NEUROLOGICAL DISORDER

Introduction:-
Neurological disorders are medically defined as disorders that affect the brain as
well as the nerves found throughout the human body and the spinal cord.
Structural, biochemical or electrical abnormalities in the brain, spinal cord or
other nerves can result in a range of symptoms.
Some neurological conditions are congenital, emerging before birth. Other
conditions may be caused by tumors, degeneration, trauma, infections or
structural defects. Regardless of the cause, all neurological disabilities result from
damage to the nervous system. Depending on where the damage takes place,
determines to what extent communication, vision, hearing, movement and
cognition are impacted.
 Examples of symptoms include paralysis, muscle weakness, poor coordination,
loss of sensation, seizures, confusion, pain and altered levels of consciousness.
According to the U.S. National Library of Medicine there are more than 600
neurologic diseases. 

Specific Neurological Disorders in Adult includes:-

Neurological disabilities include a wide range of disorders, some of them
are as follows:-
1. Epilepsy
2. Brain tumors
3. Trigeminal Neuralgia
4. Peripheral neuropathies
5. Bell’s palsy and cerebral palsy
6. Meningitis
7. Encephalitis
8. Parkinson’s disease
9. Stroke
10.Alzheimer’s disease
11.Multiple sclerosis
Definition:
 Epilepsy
It  is a central nervous system (neurological) disorder in which brain activity
becomes abnormal, causing seizures or periods of unusual behaviour,
sensations, and sometimes loss of awareness.

 Brain tumours
The growth of abnormal cells in the tissues of the brain is called brain
tumours. It is a localized intracranial lesion that occupies space within the
skull.

 Trigeminal neuralgia
Trigeminal neuralgia is a disorder of the trigeminal nerve (5th cranial nerve)
characterized by episodes of intense pain in the eyes, lips, nose, scalp,
forehead and jaw, this condition can bring about stabbing, electric shock-
like pain from just a light wind or a finger’s glance of the cheek and the pain
usually comes and goes which usually last from a few seconds to a few
minutes.

 Peripheral neuropathy
Peripheral Neuropathy is a disorder affecting the peripheral motor and
sensory nerves, often causes weakness, numbness and pain, usually in the
hands and feet. It can also affect other areas of the body. Pain is usually
bilateral and symmetric disturbance of function, usually beginning in the
feet and hands.

 Bell’s Palsy
Bell’s palsy is a condition that causes a temporary weakness or paralysis of
the muscles in the face. It can occur when the nerve that controls the facial
 muscles becomes inflamed, swollen, or compressed. The condition causes
one side of your face to droop or become stiff.

 Meningitis
It is an acute infection of meningeal membrane between the pia-mater and
arachnoid matter of the brain and spinal cord, inflammation spreads rapidly
throughout CNS because of the circulation of CSF around the brain and
spinal cord.It is potentially fatal inflammation of the meninges, caused by
bacteria, virus and other organisms.

 Encephalitis
It is an inflammatory process of CNS that produces altered function of
various portions of the brain and spinal cord. It causes irritation and
swelling of the brain usually due to infective agent that produces alteration
to various parts of the brain and spinal cord. It can be caused by variety of
organism including bacteria, fungal, protozoa, helmenthies, viruses.

 Parkinson’s disease
It  is a brain disorder that leads to shaking, stiffness, and difficulty with
walking, balance, and coordination, symptoms usually begin gradually and
get worse over time. As the disease progresses, people may have difficulty
walking and talking.

 Stroke
Stroke is also called cerebro-vascular accident or brain attack, is the
interruption of normal blood flow in one or more of blood vessels that
supply the brain. Stroke interrupts or diminishes oxygen supply and
commonly causes serious damage or necrosis in brain tissues.

 Alzheimer’s Disease
 It   is an irreversible, progressive brain disorder that slowly destroys
memory and thinking skills and, eventually, the ability to carry out the
simplest tasks.

 Multiple Sclerosis
It is a potentially disabling disease of the brain and spinal cord (central
nervous system). In MS, the immune system attacks the protective sheath
(myelin) that cover nerve fibres and causes communication problems
between your brain and the rest of your body.

Aetiology:-
The specific causes of neurological problems may vary, but can include:-

 Idiopathic
 Genetic
 Age
 Gender
 Radiations/chemicals
 Tumours
 Metabolic disorders
 Positive family history
 Infections
 Congenital abnormalities or disorders
 Lifestyle
 Environmental health problems including malnutrition
 Physical injuries
Signs of neurological disorders:-
The signs of neurological disorders can vary significantly, depending upon the
type of disorder as well as the specific area of the body that is affected. In some
instances, the patient experience emotional symptoms while in other cases,
physical symptoms may be seen.

1) Emotional symptoms of neurological disorders

 Mood swings
 Depression
 Delusion

2) Physical symptoms of neurological disorders

 Partial or complete paralysis
 Muscle weakness
 Partial or complete loss of sensation
 Seizures
 Difficulty in reading or writing
 Uncoordinated movement
 Poor cognitive abilities
 Unexplained pain
 Decreased alertness
 Hearing impairment
 Language problems
 Tremors
 Change in behaviour
 Decreased reflexes
Diagnosis:-
 Complete history taking
 Physical examination
 Neurological examination
 Genetic screening
 CT-Scan/MRI
 Cerebral angiogram
 Blood test
 Lumbar Puncture and CSF analysis

Treatment:-
1) Drug therapy
It depends upon the type of the disease condition, severity of the disease
condition and patient’s health status. Some of the medicines used in neurological
problems to treat the symptomatic problems includes:
i. Anti-convulsant
ii. Steroids
iii. Anti-depressants
iv. Mood stabilizers
v. NSAIDS
vi. Anti-chollinergic
2) Surgery
Surgical treatment is mainly done in brain tumours, stroke, aneurysm etc. It
includes:-
1) Carotid endaeterectomy
2) Biopsy
3) Clipping/wrapping/coiling
4) Minimal invasive neuroendoscopy
5) Minimal invasive endo-nasal neuroendoscopy
6) Craniotomy
7) Deep brain stimulation
8) Micro-vascular decompression
9) Brain stereotactic radiosurgery
10) Open surgical retrogasserian rhizotomy

3) Radiation and chemotherapy in case of brain tumours

NURSING MANAGEMENT
Nursing assessment:-
 Assess the risk factors
 Assess the signs and symptoms
 Assess the neurological status
 Assess the vital signs at regular interval
 Assess changes in level of consciousness or responsiveness
 Observe movement, resistance to changes of position and response
to stimulation, orientation to time, place and person
 Note presence or absences of voluntary or involuntary movement of
the extremities, muscle tone, body posture, position of head.
 Monitor colour of the face and extremities, temperature and
moisture of skin, Glass-Gow coma scale
 Monitor input/ output of the patient strictly
 Note ability to speak, eye opening, comparative size of pupils and
pupillary reaction to light and ocular position.
 Nursing diagnosis:-
 Impaired cerebral perfusion related to increased intra-cranial perfusion.
 Acute pain related to disease condition( excessive growth of new cells)
 Risk for injury related to impaired sensory and motor functions
 Anxiety related to lack of exposure to new disease
 Imbalanced nutrition related to decreased amount of intake

Nursing interventions:-
1) Promote cerebral perfusion
 Assess the patients neurological signs periodically which will be identified
early and definitive action taken to control deterioration
 Identify any signs of neurological deterioration , report any such changes to
the physician and document finding in record
 Elevate the head of bed 30 degree
 Administer drugs and other protocols as necessary
 Continue to monitor the patient’s conditions

2) Pain management
 Provide analgesics around the clock at regular intervals that will not mask
neurological changes
 Maintain the head of bed at 15-30 degree to reduce cerebral venous
congestion
 Minimizes direct sunlight by provide a darkened room for photophobic
patient
 Maintain quite environment to increase patients pain tolerance
 Collaborate with patients on alternative ways to reduce pain such as uses of
diversional therapy e.g. listening music ,talking with patient.
 Keep the patient in comfortable position as with operative side up
3) Preventing injury
 Perform baseline physical assessment and neurological assessment and
report any signs of increased ICP or worsening condition immediately
 Adjust care to reduce risk for increased ICP
 Monitor intake and output, electrolytes regularly.
 Initiate seizure precautions-keep the side rails of the bed to prevent injury if
seizures occurs, keep suction ready to work
 Initiate fall precautions-keep the side rails up all the time assist in toileting
and other as necessary avoid slippery floor
 If the patient is dysphasic or unconscious, initiate aspiration precaution,
elevate head up to 30 degree and keep NPO as needed.
 If the patient is dysphasic: instruct the sequence swallowing to maintain
feeding function.
 Maintain oxygen and suction in case of aspiration

4) Minimizing anxiety
 Observe the patient for verbal and nonverbal cues indicating anxiety
 Provide a safe environment in which the patient may verbalize fear and
anxiety
 Encourage patient to ask the question and answers the questions and
provide written information
 Anticipate need of the patient
 Introduce stress management techniques
 Provide consistency in care ,continually provide emotional supports
 Assess the patients usual coping behaviour and provide support in these
areas
 Refer and consult with resource person as necessary

5) Optimizing nutrition
 Assess the patients nutrition intake on a 24hours basis
 Assess the patient dietary intake/likes and dislikes
 Offers small meals frequently as tolerated
 Provide frequent month care to enhance intake
 Medicate for nausea vomiting before radiation ,chemotherapy and positive
changes
 Consult with dietician to evaluate food choices and provide adequate caloric
needs through parental nourishment if unable to take oral nutrition

6) Minimize fatigue which is induced by chemotherapy /radiation

 Allow the patient to express his/her feeling about general malaise
 Encourage and plan a schedule that allow for frequent rest periods
 Assess the patient’s ability to prefers activities for daily livings
 Provide frequently rest periods

7) Patient education and health maintenance

 Explain the adverse effects of treatment
 Encourage close follow up after diagnosis and treatment
 Explain about need for frequent mouth care and hygiene
 Avoid irritating foods such as citrus fruits and provide a soft balance diet.

8) Rehabilitation
 Providing support to the patient and family members
 Maintaining integrity
 Preventing secondary disabilities
 Evaluating the progress
 Restoring the potential functions through self care
 Maximizing the existing capabilities