18 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 21
Common Therapeutic Measures (cont.)
• Surgery
• Craniotomy
• Surgical opening of the skull
Slide 22
Migraine Headache
• Intracranial vasoconstriction followed by vasodilation
• Triggered by menstruation, ovulation, alcohol, some foods, stress
• Pain usually unilateral, often begins in the temple or eye area and is very intense
• Tearing and nausea and vomiting may occur
• Hypersensitive to light and sound; prefers dark, quiet environment
• Mild migraines treated with acetaminophen or aspirin; severe ones with ergotamine
(Cafergot) or sumatriptan (Imitrex) tablet or autoinjector for self–injection
TALKING POINTS:
• What preventive measures for migraine headaches should be taught?
Slide 23
Cluster Headache
• Occur in a series of episodes followed by a long period with no symptoms
• Intensely painful and seem to be related to stress or anxiety
• Usually have no warning symptoms
• Treatment may include cold application, indomethacin (Indocin), and tricyclic
antidepressants
6
&
Tension Headache
• Result from prolonged muscle contraction from anxiety, stress, or stimuli from other
sources, such as a brain tumor or an abscessed tooth
Slide 25
Seizure Disorder
• Electrical impulses in the brain are conducted in a highly chaotic pattern that yields
abnormal activity and behavior
• Related to trauma, reduced cerebral perfusion, infection, electrolyte disturbances,
poisoning, or tumors
• Medical diagnosis
TALKING POINTS:
• Seizure activity involves a large number of hyperactive neurons that use excessive
oxygen and glucose.
• What may occur if oxygen and glucose stores are depleted during seizure activity?
____________________________________________________________ Chapter 27 Neurologic Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 26
Seizure Disorder: Classification
• Partial seizures
• Simple
• Part of one cerebral hemisphere; consciousness not impaired
• Complex
TALKING POINTS:
• A simple partial seizure may include motor, somatosensory, autonomic, or psychic
symptoms.
• Focal motor seizures are a subtype of simple seizures in which the abnormal brain activity
remains localized to a specific motor area.
• What is jacksonian march?
• The tonic-clonic seizure is characterized by stiffening of the muscles or extremities with
loss of consciousness followed by a rhythmic movement of the extremities.
Slide 27
Seizure Disorder
• Status epilepticus
• Medical emergency: continuous seizures or repeated seizures in rapid succession for
30 minutes or more
TALKING POINTS:
• If good seizure control is not accomplished with one drug, combinations of drugs may be
prescribed.
• How is status epilepticus treated?
Slide 28
Seizure Disorder (cont.)
• Surgical treatment
TALKING POINTS:
• Who may be a candidate for surgical treatment?
20 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 29
Seizure Disorder: Nursing Care
• Assessment
• Describe the seizure episode, including the postictal period (following the seizure),
and document drug therapy
Slide 30
Seizure Disorder: Nursing Care (cont.)
• Risk for injury
• Side rails of bed up and padded, suction machine readily available, bed maintained in
the low position
• Quickly move objects away from the patient
Slide 31
Head Injury: Types
• Scalp injuries
• Lacerations, contusions, abrasions, and hematomas
• Concussion
• Trauma with no visible injury to the skull or brain
• Contusion
• Bruising and bleeding in the brain tissue
Slide 32
Head Injury
• Surgical treatment
• Directed at evacuating hematomas and débriding damaged tissue
Slide 33
Head Injury: Nursing Care
• Interventions
• Ineffective tissue perfusion
• Ineffective breathing pattern
• Risk for injury
____________________________________________________________ Chapter 27 Neurologic Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 34
Brain Tumors
• Cause and risk factors
• Some congenital; others may be related to heredity
• Drug/environmental factors may play a role in development
• Signs and symptoms
• Directly related to area of brain invaded by the tumor
TALKING POINTS:
• Not all brain tumors are malignant.
• However, the invasion of any kind of tumor into normal brain tissue is never insignificant.
• Difficulties with balance and coordination may be seen with which type of tumor?
Slide 35
Brain Tumors: Nursing Care
• Interventions
• Acute pain
• Disturbed thought processes
• Disturbed sensory perception
Slide 36
Meningitis
• Cause and risk factors
• Inflammation of the meningeal coverings of the brain and spinal cord caused by either
viruses or bacteria
• Signs and symptoms
TALKING POINTS:
• Organisms may reach the meninges through the blood, through head wounds, or from
other cranial structures such as the sinuses or inner ear.
22 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 37
Meningitis (cont.)
• Medical treatment
• Bacterial infections usually respond to antimicrobial therapy, but no specific drugs
effective against most viral infections
TALKING POINTS:
• If needed, isolation precautions should be initiated.
• How are organisms responsible for meningococcal meningitis spread?
Slide 38
Meningitis: Nursing Care
• Assessment
• Assess vital signs and neurologic status frequently to determine further deterioration
or onset of complications
Slide 39
Meningitis: Nursing Care (cont.)
• Interventions
• Ineffective tissue perfusion
• Ineffective breathing pattern
• Acute pain
• Risk for injury
• Deficient fluid volume
Slide 40
Encephalitis
• Cause and risk factors
• Inflammation of brain tissue caused by virus
• Signs and symptoms
• Fever, nuchal rigidity (stiff neck), headache, confusion, delirium, agitation, and
TALKING POINTS:
• These viruses may be prevalent during certain times of the year or in a specific
geographic area.
• Toxic substances or other types of viral infections, such as herpes simplex, may
precipitate encephalitis.
Slide 41
Encephalitis: Nursing Care
• The nursing plan of care parallels that of the patient with meningitis
____________________________________________________________ Chapter 27 Neurologic Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 42
Guillain-Barré Syndrome
• Cause and risk factors
• Although specific cause unknown, it is believed to be an autoimmune response to a
viral infection
• Patients often report some recent viral infection or vaccination
TALKING POINTS:
• What part of the nervous system is affected by Guillain-Barré syndrome?
Slide 43
Guillain-Barré Syndrome (cont.)
• Initial phase
• Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper
extremities
TALKING POINTS:
• Despite all the motor and sensory changes, level of consciousness and intellectual
functioning remain unchanged.
• What is dysautonomia?
patients with Guillain-Barré syndrome have a nearly complete recovery.
• What residual symptoms may occur?
Guillain-Barré Syndrome (cont.)
• Plateau phase
• Remains essentially unchanged
TALKING POINTS:
• Because the underlying axon generally remains undamaged, approximately 95% of
Guillain-Barré Syndrome (cont.)
• Medical diagnosis
• Characteristic onset and pattern of ascending motor involvement
24 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 46
Guillain-Barré Syndrome (cont.)
• Medical treatment
• Preserve vital function, particularly respiration
TALKING POINTS:
Slide 47
Guillain-Barré Syndrome: Nursing Care
• Assessment
• Health history describes the progression of symptoms
• Note fears, coping strategies, and sources of support
• Physical examination focuses on cranial nerve, motor, respiratory, and cardiovascular
function
Guillain-Barré Syndrome: Nursing Care (cont.)
• Interventions
• Ineffective breathing pattern
• Rehabilitation
Slide 49
Parkinson’s Syndrome
• Cause and risk factors
• Progressive degenerative disorder of the basal ganglia: an eventual loss of
coordination and control over involuntary motor movement
• Signs and symptoms
• Tremor, rigidity, and bradykinesia
TALKING POINTS:
• What is idiopathic Parkinson’s syndrome?
• A deficiency of dopamine, a neurotransmitter, contributes to the loss of motor function.
____________________________________________________________ Chapter 27 Neurologic Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 50
Parkinson’s Syndrome (cont.)
• Medical diagnosis
• From health history and physical examination
• MRI to rule out other causes of the symptoms
• Medical treatment
• Control symptoms: physical therapy and drug therapy
TALKING POINTS:
Slide 51
Parkinson’s Syndrome: Nursing Care
• Assessment
• Weakness, fatigue, muscle cramps, sweating, dysphagia, constipation, difficulty
Slide 52
Multiple Sclerosis (MS)
• Cause
• Chronic, progressive degenerative disease
• Attacks the protective myelin sheath around axons and disrupts the conduction of
impulses through the CNS
• Chronic, progressive MS: progresses steadily
• Exacerbating-remitting MS: exacerbations and remissions
TALKING POINTS:
• What age group has the highest incidence of MS?
Slide 53
Multiple Sclerosis (cont.)
• Signs and symptoms
• Fatigue, weakness, and tingling in one or more extremities; visual disturbances;
problems with coordination; bowel and bladder dysfunction; spasticity; and depression
26 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 54
Multiple Sclerosis (cont.)
• Medical diagnosis
• Based on the physical examination and history of cyclic remission-exacerbation
periods
• Magnetic resonance imaging of the brain and spinal cord may reveal plaques
characteristic of MS
Slide 55
Multiple Sclerosis (cont.)
• Medical treatment
• Corticosteroids (ACTH, prednisone, methylprednisolone)
• Interferon 1b (Betaseron) and interferon 1a (Avonex)
Multiple Sclerosis: Nursing Care
• Assessment
• Onset and progression of symptoms, especially those that affect mobility, vision, eating,
TALKING POINTS:
• What effects may MS have on the person’s lifestyle?
• Identify the patient’s usual coping strategies.
Slide 57
Multiple Sclerosis: Nursing Care (cont.)
• Interventions
• Impaired physical mobility
• Disturbed sensory perception
Amyotrophic Lateral Sclerosis (ALS)
• Cause
• Also known as Lou Gehrig’s disease; a degenerative neurologic disease
TALKING POINTS:
• ALS affects males two to four times as often as females and strikes most often in the
disease?
____________________________________________________________ Chapter 27 Neurologic Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 59
Amyotrophic Lateral Sclerosis (cont.)
• Signs and symptoms
• Weakness of voluntary muscles of the upper extremities, particularly the hands
• Difficulty swallowing and speaking
• Eventually, respirations shallow; difficulty clearing airway of pulmonary secretions
• Death results from aspiration, respiratory infection, or respiratory failure
Amyotrophic Lateral Sclerosis (cont.)
• Medical diagnosis
Slide 61
Amyotrophic Lateral Sclerosis: Nursing Care
• Assessment
• Dyspnea, dysphagia, muscle cramps, weakness, twitching, joint stiffness, muscle
atrophy, abnormal reflexes and gait, and paralysis
6
Slide 62
Amyotrophic Lateral Sclerosis: Nursing Care (cont.)
• Interventions
• Ineffective airway clearance
• Impaired physical mobility
Slide 63
Huntington Disease
• Inherited degenerative neurologic disorder
• Usually begins in middle adulthood with abnormal movements, emotional disturbance,
Slide 64
Myasthenia Gravis
• Cause
• May have an autoimmune basis
• Pathophysiology
• Insufficient receptor sites at the junction of the motor nerve with the muscle
TALKING POINTS:
• Some patients present with an increase in the titer of acetylcholine receptor antibody.
• How does the presence of the acetylcholine receptor antibodies affect the muscle
strength?
28 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Slide 65
Myasthenia Gravis (cont.)
• Signs and symptoms
• Weakness of voluntary muscles, particularly those of chewing, swallowing, and
speaking
TALKING POINTS:
• The patient becomes unable to perform any activity that demands sustained muscular
Slide 66
Myasthenia Gravis (cont.)
• Medical diagnosis
• Administering edrophonium (Tensilon)
• Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5
minutes
• Medical treatment
• Anticholinesterase drugs
TALKING POINTS:
• What effect do the drugs neostigmine and pyridostigmine have on the neuromuscular
junction?
Slide 67
Myasthenia Gravis: Nursing Care
• Assessment
• Health history describes the onset of symptoms: muscle weakness, diplopia,
dysphagia, slurred speech, breathing difficulties, and loss of balance
• Interventions
• Ineffective breathing pattern
• Impaired physical mobility
• Self-care deficit
• Impaired swallowing
• Deficient knowledge
____________________________________________________________ Chapter 27 Neurologic Disorders 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
Activities
Classroom Choose from below to make 30 minutes
6
DISCUSS
• Discuss the commons types of headache
and options for prevention and treatment.
• Discuss the two main classifications of
seizures. What content is important to
include in a teaching plan for a patient with a
seizure disorder?
• Divide the class into groups, and have them
discuss the types of seizures and medical
management. Then have the groups list
three drugs used to control seizures. Next,
have the groups develop a list of the “DOs”
and “DON’Ts” for seizure management. Ask
the class: “What is meant by an aura? What
is status epilepticus?”
• Present the following definitions to the class
and have them identify the condition or
disorder:
• Meningioma
• Inflammation of brain tissue
• Autoimmune response to a viral infection
• Discuss the cause, symptoms, and
complications of a patient who has
Parkinson’s syndrome.
• Discuss the cause, symptoms, and
30 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
6
• Divide the class into groups, and assign
each group a different neurologic disorder,
such as multiple sclerosis (MS), brain tumor,
amyotrophic lateral sclerosis (ALS), and
head injury. Let each group list potential
questions that a patient or family member
might have, and have each group develop
myasthenia gravis.
• Discuss the cause, symptoms, and
complications of a patient who has cerebral
palsy.
• Divide the class into groups, and present the
following scenario:
• A 56-year-old woman with trigeminal
neuralgia and severe pain tells the nurse
____________________________________________________________ Chapter 27 Neurologic Disorders 31
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
7
DISCUSS
• Make a heading on the board labeled “Head
Injuries.” Then, let the students voluntarily
name the types of head injuries until all
seven are listed (scalp injuries, concussion,
contusion, hematomas, subdural hematoma,
intracerebral hemorrhage, penetrating
injuries).
• Discuss the nursing care of a patient with a
brain tumor. What are some common
interventions?
• Divide the class into two groups. Have one
group discuss the causes, symptoms,
• Discuss the nursing care of a patient with
Parkinson’s syndrome. What are some
typical interventions?
• Discuss the nursing care of a patient with
MS. What are some typical interventions?
• Divide the class into groups, and assign
each one of the following neurologic
disorders:
• Parkinson’s syndrome
• MS
• Amyotrophic lateral sclerosis (ALS)
Have each group refer to the Nursing
Diagnoses, Goals, and Outcome Criteria:
32 Chapter 27 Neurologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 27.2
7
• Divide the class into groups, and present the
following scenario:
• A 48-year-old man with myasthenia
gravis develops increased difficulty
swallowing and breathing. He is
admitted to the hospital with a diagnosis
of myasthenic crisis and will require
endotracheal intubation and mechanical
ventilation.
Critical Thinking Question
What is the difference between a partial seizure and a generalized seizure? What is the goal
of nursing care for a patient with a seizure disorder? What are some key interventions?
Discussion Guidelines: The classifications of seizures include partial, or focal, and generalized.
With partial seizures, the patient usually does not lose consciousness, because the seizure involves
Instructor Notes/Student Feedback
____________________________________________________________ Chapter 27 Neurologic Disorders 33
Introduction to Medical-Surgical Nursing, 6th ed.
27
Assessments for
Neurologic Disorders
CHAPTER 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.
Assessments by Lesson & Objective
Lesson 27.1
1
Study Guide
• Part IA: 1-10 (p. 157)
Evolve Instructor Resources
• Test Bank: 2, 3, 30
Evolve Student Resources
• NCLEX Review: 1
2
Study Guide
• Part IA: 10-15 (p. 158)
• Part ID: 1 (p. 159)
3
Study Guide
• Part IG: 1-9 (p. 160)
• Part IIK: 1, 2 (pp. 161-162)
Evolve Student Resources
• NCLEX Review: 5, 6
4
Study Guide
• Part II: 1-3 (p. 161)
Evolve Student Resources
• NCLEX Review: 3, 9, 10
34 Chapter 27 Neurologic Disorders ____________________________________________________________
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Assessments by Lesson & Objective
5
Study Guide
• Part IIK: 2-5, 13 (pp. 162-163)
Evolve Instructor Resources
• Test Bank: 9, 10, 17
Evolve Student Resources
• NCLEX Review: 4
Lesson 27.2
6
Study Guide
• Part IA: 16-23 (p. 158)
• Part IE: 1-11 (p. 159)
Evolve Instructor Resources
• Test Bank: 12, 13, 15, 19, 21, 24, 25, 29
7
Study Guide
• Part IIK: 12-14, 17, 18 (pp. 162-163)
• Part IIIL: 1-4 (p. 163)
• Part IIIM: 1-4 (pp. 163-164)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 2, 7, 8
• Prioritization: 1-5
Instructor’s Notes/Student Feedback