Nursing Tips: Nervous

Central Nervous System (CNS)

Nervous Med-Surg

The central nervous system (CNS) is composed of the brain and spinal cord.

Autonomic Dysreflexia

Nervous Medical-Surgical

A patient with a spinal cord injury is at risk for experiencing life-threatening hypertension known as autonomic dysreflexia.

Tonic-clonic Seizure

Nervous Med-Surg

After a tonic-clonic seizure, a patient enters the "postictal phase," and may exhibit confusion, sleepiness, or agitation.

Febrile Seizures

Nervous Pediatrics

The most common seizure disorder in children is febrile seizures.

Performing a Snellen Exam

Nervous Pediatrics

When performing a Snellen exam for visual acuity, an adult should stand 20 feet away from the chart, but a child should stand 10 feet from the chart.

Loss of Central Vision

Nervous Med-Surg

A patient reporting a loss of central vision should be evaluated for macular degeneration.

Acetaminophen, a non-opioid analgesic, can cause hepatotoxicity in high doses. Educate patients to take no more than 4 g per day, and to read the labels of OTC medications as many contain acetaminophen!

Acetaminophen: Patient Teaching

Nervous Pharmacology

Acetaminophen, a non-opioid analgesic, can cause hepatotoxicity in high doses.

A child with meningocele or myelomeningocele is at risk for injury due to the exposed spinal cord. Cover the sac with sterile, saline-moistened, non-adherent dressing. Place infant prone with the hips flexed.

Meningocele and Myelomeningocele in Children

Nervous Pediatrics

A child with meningocele or myelomeningocele is at risk for injury due to the exposed spinal cord. Cover the sac with sterile, saline-moistened, non-adherent dressing. Place infant prone with the hips flexed.

A child with meningitis is likely to have a fever, headache, nausea, vomiting, irritability, nuchal (neck) rigidity, photophobia, and positive Kernig's and Brudzinski's signs.

Meningitis in Children

Nervous Pediatrics

A child with meningitis is likely to have a fever, headache, nausea, vomiting, irritability, nuchal (neck) rigidity, photophobia, and + Kernig's and Brudzinski's signs.

A key finding in Huntington's Disease is chorea, which is a type of abnormal and excessive involuntary movement. Tetrabenazine may be given to treat this symptom.

Chorea and Huntington's Disease

Nervous Med-Surg

A key finding in Huntington's Disease is chorea, which is a type of abnormal and excessive involuntary movement. Tetrabenazine may be given to treat this symptom.

A key side effect of phenytoin (an anti-seizure medication) is gingival hyperplasia. Educate patients to maintain regular dental checkups.

Phenytoin and Gingival Hyperplasia

Nervous Pharmacology

A key side effect of phenytoin (an anti-seizure medication) is gingival hyperplasia. Educate patients to maintain regular dental checkups.

A child with a head injury is at risk for elevated intracranial pressure (ICP).

Intracranial Pressure (ICP); Nursing Care

Nervous Pediatrics

A child with a head injury is at risk for elevated intracranial pressure (ICP). Nursing care to decrease ICP includes reducing hypercapnia by hyperventilating the patient, avoiding oral suctioning, keeping the HOB at 30 degrees, and keeping the head in a neutral/midline position.

A child with ADHD may be treated with CNS stimulants such as amphetamine mixtures or methylphenidate.

ADHD in Children: Treatment and Nursing Care

Nervous Pediatrics

A child with ADHD may be treated with CNS stimulants such as amphetamine mixtures or methylphenidate.

Spina Bifida Occulta

Nervous Pediatrics

A child who presents with an abnormal tuft of hair, a dimple, or a birthmark on the spine should be evaluated for spina bifida occulta, a form of spina bifida. Report these findings to the provider.

A child who appears to be frequently "day dreaming" or often exhibits blank staring, eye fluttering, lip smacking, or picking at clothes should be evaluated for absence seizures.

Absence Seizures: Signs and Symptoms

Nervous Pediatrics

A child who appears to be frequently "day dreaming" or often exhibits blank staring, eye fluttering, lip smacking, or picking at clothes should be evaluated for absence seizures.

Signs and Symptoms of Autism

Nervous Pediatrics

Key signs/symptoms of Autism: Lack of eye contact Repetitive motions/actions Delayed speech and language skills Strict adherence to routines Unusual eating or sleeping habits Digestive problems.

Extrapyramidal Side Effects

Nervous Pharmacology

Extrapyramidal side effects (EPS) are common with Conventional Antipsychotics. Symptoms of EPS include: Dystonia, Parkinson's symptoms, Tardive dyskinesia, Akathisia.

Early Signs of Increased ICP in Infants

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Nervous Pediatrics

Early signs of increased ICP in infants: irritability, high-pitched cry, poor feeding, “setting-sun” phenomenon, bulging fontanels, separation of cranial sutures.

Don't confuse clozapine with clonidine! Clozapine is an antipsychotic (note both cloZapine and schiZophrenia have a Z). Clonidine is an antihypertensive.

Clozapine vs. Clonidine

Nervous Pharmacology

Don't confuse clozapine with clonidine! Clonidine is an antihypertensive. Clozapine is an antipsychotic.

Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Dementia vs. delirium

Nervous Med-Surg Psychiatric Mental Health

Dementia vs delirium: Dementia has slow onset, does NOT alter vital signs, and is irreversible. Delirium has rapid onset, can alter vital signs and level of consciousness, and is reversible.

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Donepezil & Alzheimer's

Nervous Pharmacology Psychiatric Mental Health

Donepezil is a KEY medication used for Alzheimer's disease. It does NOT cure the disease, but it may improve memory, cognition, and an individual’s ability to perform ADLs.

Amitriptyline

Nervous Pharmacology

Amitriptyline is a Tricyclic Antidepressant. "Amy tripped over a tricycle in the desert". Desert helps you remember anticholinergic side effects (urinary retention, constipation, dry mouth, blurry vision, photophobia, tachycardia)

ADHD medications (e.g. methylphenidate and amphetamine mixtures) cause decreased appetite and weight loss in children. Key Nursing Intervention: Monitor child's weight during therapy!

ADHD Medication and Children's Weight

Nervous Pharmacology Psychiatric Mental Health

ADHD medications cause decreased appetite and weight loss in children.

Diagnosis of meningitis is done by analyzing the patient's CSF (cerebrospinal fluid). Bacterial meningitis: CSF is cloudy with ↓ glucose. Viral meningitis: CSF is clear and glucose levels are typically normal.

Meningitis diagnosis

Nervous Med-Surg

Diagnosis of meningitis is done by analyzing the patient's CSF (cerebrospinal fluid).

During a patient's seizure: Lower patient to the bed or floor if standing/sitting. Turn the patient to his/her side. Loosen restrictive clothing. Do NOT put anything in the patient’s mouth. Do NOT restrain patient. Note onset/duration of seizure.

Seizures

Nervous Med-Surg

During a seizure, take these important nursing actions

Halo Traction Devices

Musculoskeletal Nervous Med-Surg

If your patient has a halo traction device in place, make sure wrench/screwdriver are attached to the vest to release patient from the device in the event of an emergency.

Lithium

Nervous Pharmacology Psychiatric Mental Health

Lithium is a mood stabilizer, used for Bipolar Disorder. Patients on lithium need adequate fluid and sodium intake! Diuretics, anticholinergics, NSAIDs are not recommended.

MAOIS for Depression

Nervous Pharmacology

MAOIs are used to treat depression.

Important points about MAOIs: They interact with MANY other medications. Eating foods rich in tyramine can cause a hypertensive crisis. Foods rich in tyramine include aged cheese, avocados, bananas, red wine, salami/pepperoni, chocolate.