CNS

It represents the record of the Electrical Activity generated in the brain

electrodes are placed in the scalp

• 1. Diagnosing and evaluating seizure disorders
• 2. coma
• 3. organic brain syndrome
• 4. tumors
• 5. brain abscesses
• 6. blood clots
• 7. infection in the brain
• 8. brain death

• pt lies quietly with both eyes closed
• asked to hyperventilate fir 3-4 mins
• or to look at a bright, flashing light

• Why to look at lights?
• to evoke abnormal electrical discharge (seizure potentials)

it is recorded after sedation

• 1. Pt deprived of sleep the night before EEG
• 2. Anti-seizure, tranquilizers, stimulants & depressents w/held 24 hrs prior
• 3. no coffee, tea, chocolate, colas
• 4. meal is given
• 5. procedure takes 45-60 mins

• a temporary loss of neurologic fn with no apparent structural damage to the brain.
• may or may not cause a brief loss of consciousness

• 1. Blunt trauma - from an acceleration-deceleration
• 2. a direct blow
• 3. a blast injury

temporary amnesia or disorientation

it produces bizzare, irrational behavior from the pt

• Mild
• Classic

less than 30 minutes

• 1. Seizures
• 2. headache
• 3. Dizziness
• 4. irritability
• 5. fatigue
• 6. poor concentration

*there is usually a memory lapse at time of injury

• 1. a period of observed or self-reported transient confusion
• 2. disorientation
• 3. impaired consciousness

injury that results in a loss of conscioussness that lasts less than 6 hrs with post traumatic amnesia.

• 1. headache
• 2. dizziness
• 3. lethargy
• 4. irritability
• 5. emotional lability
• 6. fatigue
• 7. poor concentration

• postconcussion syndrome S/S
• 1. decreased attention span
• 2. memory difficulties
• 3. intelectual dysfunction

episodes of abnormal motor, sensory, autonomic, or psychic activity that result from sudden excessive discharge from cerebral neurons

• 1. an electrical disturbance (dysrhythmia) in the nerve cells in one section of the brain
• 2. these cells emit abnormal, recurring, uncontrolled electrical discharges
• 3. excessive neuronal discharge

• 1. simple-partial seizure (beginning locally)
• 2. complex-partial seizure (1 part of the brain)
• 3. generalized seizure (entire brain)

• begins in one part of the brain
• consciousness remains intact with
• 1. motor symptoms
• 2. sensory/somatosensory symptoms
• 3. autonomic symptoms (loss of bladder/bowels)
• 4. compound forms

• impairment of consciousness only
• 1. cognitive symptoms
• 2. affective symptoms
• 3. psychosensory symptoms
• 4. psychomotor symptoms
• 5. compound forms

convulsive or non-convulsive bilaterally symmetric without local onset

• types:
• 1. tonic-clonic seizures
• 2. tonic seuzires
• 3. clonic seizures
• 4. absence (petit mal) seizures
• 5. atonic seizures
• 6. myoclonic seizures
• 7. unclassified seizures

**observe & record the sequence of signs**

• 1. circumstances before the seizure
• a) visual stimuli
• b) auditory/olfactory stimuli
• c) tactile stimuli
• d) emotional/psychological disturbances
• e) hyperventilation
• 2. occurance of an aura (warning or sensation before seizure)
• 3. 1st thing patient does in the seizure
• 4. types of movement in the part of the body involved
• 5. areas of the body inolved
• 6. both size of pupils (are eyes open or closed?)
• 7. do the eyes or head turn to one side?
• 8. automations? (involuntary activity like lip smacking
• 9. incontinence, how long seizure is
• 10. unconsciousness - duration

• 1. ease patient to the floor
• 2. protect the head
• 3. loosen clothing
• 4. remove pillows & raise side rails of bed (3 rails only)
• 5. don't try & pry open jaws that are clenched
• 6. don't restrain patient
• 7. place pt on side w/ head flexed forward to prevent aspiration (bed in low position)

• 1. document events leading to & occuring during & after
• 2. prevention of complication like injury and aspiration
• 3. let pt sleep if wanted

• group of syndromes characterized by unprovoked, recurring seizures
• most common - generalized & partial-onset seizures

idiopathic (unknown cause)

epilepsy is a symptom of another underlying condition - brain tumor

• unwanted discharges (neuronal) - body may perform erratically
• *if these uncontrolled, abnormal discharges occur repeatedly, a person has epileptic syndrome

• 1. Simple-partial seizure
• 2. Complex-partial seizure
• 3. Generalized seizure

• only a hand may shake
• mouth may jerk uncontrollably
• person may talk unintelligibly
• may be dizzy or
• may experience unusual sights, smells, sounds or tastes

• either remains motionless or moves automatically bu inappropriately
• may experience excessive emotions of fear, anger.

*pt doesn't remember episode at all*

• 1. involves both hemispheres of the brain - causing both sides of body to react
• 2. intense rigidity of the entire body followed by alternating muscle relaxation & contraction
• 3.tongue is chewed, incontinent of urine & feces
• 4. pt then lies in a deep coma - breathes noisily w/ abd breathing

• *After seizure
• pt is hard to arise & may sleep for hrs
• may have headache, sore muscles, fatigue, & depression

contracting of diaphragm & chest muscles together

• MRI - used to detect structural lesions (location of seizure)
• EEG - assissts in classifying type of seizures and monitors electrical brain activity (type of seizure)

• inc. in seizures during their periods
• contraceptives are reduced by antiseizure meds
• change in pattern of seizures during pregnancy
• low bone mass - associated w/ anti-seizure meds

• high incidence of new onset
• why? - cerebrovascular disease (leading cause of seizures in elderly)

*meds may be too expensive - low adherence to prescribed regimen

Avoid head injury - wear helmets, seat belts

medications objective - to achieve seizure control w/ minimal side effects

*meds control they don't cure epilepsy

*start w/ 1 med - adjust med according to concurrent illness, weight changes, or stress

• 1. idiosyncratic or allergic d/o - manifest mainly in skin reactions
• 2. acute toxicity - usually occurs when med is 1st prescribed
• 3. chronic toxicity - occurs late in tx

• seizure hx
• factors/events that precipitate seizures
• alcohol intake
• aura w/ seizure?

• risk for injury
• fear r/t seizure activity
• ineffective coping

• 1. Prevent injury - side rails x3, pads on side rails
• 2. reduce fear
• a) stick to prescribed meds
• b) avoid stimulants (caffeine, sleep deprivation), no alcohol
• c) moderate exercise
• d) ketogenic diet (high protein, high fat, low carbs)
• e) avoid flickering lights, tv, wear dark glasses outside

• it is a complication of epilepsy
• acute prolonged seizure activity
• a series of generalized seizures that occur without full recovery of consciousness between attacks

because it can cause respiratory arrest and extreme hypoxia to the brain

• withdrawal of antiseizure meds
• fever
• concurrent infections

• 1. stop seizure
• 2. oxygen to the brain
• 3. maintain a seizure-free pt

• *IV valium is adm slowly to halt seizures
• *IV dextrose if seizure is caused by hypoglycemia

• monitor/document seizure activity
• side lying position
• IV line
• protect from injury (seizure precautions)
• protect nurses/doctors from harm

sudden loss of fn resulting from disruption of blood supply to a part of the brain

3 hr window for thrombolytic therapy (tPA) - fewer stroke symptoms & less loss of fn

disruption of the cerebral blood flow d/t obstruction of a blood vessel

cerebral blood flow less than 25ml --> causing ischemia --> acidosis --> intracellular calcium increase --> cells break down (free radicals, protein dec.) --> cells die.

or

cerebral blood flow less than 25 ml --> causing ischemia --> ion imbalance --> depolarization --> cells break down and die

depends on location of obstruction (which vessels are obstructed)

• 1. numbness/weakness of face, arm, or leg (usually one-sided)
• 2. confusion/change in mental status
• 3. trouble speaking or understanding speech
• 4. visual problems
• 5. diff. walking, dizziness, or loss of balance or coordination
• 6. *sudden severe headache
• 7. motor loss
• 8. communication loss (language & communication)
• 9. perceptual disturbances
• 10. sensory loss
• 11. cognitive impairment & psychological effects

stroke in upper motor neuron lesion results in loss of voluntary control over movements

*Rt sided stroke -> left side loss of control (vice-versa)

• hemiplegia - paralysis of one side of body (most common)
• hemiparesis - weakness of one of body

• 1. dysarthria - diff speaking caused by paralysis of muscle responsible for producing speech
• 2. dysphasia - impaired speech
• 3. aphasia - loss of speech (stroke is the most common cause)
• 4. expressive aphasia - unable to form words that are understandable. can speak in single - word responses
• 5. receptive aphasia - unable to comprehend the spoken word. can speak but doesn't make sense
• 6. global (mixed) aphasia - combo of receptive & expressive aphasia
• 7. apraxia - inability to perform a previously learned action

• loss of half of the visual field
• can be temporary or permanent

*affected side of vision corresponds to paralyzed side of the body

deficits in the ability to recognize previously familiar objects perceived by one or more of the senses

• may impair
• 1. learning capacity
• 2. memory
• 3. higher intellectual fns

ex: limited attention span, diff comprehend, forgetfulness, & lack of motivation

• 1. airway patency
• 2. cardiovascular status
• 3. neurologic deficits

small strokes - lasting less than 1 hour

• 1. sudden loss of motor
• 2. sudden loss of sensory
• 3. sudden loss of visual fn

TIA may serve as a waring of impending stroke

• CT scan - initial test to see if ischemic or hemorrhagic
• 12-lead carotid ultrasound, and electrocardiogram

• Primary prevention - best approach for prevention
• modifiable
• 1. no smoking
• 2. healthy weight
• 3. healthy diet
• 4. modest alcohol consumption
• 5. lose-dose aspirin
• 6. controlling htn
• 7. lowering cholesterol

• non-modifiableage
• 1. age - 55 yrs and up
• 2. gender - men
• 3. race - african american

• 1. coumadin
• 2. statin drugs
• 3. plavix & aspirin (anti-platelets)
• 4. anti-hypertensive drugs (ACE inhibitors)
• 5. thiazides

it works by dissolving the blood clot that is blocking blood flow to the brain.

t-PA binds to fibrin & converts plasminogen to plasmin which stimulates fibrinolysis of the plaque

• leads to decreased size of stroke
• overall improvement in outcome after 3 months

bec revascularization of necrotic tissue increases risk of cerebral edema and hemorrhage

• 18 yrs old and up
• ischemic stroke
• less than 3 hrs of stroke
• no seizure w/ stroke
• not on coumadin
• no heparin
• no intracranial hemorrhage
• no major sx 14 days prior to stroke
• no previous stroke, head injury, brain sx in 3 mos
• no GI or urinary bleeding w/in 21 days

• symptom onset > 3 hrs
• anticoagulated pt (INR > 1.7
• previous stroke, head injury, or trauma
• hx of DVTs - bleeding

max is 90 mg a dose

• 10% given as IV bolus over 1 min
• 90% administered in 1 hr

• bleeding
• intracranial bleeding

it is a surgical prevention for ischemic stroke

-removal of an atherosclerotic plaque or thrombus from carotid artery to prevet strokes in pts w/ occlusive disease of the extracranial cerebral arteries

1-3 days

• 1. change in LOC or responsiveness
• 2. presence/absence of voluntary or involuntary movements of the extremities, muscle tone, body posture & position of the head
• 3. stiffness/flaccidity of the neck
• 4. eye opening - size of pupils, reactive/non reactive
• 5. color of face & skin; temp of skin
• 6. pulse, resp, blood gases
• 7. ability to speak
• 8. I&Os
• 9. bleeding
• 10. BP

improve mobility & prevent joint deformities because arm tends to adduct & rotate internally. shoulder tends to adduct.

place pillows on axilla - keeps arm away from chest

• positioned so they are barely flexed
• placed in slight supination

don't use hand roll bec it stimulates the grasp reflex

• every 2 hrs
• may turn side to side but limit time on affected side
• prone position 15-30 mins 2x a day.

why? helps promote hyperextension of the hip & drain bronchial secretions