Neurology

Anatomy & Physiology

 Occipital: Vision

Lobes of the brain Temporal: Memory, understanding language

Parietal: Perception, math, spelling, logic

Frontal: Thinking, planning, organizing,

problem solving, emotions, behavioral control,
personality

Cerebellum: Balance

*Language centers:

Broca’s area: expressive language

Wernicke’s area: receptive language
Meninges
Connective tissue covering the CNS

Cerebrospinal fluid
A clear, colorless liquid found in your brain and spinal cord.
Intracranial Pressure
● The pressure inside of the skull
● Normal = 5-15
● Monro-Kellie hypothesis
○ The skull is a rigid container filled with: blood, brain, and CSF. If one of those three increases,
another must decrease.
● Causes of increased ICP:
○ Tumor
○ Bleeding
○ Hydrocephalus
○ Edema
 T r av e l e d And
Cranial Nerves
Oh , O h , T hey Ve ry
I - Olfactory (smell) Oh, rt Gu a rd i n g
V ol d e m o
II - Optic (vision)
Found t) Ho r c ru xes
cien
Secret (An
III - Oculomotor (pupil constriction)

IV - Trochlear (downward movement of eyes)

V - Trigeminal (jaw movement, sensation of face and neck)

VI - Abducens (lateral movement of eyes)

VII - Facial (facial movement, taste on anterior 2/3 of tongue)

VIII - Vestibulocochlear (hearing and balance)

IX - Glossopharyngeal (swallowing, taste on posterior 1/3 of tongue)

X - Vagus (swallowing, speaking)

XI - Spinal/Accessory (flexion and rotation of head)

XII - Hypoglossal (tongue movements)

 Skull Injury
● Basilar skull fracture
○ Battle’s sign → Bruising over the
mastoid process
○ Raccoon eyes → Periorbital bruising
○ Cerebrospinal rhinorrhea
■ Test drainage for CSF
● Halo test
● Glucose
○ NEVER INSERT AN NG TUBE IN A
client WITH A BASILAR SKULL
FRACTURE
● Open fracture → Torn dura
● Closed fracture → Dura is intact
Epidural Hematoma
● Rupture to the middle meningeal artery
● Fast bleed
● High pressure
● Characteristic pattern of symptoms:
○ Injury → loss of consciousness → recover → body compensates and they seem okay → body
is unable to compensate anymore and neuro changes begin
■ Agitation
■ Restlessness
■ Pupil change
● “Talk and die phenomenon” - medical emergency
● Treatment - burr hole

Subdural Hematoma
● Venous bleed
● Slower and less pressure
● Commonly seen in chronic geriatric clients
● Treatment: craniotomy
 Hydrocephalus

What is hydrocephalus?
● Increased accumulation of cerebrospinal fluid
● Increases ICP
● Causes:
○ Tumor
○ Hemorrhage
○ Infection
○ Congenital
External Ventricular Drain (EVD)

VP Shunt

○ Ventricle - Space in the brain

○ Peritoneum - Serous membrane
lining the abdominal
compartment
○ Shunt that drains extra CSF
from brain to the abdomen,
where it can then be excreted
as urine.
 Meningitis

What is Meningitis?
● Inflammation of the spinal cord or brain.
● Caused by a virus or bacteria.
○ Bacterial is more dangerous
Assessment
● Nuchal rigidity
● Photophobia
● Kernig’s sign
● Brudzinski’s sign
Treatment
● Steroids
● Analgesics
● Antibiotics - only if bacterial!!
● Isolation precautions
○ Viral - contact precautions
○ Bacterial - Droplet precautions
■ Bacterial meningitis is VERY contagious!! Medical emergency!!
● Prevention
○ Hib vaccine
○ Recommended for college students due to living in close quarters in dorms

Spinal Cord Injury

(SCI)
 What is a Spinal Cord Injury?
● Damage to the spinal cord causes permanent changes in strength, sensation and other
body functions below the site of the injury.
● Symptoms depend on location of the injury
● The higher the injury - the more function that is lost.
● Injuries above T6:
○ Monitor for autonomic dysreflexia

Autonomic dysreflexia
● Syndrome characterized by
○ Sudden severe hypertension
○ Bradycardia
○ Headache
○ Nasal stuffiness
○ Flushing
○ Sweating
○ Blurred vision
○ Anxiety
Treatment
1. Sit the client up to lower their BP
2. Antihypertensives
a. Hydralazine
3. Find the cause and treat
a. Full bladder? Cath
b. Constipated? Remove impaction
c. Pressure injury? Reposition
d. Painful stimuli? Remove stilumi
e. Cold room? Change the temperature
 Stroke

What is a stroke?
“A disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a
leading cause of disability in the United States. A stroke occurs when a blood vessel that carries
oxygen and nutrients to the brain is either blocked by a clot or bursts”

…..There is a lack of oxygen to the brain, and that causes damage!

This lack of oxygen can be:

● Hemorrhagic
● Ischemic
○ Embolic
○ Thrombotic
Pathophysiology - Hemorrhagic stroke
● A vessel ruptures and bleeds into the brain.
● As the blood accumulates, there is increased pressure on the brain
● The rupture can be caused by a weakened vessel, such as in an aneurysm.

“Worst headache of my life”

Pathophysiology - Ischemic stroke

● Blood flow to the brain is blocked by a blood clot.
○ Thrombotic - a blood clot (thrombus) in an artery going to the brain. Onset in a stepwise fashion.
○ Embolic - a clot that’s formed elsewhere (usually in the heart or neck arteries) travels in the bloodstream
and clogs a blood vessel in or leading to the brain. Sudden onset!
● There is a loss of blood circulating to this area of the brain.
● The lack of blood leads to a lack of oxygen, causing ischemia and damage.
Assessment
● FAST
○ Facial droop
○ Arm drift
○ Speech problems
○ Time - call 911 ASAP - Time is brain cells!
● Altered LOC
○ Confusion
○ Lethargy
○ ‘Not acting right”
● Aphasia
● Apraxia
● Loss of vision
○ Abnormal pupil response
○ Hemianopia
● Dysphagia

Treatment
Ischemic Hemorrhagic

● Permissive hypertension ● Get the bleeding under control

○ Ensure there is perfusion to the brain ● If caused by an aneurysm:
● Antithrombotics ○ Coiling - IR
○ tPA ○ Clipping - OR
○ Break up clot to restore blood flow ● Craniotomy
○ Must be done quickly - door to tPA = 60 ● EVD
min
● Percutaneous thrombectomy
○ Surgical removal of clot
○ Done in IR
NCLEX Question
You are working in the Emergency Department when a client with a suspected
stroke arrives. Which of the following essential nursing actions should the nurse
perform? Select all that apply.

A. Activate the stroke team

B. Check and treat the glucose
C. Order an immediate CT or MRI of the brain
D. Administer tPA
E. Administer morphine

NCLEX Question
You are working in the Emergency Department when a client with a suspected
stroke arrives. Which of the following essential nursing actions should the nurse
perform? Select all that apply.

A. Activate the stroke team

B. Check and treat the glucose
C. Order an immediate CT or MRI of the brain
D. Administer tPA
E. Administer morphine
Answers: A, B, and C
According to the AHA, the immediate general assessment and stabilization
should include: assess the ABCs and vital signs, provide oxygen as needed,
obtain an IV, check glucose and treat as needed, perform an essential neurologic
screening, activation of the stroke team, order an immediate CT or MRI of the
brain, and obtain an ECG. All of these actions should be included within the first
10 minutes after arrival at the ED. The decision of whether or not to give tPA will
depend on the results of the CT scan or MRI. If the provider determines that there
is no brain hemorrhage, the team should complete the fibrinolytic checklist before
deciding whether or not to give rtPA. Administering morphine is not a priority in a
suspected stroke.

Seizures
What are Seizures?
● Seizures are not a disease in themselves
● They are a symptom of an underlying disorder.
● Epilepsy
○ “A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of
consciousness, or convulsions, associated with abnormal electrical activity in the brain.”
○ No other underlying disorder

● Partial - limited to a specific area of the brain

● Generalized - Involves the entire brain
● Simple - No loss of consciousness.
● Complex - Impared consciousness ranging from confusion to non responsive

● Tonic/Clonic - Phases of tonic and clonic spasm

● Myoclonic - sudden, brief contractions of a muscle or group of muscles
● Absence - Loss of consciousness; staring off into space.
Treatment
● Anticonvulsants
○ Rapid acting - lorazepam
○ Long acting - phenytoin
● Very important to monitor for therapeutic levels
● Never stop taking suddenly - can cause a seizure

Seizure Precautions
NCLEX Question
Seizure precautions have been ordered for a client admitted to the psychiatric
unit. Which of the following nursing interventions is not appropriate when
initiating seizure precautions? Select all that apply.

A. Pad the side rails of the bed

B. Lower side rails while the client sleeps
C. Remove hard or sharp objects from the bed
D. Use four point restraints to prevent injury
E. Adhere a fall risk bracelet to the seizure prone client
F. Ask the family to monitor the patient 24/7.

NCLEX Question
Seizure precautions have been ordered for a client admitted to the psychiatric
unit. Which of the following nursing interventions is not appropriate when
initiating seizure precautions? Select all that apply.

A. Pad the side rails of the bed

B. Lower side rails while the client sleeps
C. Remove hard or sharp objects from the bed
D. Use four point restraints to prevent injury
E. Adhere a fall risk bracelet to the seizure prone client
F. Ask the family to monitor the patient 24/7.
Answers: B and D
The correct answers are B and D. Padded bed rails should remain up while the client
sleeps. Patients should be provided with a call light so that they may call for help if needed.
Four-point restraints are not appropriate for the seizing client and could result in injury.

Choice A is incorrect. When initiating seizure precautions, the nurse should ensure that the
side rails are padded.

Choice C is incorrect. All sharp objects should be removed from a client's bed when
instituting seizure precautions.

Choice E is incorrect. Patients prone to seizures should wear a fall risk bracelet to alert
members of the health care team to the client's need for increased supervision.

Choice F is incorrect. It is not appropriate to ask the family to monitor the patient 24/7

What is Parkinson's Disease?

● Progressive nervous system disorder.
● Caused by degeneration of dopamine neurons
Assessment findings

Interventions
● Fall risk
● No cure
● Therapy
○ PT
○ OT
SLP
● Carbidopa-levodopa.
○ Increase dopamine in the brain
What is Multiple Sclerosis?
● Autoimmune disorder
● CNS inflammation
● Damages and degrades the myelin sheath surrounding neurons
○ Demyelination
Interventions
● No cure
● Corticosteroids
○ Decrease inflammation
● Plasmapheresis

Myasthenia Gravis
● Autoimmune disorder
●
● Communication between nerves and muscles destroyed
● Diagnosis
○ Tensilon Test
Assessment
● Weak muscles
● Ptosis
○ Drooping eyelid

Interventions
● Cholinesterase inhibitors
● Corticosteroids
● Immunosuppressants