UNIT 13 BUILDING CLINICAL COMPETENCEResponses to Altered NeurologicFunctionFunctional Health Pattern: Cognitive-Perceptual

Think about clients with cognitive-perceptual problems for whom you have cared in your clinical experiences.

■ What were the clients’ major medical diagnoses (e.g., traumatic brain injury, spinal cordinjury, stroke, aneurysm)?

■ What manifestations did each of these clients have? (Were these manifestations similar ordifferent?

■ How did each of these clients respond to interaction with you as you provided care forthem? Was it difficult for them to remember the identity of visitors or family members,that they were in a hospital, the correct year? Was their speech affected (aphasia)? Didthe family indicate that the client took longer than normal to “find the words” inconversation? Were their words “jumbled” or confused when they spoke?

The neurologic system regulates and integrates all body functions, mental abilities, and emo-tions. It is made up of the central nervous system and peripheral nervous system. These twocomponents are made up of two types of cells: neurons (which receive and transmit informa-tion) and neuroglia (which protect and support the neurons). The Cognitive-Perceptual Patternincludes functional abilities such as language, memory, judgment, decision making, and sensa-tion. The pathophysiologic factors affecting cognition and perception are:

■ Decreased blood flow to and ischemia of neurons (e.g., stroke, ruptured intracranialaneurysm or arteriovenous malformation, spinal cord injury, increased intracranialpressure, cerebral edema)

■ Direct injury to neurologic tissues from trauma or compression (e.g., traumatic braininjury, skull fractures, increased intracranial pressure, spinal cord injury, herniatedintervertebral disk, brain tumors, spinal cord tumors)

■ Alterations in the electrical activity of cerebral neurons (epilepsy)■ Infections of the neurologic system (e.g., meningitis, encephalitis, rabies, tetanus, botulism)■ Degeneration or alteration of neurons, supporting neurologic structures, or neurotransmitters

(e.g., Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Huntington’s disease, amy-otrophic lateral sclerosis, myesthenia gravis, Guillain-Barré syndrome, cranial nerve disorders).

One example of the pathophysiologic effects of neurologic disorders, increased intracranialpressure (a response to many disorders of and injuries to the brain) causes cell damage anddeath and can lead to transient or permanent manifestations such as:

■ Altered level of consciousness (with decreasing circulation to and oxygenation of neurons→ decreased cellular metabolism → Na-K pump failure → edema damage to the RAS)

■ Aphasia or dysphagia (resulting from changes in the complex neurologic pathways in thespeech center through ischemia, decreased oxygen and blood circulation, cell death, andthe toxins released by dying cells)

■ Seizures (seizure threshold is exceeded → abnormal neuronal activity remains localizedor spreads to involve the entire brain → causing local or generalized effects).

Priority nursing diagnoses within the Cognitive-Perceptual Pattern that may be appropriate forclients with neurologic disease or injury include:

■ Ineffective Tissue Perfusion: Cerebral as evidenced by level of consciousness changes,cognitive defects, and inaccurate interpretation of stimuli including confusion,comprehension, problem solving, abstraction, and memory deficits

■ Impaired Verbal Communication as evidenced by inability/difficulty in speaking orunderstanding spoken or written words

■ Powerlessness as evidenced by expressions of frustration regarding inability to controltheir illness, recovery rate, or care

■ Acute Confusion as evidenced by restlessness, hallucinations, disorientation, anxiety.

Two nursing diagnoses from other functional health patterns often are a high priority for theclient with neurologic disease or injury:

■ Impaired Swallowing (Nutritional-Metabolic)■ Impaired Physical Mobility (Activity-Exercise)

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