Central Nervous System DisordersUnit II Syllabus

Welcome to MS Nervous System Unit II 1)CNS Infections & Inflammatory disorders

(activity)2) Increased Intracranial Pressure (PP

presentation)3) Headaches (PP, activity)

4)Traumatic Brain Injury (Worksheets)5) Brain Tumors & IC Surgery (PP

Presentation)6)Spinal Disorders & Injuries (PP presentation)

(Activities 1-3 included in this PP with additional handouts)

Central Nervous System DisordersWhat structures do central CNS

disorders involve? The CNS is the control center of the

bodyCNS disorders can cause symptoms

in any part of the body

CNS InfectionsInfectious agents can enter the CNS and

alter functionTwo main CNS infections: meningitis &

encephalitisObjectives

1)Complete the CNS activity2)Discuss pathophysiologies, S&S,

diagnostic tests & treatments associated with meningitus & encephalitis

CNS Infections Meningitis

Encephalitis

Increased Intracranial Pressure (ICP)

ICP = pressure exerted within the cranial cavity.

Three components within the cranium affect ICP:

Normal ICP:Common causes: intracranial

hemorrhage, head trauma, increased amounts of CSF, tumors

Increased Intracranial Pressure (ICP)

????Critical Thinking Question????

Hyperventilation is known to trigger constriction of cerebral blood vessels. What affect will this have on ICP?

Increased ICP: Signs & SymptomsEarly S&S

Irritability & restlessnessNuchal rigidity, headache & vomitingDecreased level of consciousnessSluggish pupil reactions

Late S&SVital sign changesCushing’s response (Cushing’s triad)Widened pulse pressureFixed and dilated pupils

Increased ICP: MonitoringThree methodsIntraventricularCerebral tissueSubdural or subarachnoid space

Catheters inserted through burr holesCatheters Transducer Monitor (p. 1137

Figure 48.3)Require aggressive nursing care

Increased ICP: MonitoringClass activity: Identify structures A-D

Increased ICP: MonitoringIntraventricular Monitoring

Placement = lateral ventricleAllows for both pressure monitoring &

drainage of CSFP. 1137, figure 48.3Disadvantages: Clotting of catheter Infection

Increased ICP: MonitoringSubarachnoid Bolt &

Intraparenchymal (Brain Tissue) Monitoring

P. 1137, figure 48.4 (subarachnoid monitoring)

Allows for pressure monitoringCan not remove CSFDisadvantages: Clotting of catheters Infection

Increased ICP: Nursing ConsiderationsKeep HOB elevated 30 degreesAdminister stool softeners,

antitussives, & antiemeticsMinimize suctioningNonnarcotic medications are preferedAvoid neck flexionAvoid hip flexionSpace activitiesProvide quiet environment

CNS Disorders: HeadacheThree types of Headaches 1) Tension 2) Migraine a) classic b) common 3) Cluster

CNS Disorders: HeadachesMost headaches are transient and are

not seriousHeadaches are a common symptom of

other neurological disordersWhen headaches are persistent or

recurrent, they should be evaluatedDiagnosis is based on symptoms and

diagnostic procedures are utilized to rule out other disorders

Headaches: Class ActivityType/classification

Cause Symptoms Management/Treatments

Tension Develop gradually, locations and intensity vary. Described as tight, steady aching , & pressure

Migraine Classic Common

Prodromal phase

Immediate onset

Dietary restrictions, quiet environment nifedipine, propranolol, amitriptyline, ergot (Cafergot) , sumatriptan (Imitrex)

Cluster Vascular disturbance, stress, anxiety, emotional disturbances

Closure/Review: CNS Infections, ICP, & Headaches1) What are early symptoms of increased ICP? 2) Define widened pulse pressure3) Are opioid analgesics frequently used with

neurological disorders? Why or why not? 4) Describe Brudzinski’s & Kernig’s sign. 5) What is the cause of tension headaches?

What interventions are utilized with these? 6) What is the pathophysiology of meninigitis?

Closure/Review: CNS Infections, ICP, & Headaches1) What type of headache may be preceded by

an aura? Describe an aura. 2) Describe the pathophysiology of encephalitis3) Describe the therapeutic effect of nifedipine

as it relates to migraine headaches. 4) Describe the therapeutic action of

sumatriptan (Imitrex) when utilized for the treatment of migraine headaches.