Introduction to Medical-Surgical Nursing, 6th ed.
27
Lesson Plans for
Neurologic Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 27.1:
2. List the components of the nursing assessment of the patient with a neurologic disorder.
4. Identify the uses, side effects, and nursing interventions associated with common drug therapies
employed in patients with neurologic disorders.
5. Describe the signs and symptoms associated with increased intracranial pressure and the medical
therapies used in treatment.
Lesson 27.2:
7. Assist in developing a nursing care plan for the patient with a neurologic disorder.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to neurologic disorders, such as
headache, seizure disorder, head injury, brain tumors, infections, and inflammatory conditions.
• The chapter includes information on the anatomy and physiology of the nervous system and the
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Intracranial Regulation
• Exemplar: Seizure Disorder, p. 453
• Figure 27-14: Phases of a generalized tonic-clonic seizure, p 454
• Health Promotion: Seizures, p. 455
• Pharmacology Capsule: Sudden discontinuance of anticonvulsant drugs can trigger seizure
activity, p. 455
• Exemplar: Traumatic Brain Injury, p. 458
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Introduction to Medical-Surgical Nursing, 6th ed.
THEME: Attributes and Resources
• Concept: Functional Ability
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) The sympathetic nervous system is activated by stress to increase the release of this (these)
neurotransmitter(s).
a) Acetylcholine
b) Dopamine
c) Norepinephrine and epinephrine
d) Cerebrospinal fluid
2) The most accurate and reliable indicator of a person’s neurologic status is __________.
a) headache and dizziness
b) nausea and vomiting
c) neck stiffness
d) level of consciousness
3) Neuromuscular responses and reflexes provide a means of assessing __________.
a) cerebral and spinal cord function
b) level of consciousness
c) paralysis
d) effectiveness of medications
4) An electroencephalogram (EEG) is a diagnostic test that measures __________.
a) blood flow to the brain
b) congenital abnormalities
c) electrical activity in the brain
d) cerebrospinal fluid pressure
5) Anticonvulsants such as gabapentin, lamotrigine, and topiramate are used for __________.
a) reducing pain
b) decreasing seizure activity
c) decreasing intracranial pressure
d) preventing infection
6) When intracranial pressure increases, which of the following happens?
a) Cerebral perfusion decreases.
b) Spinal fluid becomes bloody.
c) Spinal fluid becomes cloudy.
d) Temperature lowers
7) A preferred treatment for migraine headaches may be __________.
a) ice bags to the head
b) narcotics
c) sumatriptan (Imitrex)
d) diet low in fat
8) Consciousness is usually not impaired in what type of seizure?
a) Generalized
b) Partial
c) Clonic
d) Atonic
9) An epidural hematoma developed from a head injury is the result of __________.
a) tearing of the veins that drain the brain
b) a chronic condition causing headaches
c) slow deterioration of neurologic status
d) tearing of the middle meningeal artery
10) The focus of nursing care for a patient with trigeminal neuralgia is __________.
a) hydration therapy
b) bronchodilation
c) pain management
d) maintaining mobility
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the four major components of a routine neurologic assessment?
Answer: The first component of a neurologic assessment is the level of consciousness. The Glasgow
coma scale helps determine the level of consciousness, which is the most accurate indicator of
Question: What are the two main components of the nervous system? Describe their function.
Answer: The two main components are the central nervous system (CNS) and the peripheral nervous
____________________________________________________________ Chapter 27 Neurologic Disorders 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
Instructor Preparation
Textbook Objectives Covered
1. Identify common neurologic changes in the older person and the implication of these for nursing
care.
3. Describe the diagnostic tests and procedures used to evaluate neurologic dysfunction and the
nursing responsibilities associated with each.
5. Describe the signs and symptoms associated with increased intracranial pressure and the
medical therapies used in treatment.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying neurologic disorders, including:
• Anatomy and physiology of the nervous system
• Pathophysiology of neurologic diseases
• Nursing assessment of neurologic function
• Nursing care of patients with neurologic disorders
Materials and Supplies
• computer and PowerPoint
projector
• reflex stimulator
Key Terms
• aura (p. 454)
• contralateral (p. 445)
• neuralgia (p. 477)
• neurotransmitter (p. 436)
6 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 435-441)
REVIEW
• Figure 27-1: A neuron (p. 436)
• Figure 27-2: Structures of the brain (p. 437)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2 (p. 480)
ANSWER – Study Guide
• Part IA: 1-10 (p. 157)
• Part IB: 1 (p. 158)
2
READ – Textbook (pp. 441-445)
REVIEW
• Figure 27-5: A neurologic flow sheet (p. 444)
• Figure 27-6: Reflexes are elicited by stimulating a sensory nerve (p. 447)
• Figure 27-7: Babinski reflex (p. 448)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 480)
ANSWER – Study Guide
• Part IA: 10-15 (p. 158)
• Part ID: 1 (p. 159)
3
READ – Textbook (pp. 445-449)
REVIEW
• Figure 27-8: Lumbar puncture (p. 448)
• Figure 27-9: Patient undergoing an electroencephalogram (p. 449)
ANSWER – Study Guide
• Part IG: 1-9 (p. 160)
• Part IIK: 1, 2 (pp. 161-162)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
4
READ – Textbook (p. 449)
REVIEW
ANSWER – Study Guide
• Part II: 1-3 (p. 161)
5
READ – Textbook (pp. 451-453)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5, 6, 9 (p. 480)
ANSWER – Study Guide
• Part IIK: 2-5, 13 (pp. 162-163)
Lecture Outline 20 minutes
Slide 1
Chapter 27
Neurologic Disorders
1
Slide 2
Neuron (Nerve Cell)
• Functional unit of the nervous system that conducts electrical impulses from one area of
the brain to another
• Sensory neurons
TALKING POINTS:
• The nervous system receives and interprets information from the external environment
and initiates responses to the received information.
• What does the nervous system coordinate and regulate?
Axons and Dendrites
• Branch off the main cell body
TALKING POINTS:
• What is depolarization? Repolarization?
Myelin
• Material that covers many axons and dendrites
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
Slide 5
Central Nervous System (CNS)
• Made up of the brain and spinal cord
Slide 6
Peripheral Nervous System
• Comprises all the nerves of the peripheral parts of the body, including spinal and cranial
nerves
Slide 7
Brain
• Divided into the cerebrum, cerebellum, and brainstem
TALKING POINTS:
• The cerebrum is composed of left and right hemispheres, which are subdivided into
specific lobes.
Slide 8
Cerebrospinal Fluid (CSF)
• Composed of water, glucose, sodium chloride, and protein
• Acts as a shock absorber for the brain and spinal cord
TALKING POINTS:
Slide 9
Spinal Cord
• Extends from the border of the first cervical vertebra (C1) to the level of the second
lumbar vertebra (L2)
Slide 10
Autonomic Nervous System
• Controls the involuntary activities of the viscera, including smooth muscle, cardiac muscle,
and glands
• Two major subdivisions: sympathetic nervous system and the parasympathetic nervous
system
TALKING POINTS:
• The autonomic nervous system helps maintain homeostasis for the body.
____________________________________________________________ Chapter 27 Neurologic Disorders 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
2
Slide 11
Age-Related Changes
• The number of nerve cells decreases
• Brain weight is reduced; ventricles increase in size
• Lipofuscin: aging pigment deposited in nerve cells with amyloid, a type of protein
• Increased plaques and tangled fibers in nerve tissue
Slide 12
Types of Disorders
• Developmental and genetic
• Trauma
• Infections and inflammation
• Neoplasms
• Degenerative processes
• Vascular disorders
• Metabolic and endocrine disorders
TALKING POINTS:
• Developmental disorders include structural problems such as hydrocephalus.
• Central nervous system injuries resulting from trauma can be life-threatening or severely
disabling.
Slide 13
Nursing Assessment of Neurologic Function
• Health history
• Note speech, behavior, coordination, alertness, comprehension
• Chief complaint and history of present illness
• Document what prompted the patient to seek medical attention
• Describe any injuries
Slide 14
Nursing Assessment of Neurologic Function (cont.)
• Family history
• Have immediate family members had heart disease, stroke, diabetes mellitus, cancer,
seizure disorders, muscular dystrophy, or Huntington disease?
• Review of systems
• Fatigue or weakness, headache, dizziness, vertigo, changes in vision/hearing,
10 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
3
Slide 15
Nursing Assessment of Neurologic Function (cont.)
• Functional assessment
• Document whether present symptoms interfere with the patient’s usual activities and
occupation
• Explore sources of stress, usual coping strategies, and sources of support
• Physical examination
• Level of consciousness, pupillary evaluation, neuromuscular response, and vital signs
TALKING POINTS:
• Evaluate patients for orientation to person, place, and time by asking them to state their
names, where they are, and what time it is.
Slide 16
Diagnostic Tests and Procedures
• Advanced neurologic examination
• Cranial nerves
• Coordination and balance
• Neuromuscular function
• Sensory function
• Pain
• Temperature
TALKING POINTS:
• The primary function of the cranial nerve is to control sensory and motor activities of the
head and neck, but the vagus nerve also affects cardiac, respiratory, gastric, and
gallbladder function.
• What techniques are used to assess each cranial nerve?
____________________________________________________________ Chapter 27 Neurologic Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
Slide 17
Diagnostic Tests and Procedures (cont.)
• Lumbar puncture
• Electroencephalography
• Electromyography
• Radiologic studies
• Brain scan
TALKING POINTS:
• A lumbar puncture is an invasive procedure that is most often used to detect infections
and other disorders of the CNS, tumors, and hydrocephalus.
• The electroencephalogram (EEG) is a graphic representation of electrical activity in brain
cells.
• Electromyography studies the response of peripheral motor and sensory nerves to
electrical stimuli.
4
Slide 18
Common Therapeutic Measures
• Drug therapy
• Antimicrobials
• Analgesics
• Antiinflammatories
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 19
Question 1
• Stress triggers the sympathetic nervous system to __________.
A. increase the secretion of epinephrine
B. decrease the secretion of norepinephrine
C. decrease heart rate
D. dilate peripheral blood vessels
Slide 20
Question 2
• Which of the following is NOT a normal aging change?
A. An aging pigment called lipofuscin is deposited in nerve cells.
B. Brain weight is reduced, and the ventricles increase in size.
C. The pupil of the eye is often larger and may respond to light more slowly.
D. Reflexes are usually intact except for the Achilles tendon jerk, which is often absent.
TALKING POINTS:
____________________________________________________________ Chapter 27 Neurologic Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the nervous system as a “control
system.” What are the functions of the major
parts of the brain?
• Discuss age-related changes to the nervous
system. What are the implications of these
for nursing care?
• From the list below, have the class identify
the cause (developmental, trauma, or
infection) of the neurologic disorder.
• Meningitis
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss Box 27-2 (p. 445). What is the most
accurate indicator of neurologic status and
how is it assessed?
• Using a neurologic flow sheet, fill in the
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
components of a nursing assessment for a
patient with neurologic disorder. Include
14 Chapter 27 Neurologic Disorders ____________________________________________________________
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LESSON 27.1
3
postprocedural nursing care.
DISCUSS
• Discuss Diagnostic Tests and Procedures
(pp. 445-449). What patient education and
preparation is appropriate for each test?
465). Also, demonstrate testing of the
Babinski reflex, as shown in Figure 27-7 (p.
448).
• Divide the class into groups and assign each
group one of the following diagnostic
procedures:
• Electroencephalography (EEG)
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
of diagnostic procedures used in the patient
4
preoperative nursing care and the other
DISCUSS
• Discuss the drugs listed on pages 456-457.
What are some examples of nursing
interventions?
• Divide the class in half. For a patient with a
either anticonvulsants or barbiturates.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss
preoperative and postoperative nursing care
for neurologic surgery. How does this care
differ from the general care of the surgical
5
DISCUSS
• Discuss the signs, symptoms, and medical
treatment of increased intracranial pressure.
• Divide the class into small groups. Assign
findings to the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe early
and late manifestations of increased ICP.
Critical Thinking Question
____________________________________________________________ Chapter 27 Neurologic Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.1
An 18-year-old man was admitted to the emergency department as a result of a motor
vehicle accident. He appeared alert and was talking clearly to his parents in between x-ray
examinations and laboratory tests. He had a moderate laceration on his forehead, which
was sutured. As the nurse was applying a dressing, she noticed that his pupils were
unequal. What should the nurse do next? What diagnosis may be likely?
Discussion Guidelines: Because the pupils are unequal, the nurse can suspect a subdural
hematoma and should perform a complete neurologic assessment. As a result of the head injury,
Instructor Notes/Student Feedback
16 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Textbook Objectives Covered
7. Assist in developing a nursing care plan for the patient with a neurologic disorder.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying neurologic disorders, including:
• Anatomy and physiology of the nervous system
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aura (p. 454)
• contralateral (p. 445)
• neuralgia (p. 477)
• neurotransmitter (p. 436)
____________________________________________________________ Chapter 27 Neurologic Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Student Preparation
Assignments 2 hours
6
READ – Textbook (pp. 453-479)
REVIEW
• Figure 27-12: Abnormal postures (p. 452)
• Figure 27-13: Types of intracranial herniation (p. 452)
• Figure 27-14: Phases of generalized tonic-clonic seizure (p. 454)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8, 10 (p. 480)
ANSWER – Study Guide
• Part IA: 16-23 (p. 158)
• Part IE: 1-11 (p. 159)
• Part IF: 1 (p. 159)
• Part IH: 1-7 (pp. 160-161)
• Part IJ: 1-3 (p. 161)
• Part IIK: 6-11 (p. 162)
7
READ – Textbook (pp. 453-479)
REVIEW
• Nursing Care Plan: Patient with a Head Injury (p. 460)
ANSWER – Study Guide