Chapter 11 Pathos

What are the main divisions of the nervous system and their functions?

• Central Nervous System (CNS): Brain and spinal cord; responsible for processing and coordinating sensory data and motor commands.

• Peripheral Nervous System (PNS): Cranial and spinal nerves; transmits messages between the CNS and the rest of the body.

What is the importance of neural tissue perfusion?

Neurons require a constant supply of oxygen and glucose to function.
Decreased perfusion → hypoxia → neuron death → neurological deficits (e.g., stroke).
The brain cannot store oxygen or glucose; even short interruptions cause dysfunction

What protects the brain and spinal cord?

• Meninges: Dura mater, arachnoid layer, pia mater.

• Cerebrospinal Fluid (CSF): Cushions and nourishes.

• Skull and Vertebral Column: Physical protection.

What is the difference between the sympathetic and parasympathetic systems?

System	Function	Example
Sympathetic (SNS)	“Fight or flight”	↑ HR, dilate pupils, ↓ digestion
Parasympathetic (PNS)	“Rest and digest”	↓ HR, constrict pupils, ↑ digestion

The myelin sheath increases:
A. Number of neurons
B. Speed of impulse transmission
C. Synaptic delay
D. Neurotransmitter secretion

B

The parasympathetic nervous system is responsible for:
A. Pupil dilation
B. Digestion and relaxation
C. Increasing heart rate
D. Vasoconstriction

B

What is dementia?

A progressive loss of cortical function affecting memory, reasoning, language, and behavior. Common causes include Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia

What are common etiologies for dementia?

• Vascular disease (atherosclerosis)

• Infections (e.g., HIV)

• Toxins, metabolic disorders

• Genetics

 What are progressive manifestations of dementia?

• Early: Memory loss, difficulty with problem-solving.

• Middle: Disorientation, confusion, mood swings.

• Late: Incontinence, loss of speech, immobility.

Nursing Considerations for Dementia

• Ensure safety (remove hazards, monitor for wandering).

• Use memory aids and maintain routines.

• Provide calm environment and emotional support.

• Prevent injury, dehydration, and malnutrition

Alzheimer’s disease is associated with:
A. Amyloid plaques and neurofibrillary tangles
B. Excess dopamine
C. Autoimmune myelin damage
D. Viral infection

A

Which of the following is a safety intervention for dementia?
A. Use of door alarms and supervision
B. Restraining the patient
C. Frequent environmental changes
D. Withholding fluids

A

A patient with moderate Alzheimer’s wanders at night, looking for “the bus.”
Question: What is the best nursing response?

Gently redirect with reassurance and engage in a familiar activity. Avoid confrontation or arguing about reality.

Define stroke and differentiate its types.

A Cerebrovascular Accident (CVA) is an interruption of cerebral blood flow causing brain tissue damage.

• Ischemic: Blocked artery (thrombus/embolus).

• Hemorrhagic: Vessel rupture → bleeding into brain tissue.

Risk Factors for stroke (CVA)

• Non-modifiable: Age, gender, family history, race.

• Modifiable: Hypertension, smoking, diabetes, obesity, hyperlipidemia, atrial fibrillation, alcohol us

Clinical Manifestations of stroke (CVA)

• Unilateral weakness/paralysis

• Facial droop

• Speech difficulty (aphasia)

• Visual changes

• Confusion or altered LOC

Prevention of stroke (CVA)

Level	Strategy

Primary

Control BP, diabetes, smoking cessation

Secondary

Antiplatelet therapy, carotid endarterectomy

Tertiary

Rehabilitation, prevent complications (falls, aspiration)

A patient with atrial fibrillation is most at risk for which stroke type?
A. Embolic (ischemic)
B. Hemorrhagic
C. Subdural
D. Aneurysmal

A

Classic stroke symptom pattern includes:
A. Facial droop, arm weakness, speech difficulty
B. Tremors, rigidity, bradykinesia
C. Dizziness, tinnitus, nausea
D. Hyperreflexia, tremor, ataxia

A

A patient presents with sudden slurred speech, facial droop, and right arm weakness at 9:00 AM.
Question: What is the immediate nursing action?

• Call a stroke alert; perform quick neuro assessment.

• Check time of onset—thrombolytics can be given within 3 hours if ischemic stroke is confirmed by CT.

Define seizure and explain its cause.

A sudden, abnormal electrical discharge in the brain that can cause physical convulsions, altered behavior, or loss of awareness.
Caused by trauma, hypoglycemia, infection, electrolyte imbalance, or idiopathic epilepsy

Types of seizures

Type	Description
Focal (Partial)	Involves one brain area; may or may not affect awareness.
Generalized	Involves both hemispheres; usually causes loss of consciousness (e.g., tonic-clonic).

Phases of seizure

• Aura: Sensory warning (smell, visual, feeling).

• Ictal: Active seizure phase.

• Postictal: Recovery (confusion, fatigue).

 Nursing Interventions During a Seizure

• Protect airway and head; turn on side.

• Do not restrain or put objects in mouth.

• Monitor duration and characteristics.

• Afterward: Allow rest, document findings, provide oxygen if needed.

Which phase of a seizure involves the actual motor activity?
A. Ictal phase
B. Aura phase
C. Postictal phase
D. Interictal phase

A

Which nursing action is contraindicated during a seizure?
A. Protecting the head
B. Placing an object in the mouth
C. Turning patient on side
D. Observing duration

B

During a tonic-clonic seizure, the patient becomes cyanotic and rigid.
Question: What is the priority nursing action?

• Turn the patient to the side to maintain airway patency.

• Loosen clothing around neck, remove nearby hazards.

• After the seizure, monitor breathing and consciousness

What causes increased ICP?

• Trauma, hemorrhage, tumor, hydrocephalus, cerebral edema.

Cushing’s Triad: ↑ BP, ↓ HR, irregular respirations.

What are types of hematomas?

Type	Location	Onset	Cause

Epidural

Between skull & dura

Rapid

Arterial bleed

Subdural

Below dura

Slow (venous)

Trauma, elderly

Subarachnoid

Between arachnoid & pia

Sudden

Aneurysm rupture

Intracerebral

Inside brain tissue

Variable

Hypertension, trauma

A patient with increased ICP shows which signs?
A. Bradycardia, hypertension, irregular respirations
B. Tachycardia, hypotension, fast breathing
C. Flushed skin, normal pupils
D. Low BP, tachypnea

A

An epidural hematoma is typically caused by:
A. Arterial bleed
B. Venous leak
C. Capillary rupture
D. Lymphatic blockage

A

A patient with a head injury is alert, then suddenly becomes unconscious again.
Question: What condition should you suspect?

Answer: Epidural hematoma – brief lucid interval followed by deterioration.
Action: Emergency CT and neurosurgical evaluation.

DIFFERENTIATE DEMENTIA ISCHEMIC STROKE, HEMORRHAGIC STROKE, SEIZUREA, ICP (hematoma)

Disorder	Pathophysiology	Hallmark Manifestations	Nursing Priorities
Dementia	Neuronal degeneration	Memory loss, confusion	Safety, calm environment
Ischemic Stroke	Vessel occlusion	Unilateral weakness	Rapid assessment, thrombolytics
Hemorrhagic Stroke	Vessel rupture	Severe headache	Prevent ↑ ICP, surgery
Seizures	Abnormal electrical discharges	Convulsions, loss of awareness	Protect airway, observe
ICP/Hematoma	Pressure ↑ in skull	Cushing’s triad	Monitor LOC, elevate HOB