1. Managing clients with Neurologic Dysfunction Ma. Tosca Cybil A. Torres, RN, MAN

3. Increase ICP

4. Seizure disorders

6. Coma- a clinical state of unarousable unresponsiveness in which there are no purposeful responses to internal or external stimuli. Akineticmutism- state of unresponsiveness to the environment in which the patient makes no voluntary movement Persistent vegetative state- a condition in which the unresponsive client resumes sleep-wake cycles after coma but is devoid of cognitive or affective mental function. Locked-in syndrome- tetraplegia with inability to speak, but vertical eye movement s and lid elevation remain intact and are used to indicate responsiveness.

7. The level of responsiveness and consciousness is the MOST important indicator of the patient’s condition.

9. Toxicologic

11. Mental status

12. Cranial nerve function

13. Cerebellar function

14. Reflex, motor, and sensory function

15. Glasgow Coma Scale

16. Alertness

18. Pneumonia

19. Pressure ulcers

20. Aspiration

21. DVT

24. Risk for injury

25. Deficient fluid volume

26. Risk for impaired skin integrity

27. Impaired tissue integrity of cornea

28. Ineffective thermoregulation

29. Bowel incontinence

30. Impaired urinary elimination

31. Disturbed sensory perception

33. If the client begins to emerge from unconsciousness, every measure that is available and appropriate in calming and quieting the client should be used.

35. Protecting the client

36. Managing fluid balance and managing nutritional needs

37. Providing mouth care

38. Maintaining skin and joint integrity

39. Preserving corneal integrity

40. Maintaining body temperature

41. Prevent urinary retention

42. Promoting bowel function

43. Providing sensory stimulation

44. Managing the family’s needs

46. Etiology:

47. Head injury

48. Stroke

49. Inflammatory lesions

50. Brain tumor

52. DI

54. Restlessness

55. Confusion

56. difficulty with memory and thinking

57. pupillary dysfunction

58. Impaired extraocular movements

59. changes in vision

60. deterioration of motor function

61. Headache

63. dilated pupils, no reaction to light

64. Altered respiratory functions

65. hemiplegia that progresses

66. projectile vomiting

67. hyperthermia

68. papilledema

69. Loss of brain stem reflexes

70. Vital signs will present the "Cushing triad". hypertention, bradycardia, widening pulse pressure

71. INTERVENTIONS FOR THE PATIENT WITH INCREASED ICP Goals of Therapy Decrease cerebral blood flow Decreasing cerebral edema Lowering volume of CSF

73. Decreasing cerebral edema

74. Maintaining cerebral perfusion

75. Reducing cerebral fluid and intracranial blood volume

76. Controlling

77. Maintaining oxygenation

79. Ineffective breathing pattern

80. Ineffective cerebral tissue perfusion

81. Deficient fluid volume

83. Achieving an adequate breathing pattern

84. Optimizing cerebral tissue perfusion

85. Maintaining negative fluid balance

86. Preventing infection

88. Maintain the head of the bed at 30 - 45 degrees to facilitate venous drainage.

89. Avoid activities that can increase ICP such as suctioning or gagging.

90. Treat hyperthermia

92. Speak softly

93. Touch gently and only when needed

94. Maintain fluid balance via accurate I & O.

95. Monitor electrolytes as these patients are prone to hypernatremia, hypoglycemia, and hypokalemia with diuretic usage.

97. Specific Treatment Surgical removal of intracranial masses. b. Placement of extraventricular drain (temporary). c. Placement of VP shunt (usually permanent).

98. Seizure Disorders Seizures- episodes of abnormal motor, sensory, autonomic, or psychic activity that results from sudden excessive discharge from cerebral neurons

99. Epilepsy a group of syndromes characterized by unprovoked, uncontrolled, recurring seizures due to excessive firing of hyperexcitable neurons of the brain

100. International Classification of Seizures

103. Hypoxemia

104. Fever

105. Head injury

106. HTN

107. CNS infection

108. Metabolic and toxic conditions

109. Brain tumor

110. Drug and alcohol withdrawal

113. The occurrence of an aura

114. The first thing the patient does in the seizure

115. The type of movements in the part of the body involved

116. The areas of the body involved

117. The size of both pupils and whether the eyes are open

118. Whether the eyes or head turned to one side

119. The presence or absence of automatisms

120. Incontinence of urine or stool

122. Any obvious paralysis or weakness of arms or legs after the seizure

123. Inability to speak

124. Movements at the end of the seizure

125. Whether or not the patient sleeps afterward

127. Ease the patient to the floor, if possible

128. Loosen constrictive clothing

129. Push aside any furniture that may injure the patient during the seizure

130. If the patient in in bed, remove the pillows and raise all side rails

131. In an aura precedes the seizure, insert an oral airway

132. DO NOT ATTEMPT TO PRY OPEN JAWS THAT ARE CLENCHED IN A SPASM OR TO INSERT ANYTHING.

133. No attempt should be made to restrain the patient during the seizure

136. The patient, on awakening, should be reoriented to the environment

138. Fear

139. Ineffective individual coping

141. Reducing fear of seizures

142. Improving coping mechanisms

143. Providing patient and family education

144. Monitoring and managing potential complications

146. Medical management The goals of treatment are to stop the seizures as quickly as possible, to ensure adequate cerebral oxygenation, and to maintain the patient in a seizure-free state

149. Assessment The diagnostic evaluation includes a detailed history, a PA of the head and neck, and a complete neurologic examination

150. Migraine Migraine with an aura: Phases: Prodrome Aura phase Headache phase Recovery phase