Care of The Client With Altered Intracranial Functioning: Headaches Seizures Meningitis/Encephalitis

Care of the Client with
Altered Intracranial
Functioning
Headaches
Seizures
Meningitis/Encephalitis
Objectives
• Define the basic pathophysiology

behind headaches, seizures,
meningitis and encephalitis, and
cranial nerve disorders
• Describe expected assessment
findings for these conditions
• Develop a collaborative plan of care
including nursing and medical
orders
Seizure Disorders
A seizure is a sudden discharge of
uncontrolled electrical activity in
the brain
Common causes:
• Idiopathic: genetic, developmental
• Acquired: head trauma, stroke, alcohol/drug
withdrawal, hypoglycemia, hyponatremia…….
Epilepsy: recurrent, unprovoked

seizure activity
Types of Seizures:
Generalized
Tonic-Clonic Stiffening of muscles,
(Grand Mal) followed by rhythmic
jerking of all extremities;
lasts 1-3 min.
Absence Brief periods of staring
(Petit Mal) with loss of awareness
Myoclonic Paroxysmal jerking of a
muscle group
Atonic Sudden loss of all muscle
(Akinetic) tone
Types of Seizures:
Partial
Simple Movement of extremity
or unusual sensation;
No loss of awareness
Complex Repetitive movements

(Temporal lobe (“automatisms”) or
or emotional outbursts;
Psychomotor Loss of awareness
seizure)
Seizure Disorders
Phases of a seizure
• Pre-ictal —aura
• Ictal—seizure
• Post-ictal—recovery after seizure
Diagnostics
• EEG
• CT or MRI
• Labs to r/o metabolic cause
Seizure Disorders:
Nursing Care
High Risk for Injury; High Risk for
Ineffective Breathing Pattern
• Seizure precautions
• Maintain a med lock for
medication access
• Assure suction, oxygen are
available
• Padded bed rails may be used
Seizure Disorders:
Collaborative Care
Acute Seizure Management

• Prevent injury from falls; remove nearby objects.
Do NOT restrain
• Provide oxygen and suction as possible; do not
force anything into mouth
• Administer rapid-acting medication, such as a
benzodiazapine (e.g. Ativan); follow with Dilantin
or other drug with longer action time
Status Epilepticus—seizure activity lasting

more than 30 minutes; a neurological
emergency
Seizure Disorders:
Collaborative Care
Post Seizure Management (con’t)
*Protect the airway

• administer oxygen and stimulate to
breathe as needed
• suction as needed
• position on side
*Monitor until LOC returns
*Reorient as needed
*Document the event
Seizure Disorders:
Collaborative Care
Medications are the mainstay of
Treatment
Client Education:
• Take meds as ordered; do not stop suddenly
• Keep lab appointments
• Good dental hygiene
• Diet precautions
• Medic alert bracelet
• Safety precautions
• Contraceptive precautions
• Depression signs/symptoms
Seizure Disorders:
Collaborative Care
Other anti-epileptic interventions
• Vagal nerve stimulation—disrupts

synchronization of epileptic impulse
• Surgery
• Temporal lobectomy for uncontrolled
complex partial seizures
• Corpus collosum transection for
uncontrolled seizures from unknown focus
Headaches
• A symptom, not a disease

• Caused by inappropriate
vasodilation of cerebral vessels
• Types
• Primary: no organic cause
identified; e.g. migraines
• Secondary: associated cause; e.d.
brain tumor
Primary Headaches:
Migraine
• A unilateral throbbing in the
frontal or temporal areas
• Associated symptoms may
include nausea & vomiting,
and/or photophobia/phonophobia
• Phases
• Prodrome/aura
• Headache
• Recovery
Primary Headaches:
Migraine
Nursing Interventions
• Assist client to identify triggers
• Common triggers include foods,
odors, stress
• Encourage headache log
• Administer medications
• Management of acute pain:
• Triptan drugs (eg Imitrex, Relpax)
• NSAIDs
• Anti-emetics as needed
Primary Headaches:
Migraine
Medications (con’t)
• Preventive Therapy
• Beta blockers (e.g. Inderal)
• TCAs (e.g. Elavil)
• Anti-seizure medicines (e.g. Topamax)
Other interventions
• Rest in a dark, quiet environ
• Relaxation/Biofeedback
• Herbals: Feverfew, Butterbur
Primary Headaches:
Cluster Headaches
• Unilateral intense, boring, pain

around the eye which may
radiate to temple, cheek, or back
of head
• Associated sx of ipsilateral
tearing, ptosis, rhinorrhea, and/or
facial flushing
• Client may pace or rock
Primary Headaches:
Cluster Headaches
Treatment
• Medications as for migraines:
triptans, Topamax
• Oxygen 100% for 15 minutes
• Sunglasses for ptosis/eye pain
• Avoid potential triggers: alcohol,
stress, toxin exposure
Primary Headaches:
Cranial (Temporal)
Arteritis
• Inflammation of cranial arteries
in temporal region
• Characterized by fever, redness,
warmth over affected artery;
possibly visual deficits
• Treated with steroids and pain
medications
Meningitis
• An inflammation of the meninges of
the brain and spinal cord
• Organism crosses the blood-brain
barrier as a result of sinusitis, otitis,
or trauma
• Types of meningitis
• Bacterial—most serious
• Strep or Neisseria most common
organisms
• Viral (aseptic)
• Fungal—most common in immune
suppressed individuals
Meningitis
Client Appearance
• Infectious signs
• Fever, chills, tachycardia
• Petechial rash & purpura in Neisseria
• Meningeal signs
• Photophobia
• Headache
• Nuchal rigidity
• Neurologic signs
• Change in orientation or LOC
• Change in behavior
• Seizure activity
Meningitis
Diagnosis is confirmed
by lumbar puncture
with analysis of CSF
• Obtain client signature of
informed consent
• Assist into fetal position
Post Procedure Care:

• Bedrest 2-8 hours
• Monitor site
• Force fluids
• Medicate for headache
Assessing drainage for
CSF
• Halo sign
• + for glucose
Meningitis:
Nursing Care
Ineffective Cerebral Tissue Perfusion
d/t Infection
• Droplet precautions until infective
organism known
• Administer antibiotics ASAP!
• Monitor neuro status frequently to
detect changes in mental status
• Monitor for seizure activity
• Monitor for complications of disease,
inc. hearing, visual, and cognitive
impairment
Meningitis:
Nursing Care
• Frequent neurological checks
Meningitis: Nursing Care
Pain
• Non-opiod for headache relief
• Decadron to reduce inflammation
• HOB elevated
• Reduce environmental stimuli
Other Nursing Care issues

• Monitor for complications of
decreased tissue perfusion
• Encourage vaccination!
Encephalitis
• An acute inflammation of the brain

resulting in brain edema and areas
of necrosis
• Infective agent usually viral, most
commonly from mosquito
or tick bite
Encephalitis
Client Appearance
• Fever
• Headache
• Change in mental status
• Motor deficits, inc. tremors, ataxia,
hemiparesis, myoclonic jerks or
other seizures
• Meningeal signs
Encephalitis
Diagnostics:
• Blood work to identify infective organism
• MRI or PET scan
• LP
Collaborative Care
• Administer anti-infectives if bacterial or
fungal source suspected
• Monitor neurologic status
• Supportive care to prevent complications
Trigeminal Neuralgia (Tic
Douloureux)
• A disorder of CN 5 which
results in a unilateral
stabbing facial pain
• Pain comes in bursts
• May have twitching of
eye or mouth on affected
side
• May have sensory loss on
affected side
• No accompanying motor
deficits
Trigeminal Neuralgia
Nursing Assessment
• Triggering factors
• Hygiene and nutritional status
Collaborative Care
• Pain management (medical)
• Neuro inhibitors, such as Tegretol, Neurontin
• Biofeedback
• Invasive interventions
• nerve blocks
• surgical relief of pressure on nerve
• radiofrequency ablation of the nerve
• balloon micro-compression of nerve
Facial Paralysis
(Bell’s Palsy)
• Inflammation of CN VII results in
unilateral paralysis of facial muscles on
affected side; may be associated loss of
taste &/or hearing, or increased tearing.
• Pain behind the ear or on the face may
precede the onset
• No diagnostic tests
Facial Paralysis
(Bell’s Palsy)
Nursing Care
• Pain management: anti-
inflammatories, steroids
• Eye care to prevent drying or injury
• Monitor for aspiration of food/
fluids; diet education of client
• Monitor intake to assure adequate
nutrition
• Facial exercises

Care of The Client With Altered Intracranial Functioning: Headaches Seizures Meningitis/Encephalitis

Uploaded by

Copyright:

Available Formats

Care of The Client With Altered Intracranial Functioning: Headaches Seizures Meningitis/Encephalitis

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Care of The Client With Altered Intracranial Functioning: Headaches Seizures Meningitis/Encephalitis

Uploaded by

Copyright:

Available Formats

Care of the Client with

• Define the basic pathophysiology

Epilepsy: recurrent, unprovoked

Complex Repetitive movements

Acute Seizure Management

Status Epilepticus—seizure activity lasting

*Protect the airway

• Vagal nerve stimulation—disrupts

• A symptom, not a disease

• Unilateral intense, boring, pain

Post Procedure Care:

Other Nursing Care issues

• An acute inflammation of the brain

You might also like