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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)
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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
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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
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CNS Infections Meningitis
Encephalitis
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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
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Increased Intracranial Pressure (ICP)
????Critical Thinking Question????
Hyperventilation is known to trigger constriction of cerebral blood vessels. What affect will this have on ICP?
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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
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Increased ICP: MonitoringThree methodsIntraventricularCerebral tissueSubdural or subarachnoid space
Catheters inserted through burr holesCatheters Transducer Monitor (p. 1137
Figure 48.3)Require aggressive nursing care
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Increased ICP: MonitoringClass activity: Identify structures A-D
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Increased ICP: MonitoringIntraventricular Monitoring
Placement = lateral ventricleAllows for both pressure monitoring &
drainage of CSFP. 1137, figure 48.3Disadvantages: Clotting of catheter Infection
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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
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Increased ICP: Nursing ConsiderationsKeep HOB elevated 30 degreesAdminister stool softeners,
antitussives, & antiemeticsMinimize suctioningNonnarcotic medications are preferedAvoid neck flexionAvoid hip flexionSpace activitiesProvide quiet environment
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CNS Disorders: HeadacheThree types of Headaches 1) Tension 2) Migraine a) classic b) common 3) Cluster
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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
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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
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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?
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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.