Chapter 44
Nursing Care of Patients with Neurologic Disorders
Learning Outcomes
1. Describe the pathophysiology and manifestations of degenerative neurologic disorders, and
outline the interprofessional care and nursing care of patients with these disorders.
2. Describe the pathophysiology and manifestations of peripheral nervous system disorders,
and outline the interprofessional care and nursing care of patients with these disorders.
3. Describe the pathophysiology and manifestations of cranial nerve disorders, and outline the
interprofessional care and nursing care of patients with these disorders.
Key Concepts
I.
Degenerative Neurologic Disorders
A. Dementia: Cognitive decline caused by any disorder that permanently damages areas of the
brain necessary for memory and learning
1. Results from the death of neurons and/or the loss of communication among the cells
2. Diagnosis depends on the presence of two or more deficits in the following cognitive
abilities:
a) Memory loss
b) Ability to generate coherent speech or understand spoken or written language
c) Ability to recognize or identify objects, assuming intact sensory function
d) Ability to execute motor activities, assuming intact motor abilities, sensory function,
and comprehension of the required task
e) Ability to focus and pay attention
f) Ability reason and problem solve
3. The decline in cognitive abilities must be severe enough to interfere with daily life.
4. Causes: Alzheimer disease, vascular dementia, Parkinson disease, normal pressure
hydrocephalus, Creutzfeldt-Jakob disease, metabolic disorders, medications, poisoning,
chronic traumatic encephalopathy (CTE), and anoxia
5. Risk factors: Aging, a family history of dementia, smoking and alcohol use, atherosclerosis,
high cholesterol, elevated plasma homocysteine levels, diabetes mellitus, and Down
syndrome
B. The patient with Alzheimer disease
1. Form of dementia characterized by progressive, irreversible deterioration of general
intellectual functioning
2. 80% of dementia due to AD
3. Cause unknown, develops from interaction of multiple factors
4. Early onset: Under 65; late onset: Over 65
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a) Rare genetic variation causes some cases of early onset.
5. Pathophysiology
a) Atrophy of the cortical area of the brain and loss of neurons, especially in the parietal
and temporal lobes
b) Theories about cause and development: Amyloid hypothesis, tau hypothesis, and
vascular hypothesis
c) Neuritic plaques: Groups of nerve cells that degenerate and clump around an amyloid
core and disrupt nerve impulses
(1) Consist primarily of insoluble deposits of beta-amyloid
d) Neurofibrillary tangles: Found in the cytoplasm of abnormal neurons, composed of
fibrous proteins wound around each other; disrupt communication between neurons
(1) Contain the protein tau
6. Risk factors
a) Age, head trauma, inflammatory factors, oxidative stress, low educational level, lack of
mental stimulation, migraines, and heavy smoking and alcohol consumption
b) Gene mutation
7. Stages and manifestations
a) Stage 1: No cognitive impairment
b) Stage 2: Very mild decline
c) Stage 3: Mild cognitive decline
d) Stage 4: Moderate cognitive decline
e) Stage 5: Moderately severe cognitive decline
(1) Some assistance with ADLs is essential.
(2) Usually retain essential knowledge about themselves and family
(3) Confusion about date, day of the week, etc.
f) Stage 6: Severe cognitive decline
(1) Emergence of personality changes
(2) Extensive help with ADLs needed
(3) May forget most personal history
g) Stage 7: Very severe cognitive decline
(1) Loss of ability to respond to environment, speak, and control movement
8. Interprofessional care
a) Diagnosis: No specific test
(1) Ruling out causes for manifestations: Medications, depression, infection,
hypothyroidism, dehydration, heart disease, stroke, and chronic obstructive
respiratory disease
(2) Mental status tests: Folstein Mini Mental State Examination, Alzheimer Disease
Assessment Scale, draw a clock
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(3) Only completely confirmed in postmortem examination
b) Medications
(1) Acetylcholinesterase inhibitors (AChEls) and N-methyl-D-aspartate (NMDA): May
slow progression of cognitive decline
(2) Medications for manifestations: Sleep disturbances, depression, agitation,
delusions, and aggression
c) Nutrition
(1) Mediterranean diet has neuroprotective benefits.
d) Integrative therapies
(1) Huperzine A, a traditional Chinese medicine
(2) Coenzyme Q10, an antioxidant
(3) Supplements: Zinc, ginkgo biloba, B vitamins, vitamin E
(4) Therapies: Massage, art, music, sound, dance, and pet therapy
9. Nursing care
a) Assessment
(1) Health history
(2) Physical assessment
b) Priorities of care
(1) Falls prevention
(2) Memory loss
(3) General safety considerations
c) Diagnoses, outcomes, and interventions
(1) Reduce risk for harm
(a) Recommend a medication box labeled with days and times
(b) Provide continuity in nursing staff
(c) Repeat explanations simply and as needed
(2) Relieve anxiety
(a) Monitor for early behaviors of fatigue and agitation
(b) Remove from situations that increase anxiety
(c) Keep daily routine as consistent as possible
(d) Schedule rest periods or quiet times throughout the day and provide quite
activities
(e) Assess for decreased oxygen, infections, fatigue, constipation, and
electrolyte imbalance if unyielding anxiety
(f) Use therapeutic touch or gentle hand massage
(3) Instill hope
(a) Assess the patient’s and family’s response to the diagnosis and
understanding of AD
(b) Teach about the disorder
(c) Support positive family bonds
(d) Encourage the patient to make as many decisions as possible
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(e) Encourage the family and patient to use coping mechanisms that previously
helped
(4) Reduce caregiver stress
(a) Teach the caregivers self-care techniques
(b) Have the caregivers list and regularly take part in physical activities they
enjoy
(c) Refer the caregivers to local AD support groups, Meals on Wheels, home
health, respite care, and other community services
(d) Ensure the family knows of availability of hospice care for end stages
10. Transitions of care
a) Discuss: Support groups; care that matches the patient’s coping; regular rest periods;
and plan care for the caregiver
b) Refer to resources
C. The patient with multiple sclerosis
1. Chronic demyelinating disease of the CNS
2. Pathophysiology
a) Believed to occur as a result of an autoimmune response in a genetically susceptible
person
b) Plaques destroy myelin sheaths around nerves, disrupt nerve impulses
c) Plaques usually in white matter and may extend to gray matter
d) First stage: Development of small inflammatory lesions
e) Second stage: Lesions extend and consolidate as gliosis and demyelination occurs.
f) Courses: Relapsing–remitting, primary progression, secondary progression, and
progressive-relapsing
3. Risk factors
a) Genetics, geographic location, diagnosis of other autoimmune disorders (type 1
diabetes), low levels of vitamin D, obesity, smoking, and high salt intake
4. Manifestations
a) Fatigue
b) Pain
c) Visual deficits
d) Cognitive dysfunctions
e) Mood alterations
f) Weakness and/or numbness in one or both extremities
g) Upper motor neuron involvement
h) Bladder dysfunctions
i) Bowel dysfunction
j) Sexual dysfunction
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5. Complications
a) Increased risk for falls
6. Interprofessional care
a) Diagnosis
(1) Based on manifestations and patterns of exacerbation and remission
(2) MRI and CT scans: Can detect lesions
(3) CSF: Indicates immune response, shows elevated levels of immunoglobulin G
(IgG)
b) Medications
(1) During acute exacerbations
(a) Combination of adrenal corticosteroid hormone (ACTH) and glucocorticoids
(b) Immunosuppressive agents
(2) To reduce exacerbations in relapsing courses
(a) Interferon and glatiramer acetate
(b) Fingolimod (Gilenya)
(3) For manifestations
(a) Anticholinergics: For bladder spasticity
(b) Cholinergics: For bladder flaccidity
(c) Amantadine (Symmetrel): For fatigue
c) Nutrition and fluids
(1) Inability to ambulate and depression can lead to overweight condition
(2) Inability to prepare and eat food may occur with progression, dysphagia may
occur, diet must be accommodated
d) Rehabilitation
(1) Stretching exercises, gait training, braces, splints: For spasticity
(2) Collaborators: Speech therapists, occupational therapy and occupational
counseling, urologist, and respiratory therapist
e) Surgery
(1) Tendon release procedures : For foot drop from severe plantar flexion
7. Nursing care
a) Assessment
(1) Health history
(2) Physical assessment
b) Diagnoses, outcomes, and interventions
(1) Prevent fatigue
(a) Assess degree of fatigue, identify contributing factors
(b) Set priorities for activities and include rest periods
(c) Advise to avoid temperature extremes
(d) Provide interventions to relieve pain
(e) Refer to appropriate specialists to manage fatigue
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(2) Encourage self-care
(a) Assist with bathing, toileting, dressing, grooming, and feeding from minimal
guidance to complete dependence
8. Transitions of care
a) Discuss: Treatment and side effects; ongoing care from interprofessional team
b) Refer to helpful resources
D. The patient with Parkinson disease
1. Progressive, degenerative disorder of basal ganglia function characterized by tremor,
muscle rigidity, bradykinesia, and postural instability
2. Cause is unknown; there is a genetic link; environmental factors play a role
3. Pathophysiology
a) Decrease in production of dopamine
b) Relative excess of acetylcholine
4. Manifestations
a) Early: Patients complain of being tired and moving more slowly, may experience
impaired sense of smell and pain
b) Tremor
(1) Begins unilateral, progresses to bilateral, progressive impairment hinders
activities that require dexterity and fine muscle control
c) Rigidity and bradykinesia
(1) Rigidity can cause muscle cramps in toes or hands, stiffness, heaviness, or aching
in muscles, may cause flexion contractures
(2) Bradykinesia: Difficulty in starting, continuing, or coordinating movements
(a) Patients have staring gaze with minimal change in expression, or remain still
for long periods of time
d) Abnormal posture
(1) Postural fixation: Stooped, leaning forward position
(2) Equilibrium: Increased risk of injury from falls
e) Autonomic and neuroendocrine effects
(1) Elimination problems
(2) Orthostatic hypotension
(3) Eczematous skin changes and seborrhea
f) Mood and cognition
(1) Depression: Occurs in 50%
(2) Dementia: Occurs in 20%, similar manifestations to AD
(3) Bradyphrenia: Slow thinking and decreased ability to form thoughts or plan
g) Sleep disturbances
(1) From excess acetylcholine and muscle rigidity
h) Interrelated effects
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(1) Constipation
5. Complications
a) Paranoia, hallucinations, impaired communications, falls, infections, malnutrition,
altered sleep patterns, skin breakdown and pressure ulcers, depression and social
isolation
6. Interprofessional care
a) Diagnosis: Based on manifestations
b) Medications
(1) Dopamine precursors
(a) Carbidopa, levodopa, levodopa-carbidopa (Parcopa, Sinemet)
(b) Help balance dopamine/acetylcholine imbalance
(2) Monoamine oxidase B inhibitors
(a) Selegiline (Eldepryl, Zelapar) and rasagiline (Azilect)
(b) Selectively inhibits the enzyme that inactivates dopamine in the brain
(3) Dopamine agonists
(a) Bromocriptine (Parlodel) and pramipexole (Mirapex)
(b) Mimic role of dopamine in the brain
(4) Catechol-O-methyltransferase (COMT) inhibitors
(a) Tolcapone (Tasmar) and entacapone (Comtan)
(b) Inhibit dopamine metabolism
(5) Anticholinergics
(a) Trihexyphenidyl (Artane) and benzotropine (Cogentin)
(b) Block the excitatory action of the neurotransmitter acetylcholine
c) Nutrition
(1) Fluids
(2) Avoid high-protein diets
d) Surgery
(1) Deep brain stimulation (DBS): For those with advanced tremors
(a) Pacemaker-like neurostimulator is implanted in brain, connected to pulse
generator, pulses interfere with brain’s electrical signals that cause
manifestations
(2) Gene therapy, cell replacement therapy, and vaccines
(a) Investigational treatment
e) Integrative therapies
(1) Exercise
7. Nursing care
a) Assessment
(1) Health history
(2) Physical examination
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b) Diagnoses, outcomes, and interventions
(1) Promote physical mobility
(a) Suggest referral to physical therapist, request that caregivers learn how to
assist with ROM exercises
(b) Ask caregivers to ambulate patient at least four times a day if possible
(c) Recommend assistive devices
(d) Modify environment for safety and reduction of fall risks
(2) Promote verbal communication
(a) Assess current communication abilities in speech, hearing, and writing
(b) Develop methods of communication appropriate to coordination abilities
(c) Suggest referral to a speech pathologist
(d) Remind patient to speak more loudly, if possible
(3) Promote adequate nutrition
(a) Assess nutritional status
(b) Teach caregivers how to prepare foods of appropriate consistency
(c) Weight weekly
(d) Teach eating methods to decrease tremors
(e) Encourage diet that is high in bulk and fluids
(4) Manage sleep pattern
(a) Assess sleep pattern and existing conditions that may affect sleep
(b) Explain the disease process and the effects on sleep
(c) Review patient’s medication
(d) Teach how to modify lifestyle activities that affect sleep and mobility
8. Transitions of care
a) Discuss: Realistic expectations, equipment suppliers, home environment, gait training
and exercises, increased fluid intake, stool softeners, swallowing during eating and
taking medications, and foods that can easily swallow
b) Refer to specialists and helpful resources
E. The patient with Huntington disease
1. Progressive, degenerative, inherited neurologic disease characterized by increasing
dementia and chorea
a) Autosomal-dominant inherited
2. Pathophysiology
a) Destruction of cells in the upper and lower motor neurons
b) Other areas of the brain may selectively atrophy
c) Several neurotransmitters are decreased, including acetylcholine
d) Excess of dopamine relative to acetylcholine causes excessive, uncontrolled movement
3. Manifestations
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a) Motor effects
(1) Early: Restlessness, fidgety feeling, minor gait changes, posture and positioning
disturbances, inability to keep the tongue from protruding, and slurred speech
(2) Later: Chorea, facial grimacing, dysphagia, unintelligible speech, and impaired
diaphragmatic movement
b) Psychosocial effects
(1) Early: Irritability, outbursts of rage alternating with euphoria, and depression
(2) Late: Decreasing memory, loss of cognitive skills, and eventual dementia
4. Interprofessional care
a) Diagnosis
b) Prognosis is poor
c) Nursing care
(1) Teaching about the disease
(2) Psychologic support
(3) Genetic counseling
(4) Immobility
(5) Altered nutrition
(6) Self-care deficits
F. The patient with amyotrophic lateral sclerosis
1. Rapidly progressive and fatal degenerative neurologic disease characterized by weakness
and wasting of muscles under voluntary control, without any accompanying sensory
changes
2. 90–95% of cases occur randomly with no associated risk factors; 5–10% are inherited.
3. Pathophysiology
a) Death of the motor neurons results in axonal degeneration, demyelination, glial
proliferation, and scarring along the corticospinal tract
b) Pathogenesis is being researched.
4. Manifestations
a) Early: Spastic, weak muscles, increased deep tendon reflexes, muscle flaccidity, and
slurred speech
b) Atrophy ensues, paralysis results
c) Eventually requires ventilatory support to breathe
5. Interprofessional care
a) Diagnosis
(1) Based on manifestations and tests to rule out other diseases
b) Medications
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(1) Riluzole (Rilutek), an antiglutamate: Inhibits the presynaptic release of glutamic
acid in the CNS and protects neurons against the excitotoxicity of glutamic acid
6. Nursing care
a) Diagnoses, outcomes, and interventions
(1) Promote physical mobility
(a) Assess current condition for baseline parameters
(b) Assess skin, provide skin care, and obtain alternating-pressure mattress
(c) Institute active ROM exercises and/or perform passive ROM exercises
(d) Maintain positive nitrogen balance and hydration status
(e) Monitor for manifestations of infection
(2) Promote effective breathing
(a) Obtain a baseline assessment of breathing pattern, air movement, and
oxygen saturation
(b) Turn at least every 2 hours
(c) Elevate the head of the bed at least 30°
(d) Monitor temperature and lung sounds routinely, obtain sputum culture as
indicated
7. Transitions of care
a) Explain disease process, expected course, and prognosis
b) Referral to social worker, home health agency, dietician, physical, speech, and
occupational therapists
c) As disease progresses, focus on preventing complications, and teach family measures
d) Much consideration to psychosocial concerns
II.
Peripheral Nervous System Disorders
A. The patient with myasthenia gravis
1. Chronic autoimmune neuromuscular disorder characterized by fatigue and severe
weakness of skeletal muscles
2. Pathophysiology
a) Antibodies destroy or block neuromuscular junction receptor sites, resulting in a
decreased number of acetylcholine receptors
b) Decrease in the muscle’s ability to contract despite a sufficient amount of acetylcholine
c) Thymus believed to be a source of an autoantigen that triggers autoimmune response
d) Sometimes associated with thyrotoxicosis, rheumatoid arthritis, and lupus
erythematosus
3. Manifestations
a) Ocular and facial: Ptosis, diplopia, facial weakness, dysphagia, and dysarthria
b) Musculoskeletal: Weakness, fatigue, decreased function of hands, arms, legs, and neck
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c) Respiratory: Weakening of intercostal muscles, decrease in diaphragm movement,
breathlessness and dyspnea, poor gas exchange
d) Nutritional: Inability to chew and swallow, decreased ability to move tongue, and
impairment of fine motor movements
4. Complications
a) Aspiration and pneumonia
b) Myasthenic crisis: Sudden exacerbation of motor weakness putting the patient at risk
of respiratory failure and aspiration
(1) Due to undermedication, missed doses of medication, or a developing infection
(2) Manifestations: Tachycardia, tachypnea, severe respiratory distress, dysphagia,
restlessness, impaired speech, and anxiety
c) Cholinergic crisis: Result of overdosage with the anticholinesterase (cholinergic)
medications
(1) Manifestations: GI manifestations, severe muscle weakness, vertigo, and
respiratory distress are signs of cholinergic crisis.
5. Interprofessional care
a) Diagnosis
(1) Tensilon test: Injection of edrophonium chloride (Tensilon), results in significant
improvement of muscle strength that lasts a few minutes
(2) Single-fiber electromyography
(3) Serum assay of circulating acetylcholine receptor antibodies: Increases
b) Medications
(1) Anticholinesterases
(a) Neostigmine (Prostigmin), , pyridostigmine (Mestinon, Regonol)
(b) Enhance the effects of acetylcholine at the remaining skeletal muscle
receptors
(2) Immunosuppression with glucocorticoids: To improve muscle strength
c) Surgery
(1) Thymectomy: For patients younger than 60
(a) Transcervical approach versus transsternal approach
(b) Tapered with steroid therapy
(c) Nursing care: Preventing complications, controlling pain
d) Plasmapheresis
(1) Goal to remove antiacetylcholine receptor antibodies
6. Nursing care
a) Diagnoses, outcomes, and interventions
(1) Maintain effective airway clearance
(a) Assist with turning, deep breathing, and coughing every 2 hours
(b) Place in semi-Fowler position
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(c) Maintain hydration status and monitor for dehydration
(d) Monitor lung sounds, respiration status
(2) Reduce risk of aspiration
(a) Assess ability to manage various consistencies of foods
(b) Speech therapy consultation
(c) Plan meals to promote medication effectiveness
(d) Have the patient eat slowly, using small bites of food
(e) Give cues while eating
(f) Teach caregivers the Heimlich maneuver and suctioning
(g) Monitor lung sounds, respirations, and pulse oximetry
7. Transitions of care
a) Discuss: Treatment, realistic expectations, methods to avoid fatigue and undue stress,
and birth control measures
b) Refer to support groups and helpful resources
B. The patient with Guillain-Barré syndrome
1. Acute inflammatory demyelinating disorder of the PNS characterized by an acute onset of
motor paralysis (usually ascending)
2. Precipitating events: Respiratory or gastrointestinal viral or bacterial infection 1–3 weeks
prior to the onset of manifestations, surgery, viral immunizations, and other viral illnesses
a) Sometimes no precipitating event
3. Pathophysiology
a) Destruction of myelin sheaths results in poor conduction of nerve impulses
4. Manifestations
a) Acute stage: Severe and rapid weakness, progresses to quadriplegia and respiratory
failure; decreased deep tendon reflexes; decreased vital capacity; paresthesias,
numbness; and pain
b) Stabilizing/plateau stage: “Leveling off” of symptoms; 2–3 weeks after onset
c) Recovery stage: May take several months to 2 years; improvement of symptoms;
muscle strength and function return
5. Interprofessional care
a) Diagnosis: Based on manifestations, history of recent viral infection, elevated CSF
proteins, EMG studies
(1) CT scan, lumbar punctures, and nerve conduction study
b) Medications
(1) Antibiotics for prophylaxis
(2) Morphine for muscle pain
(3) Anticoagulation therapy to prevent thromboembolic complications
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(4) Vasopressors for hypotension
c) Nutrition and fluids
(1) Maintaining positive nitrogen balance, ensuring sufficient fluid intake and
electrolyte balance, and ensuring recommended caloric intake
(2) Total parenteral nutrition in case of swallowing problems
d) Plasmapheresis
(1) Can be beneficial within first two weeks of syndrome development
e) Physical and occupational therapy
(1) Long term and crucial to recovery
(2) Have to relearn walking
(3) Controlling pain important
6. Nursing care
a) Diagnoses, outcomes, and interventions
b) Control acute pain
(a) Listen to description of pain; determine triggers and/or pattern
(b) Use complementary therapies to relieve pain
(c) Provide analgesics as indicated
(d) Monitor for side effects of analgesics
(2) Promote good skin integrity
(a) Inspect and provide skin care every 2 hours
(b) Pad bony prominences
(c) Use an alternating-pressure mattress
(d) Monitor for incontinence
7. Transitions of care
a) Teach disease process, include patient and family in treatment decisions
b) Teach to avoid complications
c) Refer to appropriate specialists for rehabilitation
III.
Cranial Nerve Disorders
A. The patient with trigeminal neuralgia
1. Severe, brief, repetitive attacks of lightening-like or throbbing pain, occurring along the
distribution of a spinal or cranial nerve
2. Pathophysiology
a) Follows vascular compression and demyelination of the trigeminal nerve
b) Contributing factors include trauma, dental or jaw infections, flulike illnesses,
aneurysm, tumor, and MS
c) Pain episodes triggered by stimulation of trigger zones on face
3. Manifestations
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a) Brief (lasting a few seconds to a few minutes), repetitive episodes of sudden severe
facial pain
(1) May occur as often as hundreds of times a day to as infrequently as a few times
a year
4. Interprofessional care
a) Diagnosis: Based on manifestations
b) Medications
(1) Tricyclic anticonvulsant carbamazepine (Tegretol)
(2) Anticonvulsants carbamazepine (Tegretol ) or gabapentin (Neurontin) or the
skeletal muscle relaxant baclofen (Lioresal)
c) Surgery
(1) Rhizotomy: Surgical severing of a nerve root
(a) Open and closed procedures
5. Nursing care
a) Diagnoses, outcomes, and interventions
(1) Control acute pain
(a) Identify factors that trigger an attack
(b) Determine usual response to pain
(c) Assess factors that affect pain tolerance
(d) Monitor effects of medications prescribed
(2) Promote balanced diet
(a) Monitor dietary intake and weight at each visit
(b) Discuss temperature and consistency of foods
(c) Suggest chewing on unaffected side of mouth
(d) Tube feedings may be necessary
6. Transitions of care
a) Teach disease process, medications, and ways to reduce incidents of pain
B. The patient with Bell Palsy
1. Disorder of the seventh cranial (facial) nerve, characterized by unilateral weakness of the
facial muscles
2. May occur as a distinct classic disease or may accompany other diseases such as GuillainBarré syndrome, tumor, Lyme disease, or stroke
3. Pathophysiology
a) Believed to be caused by herpes simplex virus type 1 and herpes zoster virus
4. Manifestations
a) Onset is sudden.
b) Pain behind ear or along jaw may accompany symptoms.
c) Face becomes distorted.
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d) Paralysis varies.
5. Interprofessional care
a) No specific diagnostic test or treatments
b) Medications: Antiviral drugs combined with anti-inflammatory drug
c) Physical therapy
d) Moist heat to decrease pain
6. Nursing care
a) Interventions
(1) Use artificial tears
(2) Massage with warm, moist heat
(3) Soft diet
(4) Facial exercises
7. Transitions of care
a) Healthy diet
b) Daily exercise
Chapter Highlights
A. Dementia involves impairment in short- and long-term memory; impairment in language,
motor activity, recognition, and/or abstract thinking; and a clinical course characterized by
gradual onset and continuing cognitive decline.
B. Alzheimer Disease (AD) is progressive and relentless and is characterized by cognitive and
functional decline. The disease is characterized by atrophy of brain tissue, loss of neurons,
neurofibrillary tangles, and amyloid plaques. There are no effective treatments for
preventing AD, although pharmacologic and nonpharmacologic therapies may slow its
course. Education of caregivers addresses burdens and expectations and provides
instruction regarding community resources. The goal is to maximize the environment to the
patient’s functional abilities and safety needs.
C. Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous
system. MS is multifactorial, with genetic and environmental factors linked to its incidence.
Exposure to UVB light and exposure to the Epstein-Barr virus have both been implicated as
environmental factors that interact with genes to lead to the onset of MS. The loss of
myelin leads to axon dysfunction, which slows and distorts nerve impulses. Medications are
used to slow the progression of the disease, decrease the number of exacerbations, and
treat manifestations.
D. Parkinson disease (PD) is a progressive degenerative neurologic disease characterized by
tremor, muscle rigidity, and bradykinesia. The loss of voluntary motor control is the result of
pathologic processes resulting in a decrease of dopamine (an inhibitory neurotransmitter)
so that it can no longer inhibit acetylcholine (an excitatory neurotransmitter). Medications
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E.
F.
G.
H.
I.
to treat manifestations include MAO inhibitors, dopaminergics, dopamine agonists, and
anticholinergics.
Huntington disease (chorea) is a progressive, degenerative inherited neurologic disease
characterized by increasing dementia and chorea.
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive and fatal degenerative motor
neuron disease characterized by weakness and wasting of voluntary control muscles, but
without sensory or cognitive changes. The patient eventually loses the ability to
communicate and breathe.
Myasthenia gravis (MG) is a chronic autoimmune PNS disorder characterized by fatigue and
severe skeletal muscle weakness. It results from a decreased number of acetylcholine
receptors at the neuromuscular junction, so muscles are unable to contract. Lifethreatening emergencies include myasthenic crisis (sudden increase in motor weakness)
and cholinergic crisis (from an overdose of the anticholinesterase medications used to treat
MG).
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating disease of the PNS
characterized by an acute onset of flaccid motor paralysis that begins in the lower
extremities and ascends to involve the upper extremities, torso, and cranial nerves.
Paralysis of intercostal and diaphragmatic muscles often necessitates ventilatory assistance.
The progressive phase lasts up to 4 weeks, followed by recovery, which takes from 6
months to 2 years.
Cranial nerve disorders include trigeminal neuralgia (TN) and Bell palsy. TN is a chronic
disorder of cranial nerve V and causes severe facial pain. Bell palsy is an acute disorder of
cranial nerve VII, characterized by unilateral paralysis of the facial muscles.
SUGGESTIONS FOR CLASSROOM ACTIVITY—LEARNING OUTCOME ONE
Have a family member of a patient with Alzheimer disease address the class regarding the
experience of caring for a patient with Alzheimer disease in the home.
In class, have students share what they have learned about stages of Alzheimer disease and nursing
care strategies pertinent to each stage.
Have the class access the internet for information regarding support groups for each of the
disorders discussed.
SUGGESTION FOR CLINICAL ACTIVITY—LEARNING OUTCOME ONE
Assign students to care for clients with AD, MS, or PD. Have the students discuss the care required
during postclinical conference.
Copyright © 2020 by Pearson Education, Inc.
Bauldoff/Gubrud/Carno, Instructor's Resource Manual for LeMone & Burke's Medical-Surgical Nursing:
Clinical Reasoning in Patient Care, 7th Edition
SUGGESTIONS FOR CLASSROOM ACTIVITY—LEARNING OUTCOME TWO
Have students review the medical records of clinical patients for medications that are commonly
administered to people with chronic neurologic disorders. Require students to develop medication
administration information sheets on the medications. Include information regarding dose, side
effects, administration implications, and teaching required.
Have the class access the internet for information regarding support groups for each of the
disorders discussed.
SUGGESTION FOR CLINICAL ACTIVITY—LEARNING OUTCOME TWO
Assign students to care for clients with MG if possible. If not available, assign students to observe
the plasmapheresis procedure.
SUGGESTIONS FOR CLASSROOM ACTIVITY—LEARNING OUTCOME THREE
Using anatomic models, discuss the procedures to treat trigeminal neuralgia. Discuss the nursing
implications of care of the postoperative patient.
Have the class access the internet for information regarding support groups for each of the
disorders discussed.
SUGGESTION FOR CLINICAL ACTIVITY—LEARNING OUTCOME THREE
Assign students to care for a client with trigeminal neuralgia or Bell palsy. If not available, have the
students creating a teaching tool that supports self-care needs of the client with these disorders.
Copyright © 2020 by Pearson Education, Inc.
Bauldoff/Gubrud/Carno, Instructor's Resource Manual for LeMone & Burke's Medical-Surgical Nursing:
Clinical Reasoning in Patient Care, 7th Edition