MS NEURO 2

• Increased ICP


  Occurs whenever there is increase in the bulk of the brain
• Bulk of the brain


  • Brain tissues
  • Blood supply
  • CSF
• Disorders that increase the bulk of the brain tissues

  • Space-occupying lesions (e.g., cerebral tumor, abscess, edema (due to infection or trauma))
• Factors that increase the blood supply to the brain

  • Cerebral hemorrhage
  • Thrombosis
  • Embolism
  • Aneurysm
  • Arteriovenous malformation (AV malformation)
• Factors that increase the bulk of CSF

  • Obstruction to the flow of CSF caused by a brain tumor or ventricular system defects (hydrocephalus)
  • Overproduction of CSF caused by a tumor in the choroid plexus
• Increased ICP causes cerebral hypoxia
• Clinical manifestations of increased ICP

  • Restlessness
  • Headache
  • Nausea and vomiting
  • Diplopia (double vision)
  • Altered level of consciousness
  • Vital signs changes - stimulation of Cushing's reflex in response to cerebral hypoxia
• Cushing's triad


  • Elevated systolic blood pressure
  • Bradycardia
  • Slow, irregular respiration
• Widening pulse pressure is more than 40 mm Hg (S-D= PP)
• Pupillary changes


  • Anisucuria (unequal pupil)
  • Pinpoint pupils
  • Fixed, dilated pupils
• Papilledema


  Compression of the Cranial nerve II
• Lateralizing sign


  Contralateral (opposite side) loss of motor function due to decussation of motor fibers at the level of medulla oblongata
• Brainstem function impairment


  • Doll's Eye sign
  • Decorticate posturing
  • Decerebrate posturing
• Alterations in sensory function (agnosia), motor function (seizures), language and speech (expressive aphasia, receptive aphasia, alexia), bowel and bladder function (retention or incontinence)
• Collaborative management for clients with increased ICP

  • Position the client in Semi-fowlers, lateral position
  • Promote adequate oxygenation with mechanical ventilation
  • Promote safety with padded side-rails
  • Promote complete bed rest
  • Avoid activities that increase ICP
• Pharmacologic management


  • Mannitol (Osmitrol)
  • Dexamethasone (Decardron)
  • Anti-convulsants medications
  • Histamine 2 (H2) Receptor Antagonist
• Seizures are sudden, excessive, disorderly electrical discharges of the neurons
• Types of seizures


  • Grand mal seizure
  • Petit Mal (Absence Seizure/Little Sickness)
  • Jacksonian (Focal seizure)
  • Psychomotor seizure
  • Febrile seizure
  • Status epilepticus
• Collaborative management for seizure disorder

  • Stay with the client
  • Protect the client from injury
  • Promote patent airway
• Pharmacologic management for seizure disorder

  • Hydantoins (Phenytoin, Dilantin)
  • Nursing interventions in Phenytoin (Dilantin) therapy
• Side effects and adverse reactions of Phenytoin (Dilantin)

  • Gingival hyperplasia
  • Neurologic and psychiatric effects
  • Bone marrow suppression
  • Hyperglycemia
  • GI effects
  • Drowsiness, headaches, alopecia, hirsutism
  • Urine output discoloration
• Collaborative management for altered level of consciousness

  • Maintain stimulation
  • Maintain nutrition
  • Maintain elimination
  • Maintain circulation
  • Maintain normal body temperature
  • Promote safety
  • Promote activity
  • Maintain skin integrity
  • Maintain good hygiene
  • Support family
• Cerebrovascular accident (CVA)


  Disruption of the blood supply to the brain, causing neurologic deficit
• Causes of CVA


  • Thrombosis
  • Embolism
  • Cerebral hemorrhage
• CVA due to thrombosis and embolism may occur during sleep or rest period, while CVA due to hemorrhage is associated with activities and occurs during waking hours
• Transient ischemic attack (TIA)


  Transient cerebral ischemia with temporary episodes of neurologic dysfunction
• Clinical manifestations of CVA

  • Signs and symptoms of increased ICP
  • Perceptual defects
  • Sensory deficits (Agnosia)
  • Motor deficits (Apraxia, Agraphia)
  • Homonymous hemianopsia
  • Aphasia (Expressive, Receptive, Global)
• Severely limited


  Spoken output
• Frontal lobe


  • Broca's area
  • Aphasia
  • Producing speech
• Temporal lobe


  • Wernicke's area
  • Understanding & processing speech
• Cleveland Clinic
• Universidad De Dagupan
• Arellano St., Dagupan City
• College of Health Sciences-Nursing Department
• Nutrition and Gastrointestinal, Metabolism, Coordination, Acute and Chronic
• Increased ICP


  Increase in the bulk of the brain
• Bulk of the brain


  • Brain tissues
  • Blood supply
  • CSF
• Space-occupying lesions

  Disorders that increase the bulk of the brain tissues (e.g., cerebral tumor, abscess, edema)
• Factors that increase the blood supply to the brain

  • Cerebral hemorrhage
  • Thrombosis
  • Embolism
  • Aneurysm
  • Arteriovenous malformation
• Factors that increase the bulk of CSF

  • Obstruction to the flow of CSF caused by a brain tumor or ventricular system defects (hydrocephalus)
  • Overproduction of CSF caused by a tumor in the choroid plexus