• Facial palsy is also called – Bell’s palsy.
• Idiopathic facial paralysis. facial paralysis
• Facial palsy is a 7th cranial nerve disorder (facial nerve).
• The function of the 7th cranial nerve – control the muscles of facial expression.
• Receive taste sensations
• Increase saliva production.
• The facial nerve is a mixed nerve that contains sensory, motor and autonomic fibres.
• Bell’s palsy is a lower motor neuron disorder.
• 90% facial palsy is capable of self-recovery.

Definition of bell’s palsy

• Facial palsy is a sudden weakness in the muscles on one half of the face.
• bells palsy nhs for more details

bell’s palsy causes

• Idiopathic
• Herpes simplex
• Mumps virus
• Respiratory illness
• Chicken pox and shingles
• Meningitis and encephalitis
• Brain stroke
• German measles
• Cytomegalovirus infection
• Influenza B
• Diabetes
• Upper respiratory tract infection.

bell’s palsy symptoms

• Sudden weakness and paralysis of one side facial muscles.
• Patient unable to close eyelids.
• Dropping of eyes.
• Decreased tear secretion.
• Irritation in the eye.
• Drooling from one side of the mouth.
• Photophobia.
• Decrease blink reflex.
• Disturb body image.
• Painful eye sensation.
• Painful facial expressions.
• Headache
• Altered taste sensation.
• Difficulty raising eyebrows.
• Xerophthalmia.

bell’s palsy examination

• History collection and physical examination.
• CT scan and MRI.
• Electromyography (EMG).
• X-rays and image scan.
• Patient signs and symptoms.

facial palsy treatment

• Corticosteroid drugs – prednisolone
• For inflammation and to reduce swelling of the facial nerve.
• Analgesic – to control pain.
• Antiviral drugs.
• Artificial tears – to cover affected eyes and treat xerophthalmia.
• Moist heat application.
• Ciplox ointment → eye ointment → prevent infection.
• NSAID.
• Proton pump inhibitors.
• Nerve fortifier – vitamin B6, pregabalin, Nevaska.
• Physical therapy and facial exercise.

Surgical management bells palsy nhs

• Plastic surgery of face.

Complication

• Ageusia – chronic loss of taste
• Gusto Lacrimal reflex – Also known crocodile tear syndrome.
• Corneal ulceration.
• Hemi facial spasm.
• Social embarrassment.
• Jaw winking.
• Keratitis.

Nursing management

• Nurse physical finding and analysis the cause.
• Administer analgesic to relieve pain.
• Apply hot packs to improve circulation and reduce pain.
• Educate the patient to chew food on the unaffected side of the mouth.
• Encouragement for facial exercise.
• Nurses maintain patient face muscles tone by making a puff on the affected side.
• Encourage patients to raise their eyebrows.
• Maintain oral hygiene and remove secretions.
• Provide artificial tears or patch to maintain eye moisture.
• Also ointment and eye shield use at night to maintain eye moisture.
• Provide instruction to the patient to inform about ocular pain, drainage or discharge.
• Provide facial massage.
• Provide emotional and physiological support due to disturbing body image.

interesting facts about bell’s palsy

• Stroke also called – cerebral vascular accident ( CVA )

• Brain attack
• Cerebral hemorrhage.

• Stock is a medical emergency.
• Stroke occurs when a part of the brain loses function due to an interruption of blood flow to the brain.

Definition of stroke

• Brain stroke is a sudden onset and persistent loss of neurological and brain functions, resulting from disruption of blood supply to the brain.

Types of stroke

1. transient ischemic attack

• Ischemic stroke is the most common type of stroke.
• Ischemic stroke occurs due to arteries in the brain being obstructed or blocked and causing ischemia and necrosis.

Ischemic stroke is divided into –

1. Thrombotic stroke
2. Embolic stroke.

1. Thrombotic stroke

• Thrombotic strokes occur due to thrombus formation in the brain arteries.
• Arteries can narrow, because cholesterol builds up the plague formation that prevents blood supply to the brain and decreases the oxygen supply.

2. Embolic stroke

• A stroke occurs due to a clot in the brain’s blood supply.
• Generally, symbolize a blood clot arises from the heart.
• Arrhythmia is a common cause of blood clots.

2.hemorrhagic stroke

• Hemorrhagic stroke due to bleeding hemorrhage.
• Brain blood vessels lead blood into brain tissue and result in brain cell dysfunction.
• Generally bleeding due to high blood pressure and weak artery wall.

Stroke forms –

1. Transient ischemic attack ( TIA )

• Also called a mini-stroke.
• TIA is a short time episode of temporary loss of brain functions.
• Reversible ( resolve spontaneously )
• TIA is a warning sign of compromise blood circulation.
• Many patients referred to a TIA as a mini stroke.

2. Brain attack

• Brain attack is a permanent loss of brain function due to cessation of brain blood supply and causes necrosis.

Cause of stroke

• Thrombosis ( most common cause )
• Cerebral embolism
• Atherosclerosis
• Rapture brain blood vessels
• Ischemia and necrosis
• Vascular compression
• Arterial spasm.

Risk factors of stroke

• Hypertension
• High cholesterol diet
• Diabetes mellitus
• Smoking and tobacco use
• Stress ( emotional )
• Family history
• Obesity
• Oral contraceptive pills ( OCP )
• Bleeding disorder
• Heart disorder
• Increased age
• Aneurysm formation in the brain.

Pathophysiology of stroke

Cause / risk factors

↓

Compromise the brain circulation

↓

Interruption blood flow to the brain

↓

Ischemia and necrosis

↓

Oedema and congestion in the brain is tissue

↓

Focal neurological deficit

↓

Temporary and permanent loss of brain functions.

Sign/Symptoms of a stroke

stroke symptoms

• Hemiplegia – paralysis of one side of the body.
• Agnosia – unable to recognize objects.
• Ataxia – is a gait disturbance.
• Dysphagia – difficulty in swallowing.
• Aphasia – patient unable to speech and communicate.
• Dyspraxia – difficulty to perform skilled movement.
• Dysarthria – difficulty in articulation of words into sentences.
• Hemianopsia – half vision loss.
• Homonymous hemianopsia – is a half vision loss in both eyes on the same side.
• Kinaesthesia – alteration in sensation.
• Neglect syndrome – patients cannot pay attention to particular portions.
• Paraesthesia – abnormal tingling sensation.
• Neurological function deficit.
• Increased ICP.
• Nausea, vomiting.
• Headache.
• Meningeal irritation.
• Nuchal rigidity.
• Epistaxis ( nose bleeding ).
• Memory impairment.
• Bounding pulse.
• Increase pulse pressure.
• Loss of consciousness.
• Cheyne stoke breathing.
• Numbness.
• Fever, vertigo, confusion.
• Seizures.
• Disorientation.
• Retinal haemorrhage.
• Language disorder.
• Altered bowel and bladder pattern.
• Cranial nerves affect.
• Reflexes change.
• Memory impairment.
• Loss of motor and sensory function.

Note

If the left side brain hemisphere is affected – the right side area of the body is paralyzed.

Diagnostic examination of stroke

• History collection and physical examination.
• Positron emission tomography scan (PET – scan).
• CT scan and MRI.
• Cerebral angiography.
• EEG.
• CSF culture test.
• Blood test.
• Urine examination test.

Medical management of stroke

• Pharmacological –

  • Mild analgesics – to control pain.
  • Thrombolytic therapy – plasminogen activator.
  • Anticoagulant – Heparin – to dissolve blood clots.
  • Diuretics – osmotic diuretics – mannitol.
  • Antihypertensive agents – Verapamil.
  • Antiemetic – Emset.
  • Anti-seizure drugs – phenytoin.
  • Antiplatelets – decrease thrombus formation.

Surgical management of stroke

For hemorrhagic stroke – craniotomy.

For thrombotic and embolic stroke –

• Intravascular procedure
• Open procedure.

Nursing management of stroke

• Nurses monitor patient airways and general appearance.
• Remove airway secretion and administer oxygen therapy.
• Provide a head 15 – 30° elevated position to control ICP.
• Monitor patient vital signs and other physical examinations.
• Nurses observe neurological assessment and level of consciousness.
• Assess sign and symptom and brain blood supply.
• If the right side brain affects, the nurse observes the left side of body dysfunctions, and if the left side brain affects, nurses observe right side body dysfunctions.
• The Administrator prescribed medication and IV fluids.
• Maintain seizures precautions.
• Administer NG tube and catheterization.
• Provide a calm, quiet and non stimulating environment.
• Maintain patient hygiene conditions and conduct daily baths.
• A nurse prepares the patient for the surgical procedure.
• Maintain patient skin integrity and posture.
• Nurses start bladder sphincter control training.
• Nurses help patients to mobilize the patient with support.
• Nursing encourages patients to speak, try to understand, perform the activity, and use affected areas in activity and passive exercise.
• Provide health education.

Stroke FAQ.

• Seizure is also called – convulsion and fits.
• Seizure is an episode of neural dysfunction.
• Seizure disorder is the result when the brain’s electrical activity is disrupted.
• Epilepsy is a CNS disorder in which brain activity becomes abnormal and causes seizures disorder.

Definition of Seizure

• Seizure is a central nervous system (CNS) disorder in which sudden, uncontrolled electrical disturbance in the brain.
• Seizures change the electrical activity of the brain.

Types of seizures  

1. Primary seizures
2. Secondary seizures
3. Generalized seizures
4. Partial (focal) seizures.

1. Primary seizures –

• Also known as an epileptic seizure and idiopathic seizure.
• Primary seizures occur without any cause.

2. Secondary seizures – 

• Seizures occur due to any pathological cause –
• For example – Head injury, CVA, Brain tumour, meningitis, fever, spinal cord injury etc.

3. Generalized seizures

• Generalized seizures involve both hemispheres as well as deeper brain structures.
• Hereditary factors are essential.
• Generalized seizures begin with a widespread electrical discharge.

Generalized seizures types –

1. Generalised tonic-clonic seizures
2. Generalised tonic seizure
3. Myoclonic seizure
4. Atonic seizure
5. Absent seizure.

1. Generalised tonic-clonic seizure  

• Also known as Grand Mal seizures.
• Patient’s loss of consciousness is quickly followed by a sudden fall to ground.
• Average duration 2 to 5 minute.

Stages/type of Generalised tonic-clonic seizure-

Generalized tonic-clonic seizure has 4 types/stages

1. Aura
2. Tonic
3. Clonic
4. Relaxation.

1. Aura –

• Pre-monitoring phase and warning phase.
• This phase gives direction that something big is about to happen.
• In these phases, patients feel that something is going to happen and feel discomfort.

2. Tonic –

• Tonic phase includes tonic contraction of muscles and loss of consciousness.
• The body of the patient forms an arched shape.
• Duration 30 second
• Cessation of respiration due to spasm of respiratory muscles.
•  

3. Clonic –

• clonic phase includes Jerky movements and tremors in all over the body.
• Duration 60 – 90 seconds.
• Clonic phase is a dangerous phase including the tongue bite and froth from mouth.

4. Relaxation –

• Stop Jerky movement and seizures.
• The patient goes to deep sleep.

B. Generalised tonic seizure  

• In such a condition, suddenly muscles stiffness of the patient, cause the patient to fall backwards.

C.  Myoclonic seizure

• Repeated jerking movement of patients.

D.  Atonic seizure

• Also known drop attack seizure.
• In this type of seizure, suddenly the muscle tone of the patient relaxes, causing the patient to fall forward.
•  

 E.  Absent seizure 

• Absence seizure also called – petit Mal seizure. 
• Absent seizures occur within the brain but are externally absent.
• Absent seizures mainly occur in children.
• Absent seizures last from 5 to 10 seconds.

5. Partial seizures 

• Also called focal seizures.
• Partial seizures are limited in a particular hemisphere/ lobe of the brain.

Partial seizures are divided into 2 types –

1. Simple partial seizure
2. Complex partial seizure.

1. Simple partial seizure

• Simple partial seizure associated with awareness.
• Include alteration in motor function, sensory function.
• Recurrent muscles contractions.

2. Complex partial seizures

• Also called psychomotor seizures.
• Seizures discharge in the temporal lobe of the brain.
• Seizures are associated without awareness.
• Loss of consciousness contact with environments.

Cause of seizure

• Idiopathic
• Genetics
• Fever
• Hypoxaemia
• Injury
• Head trauma
• Developmental disorder
• Meningitis and encephalitis
• Brain tumour
• Metabolic changes
• Degenerative brain disorder
• CVA
• Toxicity in pregnancy
• Hyperglycaemia
• Hypocalcaemia
• Allergic disorder
• Age
• Brain stroke
• Dementia.

Sign/Symptom of seizure

Clinical manifestation

• Altered level of consciousness
• Loss of muscles tone and movement
• Loss of sensory and motor function
• Rigid and arching body in tonic phase
• Tongue bite
• Fixed Jaw
• Disturbance in autonomic functions
• Fracture
• Head injury
• Urine and fecal incontinence
• Jerky muscles movement
• Excessive salivation
• Involuntary movement of arms and legs.

Read Also:- Burn: Types, Treatment, and Nursing Management

Diagnostic examination  of seizure

• History collection and physical examination.
• EEG ( electroencephalography )
• CT scan and MRI
• Skull X-Ray
• Lumbar puncture
• Neurological test
• ABG analysis
• Blood culture test.

Medical management of Seizures-

• Manage patient seizure and cause.
• Anticonvulsant antiepileptic drugs –
• Phenytoin sodium
• Diazepam
• Midazolam
• Valproate
• IV administration
• Calcium channel blockers
• Oxygen therapy administer
• Seizure precautions.

Surgical management of Seizure 

• Vagal nerve stimulation therapy.
• Destroying minute area of the brain.

Nursing management

1. Nursing care before seizure –

• Nurses monitor vital signs and maintain patient airways.
• Administer prescribed drugs.
• To prevent injury.
• Provide seizure precautions –
• Side rails up
• Pillow under heads
• Side-lying positions
• Suction available
• Provide privacy
• Loose tight clothes
• Don’t put anything in mouth
• Remove hazards.

2. Nursing care during Seizures

• Provide a comfortable position.
• Clearance Airway.
• Loose clothes.
• Be prepared for suction.
• Monitor seizure type and duration.
•  

3. Nursing care after seizures

• Assist the patient in behaviour after a seizure.
• Do not live alone.
• Keep the patient on one side to prevent aspiration.
• Monitor patient vital signs and any injury.
• Perform neurological check-ups.
• Encourage the patient to wear a medical alert bracelet.
• Educate about follow-up care

FAQ.

• Parkinson’s disease is a neurodegenerative disorder.
• Parkinson’s disease was first described by James Parkinson in 1817 as “shaking palsy“.
• Parkinson’s diseases mainly affect the central nervous system (CNS).

Definition of Parkinson’s disease

Parkinson’s disease is a chronic, progressive neurodegenerative disorder that affects the basal ganglia of the brain and leads to a deficiency of dopamine neurotransmitters. Decrease dopamine neurotransmitter level in the body cause the tried symptoms –

• Tremor
• Bradykinesia
• Rigidity.

Causes of Parkinson’s disease

• Idiopathic
• Genetic disorder
• Age factors
• Exposure to toxin
• Sex (men more exposure)
• Deficiency of dopamine
• Arterial hypertension
• Affect substantia nigra
• Carbon monoxide
• Head injury
• Exposure to Toxins
• Encephalitis
• Atherosclerosis
• Environmental triggers.

• 

Pathophysiology (Process of Parkinson’s disease)

Cause

↓

Affect the substantia nigra of basal ganglia

↓

Decrease dopamine production

↓

Degeneration of neurons in basal ganglia

↓

Affect daily routine activity and cause the tremor, rigidity or bradykinesia

↓

Parkinson disease.

Symptoms/Signs of Parkinson’s Disease

• Classical symptoms of Parkinson – tremor

  

• Rigidity
• Bradykinesia.

• Masks like facial expressions.
• Immobile daily activity
• Wrist sluggish moment
• Shuffling gait
• Speech difficulty
• Dysphagia
• Balance problem
• Propulsive gait
• Impaired gross motor coordination
• Loss of sense of smell
• Swallowing and chewing difficulty
• Frothy saliva from the mouth
• Stop automatic swinging of hand during the walk
• Stooped posture
• Dystonia
• Sexual dysfunction
• Micrographic
  

  

• Constipation.

Diagnosis of Parkinson’s Disease

• History collection and physical examination.
• CT scan and MRI
• Imaging test
• PET scan
• Mental status examination.

Treatment of Parkinson’s disease

• Levodopa and carbidopa
• Dopamine agonist – bromocriptine
• Anticholinergics – benztropine.
• Monoamine oxidase type – B (MAO – B)
• Antihistamine
• Tricyclic medication
• COMT inhibitor (catechol – o – methyltransferase inhibitors)
• Antiviral substance.

Complications in Parkinson’s disease

• Disability
• Aspiration
• Sexual dysfunction
• Dementia
• Injury from fall
• Cognitive problem.

Who to Manage Parkinson’s disease Patients

• Nurses monitor patients’ daily activity and vital signs.
• Assess physical examination and mental ability.
• Assess patient chewing and swallowing ability.
• Provide soft and fibre diet for easily eating.
• Nursing encourages patients for daily active and passive movement.
• Provide physical and occupational therapy.
• Provide a medical alert bracelet.
• Provide all prescribed medication and maintain IV therapy.
• The nurse monitors the respiration pattern.
• Nurses educate to avoid – high heel shoes
• Hard mattress use
• Vitamin B6.
• The nurse will encourage the patient to do minor tasks.
• The nurse will assist the patient while descending the stairs.
• The nurse will explain to all family members about Parkinson’s.

Important Points about Parkinson’s disease

1. What was the first name of Parkinson’s disease – Shaking palsy?
2. Parkinson’s disease is a – Neurodegenerative disorder.
3. Tried symptoms of Parkinson’s disease – Tremors, rigidity, and bradykinesia.
4. The most common cause of Parkinson’s disease – Dopamine deficiency.
5. Which neurotransmitter affects Parkinson’s disease – Dopamine
6. Parkinson’s disease was discovered by – James Parkinson.
7. Parkinson’s disease is a – Progressive brain disorder.
8. The average age of onset of Parkinson’s disease is about – 60.
9. How many stages of Parkinson’s disease – 4.
10. Parkinson’s disease is most commonly found in – Males.

Parkinson’s disease Slideshare

Head injury is also known as traumatic brain injury and craniocerebral trauma. Brain injury occurs due to outside force. A common incidence of head injury is a motor vehicle accident. Head injury is a special issue in developing countries and causes mortality and morbidity. In this artical fully explane with Head Injury Pictures and Head Injury Digrams.

head injury pictures explication

Head injury is defined as the injuries to the head due to trauma to the scalp, skull and brain. Head injury caused acute, chronic, and life-threatening neurological issues. in this artical Head Injury Pictures are brodely explanne with Head Injury Pictures and every student easly lern about Head Injury Pictures Concussion this artical are nursing Students.

Types of head injury  

1. Open head injury Pictures
2. Closed head injury Pictures

Open head injury

• Open head injury breaks the scalp and skull and is observed by nude eyes.
• Open head injuries are – scalp injury
• Skull bone injury
• Injury in meningitis as layers.

Closed head injury

• Closed head injury does not break the skull and cannot be seen with the naked eyes.
• Closed the head injury – concussion
• Cerebral contusion
• Epidural hematoma
• Subdural hematoma
• Intracerebral hamartoma.

1. Concussion –

the vibration of brain and cranial cavity. Direct below to the head and violent shaking of the head. Transient interruption in brain activity and no structural injury.

2. Cerebral contusion – Brushing and laceration of the brain tissue within cranial cavity associated with swelling.

3. Epidural hematoma –

a collection of blood between the dura mater and skull bone due to injury. Collection blood due to meningeal artery trauma. It is a most common type of intracranial hemorrhage. It is a surgical and neurological emergency.

4. Subdural hematoma –

a collection of blood between the dura mater and arachnoid space. Venous blood accumulated due to injury. Hematoma may be slower to develop. Subdural hematoma related to acceleration deceleration injury.

5. Intracerebral hematoma – Bleeding into the brain tissue commonly associated with edema.

6. Subarachnoid hemorrhage – Collection of blood between arachnoid space and pia mater due to injury.

• Subarachnoid haemorrhage associated with CSF accumulation.

Head Injury Causes

• Accident (motor vehicle accidents)
• Falls and assault
• Domestic and industrial hazards
• Sports accidents
• Occupational accidents
• Gunshot.

Clinical Manifestation  

• Altered LOC (level of consciousness)
• Dilated pupils
• Loss of normal eye movement
• Increased intracranial pressure (ICP)
• Headache, vertigo
• Nausea and vomiting
• Airway affect
• Dizziness, weakness and restlessness
• Change in the body temperature
• Cardiac arrhythmias
• Comma and seizures
• Trouble walking and speaking
• Scalp injury and breathing
• Sensory and motor function loss.
• Ear, nose and mouth secretion
• Swelling and bruising of the brain.

Diagnosis of Head Injury

• History collection and physical examination.
• CT scan and MRI.
• X-ray ( radiography)
• Glasgow Coma scale (GCS) – assess level of consciousness.
• Neurological assessment.
• EEG and brain scan.
• Ultrasonography imaging.

Head Injury Treatment

• Maintain patient ABC (Airway, breathing, circulation)
• TT injection
• Pharmacological management –
  • Osmotic diuretics – mannitol to reduce increased ICP.
  • Steroids – for inflammation and decrease edema.
  • Antihypertensive – for decrease BP.
  • Anti-seizure medication.
  • Mild analgesics
  • Antibiotic therapy for infection.
  • Antipyretics drugs.
  • Morphine sulphate.
• Patient on NPO.
• Administer IV line.
• Nasogastric tube administer.
• Catheterization method.

Surgery of Head Injury

Craniotomy – removal of hematoma by incision into the cranium.

Complication Head Injury

• Increased intracranial pressure (ICP)
• Coma and Seizures
• Hydrocephalus and brain herniation
• Permanent neurological deficits
• Paralysis and chronic headache
• Altered neurological behavior
• Death.

Nursing Management Head Injury

• Nurses monitor patient head injury type and control haemorrhage by cover and applied pressure dressing.
• To clean wounds by an antiseptic solution.
• Check the patient Airway, breathing, circulation (ABC) and vital signs.
• Provide a comfortable position (head elevated 30° angle and maintain neutral neck).
• Airway clearance by removing secretions.
• Maintain patient NPO and provide fluid by IV line or food provided by NG tube.
• Nurse monitor increased ICP and cerebral edema.
• After head injury, the nurse will monitor glucose tests from body secretion to identify CSF leakage.
• Nurses maintain the Seizures precautions.
• The nurse will prepare the patient for surgery.
• The nurse will check the level of consciousness of the patient with the help of Glasgow Coma scale.
• Nurses monitor the neurological status of patients.
• Provide health education.

Key Points head injury pictures

1. What is another name for head injury – Craniocerebral trauma?
2. The most common reason for head injury – Motor vehicle accidents.
3. What is the head injury that can be observed with naked eyes – Open head injury.
4. A head injury consists of provision and laceration of the brain tissue – Cerebral contusion.
5. Collection of blood between the skull bone and dura mater – Epidural hematoma.
6. Collection of blood between dura mater and arachnoid space – Subdural hematoma.
7. Collection of blood between space and pia mater – Subarachnoid hemorrhage.
8. Common finding associated with head injury – Increased ICP.
9. Common finding associated with increased ICP – Altered LOC.
10. Level of consciousness assessed by – the Glasgow Coma scale.
11. Most common surgery for head injury – Craniotomy.
12. The common position provided when ICP is increased – Head and elevated 30° angle.
13. If Glasgow Coma scale finding less than 7 – Severe head injury.
14. Drug of choice for increased ICP – Mannitol.
15. Epidural hematoma include the – Arterial blood.