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Adult II Nursing
Neurological Nursing
Cranial nerves:
I olfactory
Nose to brain
Smell
II optic
Eye to brain
Vision
Brain to eye and eye
muscles
Contraction of upper
eyelid
Maintain position of
eyelid
Pupillary reflexes
Eye movements
III oculomotor
IV Trochlear
V trigeminal
VI Abducens
VII Facial
VIII Acoustic
Brain to external eye
muscles
From skin & mucous
membranes of head & teeth
to chewing muscles
From brain to external eye
muscles
From taste buds & facial
muscles to muscles facial
expression
From organ of corti to brain
From pharynx & tongue to
brain
IX
Glossopharyngeal From brain to throat
muscles and salivary glands
From throat & organs in
thoracic & abdominal
cavities
X Vagus
XI Accessory
XII Hypoglossal
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From brain to shoulder and
neck muscles
From brain to tongue
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Sensations of head &
teeth
Muscles of chewing
Eye movements
Taste
Facial expressions
Hearing
Sensations of tastes&
swallowing
Secretion of salvia
Important in
swallowing, speaking,
peristalsis and
production of gastric
juices
Rotation of head and
raising shoulders
Movement of tongue
Adult II Nursing
Neurological Nursing
Spinal nerves: 31 Pairs: conduct impulses necessary for sensation and
voluntary movements: each group named for the corresponding part of
spinal column
 Autonomic nervous system (ANS): functional classification of the
PNS---regulates involuntary activities. Part of PNS: controls smooth
muscle, cardiac muscle, and glands
It has two divisions;
1. Sympathetic-flight or fight response: increases heart rate and blood
pressure; dilates pupils
2. Parasympathetic : dominates control under normal conditions:
maintains homeostasis
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Somatic nervous system (SNS) : Functional classification of the PNS: -allows conscious or voluntary control of skeletal muscles
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Neurons or nerve cells
Respond to a stimulus, connect it into a nerve impulse (irritability), and
transmit the impulse to neurons, muscle, or glands (conductivity),
consists of three main parts
Neurons main parts
1. Cell body: contains nucleus and one or more fibers or process
extending from the cell body
2. Dendrites: conduct impulses toward cell body: neurons has many
dendrites
3. Axons: conduct impulses away from cell body: neuron has one axon
Types of neurons
1. Motor (efferent ): conduct impulses from CNS to muscle and glands
2. Sensory (afferent): conduct impulses toward CNS
3. Connecting ( interneuron): Conduct impulses from axon to dendrites
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Synapse-chemical transmission of impulses from axon to dendrites
Myelin sheath – protects and insulates the axon fibers: increases the rate
of transmission of nerve impulses
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Adult II Nursing
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Neurological Nursing
Neurilemma– sheath covering the myelin: found in PNS : function is
regeneration of nerve fiber
Neuroglia- connective or supporting tissue—important in reaction of
nervous system to injury or infection
Ganglia-clusters of nerve cells outside CNS
White Matter-bundles of myelinated nerve fibers – conducts impulses
along fibers
Gray matter- clusters of neuron cell bodies—fibers not covered with
myelin –distributes impulses across selected synapses
Neurological Terms:
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Anesthesia- complete loss of sensation
Aphasia-loss of ability to use language
Auditory/receptive aphasia- loss of ability to understand
Expressive aphasia- loss of ability to use spoken or written word
Ataxia- uncoordinated movements
Coma- state of profound unconsciousness
Convulsion- involuntary contractions and relaxation of muscles
Delirium- mental state characterized by restlessness and disorientation
Diplopia- double vision
Dyskeinesia- difficulty in voluntary movement
Flaccid- without tone- limp
Neuralgia- intermittent, intense pain, along the course of a nerve
Neuritis- inflammation of a nerve or nerves
Nuchal rigidity-stiff neck
Nystagmus- involuntary, rapid movements of the eyeball
Papilledema- swelling of optic nerve head
Paresthesia- abnormal sensation without obvious cause, with numbness
and tingling
Spastic- convulsive muscular contractions
Stupor- state of impaired consciousness with brief response only to
vigorous and repeated stimulation
Tic-spasmodic, involuntary twitching of a muscle
Vertigo- dizziness
Dr: Fakhria Jaber
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Adult II Nursing
Neurological Nursing
Transient Ischemic Attacks
TIA
Definition:
Altered cerebral tissue perfusion related to a temporary neurologic
disturbance. It is manifested by sudden loss of motor or sensory function. It
lasts for a few minutes to a few hours, caused by temporarily diminished
blood supply to an area of the brain
Treatment:
Control hypertension
Low sodium diet
Possible anticoagulant therapy
Stop smoking
Cerebro Vascular Accident
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(CVA)(Stroke)
Definition:
It is defined as decreased blood supply to
a part of the brain, which caused by
rupture, occlusion, or stenosis of the
blood vessels. Its onset may be sudden or
gradual
 Right
CVA results in Left side
involvement often associated with
safety/ judgment
 Left
CVA results in Right side
involvement often associated with
speech problems
 Approximately
50% of survivors
permanently disabled
 High
proportion
experiencing
recurrence within weeks to years
 Chances
for complete recovery
depending an circulation returning to
normal soon after the initial stroke
 Third most common cause of neurological disability
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Adult II Nursing
Neurological Nursing
Pathophysiology/Etiology:
1. Partial or complete occlusion of a
cerebral blood vessel resulting from
cerebral
thrombosis
(due
to
arteriosclerosis) or embolism.
2. Ischemia related to decreased blood
flow to an area of the brain secondary
to systemic disease, such as cardiac or
metabolic disease.
3. Hemorrhage occurring outside the dura
(extradural), beneath the dura mater
(subdural), in the subarachnoid space
(subarachnoid), or within the brain
substance (intracerebral).
4. Risk factors include hypertension,
TIAs,
heart
disease,
elevated
cholesterol, diabetes mellitus, obesity,
carotid
stenosis,
polycythemia,
cigarette smoking.
Predisposing factors-CVA:
Cigarette smoking
Family history
Incidence increased with aging
Atherosclerosis
Embolism
Thrombosis
Hemorrhage from ruptured cerebral
aneurysm
Hypertension
History TIA’s
Hypertension
Arrhythmias
Atherosclerosis
Rheumatic Heart Disease
MI
DM
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Adult II Nursing
Neurological Nursing
High serum triglyceride levels
Lack of exercise
Signs and Symptoms:
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Altered LOC
 Change in mental status
 Decreased attention span
 Decreased ability to think and reason
 Difficulty following simple
directions
 Communication; motor and sensory
aphasia difficulty with reading
,writing, speaking, or understanding
 Bowel and bladder dysfunction
retention impaction or incontinence
 Seizures
 Limited motor function; paralysis,
dysphgia, weakness , hemiplegia,
loss of function or contractures
 Loss of sensation/ perception
 Headaches and syncope
 Loss of temp regulation elevated TPR
and BP
 Absent of gag reflex ( aspiration)
 Unusual emotional responses;
depression, anxiety, anger, verbal
outburst, and crying: emotional
lability
 Problems related with immobility
Diagnostic test:
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Physical assessment
Pt and family history
EEG
CT scan
Lumbar puncture
Cerebral angiogram
Carotid ultra sonogram
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Dr: Fakhria Jaber
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Adult II Nursing
Neurological Nursing
Treatments:
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Remove cause, prevent complications,
and maintain function, rehabilitation to
restore function
Medications
Anti-hypertensive
Anticoagulants
Stool softeners
Surgical removal of clot, repair of aneurysm, carotid
endarterectomy or balloon angioplasty
Nursing Interventions:
Patent airway
o O2 with humidity
o Suction PRN
o Keep head turned to side
o Place in semi- fowler’s
Maintain therapeutic bed rest
o Use turn sheet
o Footboard
o Firm mattress
o Pillow and torchanter rolls
o Maintain proper body alignment
o Place items within reach
o Reposition q2h
o ROM passive and active
o Flotation mattress or sheepskin
o Skin assessment
o Prevent complications of immobility
o ADL’s
Assess nutrition daily with I&O, WT, %diet, calorie count
o Provide N/G or PEG feedings if needed
o Maintain IV fluids
o Progress to soft diet PRN
o TPN as ordered
o Aspiration precautions
o Dietary consult & Speech for swallowing
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Dr: Fakhria Jaber
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Adult II Nursing
Neurological Nursing
Establish means of communication
o Call bell pad and pencil
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Nonverbal gestures
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Use simple commands
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Speak slowly
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Explain all care
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Speech therapy
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Be nonjudgmental about personality changes
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Encourage family participation
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Provide diversional activities
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Be realistic
Assess LOC
Maintain safety
o Use side rails
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Restrain only as necessary
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Seizure precautions
Observe for ICP
V/S & Neuro CKS q 4 h
Ensure elimination
o Assess bowel sounds
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Monitor bowel movements
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I&O
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Indwelling catheter PRN
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Bowel and bladder training
Family support
Begin discharge teaching early
Rehabilitation therapy
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Physical therapy (see figures).
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Speech therapy
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Occupational therapy
Dr: Fakhria Jaber
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Adult II Nursing
Neurological Nursing
PHYSICAL EXERCISES & RANGE OF MOTION
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Adult II Nursing
Dr: Fakhria Jaber
Neurological Nursing
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