Neurologic Function and Increased Intracranial Pressure

• Neurologic disorders affect the central nervous system (CNS), which includes the brain and spinal cord
• These disorders can significantly impair a person's physical, cognitive, and emotional functions

Assessment of Neurologic Function

• A neurological assessment includes evaluation of mental status, cranial nerves, motor function, sensory function, and reflexes
• Mental status is evaluated by assessing the patient's level of consciousness, orientation, memory, and cognitive abilities
• Cranial nerves are assessed to evaluate specific functions such as vision, hearing, facial movement, and swallowing
• Motor function assessment includes evaluating muscle strength, coordination, and gait
• Sensory function assessment involves testing the patient's ability to perceive touch, pain, temperature, and vibration
• Reflexes are assessed to evaluate the integrity of the spinal cord and peripheral nerves

Increased Intracranial Pressure (ICP)

• Increased ICP is a life-threatening condition caused by a rise in pressure inside the skull
• Normal ICP is between 5 and 15 mm Hg
• Elevated ICP can result from brain tumors, hemorrhage, edema, or increased cerebrospinal fluid (CSF) production
• Common signs and symptoms of increased ICP include headache, vomiting, altered level of consciousness, and papilledema

Nursing Management of Increased ICP

• Nursing interventions focus on reducing ICP and preventing complications
• Monitor neurologic status closely, including level of consciousness, vital signs, and pupillary response
• Elevate the head of the bed to 30-45 degrees to promote venous drainage from the brain
• Administer medications such as osmotic diuretics (e.g., mannitol) and corticosteroids to reduce cerebral edema
• Maintain a calm, quiet environment to minimize stimulation
• Prevent straining activities such as coughing, sneezing, and Valsalva maneuver

Headaches

• Headaches are a common neurological symptom that can result from various causes
• Primary headaches include tension headaches, migraines, and cluster headaches
• Secondary headaches are caused by underlying medical conditions such as head injuries, infections, or tumors
• Assessment of headaches includes evaluating the location, intensity, duration, and associated symptoms

Nursing Management of Headaches

• Nursing interventions focus on pain relief and identifying triggers
• Administer analgesics as prescribed, such as NSAIDs, acetaminophen, or triptans for migraines
• Provide a dark, quiet environment to reduce sensory stimulation
• Encourage patients to keep a headache diary to identify potential triggers
• Teach patients about stress management techniques and lifestyle modifications

Seizures

• Seizures are episodes of abnormal electrical activity in the brain that can cause changes in motor function, sensation, or consciousness
• Epilepsy is a chronic neurological disorder characterized by recurrent seizures
• Seizures can be classified as partial (focal) or generalized, depending on the extent of brain involvement
• Status epilepticus is a life-threatening condition characterized by prolonged or repeated seizures without recovery between episodes

Nursing Management of Seizures

• During a seizure, protect the patient from injury by padding the surrounding area and loosening restrictive clothing
• Do not insert anything into the patient's mouth
• Observe and document the characteristics of the seizure, including duration, type of movements, and any associated symptoms
• Administer anticonvulsant medications as prescribed to prevent further seizures
• Monitor the patient's airway and breathing after the seizure
• Provide emotional support and education to the patient and family

Stroke

• Stroke, also known as cerebrovascular accident (CVA), occurs when blood flow to the brain is interrupted, resulting in brain cell damage
• Ischemic stroke is caused by a blockage of a blood vessel in the brain
• Hemorrhagic stroke is caused by bleeding into the brain tissue
• Risk factors for stroke include hypertension, hyperlipidemia, smoking, diabetes, and atrial fibrillation

Nursing Management of Stroke

• Nursing care focuses on minimizing brain damage, preventing complications, and promoting rehabilitation
• Assess neurologic status frequently, including level of consciousness, motor function, and sensory function
• Monitor vital signs and maintain blood pressure within prescribed parameters
• Administer thrombolytic medications (e.g., alteplase) for ischemic stroke within the appropriate time window
• Prevent complications such as aspiration, pneumonia, and deep vein thrombosis (DVT)
• Provide supportive care and education to the patient and family regarding rehabilitation and long-term management

Traumatic Brain Injury (TBI)

• TBI occurs when an external force causes damage to the brain
• TBI can result in a variety of physical, cognitive, and emotional deficits
• Severity of TBI is classified as mild, moderate, or severe based on the Glasgow Coma Scale (GCS) score
• Common complications of TBI include increased ICP, seizures, and cognitive impairment

Nursing Management of TBI

• Nursing care focuses on minimizing secondary brain injury, preventing complications, and promoting rehabilitation
• Monitor neurologic status closely, including level of consciousness, pupillary response, and motor function
• Maintain adequate oxygenation and ventilation
• Prevent increased ICP by elevating the head of the bed and administering medications as prescribed
• Provide supportive care and education to the patient and family regarding rehabilitation and long-term management

Spinal Cord Injury (SCI)

• SCI occurs when there is damage to the spinal cord, resulting in loss of motor and sensory function below the level of injury
• The level of injury determines the extent of impairment
• SCI can result in quadriplegia (paralysis of all four limbs) or paraplegia (paralysis of the lower limbs)
• Common complications of SCI include autonomic dysreflexia, respiratory dysfunction, and pressure ulcers

Nursing Management of SCI

• Nursing care focuses on preventing complications, promoting rehabilitation, and maximizing the patient's independence
• Maintain spinal stabilization to prevent further injury
• Monitor respiratory function closely and provide respiratory support as needed
• Prevent autonomic dysreflexia by monitoring blood pressure and managing bowel and bladder function
• Prevent pressure ulcers by repositioning the patient frequently and providing skin care
• Provide supportive care and education to the patient and family regarding rehabilitation and long-term management

Infections of the Central Nervous System

• Infections of the CNS include meningitis, encephalitis, and brain abscesses
• Meningitis is an inflammation of the membranes surrounding the brain and spinal cord
• Encephalitis is an inflammation of the brain tissue
• Brain abscesses are localized collections of pus in the brain

Nursing Management of CNS Infections

• Nursing care focuses on identifying and treating the infection, preventing complications, and providing supportive care
• Administer antibiotics or antiviral medications as prescribed
• Monitor neurologic status closely and manage symptoms such as fever, headache, and seizures
• Prevent complications such as increased ICP and respiratory distress
• Provide supportive care and education to the patient and family

Degenerative Neurologic Disorders

• Degenerative neurologic disorders are characterized by progressive loss of neurologic function
• Examples include Alzheimer's disease, Parkinson's disease, and multiple sclerosis (MS)
• These disorders can significantly impact a person's physical, cognitive, and emotional functions

Nursing Management of Degenerative Neurologic Disorders

• Nursing care focuses on managing symptoms, preventing complications, and providing supportive care
• Administer medications to manage specific symptoms such as tremors, rigidity, and cognitive decline
• Provide assistance with activities of daily living (ADLs) as needed
• Promote mobility and prevent falls
• Provide emotional support and education to the patient and family regarding disease progression and long-term management