RNSG 1341: Common Concepts of Adult Health

Module 12: Nursing Care of the Individual with Neurosensory Disorders

Module Objectives:

Utilizing critical thinking and the nursing process, the student is expected to:

  1. Examine the etiology and pathophysiology and risk factors for the following disorders:
    • Headache: cluster, migraine, tension
    • Seizures: partial (simple, Jacksonian, automatism), generalized (absence, tonic-clonic, and status epilepticus)
    • Dementia vs delirium (causes of each)
    • Alzheimer's disease: familial and sporadic
  2. Assess the patient with neurosensory problems
    • Glascow coma scale
    • Analysis of any symptoms
    • Related History
    • Physical exam: mental status exam, neuro checks, cranial nerve assessment
  3. Examine the signs and symptoms of the disorders:
    • Differentiate between the classifications of seizures
    • types of headaches (table 59-1)
    • stages of Alzheimer's Disease
  4. Examine the complications of the neurosensory disorders.
  5. Examine the following diagnostic test including the purpose, nursing care, normal values, and interpretation of abnormal values.
    • Electroencephalogram or EEG
    • CT scan
    • Magnetic Resonance Imaging or MRI
    • cerebral angiogram
    • Blood tests: serum glucose, BUN, Vit b, B6, B12, thyroid function tests, liver function,
    • IHS criteria, headache diary
  6. Select relevant nursing diagnosis that address physical, psychosocial, and learning needs.
    • Seizures
      • Ineffective breathing pattern r/t neuromuscular impairment secondary to prolonged tonic phase of seizure or during postictal period
      • Risk for injury r/t seizure activity and subsequent impaired physical mobility
      • Ineffective coping r/t perceived loss of control and denial of diagnosis of seizures
      • Ineffective therapeutic regimen management r/t to lack of knowledge about management of seizure disorder
    • Alzheimer's
      • Disturbed thought processes r/t effects of dementia
      • Self-care deficit r/t memory deficity & neuromuschular impairment
      • HRF Injury r/t impaired judgement, gait instability, weakness, sensory perceptual alteration
      • Wandering r/t disease process (see sundowning pg 1573)
    • Headaches
      • Acute pain
      • Ineffective coping
  7. Plan goals to assist the client toward health promotion, maintenance, and or restoration.
  8. Select nursing interventions to meet goals:
    • Medications
      • Seizures
        • Antiseizure: Dilantin (phenytoin), Depakene (valproic acid), Tegretol (carbamazepine) Topamax (topiramate), Phenobarbital Table 59-3
      • Dementia
        • benzodiazepines: Valium, Ativan
        • cholinesterase inhibitors: Aricept (donepezil), Namenda (memantine),
        • antipsychotics: risperidone (Risperdal), olanzapine (Zyprexa)
      • Headaches (distinguish between prophylactic and symptomatic treatment)
        • beta blocker
        • antidepressant
        • triptans: sumatriptan (Imitrex)
        • antiseizure: topiramate (Topamax)
        • calcium channel blocker: verapamil (Isoptin)
        • serotonin antagonist: methysergide (Sansert)
    • Patient teaching:
      • Headaches
        • Teaching related to medications, factors that can trigger a headache, diet, stress reduction, exercise, contact health provider
      • Seizures
        • Complications
        • medications
        • identify ways to promote health with the disorder
        • Family teaching for a patient with seizures
        • Seizure precaustions
      • Alzheimer's
        • Nursing Implementation for Alzheimer's, pg 1570-1575
    • Collaborative interventions: Identify other health care team members involved in the care of the patient with the disorder
      • seizure precautions
      • Managing confusion and anxiety in Alzheimer's disease
      • communication with the Alzheimer's patient.
    • Consider efficient use of human and material resources.
  9. Evaluate goals and explain possible changes in the nursing care plan.
  10. Discuss associated issues and trends and legal/ethical consideration.

Learning Activities:

Review module objectives.

Read:

  • Lewis, S., Heitkemper, M., Dirksen, S., O'Brien, P., and Bucher, l. (2007). Medical Surgical Nursing: Assessment and Management of Clinical Problems, St. Louis: Mosby,Neurological Assessment & glasgow coma scale pp.1476-1477 & headache - pp. 1527-1532; seizures - pp. 1533-1541; alzheimer's disease - pp. 1561-1579.

Complete module exercises:

   

Additional Resources (not required):

  • O'Brien, P.Lewis, S., Heitkemper, M., Dirksen, S.,and Bucher, l. (2007)Study Guide: Medical Surgical Nursing. Chapter 59: questions: 1-6,8-15, Chapter 60: 1-7,9-18, alzheimers case study
  • Alzheimer's Disease Education and Referral Center
  • Another Alzheimer's site I like this site because it gives 7 stages which I find more helpful in tracking progression than the more simple 3 stage approach. In reality there is a lot of variation in symptoms at any stage, depending on what part of the brain is affected first.
  • Powerpoint presentation on diagnosis of Alzheimer's Disease.

Review module objectives and check for knowledge gaps.


Complete the module quiz in Blackboard.