Neurological & Neurovascular Systems – Vocabulary Flashcards

Key Motor‐Deficit Terms

• Hemiplegia

  • Paralysis of one half (right or left) of the body.

  • Commonly occurs after cerebro-vascular accidents (stroke) or traumatic brain injury (TBI).

• Paraplegia

  • Paralysis of the lower half of the body (both legs ± lower trunk).

  • Typical aetiologies: spinal cord injury (SCI) below T\,1, congenital defects (spina bifida), tumours, vascular lesions.

• Quadriplegia / Tetraplegia

  • Paralysis from the neck downward: trunk + both upper & lower limbs.

  • Occurs with cervical cord damage above C\,6, high cervical tumours, or advanced neuro-degenerative disease.

Auto-Immune & Degenerative Disorders

• Myasthenia Gravis (MG)

  • Chronic auto-immune disease; antibodies destroy post-synaptic acetyl-choline receptors → failed neuromuscular transmission.

  • Hallmarks: fluctuating skeletal-muscle weakness (ocular, bulbar, limb).

  • Tensilon (edrophonium) test & anti-AChR antibodies diagnostic.

• Guillain-Barré Syndrome (GBS)

  • Acute post-infectious poly-neuropathy; immune attack on peripheral-nerve myelin.

  • Ascending symmetrical weakness → areflexia; watch for respiratory failure.

• Parkinson’s Disease (PD)

  • Age-related, progressive loss of dopamine-producing cells in substantia nigra.

  • “Cardinal” triad: bradykinesia, resting tremor, postural instability.

• Alzheimer’s Disease (AD)

  • Irreversible cortical atrophy with β-amyloid plaques + tau tangles.

  • Slow decline in memory → executive dysfunction → loss of ADL skills.

  • Late-onset: >65 y; Early-onset: 30–60 y (rare).

• Bell’s Palsy

  • Acute unilateral facial-nerve (VII) paralysis of unknown cause (likely viral inflammation).

  • S/S: ptosis, mouth droop, salivation, corneal drying.

  • Usually self-resolving; early corticosteroids ↓ severity; eye protection imperative.

Neuro-Vascular Disease: Risk Profile

• Non-modifiable:

  • Ageing; genetic predisposition.

• Modifiable:

  • Hypertension, atherosclerosis, diabetes, gout, obesity, smoking, stress, poor diet, adverse environment.

Neurological Status Assessment — Glasgow Coma Scale (GCS)

• Evaluates best Eye (E), Verbal (V), Motor (M) responses to stimuli.

• Score range: 3\;\text{(deep coma)} \rightarrow 15\;\text{(fully alert)}.

• Eye (E) \max 4: spontaneous 4 | to speech 3 | to pain 2 | none 1.

• Verbal (V) \max 5: oriented 5 | confused 4 | inappropriate words 3 | incomprehensible sounds 2 | none 1.

• Motor (M) \max 6: obeys commands 6 | localises pain 5 | withdraws 4 | abnormal flexion (decorticate) 3 | extension (decerebrate) 2 | none 1.

• Serial charting identifies deterioration/improvement trends.

Principles of Nursing the Unconscious Patient

• Airway/Breathing

  • Lateral position, head–neck alignment, oral airway, bedside suction, O₂ or mechanical ventilation PRN.

• Circulation/Nutrition/Fluids

  • Enteral or IV feeding; strict I&O; monitor electrolytes, CVP/PA pressures; prevent dehydration or overload.

• Bowel & Bladder

  • Record stool/urine; prevent constipation (hydration, mild laxative, suppository); catheter care/Paul’s tubing; weigh diapers.

• Comfort & Pain

  • Reposition q2h; support limbs; observe subtle pain cues; give analgesics.

• Temperature Regulation

  • Axillary/rectal probes; address hyper/hypothermia; avoid oral thermometers.

• Immobility Complications

  • Pressure-area care, passive ROM, anti-embolism stockings, prophylactic anticoagulants.

• Infection Control

  • Aseptic technique; monitor VS/q4h; early antibiotics if indicated.

• Self-care & Hygiene

  • Daily bed-bath, oral/eye care (lubricants), hair/nails, dryness to prevent sores.

• Psychosocial

  • Assume hearing intact; speak respectfully, orient to time/time, encourage family interaction, provide sensory input (radio/TV).

Study-Framework Summaries

Meningitis (Viral & Bacterial)

• Definition: Infection/inflammation of meninges.

• Causes: Mainly CSF invasion by bacteria (e.g., Neisseria meningitidis, H. influenzae) or viruses; also non-infective.

• Pathophysiology: Inflamed meninges → exudate ↑ ICP; ↑ CSF production; cerebral irritation → convulsions; scarring → epilepsy/hydrocephalus.

• Clinical Manifestations: Flu-like prodrome, high fever, headache, photophobia, neck stiffness, positive Brudzinski/Kernig, altered LOC, convulsions, focal signs.

• Diagnostics: Lumbar puncture → cloudy CSF, ↑ WBC, ↑ protein, ↑ pressure.

• Complications: Septic shock, petechiae, Waterhouse–Friderichsen (adrenal failure), septic arthritis (H. influenzae).

• Medical Tx: IV antibiotics/acyclovir; anticonvulsants; prophylaxis for contacts (meningococcal).

• Nursing: Neuro obs, temp control (tepid sponge, paracetamol), quiet room, analgesia (DF-118 if severe), isolation as per policy.

• Health Ed: Vaccination, early treatment, contact prophylaxis.

Encephalitis

• Definition: Inflammation of brain parenchyma.

• Causes: Mostly viral; epidemic (mosquito/tick); post-viral.

• Manifestations: Gradual onset headache, fever, lethargy, ↓ LOC, seizures.

• Management: Supportive (ABC, nutrition), prevent immobility issues, monitor neuro changes; antivirals (acyclovir/vidarabine) esp. HSV before coma.

Epilepsy

• Definition: Chronic disorder with recurrent, spontaneous, idiopathic seizures.

• Causes: 75\% idiopathic; known triggers: trauma, congenital CNS defects, metabolic errors, infections, tumours, vascular lesions, electrolyte/acid-base imbalances.

• Pathophysiology: Hyper-synchronous neuronal discharge from seizure focus; may generalise.

• Types:

  • Petit mal (absence): brief blank stare/twitch; no fall.

  • Grand mal (tonic–clonic): aura → tonic stiffening → clonic jerks → post-ictal sleep; possible incontinence, injury.

  • Partial: simple (Jacksonian) – focal motor without LOC; complex – focal + impaired consciousness.

• Diagnostics: EEG patterns.

• Treatment:

  • Pharmacological: Anticonvulsants suppress discharge or spread (e.g., phenytoin, carbamazepine, valproate).

  • Refractory cases: cortical resection, stereotactic ablation, vagal stimulation, biofeedback.

  • Status epilepticus: emergency—secure ABC, IV benzodiazepine/phenytoin; if refractory → phenobarbitone infusion → GA with ventilation & continuous EEG.

• Nursing During Seizure: Side-lying, protect airway, do not force mouth open, note duration & features, document.

• Health Education: Lifelong meds compliance, Medic-Alert, avoid triggers (ETOH, stress, sleeplessness), safe recreation (no solo swimming/climbing), driving allowed after \ge 2 y seizure-free.

Pain Assessment & Management

• Assessment Mnemonic — PQRSTU

  • P – Precipitating/Palliating.

  • Q – Quality (burning, stabbing…).

  • R – Radiation.

  • S – Severity (scale 0\text{–}10).

  • T – Timing (onset, duration).

  • U – Understanding (patient’s perspective).

• Observation of Non-Verbal Cues: posture, facial grimace, agitation, sounds; critical for children, elderly, unconscious, cognitively-impaired.

• Age-/Cognition-Specific Tools:

  • Faces scale; Oucher 0\text{–}10 photos; Colour tool; FLACC (Face, Legs, Activity, Cry, Consolability).

• Principles of Management:

  • Comprehensive assessment; believe patient; separate & rate each pain; integrate pharmacologic & non-pharmacologic measures; adjust for acute vs chronic goals (elimination vs minimisation/rehabilitation).

• Non-Pharma Options: psychosocial support, physiotherapy, heat/cold, acupuncture, TENS, trigger-point injections, relaxation/distraction, reflexology, aromatherapy, palliative radiotherapy, nerve blocks, surgery & mobility aids.

• Education: Provide realistic information, dispel myths, involve family, supply written material, plan for breakthrough pain (e.g., when starting morphine).