My neurological nursing

NEUROLOGICAL NURSING

Anatomy and Physiology

Neurological Nursing

Purpose: To understand the workings and functions of the human nervous system.

To successfully identify disease processes common to the human nervous system.

To provide proficient care to individuals afflicted with disease processes or injuries affecting the human nervous system.


A & P of the Nervous System


Neuron- The functional unit (cell) of the nervous system that conducts electrical impulses to the brain and to other areas of the body.

Sensory Neurons- Carry information from the distal parts of the body toward the central nervous system (CNS)

Motor Neurons- Carry motor information from the CNS to the periphery.


Axon and dendrites branch off of the main body of the neuron.

Axon- Carry impulses away from the cell body

Dendrites – Carry impulses to the cell body.

Myelin- is a substance that sheaths many axons and dendrites. It enhances conduction along the nerve fiber (moves impulse very quickly) and gives the axons their white appearance.


The Central Nervous System (CNS)

Made up of the BRAIN and the SPINAL CORD

The Peripheral Nervous System (PNS)

Made up of all of the peripheral of the body, including the spinal and cranial nerves



The Brain is divided into the Cerebrum, Cerebellum and the Brain Stem.

Cerebral Spinal Fluid (CSF) is composed of water, glucose, sodium chloride and protein.

Its FUNCTION is that it acts as a shock absorber for the brain and spinal cord.



The Spinal Cord

Extends from C1 to L2There are 31 pairs of spinal nerve roots that exit the spinal cord, each consisting of an afferent root (posterior sensory)and efferent root (anterior motor).These roots, along with the 12 cranial nerves make up the PERIPHERAL NERVOUS SYSTEM.


Autonomic Nervous System

Controls the INVOLUNTARY activities of the viscera including smooth muscle, cardiac muscle and glands

Two major subdivisions: The SYMPATHETIC NERVOUS SYSTEM (SNS) and the PARASYMPATHETIC NERVOUS SYSTEM (PNS).

Cerebrum

Complex functions:

Initiation of movements, recognition of sensory input, higher-order thinking, regulating emotional behavior and endocrine and autonomic functions

Cerebrum

Divided into two halves: hemispheres

Each hemisphere controls the opposite side of the body: the right hemisphere controls the left side of the body, and the left hemisphere controls the right side of the body

The cortex of each is divided into the parietal, frontal, temporal, and occipital lobes; each has a different area of function

Cerebrum

Cerebrum

Brainstem

Includes midbrain, pons, medulla, and part of the reticular activating system

Controls vital, basic functions, including respiration, heart rate, and consciousness

Cerebellum

Uses information received from the cerebrum, muscles, joints, and inner ear to coordinate movement, balance, and posture

Unlike the cerebrum, the right side of the cerebellum controls the right side of the body, and the left side of the cerebellum controls the left side of the body

Circulation

Carotid System

Begins as one common artery; later divides into the external and internal carotid arteries

The external carotid arteries divide to supply blood to the face

The internal arteries further divide into the middle cerebral artery and the anterior cerebral artery to supply blood to the brain

Circulation

Carotid System

Begins as one common artery; later divides into the external and internal carotid arteries

The external carotid arteries divide to supply blood to the face

The internal arteries further divide into the middle cerebral artery and the anterior cerebral artery to supply blood to the brain

Circulation

Vertebral Arteries

Originate from the subclavian artery, travel up the anterior neck to merge and form the basilar artery at the brainstem

Second division forms posterior cerebral artery

Internal carotid and vertebrobasilar arteries unite to form the circle of Willis

Circulation

Neurological NursingPATHOPHYSIOLOGY

TYPES OF DISORDERS

Genetic/ Developmental Trauma Infection and Inflammation Neoplasms Degenerative processes Vascular Disorders Metabolic and Endocrine Disorders

Neurological NursingMigraine Headache

Thought to be caused by: Intracranial vasoconstriction followed be

vasodilation.

TRIGGERED BY: Menstruation Ovulation Alcohol consumption Some foods STRESS


PAIN:

Usually unilateral Often begins in the temple or eye area VERY INTENSE Tearing and nausea and vomiting may occur Hypersensitivity to light and sound


TREATMENT MEDICATIONS

Mild migraines: Acetaminophen or aspirin

Severe migraines: Ergotamine (Cafergot) Sumatriptan tablet (Imitrex) Sumatriptan autoinjector (for self injection)

Neurological Nursing 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 no warning symptoms.

Neurological Nursing Cluster Headache


Cold application

Indomethacin (Indocin)

Tricyclic antidepressants (Elavil)

Neurological Nursing Tension Headache

Results from prolonged muscle contraction from anxiety, stress, or stimuli from other sources, such as brain tumor or an abscessed tooth.

Pain location may vary May have N/V Dizziness Tinnitus Tearing


TREATMENT

Correction of known causes Psychotherapy Massage Heat application Relaxation techniques



Analgesics (usually non-opiod)

Benzodiazepines to relieve anxiety if severe.

SEIZURE DISORDERS

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.

SEIZURE DISORDERS

MEDICAL DIAGNOSIS

Accurate history of the seizure disorder

Electroencephalogram (EEG)

SEIZURE DISORDERS Classification

Partial Seizure

SimplePart of one cerebral hemisphere; consciousness not impaired

ComplexConsciousness impaired; may exhibit

bizarre behavior


Generalized seizures Involves the whole brain Consciousness lost during the ictal (seizure) period

TYPES Tonic-Clonic (Grand Mal) Absence (Petit Mal) (Eye Blinking, Lip Smacking,

Daydreaming) generally identified in childhood. Myoclonic (brief jerking or stiffening of extremities) Atonic (Drop attacks) sudden loss of muscle tone

causes patient to collapse


Status EpilepticusMedical emergency. The continuous

seizure or repeated seizure in rapid succession for 30 minutes or more.

AuraDizziness, numbness, visual or hearing

disturbance, noting an offensive odor, or pain may precede a seizure

SEIZURE DISORDERS

MEDICAL TREATMENT

Resolution of the underlying condition

Anticonvulsant therapy If good seizure control is not accomplished with

one drug, combinations of drugs may be prescribed.

SEIZURE DISORDERS

SURGICAL TREATMENT

Removal of seizure foci in the temporal lobe and pallidotomy or vagal nerve stimulator.

SEIZURE DISORDERS

Assessment

Describe the seizure episode, INCLUDING the post-ictal period, and documenting drug therapy.

NURSING DIAGNOSES

Risk for Injury:

Nursing Interventions

Side rails Padded bed. Suction machine Bed in low position Remove objects away from the patient DO NOT attempt to restrain the patient

NURSING DIAGNOSES

Ineffective Coping and Knowledge Deficit

Nursing Interventions

Teach family and patient about seizure disorder and the therapy

Teaching must be directed toward helping the patient and family adjust to a chronic condition

Encourage questions and concerns

HEAD INJURIES

TYPES

Scalp Injuries Lacerations, contusions, abrasions, and

hematomas

ConcussionTrauma with no visible injury to the skull or

brain

ContusionBruising and bleeding in the brain tissue

HEAD INJURIES

TYPES

HematomaSubdural hematoma or epidural

hematoma

Intracerebral HemorrhageFrom lesions within the tissue of the brain

itself

Penetrating InjuriesSharp objects penetrate the skull and brain

tissue

HEAD INJURIES

Surgical Treatment

Directed at evacuating hematomas and debriding damaged tissue

NURSING DIAGNOSES

Ineffective Tissue Perfusion Ineffective Breathing Pattern Risk for Injury Risk for Infection Impaired Physical Mobility Disturbed Body Image Ineffective Role Performance

BRAIN TUMORS

Cause and Risk Factors

Some congenital; others may be related to heredity

Drug/environmental factors may play a role in development

BRAIN TUMORS

Signs and symptoms Directly related to area of brain invaded

by the tumor Visual disturbances and headache New-onset seizure activity Difficulties with balance and coordination

BRAIN TUMORS

Medical Treatment

Surgery often followed by radiation with or without chemotherapy

NURSING DIAGNOSES

Acute PainDisturbed Thought ProcessesDisturbed Sensory PerceptionImpaired Physical MobilitySelf-Care DeficitIneffective Coping

Meningitis


Inflammation of the meningeal coverings of the brain and spinal cord caused by either viruses or bacteria

Meningitis

Signs and Symptoms

Headache, nuchal rigidity (stiffness of the back of the neck) irritability diminished level of consciousness photophobia (sensitivity to light) hypersensitivity seizure activity Positive Kernig sign Brudzinski sign

Positive Kernig Sign

Brudzinski Sign

Meningitis

Medical Treatment

Bacterial infections usually respond to antimicrobial therapy, but no specific drugs effective against most viral infections

Anticonvulsants used to control seizure activity if necessary

Meningitis

Assessment

Assess vital signs

Neurologic status frequently to determine further deterioration or onset of complications

NURSING DIAGNOSES

Ineffective Tissue PerfusionIneffective Breathing PatternAcute Pain Risk for InjuryDeficient Fluid Volume

Encephalitis

Cause and Risk FactorsInflammation of brain tissue caused by virus

Signs and SymptomsFever AgitationNuchal rigidity (stiff neck) HeadacheConfusion HemiparesisRestlessness Exhibit aphasiaDelirium Facial weaknessComatose Other alterations in motor activity

Encephalitis

Medical Treatment

Enhance patient comfort and increase strength

Because seizure activity is a potential problem, take appropriate safety precautions

NURSING DIAGNOSES

The nursing plan of care parallels that of the patient with meningitis

Guillain-Barré Syndrome


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


Initial Phase

Symmetric muscle weakness: begins in lower extremities; ascends to trunk and upper extremities

Visual and hearing disturbances, difficulty chewing, and lack of facial expression

Mild paresthesias or anesthesia in feet and hands in a glove or stocking distribution pattern

Hypertension, orthostatic hypotension, cardiac dysrhythmias, profuse sweating, paralytic ileus, and urinary retention


Plateau PhaseRemains essentially unchangedNo further neurologic deterioration, but no improvement either

Recovery PhaseRemyelinization; muscle strength returns in a proximal-to-distal pattern (head to toes)


Medical Diagnosis

Characteristic onset and pattern of ascending motor involvement

Elevated protein level in the CSF

Nerve conduction velocity studies reveal slowed conduction speed in the involved nerves


Medical Treatment

Preserve vital function, particularly respiration

Respiratory status is closely monitored and mechanical ventilation initiated if vital capacity falls to 15 ml/kg of body weight

Massive doses of corticosteroids prescribed to suppress the inflammatory process

Plasmapheresis


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

NURSING DIAGNOSES

Ineffective Breathing PatternDecreased Cardiac OutputRisk for Disuse SyndromeImbalanced Nutrition: Less Than Body Requirements AnxietyDeficient KnowledgeRehabilitation

Parkinson Syndrome


Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement

Parkinson Syndrome

Signs and Symptoms

Tremor, rigidity, and bradykinesia

Loss of dexterity and power in affected limbs, aching, monotone voice, handwriting changes, drooling, lack of facial expression, rhythmic head nodding, reduced blinking, and slumped posture Depression common; dementia may develop

Clinical Manifestations of Parkinson Syndrome.

Parkinson Syndrome

Medical Diagnosis

From health history and physical examination

MRI to rule out other causes of the symptoms

Parkinson Syndrome

Medical Treatment

Control symptoms: physical therapy and drug therapy

Massage, heat, exercise, and gait retraining

Parkinson Syndrome

Medications

Dopamine receptor agonists: Pramipexole (Mirapex)

Ropinirole (Requip); L-dopa (L-dihydroxyphenylalanine); Carbidopa/levodopa (Sinemet)

Anticholinergic drugs:Trihexyphenidyl (Artane) Benztropine (Cogentin)

Parkinson Syndrome

Assessment

Weakness, fatigue, muscle cramps, sweating, dysphagia, constipation, difficulty voiding, and unusual movements

Note lack of facial expression, eyes fixed in one direction, drooling, slurred speech, tearing, tremors, muscle stiffness, and poor balance and coordination

NURSING DIAGNOSES

Impaired Physical Mobility Risk for InjuryImbalanced Nutrition: Less Than Body RequirementsIneffective Coping Deficient Knowledge

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


Signs and Symptoms

Fatigue, weakness, and tingling in one or more extremities; visual disturbances; problems with coordination; bowel and bladder dysfunction; spasticity; and depression


Relapsing-progressive MS: less stable periods than exacerbating-remitting

Stable MS: stable; no active disease for a year

Exact cause of MS is unknown; viral infections and autoimmune processes have been implicated

The lesions in multiple sclerosis: location and effects.


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


Medical TreatmentCorticosteroids

(ACTH, prednisone, methylprednisolone)

Interferon 1b (Betaseron) and interferon 1a (Avonex)

Glatiramer acetate (Copaxone) Immunosuppressants:

mitoxantrone (Novantrone)

Amantadine (Symmetrel)


Urinary retention treated with cholinergics, such as bethanechol (Urecholine) or neostigmine (Prostigmine)


Assessment

Onset and progression of symptoms, especially those that affect mobility, vision, eating, and elimination

Range of motion and strength, gait abnormalities, tremors, and muscle spasms

NURSING DIAGNOSES

Impaired Physical MobilityDisturbed Sensory PerceptionSelf-Care DeficitFunctional Urinary IncontinenceRisk for InfectionIneffective Coping Deficient Knowledge

Amyotrophic Lateral Sclerosis (ALS)

Cause

Also known as Lou Gehrig’s disease; a degenerative neurologic disease

Virus suspected, but exact cause unknown


Pathophysiology

Degeneration of the anterior horn cells and the corticospinal tracts, so patient exhibits upper and lower motor neuron symptoms


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


Medical Diagnosis

History and physical examination findings

Electromyography


Medical Treatment

Because no known cure or treatment, therapy is supportive; focuses on preventing complications and maintaining maximum function


Assessment

Dyspnea, dysphagia, muscle cramps, weakness, twitching, joint stiffness, muscle atrophy, abnormal reflexes and gait, and paralysis

NURSING DIAGNOSES

Ineffective Airway ClearanceImpaired Physical MobilityImbalanced Nutrition: Less Than Body RequirementsImpaired Verbal CommunicationImpaired Skin IntegrityAnticipatory GrievingSituational Low Self-EsteemInterrupted Family Processes

Huntington Disease

Inherited degenerative neurologic disorder

Usually begins in middle adulthood with abnormal movements, emotional disturbance, and intellectual decline

Symptoms progress steadily: increasing disability and death in 15 to 20 years

Medical and nursing care are supportive only; there is no cure

Myasthenia Gravis

CauseMay have an autoimmune basis

Pathophysiology Insufficient receptor sites at the junction

of the motor nerve with the muscle With repeated stimulation, muscle

becomes exhausted; eventually unable to contract at all

If respiratory muscles involved, death from respiratory insufficiency or arrest possible

Myasthenia Gravis

Signs and Symptoms

Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking

Partial improvements of strength with rest

Dramatic improvement with the use of anticholinesterase drugs

Ptosis and diplopia commonly seen

Myasthenia Gravis

Medical Diagnosis

Administering edrophonium (Tensilon)

Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes

Myasthenia Gravis

Medical Treatment

Anticholinesterase drugs Neostigmine and pyridostigmine

(Mestinon) Corticosteroids Cytotoxic therapies Thymectomy Plasmapheresis

Myasthenia Gravis

Assessment

Health history describes the onset of symptoms: muscle weakness, diplopia, dysphagia, slurred speech, breathing difficulties, and loss of balance

NURSING DIAGNOSES

Ineffective Breathing Pattern

Impaired Physical Mobility and Self-Care Deficit

Impaired Swallowing

Deficient Knowledge

Nursing Assessment of Neurologic Function

Health History Note speech, behavior, coordination,

alertness, comprehension

Chief Complaint and history of present illness

Document what prompted the patient to seek medical attention

Describe any injuries If patient has pain, note the onset,

severity, location, and duration


Past Medical History

Head injury, seizures, diabetes mellitus, hypertension, heart disease, and cancer

Record dates and types of immunizations


Family History

Have immediate family members had heart disease, stroke, diabetes mellitus, cancer, seizure disorders, muscular dystrophy, or

Huntington disease?


Review of Systems

Fatigue or weakness, headache, dizziness, vertigo, changes in vision/hearing, tinnitus, drainage from ears or nose, dysphagia, neck pain or stiffness, vomiting, bladder or bowel function, sexual dysfunction, fainting, blackouts, tremors, paralysis, incoordination, numbness or tingling, memory problems, mood changes


Functional Assessment

Document whether present symptoms interfere with the patient’s usual activities and occupation Explore sources of stress, usual coping strategies, and sources of support


Physical Examination

Level of consciousness, pupillary evaluation, neuromuscular response, and

vital signs

Cerebrovascular Accidents

Risk Factors for Stroke

Non-modifiable factors Risk factors that cannot be changed

Age, race, gender, and heredity

Modifiable factors Those that can be eliminated or controlled

Transient Ischemic Attack (TIA)

Temporary neurologic deficit caused by impairment of cerebral blood flow

Blood vessels occluded by spasms, fragments of plaque, or blood clots

Important warning signs for the individual experiencing a full stroke


Signs and Symptoms

Dizziness, momentary confusion, loss of speech, loss of balance, tinnitus, visual disturbances, ptosis, dysarthria, dysphagia, drooping mouth, weakness, and tingling or numbness on one side of the body


Medical Diagnosis

Health history, physical examination findings, and results of brain imaging studies

Laboratory studies, electrocardiography (ECG), duplex ultrasonography, and cerebral angiography


Medical Diagnosis

Health history, physical examination findings, and results of brain imaging studies

Laboratory studies, electrocardiography (ECG), duplex ultrasonography, and cerebral angiography


Medical Treatment

Depends on the location of the narrowed vessel and the degree of narrowing

Acetylsalicylic acid (aspirin)Ticlopidine hydrochloride (Ticlid) Extended-release dipyridamole (Aggrenox) Clopidogrel bisulfate (Plavix) decrease platelet clumping Warfarin (Coumadin) and heparin

Carotid endarterectomy and transluminal angioplasty


Stroke

An abrupt impairment of brain function resulting in a set of neurologic signs and symptoms that are caused by impaired blood flow to the brain and last more than 24 hours

Stroke

PathophysiologyHemorrhagic stroke

Blood vessel in brain ruptures; bleeding into the brain occurs

Ischemic stroke Obstruction of blood vessel by atherosclerotic

plaque, blood clot, or a combination of the two, or by other debris released into vessel that impedes blood flow to an area of the brain

Stroke

Stroke

Signs and Symptoms

Different signs and symptoms, depending on the type, location, and extent of brain injury

Hemorrhagic stroke Occurs suddenly; may include severe headache

described as “the worst headache of my life”

Other symptoms: stiff neck, loss of consciousness, vomiting, and seizures

Stroke

Signs and Symptoms

Embolic stroke

Appear without warning

One or more of the following signs and symptoms: one-sided weakness, numbness, visual problems, confusion and memory lapses, headache, dysphagia, and language problems

Age-Related Changes

The number of nerve cells decreases

Brain weight is reduced; ventricles increase in size

Lipofuscin: aging pigment deposited in nerve cells with amyloid, a type of protein

Increased plaques and tangled fibers in nerve tissue

Eye pupil often smaller; may respond to light more slowly

Age-Related Changes

Reflexes intact except for Achilles tendon jerk, which is often absent

Reaction time increases, especially complex reactions

Tremors in the head, face, and hands are common Some develop dizziness and problems with balance

Stroke

Stroke

Signs and Symptoms

Aphasia A defect in the use of language; speech,

reading, writing, or word comprehension

Dysarthria The inability to speak clearly

Dysphagia Swallowing difficulty

Stroke

Signs and Symptoms

Dyspraxia The partial inability to initiate

coordinated voluntary motor acts Hemiplegia Defined as paralysis of one side of the

body

Stroke

Stroke

Signs and Symptoms

Sensory impairment Unable to feel touch, pain, or

temperature in affected body parts

Unilateral neglect Do not recognize one side of the body

as belonging to them

Stroke

Signs and Symptoms

Homonymous hemianopsia Perceptual problem: involves loss of one side

of field of vision

Elimination disturbances Neurogenic bladder Flaccid bladder Bowel incontinence

Stroke

Medical Diagnosis

Blood studies, electrocardiogram (ECG), computed tomography, magnetic resonance imaging, carotid ultrasound studies, cerebral and carotid angiography, electrocardiography, positron-emission tomography, and single-photon emission computed tomography

Stroke

Complications

Constipation, dehydration, contractures, urinary tract infections, thrombophlebitis, decubitus ulcers, and pneumonia

Sensory losses put patient at risk for traumatic and thermal injuries

Swallowing difficulties place patient at risk for pulmonary complications, such as choking and aspiration pneumonia

Stroke

Prognosis

Prognosis for TIA or stroke increasingly hopeful

Critical variables for recovery: patient’s condition before the stroke, time between stroke and diagnosis, treatment and support in acute phase (usually the first 48 hours), severity of patient’s symptoms, and access to rehabilitative therapy

Stroke

Prognosis

Long-term recovery may depend on the care received immediately after the stroke

Most recovery takes place in the first 3 to 6 months, but progress often continues long after that

Stroke

Medical Treatment in the Acute Phase

Begins with the onset of signs and symptoms and continues until vital signs, particularly blood pressure and neurologic condition, stabilize

This phase usually lasts 24 to 48 hours Many medical management interventions are directed at minimizing complications and deterioration of the patient’s condition after a stroke

Stroke


Major focus areas Hypertension Oxygenation Hyperthermia Hyperglycemia

Drug therapy Tissue plasminogen activator (rt-PA, alteplase,

Activase) Given to dissolve clots in acute ischemic strokes

Stroke


Other Medications Mannitol Nimodipine (Nimotop) Phenytoin (Dilantin) and phenobarbital Acetylsalicylic acid (aspirin), ticlopidine

hydrochloride (Ticlid), Aggrenox, and clopidogrel (Plavix)

Stroke


Surgical intervention An option for some patients with hemorrhagic

strokes

Decisions about surgery are based on patient’s age, intracranial pressure, and location of the hemorrhage

Stroke


Fluids and Nutrition Intravenous fluids Dietary order based on patient’s

nutritional requirements and ability to eat Regular, soft, or pureed

Total parenteral nutrition may be ordered for the malnourished patient

Stroke


Urine Elimination

Indwelling catheter to manage urinary incontinence

Intermittent catheterization: controlling incontinence caused by a flaccid bladder

Stroke

Assessment

Evaluate type and extent of the stroke: time of onset, symptoms, other details

Cincinnati Pre-hospital Stroke Scale

Stroke

Health History

Chief complaint and history of present illness Medical history Family history Review of systems Functional assessment

Stroke


Assess patient’s general appearance, responsiveness, and behavior

Record restlessness or agitation

Measure vital signs; weight and height if possible

Stroke


Inspect the face for symmetry; mouth for moisture and drooling

Evaluate the alert patient’s ability to swallow

Inspect pupils for size, equality, and reaction to light

Stroke


Conduct a gross vision assessment

Inspect skin color and palpate for moisture and turgor

Assess extremities for muscle tone and strength, sensation, and voluntary movement

Record evidence of incontinence or bladder distention

Frequently repeat neurologic checks: evaluating level of consciousness, pupil appearance and response to light, the patient’s ability to follow commands, and the movement and sensation of extremities

NURSING DIAGNOSES

Ineffective Airway Clearance and Ineffective Breathing Patterns Risk for Injury Deficient Fluid Volume or Excess Fluid VolumeImbalanced Nutrition Disturbed Sensory Perception Ineffective Thermoregulation Disturbed Thought Processes

NURSING DIAGNOSES

Impaired Verbal Communication

Impaired Physical Mobility

Total or Functional Urinary Incontinence

Constipation and/or Bowel Incontinence

Ineffective Coping

Interrupted Family Processes

Nursing Care in the Rehabilitation Phase

Assessment

Reassess patient’s abilities, expectations, knowledge, motivation, and resources

NURSING DIAGNOSES

Rehabilitation Phase

Self-Care Deficit Risk for Injury Ineffective Coping Impaired Verbal Communication Imbalanced Nutrition Impaired Physical Mobility ConstipationTotal and Functional Urinary Incontinence

REHAB

REHAB

REHAB

Discharge

Patients may be discharged to home or go to specialized rehabilitation centers for continued therapy

Outpatient therapy is an option for some patients

When able, patients are transitioned back into the home setting

Essential to include family, friends, and significant others in this process

Discharge

During and after the rehabilitation phase, patients and families need to be made aware of resources to help them deal with continuing disabilities

In rehabilitation, the patient is respectfully challenged to return to the highest level of function possible

Spinal Cord

Anatomy and Physiology

Consists of 33 vertebrae7 cervical (C1 through C7)12 thoracic (T1 through T12)5 lumbar (L1 through L5)5 sacral (S1 through S5)4 fused coccygeal

Spinal Cord

Spinal Cord

Vertebral Column

My neurological nursing

Health & Medicine

human nervous system

physical examination findings

peripheral nervous system

medical diagnosishealth history

spinal cord

risk factors

carotid systembegins

medical treatment