learning Objectives - Describe the nursing management of clients with Neurological disorders. Demonstrate skill in giving nursing care to clients with Neurological disorders .
Hours - 20
Teaching and Learning Activities - Lecture cum discussion Clinical teaching Demonstration of reflexes and use of Glasgow coma scale Simulation Videos and Films Charts
Assessment Methods - Short answer Objective type Essay type Return demonstration
Content of the chapter
a) Assessment Neurological functions
– History
– Physical examination
– Diagnostic evaluation
b) Management of patients with neurologic
dysfunctions
– Altered level of consciousness
– Increased Intracranial pressure
– Intracranial surgery
c) Management of patients with neurological
disorders
– Headache
– Migraine
– Seizures
– Epilepsy
– Status epileptics
– Cerebrovascular disorder – CVA
– Neurological trauma – Head, brain, spinal
cord, subdural and extradural hematoma
– Neurologic infection
• Meningitis
• Brain abscess
• Encephalitis
– Degenerative disorders
• Multiple sclerosis
• Myasthenia gravis
• Guillain – Barre syndrome
• Parkinsonism
• Alzheimer disease
– Neuralgia
– Bell’s Palsy
– Peripheral neuropathies
– Brain and spinal cord tumors
– Huntington’s disease
– Muscular Dystrophies
– Herniation of the intervertebral disc
d) Alternate therapies
e) Drugs used in treatment of neurological
disorders
Nursing Management of Patients with Neurological Disorders
Neurological disorders affect the brain, spinal cord, and peripheral nerves, leading to disturbances in consciousness, motor and sensory function, cognition, and coordination. Nursing care aims at assessment, monitoring, prevention of complications, rehabilitation, and patient education.
a) Assessment of Neurological Functions
1. History
- Present complaints: headache, dizziness, weakness, numbness, seizures
- Onset, duration, and progression of symptoms
- Past neurological illness or trauma
- Drug and substance history
- Family history of neurological disorders
- Effect on daily life
2. Physical Examination
- Level of consciousness (LOC): Glasgow Coma Scale
- Vital signs: BP, pulse, temperature
- Pupils: size, equality, reaction to light
- Motor function: muscle strength, tone, coordination
- Sensory function: pain, touch, temperature
- Cranial nerve assessment
- Reflexes
- Gait and balance
3. Diagnostic Evaluation
- CT scan / MRI
- EEG
- Lumbar puncture (CSF analysis)
- EMG / Nerve conduction studies
- Blood tests for infection or metabolic causes
- Cerebral angiography
b) Management of Patients with Neurologic Dysfunctions
1. Altered Level of Consciousness
- Maintain airway and breathing
- Frequent neurological assessments
- Prevent aspiration
- Safe environment to prevent injury
- Nutritional support (NG feeding if needed)
2. Increased Intracranial Pressure (ICP)
- Elevate head of bed (30°)
- Avoid activities increasing ICP (straining, coughing)
- Monitor GCS and pupillary response
- Administer osmotic diuretics (Mannitol) if prescribed
- Maintain oxygenation
3. Intracranial Surgery
- Preoperative education
- Postoperative monitoring: vitals, neurological status
- Wound and CSF leak care
- Pain management
- Prevent complications like infection or hemorrhage
c) Management of Patients with Neurological Disorders
Headache & Migraine
- Identify and avoid triggers
- Provide rest in a quiet, dark room
- Administer analgesics or anti-migraine medications
Seizures, Epilepsy & Status Epilepticus
- Protect patient from injury
- Maintain airway
- Administer antiepileptic drugs
- Emergency management in status epilepticus
Cerebrovascular Disorders (CVA / Stroke)
- Maintain airway and oxygenation
- Positioning and skin care
- Early mobilization
- Speech and swallowing assessment
- Prevent aspiration and contractures
Neurological Trauma
- Head, brain, spinal cord injuries
- Immobilization
- Monitor ICP
- Prevent secondary injury
- Subdural & extradural hematoma
- Pre- and post-operative care
Neurological Infections
- Meningitis: isolation, antibiotics, monitor fever and LOC
- Brain abscess: antibiotics, surgical drainage care
- Encephalitis: supportive care, seizure management
Degenerative Disorders
- Multiple Sclerosis: prevent fatigue, physiotherapy, medications
- Myasthenia Gravis: prevent respiratory crisis, medication timing
- Guillain–Barré Syndrome: monitor respiratory function, physiotherapy
- Parkinsonism: mobility assistance, fall prevention
- Alzheimer’s Disease: cognitive support, safe environment
Others
- Neuralgia: pain management, trigger avoidance
- Bell’s Palsy: eye care, facial exercises
- Peripheral neuropathies: protect insensate areas, pain relief
- Brain & Spinal Cord Tumors: pre- and post-operative care, steroids for edema
- Huntington’s Disease: safety, psychological support
- Muscular Dystrophies: maintain mobility, respiratory care
- Herniated Intervertebral Disc: pain management, physiotherapy
d) Alternate Therapies
- Physiotherapy and occupational therapy
- Speech therapy
- Yoga and relaxation exercises
- Cognitive therapy
- Support groups and counseling
- Hydrotherapy and massage for mobility/flexibility
e) Drugs Used in Neurological Disorders
- Antiepileptics: Phenytoin, Valproate, Levetiracetam
- Analgesics / NSAIDs: Paracetamol, Ibuprofen
- Anti-migraine: Sumatriptan
- Corticosteroids: Dexamethasone
- Anti-Parkinsonian drugs: Levodopa, Carbidopa
- Muscle relaxants: Baclofen, Diazepam
- Osmotic diuretics: Mannitol (for raised ICP)
- Antibiotics / antivirals: as indicated
Conclusion
Nursing management of neurological disorders focuses on early assessment, monitoring neurological status, prevention of complications, rehabilitation, and patient/family education. Skilled nursing care significantly improves patient outcomes and quality of life.