✔ (+) Doing activities = (-) Tremors

NEUROSENSORY b) Pill rolling

c) Unilateral (only one hand is affected)
DISORDERS
PARKINSON’S DISEASE
❒ Chronic (no cure)
❒ Progressive (Worsens as time progresses)
❒ Degenerative (loss of motor function) 2) Muscle Rigidity
❒ Affects Central Nervous System ✔ Robot-like movement
✔ Decrease/Depleted dopamine 3) Bradykinesia
levels ✔ Slow movements
4) Postural Instability
✔ Increase risk of falls

OTHER SIGNS & SYMPTOMS:

5) Mask-like Appearance
✔ Absence facial expression
6) Monotonous Speech
❒ CAUSE: Unknown
7) Difficulty of chewing
● Related to destruction of
8) Dysphagia
substantia nigra
✔ Increase risk of aspiration
9) Constipation
10)Shuffling Gait
✔ Increase risk of falls
11)Drooling
✔ Increase risk of dehydration

MANAGEMENT:
❒ RISK FACTORS:
1) GOAL: Patient fulfills ADLs with optimum
a) Age (Onset: 60 y.o. above)
level of functioning
✔ Organs occur in degenerative
2) PRIORITY: Safety
changes as age increases
a) Install handle bars throughout the
b) Hereditary (Family History)
house (esp. bathroom)
c) Gender (Males > Females)
b) Wear non-skid footwear
d) Frequent/Repeated Head injuries
c) Eliminate wirings & rugs on the
❒ GOAL OF TREATMENT:
floor
✔ Decrease the severity of s/sx of the
d) Teach patient how to use assistive
disease to fulfill patient’s ADLs and
devices (cane, walker, crutches)
optimum level of functioning.
3) DIET:
4 CARDINAL SIGNS:
a) High Calorie (to provide energy)
1) EARLIEST: Tremors
b) High Protein
a) Resting = (+) Tremors
 c) High Fiber
d) Soft diet
e) Thick liquids
f) Small frequent feedings
g) Increase Oral fluid intake

4) POSITIONING:
a) UPRIGHT position
b) When eating: Instruct to flex the
neck while swallowing
5) PROMOTE INDEPENDENCE
a) To maximize patient’s optimum level
of functioning
b) AVOID rushing the client with ADLs
6) REFER FOR:
a) Physical therapy (for movement
problems)
b) Occupational therapy (for ADLs
problems)
7) PHARMACOLOGICAL MANAGEMENT
a) Dopaminergics (increase dopamine
levels)
✔ Decreases severity of signs and
symptoms
✔ EXAMPLES:
a. Carbidopa-Levodopa
b. Amantadine b) Anticholinergics
c. Bromocriptine ✔ Decreases severity of signs and
d. Rasagiline symptoms
✔ EXAMPLES:
a. Benztropine mesylate
b. Trihexyphenidyl HCl
 f) Cigarette Smoking
❒ GOAL OF TREATMENT:
❒ Decrease the severity of s/sx of the
disease to fulfill patient’s ADLs and
optimum level of functioning.

SIGNS & SYMPTOMS: AFFECTED FRONTAL

LOBE
1) Decrease cognitive function
2) Memory Loss

SIGNS & SYMPTOMS: AFFECTED TEMPORAL

LOBE
1) Vertigo (loss of balance)

MULTIPLE SCLEROSIS (MS) SIGNS & SYMPTOMS: AFFECTED PARIETAL

❒ Chronic LOBE
❒ Progressive 1) Parathesias (tingling sensation)
❒ Characterized of periods of remissions 2) Chronic pain
and exacerbations
❒ Debilitating disorder (loss of cognitive, SIGNS & SYMPTOMS: AFFECTED OCCIPITAL
sensory & motor function) LOBE
❒ Affects Central Nervous System 1) Blindness
✔ Demyelination of neurons
(Delayed transmission of impulses)
❒ CAUSE: SIGNS & SYMPTOMS: AFFECTED BRAIN STEM
a) Autoimmune (body’s immune 1) Dysphagia
system attacks and damages the 2) Nystagmus (rapid eye movement)
myelin sheath of neurons in the 2) Diplopia
CNS)
❒ RISK FACTORS: SIGNS & SYMPTOMS: AFFECTED SPINAL CORD
a) Age (Onset occurs around 20-40 1) Bladder & Bowel Problems
years old) 2) Muscle weakness
b) Hereditary (Family History) 3) Fatigue
c) Gender (Males < Females) 4) Tremors (Intentional)
d) Exposure/History of viral ✔ (+) Doing activities = (+) Tremors
infections: ✔ Resting = (-) Tremors
✔ Epstein-Barr Virus 5) Scanning speech (Slurred)
e) Existing autoimmune diseases:
✔ DM Type 1
✔ Inflammatory Bowel
Diseases
✔ SLE
✔ Pernicious Anemia
MANAGEMENT:
1) GOAL: Maximum optimum level of
functioning
2) PRIORITY: Safety
3) FATIGUE MANAGEMENT:
a) Provide Rest periods in between
activities
b) Cool environment 9) POSITIONING:
a) UPRIGHT position
b) When eating: Instruct to flex the
neck while swallowing
10)PHARMACOLOGICAL MANAGEMENT
a) Immunomodulators
✔ Modify the disease
✔ Treat acute episodes of
4) exacerbations (relapses)
4) DIPLOPIA/ NYSTAGMUS ✔ EXAMPLES:
MANAGEMENT: a. Interferons
a) Wearing of eye patches
5) BOWEL PROBLEMS MANAGEMENT:
a) Regular elimination
b) Bowel training program
6) PROMOTE INDEPENDENCE
a) To maximize patient’s optimum level
of functioning
7) REFER FOR:
b) Stool Softeners
a) Physical therapy (for movement
✔ Treat constipation
problems)
✔ EXAMPLES:
b) Occupational therapy (for ADLs
a. Docusate
problems)
c) Dopamine Agonist
c) Speech therapy (for speech problems)
✔ Treat fatigue
✔ EXAMPLES:
8) DIET:
a. Amantadine
a) High Calorie (to provide energy)
d) Anticonvulsants
b) High Protein
✔ Treat neuropathic pain
c) High Fiber
✔ EXAMPLES:
d) Increase oral fluid intake
a. Gabapentin
e) Soft diet
b. Carbamazepine
f) Thick liquids
e) SSRIs
g) Small frequent feedings
✔ Treat depression
✔ EXAMPLES:
b. Fluoxetine
c. Sertraline
 c) Small frequent feedings
MYASTHENIA GRAVIS (MG) 5) POSITIONING:
❒ Neuromuscular disease a) UPRIGHT position
❒ Descending Paralysis related to decrease b) When eating: Instruct to flex the
transmission of acetylcholine in the neck while swallowing
muscle. 6) Encourage Independence
❒ CAUSE: 7) Provide Rest
a) Autoimmune (body’s immune 8) AVOID the following:
system block the acetylcholine a) Fatigue
receptors, resulting absent b) Infection
muscular contractions) c) Stress
❒ RISK FACTORS: d) Beta blockers (it exacerbates the
a) Thymoma (tumor in the thymus condition)
gland) e) Quinidine (it exacerbates the
✔ Abnormal increase of condition)
antibody production f) Quinines (it exacerbates the
b) Hereditary (Family History) condition)
c) Age & Gender : g) Phenytoin (it exacerbates the
✔ Men (Onset: 60 yrs. Old) condition)
✔ Women (Onset: 40 yrs. 9) PHARMACOLOGICAL MANAGEMENT
Old) a) Anticholinesterase
✔ Increases availability of
SIGNS & SYMPTOMS: DESCENDING PARALYSIS acetylcholine in the muscle
1) Earliest: Ptosis (Drooping of the eyelids) ✔ Manages s/sx of paralysis
2) Myasthenic Smile ✔ EXAMPLES:
3) Difficulty of chewing a. Neostigmine
4) Dysphagia b. Pyridostigmine
5) Weak, hoarseness of voice c. Ambenonium
6) Chest muscle paralysis d. Edrophonium (Tensilon)
✔ Increase risk of respiratory arrest

MANAGEMENT:
1) GOAL: Prevent complications (e.g.
respiratory arrest)
2) PRIORITY: Monitor respiratory status
✔ Vital signs (RR)
✔ O2 Saturation
❒ WATCH OUT FOR CRISIS!
3) BED SIDE: Emergency Equipment
MYASTHENIC CHOLINERGIC
✔ Endotracheal tube CRISIS CRISIS
✔ Ambu bag CAUSE UNDER OVER medication
✔ Mechanical ventilator medication
4) DIET:
a) Soft diet
b) Thick liquids
 S/Sx ❒ Weakness ❒ Weakness Respiratory Paralysis Cardiac Dysrhythmias
❒ Paralysis ❒ Diarrhea Respiratory Failure Cardiac Arrest
❒ Ptosis ❒ Hypersalivation Respiratory Arrest
❒ Absence of ❒ Hypotension
cough & ❒ Bradypnea MANAGEMENT:
swallowing 1) GOAL: Prevent complications (e.g.
reflex respiratory arrest)
❒ Dyspnea
2) PRIORITY: Monitor respiratory/cardiac
MANAGEMENT ADMINISTER STOP status
Anticholinesterase Anticholinesterase ✔ Vital signs (RR & HR)
✔ O2 Saturation
ANTIDOTE ATROPINE ✔ Patient is in cardiac monitor (for
SULFATE
GIVE INCREASE muscle WORSENS
ECG status)
Tensilon strength weakness 3) BED SIDE: Emergency Equipment
✔ Endotracheal tube
✔ Ambu bag
✔ Mechanical ventilator
GUILLAIN-BARRE ✔ Cardiac medications
4) Turn Patient every 2 hours (prevent
SYNDROME (GBS) pressure ulcers)
❒ Acute Infectious Neurortis of cranial & 5) Apply anti-embolic stockings
peripheral nerves (PNS) 6) PHARMACOLOGICAL MANAGEMENT:
❒ CAUSE: a) IVIG(Intravenous Immunoglobulin)
a) Autoimmune (body’s immune ✔ Modify the disease
system attacks nerves of the PNS) (immunomodulator)
❒ RISK FACTORS: ✔ Prevents the immune system
a) Exposure/History of from attacking the PNS.
GI/Respiratory infections:
✔ Campylobacter
✔ Influenza Virus
✔ Cytomegalovirus
✔ Epstein-Barr Virus
✔ Zika Virus
✔ HIV/AIDS
✔ COVID-19
b) Hodgkin’s Lymphoma
c) Received J&J Vaccines for COVID-19
SIGNS & SYMPTOMS: ASCENDING PARALYSIS
1) Earliest: Weakness of Lower
Extremities
2) (-) Deep Tendon/Patellar Reflex BELL’S PALSY
3) Bladder/Bowel Problems ❒ Inflammation of CN VII (Facial Nerve)
4) Chest muscle paralysis
INCREASE RISK OF:
 c) Small Frequent Feedings
d) Increase amount of spices
4) PHARMACOLOGICAL MANAGEMENT:
a) STEROIDS
✔ Has anti-inflammatory and
immunosuppressive effect

❒ CAUSES:
a) Autoimmune (body’s immune
system goes hyperactive after
Varicella virus infection)
b) Trauma (inflames the CN VII)
c) Tumor (compression of CN VII)
❒ RISK FACTORS:
a) Exposure/History of Upper
Respiratory infections:
✔ Chicken pox
✔ Herpes Zoster (Shingles)
b) Diabetes Mellitus
c) Pregnant Women

SIGNS & SYMPTOMS:

1) Unilateral Facial Paralysis
2) INABILITY to:
TRIGEMINAL NEURALGIA
a) Smile ❒ Sensory Disorder of CN V (Trigeminal
b) Frown Nerve)
c) Raise the eyebrows ❒ Hypersensitivity of CN V (causes facial
d) Close eyelid of the affected side pain)
of the face ❒ CAUSE:
3) Drying Of The Affected Eye a) Tumor (compression of CN V)
4) Loss of Taste b) Formation of BV that
5) Loss of Appetite compresses the CN V
6) Weight Loss c) Multiple Sclerosis (affecting the
parietal lobe)
MANAGEMENT:
1) Encourage facial exercises (Rehabilitation SIGNS & SYMPTOMS:
of facial muscles) 1) Severe Unilateral Facial Pain
2) Administer artificial tears (prevent drying ❒ Sharp & Recurrent Pain
of eyes) ❒ TRIGGERS:
3) Encourage wearing of eye patch upon a) Shaving
sleeping (to stabilize closing of eye) b) Touching the face
4) DIET: c) Eating/Drinking
a) Soft Diet d) Brushing of teeth
b) Thick Liquids e) Putting on makeup
 f) Smiling
g) Washing of face
INCREASED INTRACRANIAL
PRESSURE (ICP)
MANAGEMENT:
1) SURGERY:
a) Microvascular Decompression
(relocates the affected artery due to
the compression of trigeminal
nerve)
b) Rhizotomy (resection of trigeminal
nerve)
2) PHARMACOLOGIC MANAGEMENT:
a) Carbamazepine

❒ can cause compression of brain stem

(cardiac and respiratory problems)
❒ Can cause brain herniation
❒ CAUSE:
a) Brain/Head Injury
b) Brain infection
c) Brain tumor
d) Bleeding into the brain (e.g. BV
rupture)
e) Hematoma formation (e.g.
epidural hematoma)
f) Stroke (e.g. ischemic/hemorrhagic
stroke)
g) Hydrocephalus (Infants)

SIGNS & SYMPTOMS:

1) EARLIEST: Decreased LOC/Restlessness
2) Hyperthermia/Fever (Compression of the
Hypothalamus)
 ✔ EXAMPLE: 120/80 mmHg =
120-80 = 40 Pulse Pressure

2) Cheyne-Stokes Respirations

3) Nausea & Vomiting

4) Headaches
5) (-) Doll’s Eyes Reflex

3) Decorticate & Decerebrate Position

DECORTICATE DECEREBRATE

Extension of lower extremities

Flexion of upper Extension of upper

extremities extremities

6) Nystagmus (Rapid Eye Movement)

7) Sunset Eyes (Infants)

LATE SIGNS:
1) Cushing’s Triad
❒ Widen Pulse Pressure (difference of
SBP & DBP)
 2) Maintain body temperature (36.5-37.5°C)
✔ Administer antipyretics
✔ Tepid sponge baths
✔ Cooling blankets
3) Decrease Environmental Stimuli
✔ Private room
✔ Dim lights
✔ Close doors & Windows
✔ AVOID television, radios, etc.
✔ Restrict visitors
4) POSITIONING:
⮚ HOB elevated 30-40 degrees
⮚ Semi-Fowler’s Position
⮚ Head/Neck in NEUTRAL position
✔ NOT flexed
✔ NOT extended
✔ NOT on right/left side
5) LIMIT oral fluid intake
✔ Limit up to 1200mL/day
6) AVOID the following activities:
a) Excessive coughing/Sneezing
b) Blowing of nose
c) Straining (Valsalva maneuver)
7) INITIATE SEIZURE PRECAUTIONS
8) PHARMACOLOGICAL MANAGEMENT:
a) Anti-inflammatory Medications
4) Seizures ✔ Steroids (decreases cerebral
swelling)
MANAGEMENT: b) Antiemetic
1) PRIORITY: ✔ Metoclopramide
a) Maintain patency of airway c) Diuretics
✔ Suction secretions as needed ✔ Mannitol IV
b) Maintain PaO2 (80-100) and PaCO2
(<35)
 ❒ Bruising injury to the brain

C. HEMATOMAS
EPIDURAL SUBDURAL
MOST serious

RAPID onset SLOW onset

d/t ARTERIAL d/t VENOUS bleeding

bleeding
Requires EMERGENCY
SURGERY
Initially AFTER
d) Anticonvulsants/Anti seizures accident:
UNCONSCIOUS
✔ Diazepam
AFTER few hours:
✔ Lorazepam CONSCIOUS
✔ Phenobarbital AFTER another few
✔ Carbamazepine hours: DECREASED
LOC (Lucid interval)

TRAUMATIC HEAD/BRAIN
INJURY
❒ Trauma to the skull causing:
✔ Mild brain injury
✔ Severe brain injury
❒ COMPLICATIONS:
a) Cerebral bleeding
b) Cerebral hematoma
c) Uncontrolled increased ICP
d) Seizure attacks

TYPES OF TRAUMATIC HEAD/BRAIN

INJURY: D.BASILLAR SKULL FRACTURE
A. CONCUSSION
❒ Mild type of traumatic brain/head injury SIGNS & SYMPTOMS: Related with Increased
❒ Jarring of the brain ICP

MANAGEMENT: Related with Increased ICP

B. CONTUSION
❒ Mild type of traumatic brain/head injury
SURGICAL MANAGEMENT (Hematomas):
 a) Supratentorial Approach
❒ POST-OP POSITIONING:
⮚ HOB elevated 30-40 degrees
⮚ Head/Neck in NEUTRAL position
✔ NOT flexed
✔ NOT extended
✔ NOT on right/left side
b) Infratentorial Approach
❒ POST-OP POSITIONING:
⮚ FLAT on bed (surgical site is at
the BACK of head)
⮚ Head turned on either side

GENERAL NURSING INTERVENTIONS

(CRANIOTOMY):
1) Monitor V/S
2) Monitor S/Sx of Increased ICP
3) RESPIRATORY GOAL:
a) PaO2: 80-100
b) PaCO2: <35
4) POST-OP: Non-stimulating environment
5) Monitor drains
6) Measure drainage every shift
7) Turn patient every 2 hours
8) Wearing of anti-embolic stockings
9) Encourage patient to Deep Breathing SEIZURE
Exercises (DBE)
❒ Sudden, excessive & abnormal electrical
1) AVOID the following activities:
discharges activity within the brain.
d) Excessive coughing/Sneezing
❒ CAUSES:
e) Blowing of nose
a) Hyperpyrexia
f) Straining (Valsalva maneuver)
b) Head trauma
c) Brain tumor
d) Brain infection (e.g. meningitis)
e) Stroke
f) Increased ICP
g) Electrolyte Imbalances (e.g.
hypocalcemia, hyponatremia)
h) Use of recreational substances (e.g.
methamphetamines, cocaine, etc.)
i) Alcohol Withdrawal
TYPES OF SEIZURES:
A. TONIC-CLONIC SEIZURES
(GRAND MAL)
❒ 4 PHASES:
1) AURA PHASE (Warning Stage)
a) Headache
b) Blurring of vision
c) Epigastric pain
2) TONIC PHASE (10-20 seconds) D.ATONIC/AKINETIC
● Stiffening/rigidity of muscles
● AFTERWARDS: Loss of
SEIZURES (DROP Seizures)
consciousness ❒ Sudden loss of muscle tone
3) CLONIC PHASE (30 seconds) ❒ Can cause: FALL INJURY
● Alternate muscle contraction
and relaxation (Jerking) MANAGEMENT (DURING SEIZURE):
● STILL UNCONSCIOUS 1) PRIORITY:
4) POST ICTAL PHASE a) Maintain Airway Patency
● Seizure STOPS ❒ Turning patient to the side (to
● STILL UNCONSCIOUS drain oral secretions)
● AFTER AWAKENS: exhibits b) Maintain Safety
short term memory loss ❒ Remove hazardous items
around patient
❒ AVOID restraints
B. ABSENCE SEIZURES (PETIT ❒ AVOID putting anything inside
MAL) mouth (prevent aspiration)
❒ NO Loss of Consciousness ❒ Put pillow under the head
❒ NO CHANGE in muscle tone
❒ Patient looks like he is day dreaming MANAGEMENT (AFTER SEIZURE):
❒ COMMON in children 1) PRIORITY:
a) Maintain Airway Patency
❒ Maintain side-lying position (to
C. MYOCLONIC SEIZURES drain oral secretions)
❒ Sudden jerking ❒ Suction AS NEEDED
❒ Sudden stiffening of extremities 2) REORIENT Patient in the environment
❒ Can cause: FALL INJURY
 a) Ischemia (blockage/narrowing in the
BV of brain)
b) Head trauma
c) Brain tumor

GENERAL NURSING INTERVENTIONS

(ANTICONVULSANT ADMINISTRATION):
1) Take WITH MEALS (decrease GI
irritation)
2) AVOID alcohol (CNS depressant)
3) AVOID caffeinated products (CNS
stimulant)
4) AVOID operating large machines or
activities requiring mental concentration
(e.g. driving)
5) In discontinuation: TAPER the dose
GRADUALLY
✔ Abrupt discontinuation: REBOUND
SEIZURE

STROKE
❒ Blood supply to a certain part of the
brain is interrupted
❒ Brain cells/tissues on the affected part
with no blood supply dies (necrosis)
❒ It can cause neurological deficits
❒ CAUSES: