NLE Neurosensory Nursing — Seizure, Infectious, and Degenerative Neurologic DisordersConcept Map

Concept

Seizures and Epilepsy

Sub Concepts

• Generalized Tonic-Clonic Seizures
• Absence Seizures
• Focal Seizures
• Status Epilepticus
• Antiseizure Medications (Phenytoin, Carbamazepine, Valproic Acid, Levetiracetam, Lamotrigine)

Relationship To Central

Acute neurologic emergency requiring immediate nursing intervention for airway protection and injury prevention

Concept

Central Nervous System (CNS) Infections

Sub Concepts

• Bacterial Meningitis (Kernig's Sign, Brudzinski's Sign, Petechial Rash)
• Viral Meningitis
• Encephalitis (Herpes Simplex, Arboviruses)
• CSF Analysis and Lumbar Puncture
• Droplet Precautions
• Dexamethasone and IV Antibiotics

Relationship To Central

Life-threatening infections requiring rapid diagnosis, empiric antibiotic therapy, and infection control measures

Concept

Degenerative Neurologic Disorders

Sub Concepts

• Parkinson's Disease (Dopamine Deficiency)
• Multiple Sclerosis (CNS Demyelination)
• Amyotrophic Lateral Sclerosis (Motor Neuron Degeneration)
• Myasthenia Gravis (Neuromuscular Junction Disorder)
• Guillain-Barré Syndrome (Acute Peripheral Nerve Demyelination)
• Alzheimer's Disease (Irreversible Dementia)

Relationship To Central

Progressive, chronic conditions requiring long-term management, symptom control, and caregiver support

Concept

Nursing Process and Priorities

Sub Concepts

• NANDA Nursing Diagnoses
• Maslow's Hierarchy of Needs (Airway → Safety → Cognition)
• NCM Competency Levels (I–IV)
• RA 9173 Philippine Nursing Practice Standards
• Patient Safety and Fall Prevention
• Medication Adherence and Patient Teaching

Relationship To Central

Framework for assessment, diagnosis, planning, intervention, and evaluation across all neurologic disorders

Concept

Pharmacologic Management

Sub Concepts

• Antiseizure Drugs and Therapeutic Levels
• Benzodiazepines for Acute Seizures
• Levodopa-Carbidopa for Parkinson's
• Disease-Modifying Therapies (MS)
• Anticholinesterases (Myasthenia Gravis)
• IV Immunoglobulin and Plasmapheresis

Relationship To Central

Critical interventions for symptom control, disease modification, and emergency management

Concept

Common Complications and Emergency Differentials

Sub Concepts

• Myasthenic vs. Cholinergic Crisis
• Aspiration and Swallowing Dysfunction
• Respiratory Failure and Vital Capacity Monitoring
• Dementia vs. Delirium
• Waterhouse-Friderichsen Syndrome (Meningococcemia)

Relationship To Central

Critical distinctions that guide immediate and definitive management decisions

To

Status Epilepticus

From

Seizures and Epilepsy

Strength

strong

Relationship

Status epilepticus is a severe, life-threatening extension of recurrent seizures lasting 5+ minutes without consciousness recovery; requires emergency benzodiazepine therapy and airway management

To

Antiseizure Medications

From

Seizures and Epilepsy

Strength

strong

Relationship

Antiseizure drugs are the primary pharmacologic treatment for preventing seizures and maintaining therapeutic levels; phenytoin requires careful IV administration, monitoring of therapeutic levels (10-20 mcg/mL), and management of gingival hyperplasia

To

Bacterial Meningitis

From

CNS Infections

Strength

strong

Relationship

Bacterial meningitis is the most critical CNS infection; presents with fever, nuchal rigidity, and positive Kernig's and Brudzinski's signs; requires immediate empiric IV antibiotics, dexamethasone, and droplet precautions

To

Encephalitis

From

CNS Infections

Strength

moderate

Relationship

Encephalitis is viral brain inflammation often caused by herpes simplex or arboviruses; treated with IV acyclovir; common in tropical regions like the Philippines with Japanese encephalitis risk

To

Levodopa-Carbidopa

From

Parkinson's Disease

Strength

strong

Relationship

Levodopa-carbidopa is the cornerstone treatment for Parkinson's disease; carbidopa protects levodopa from peripheral breakdown, allowing more drug to cross the blood-brain barrier and be converted to dopamine in the CNS

To

Trigger Avoidance

From

Multiple Sclerosis

Strength

strong

Relationship

Patients with MS must avoid heat, stress, and infection, which can precipitate relapses; heat exposure particularly worsens symptoms temporarily due to impaired nerve conduction in demyelinated areas

To

Respiratory Failure

From

Amyotrophic Lateral Sclerosis

Strength

strong

Relationship

ALS is progressive motor neuron degeneration that inevitably leads to respiratory muscle weakness and respiratory failure, the primary cause of death; requires advance planning for mechanical ventilation and end-of-life care

To

Myasthenic vs. Cholinergic Crisis

From

Myasthenia Gravis

Strength

strong

Relationship

MG patients face two opposing critical crises: myasthenic crisis (too little anticholinesterase, inadequate treatment) and cholinergic crisis (too much drug causing toxicity); the Tensilon test differentiates them; airway protection is the priority for both

To

Pyridostigmine

From

Myasthenia Gravis

Strength

strong

Relationship

Pyridostigmine is an anticholinesterase that increases available acetylcholine at the neuromuscular junction; must be given on time (especially before meals for swallowing), and never abruptly stopped; management timing is critical for preventing crisis

To

Respiratory Monitoring

From

Guillain-Barré Syndrome

Strength

strong

Relationship

GBS causes ascending paralysis from legs upward to respiratory muscles; serial vital capacity measurement is the critical monitoring priority; mechanical ventilation must be available and ready for use as weakness advances

To

Dementia vs. Delirium

From

Alzheimer's Disease

Strength

strong

Relationship

Alzheimer's is the most common cause of dementia (irreversible, gradual, progressive); distinguished from delirium (acute, fluctuating, reversible with identifiable cause); nursing care emphasizes safety, routine, and caregiver support

To

Maslow's Hierarchy of Needs

From

Nursing Process and Priorities

Strength

strong

Relationship

Neurologic disorder nursing prioritization follows Maslow's hierarchy: physiologic (airway, breathing, circulation) → safety (seizure precautions, fall prevention) → social (family support, communication) → higher needs (meaning, control); addresses NANDA diagnoses at each level

To

RA 9173 Standards

From

Nursing Process and Priorities

Strength

strong

Relationship

All nursing interventions must comply with RA 9173 (Philippine Nursing Practice Law); nurses operate at NCM competency levels I-IV depending on patient acuity; independent, interdependent, and dependent functions are clearly delineated

To

Seizure Precautions

From

Patient Safety

Strength

strong

Relationship

During seizure risk: padded side rails, emergency suction and oxygen at bedside, emergency medications (benzodiazepines) ready, continuous or frequent monitoring; if seizure occurs: turn to lateral position, protect from injury, do not restrain or force objects in mouth

To

Never Stop Antiseizure Drugs Abruptly

From

Medication Adherence

Strength

strong

Relationship

Critical patient teaching: abrupt withdrawal of antiseizure medications can trigger status epilepticus and death; requires consistent dosing, steady blood levels, regular follow-up, and medic alert identification; applies to phenytoin, carbamazepine, valproic acid, levetiracetam, lamotrigine

To

Swallowing Dysfunction

From

Aspiration Risk

Strength

strong

Relationship

Across neurologic disorders (ALS, Parkinson's, GBS, myasthenia gravis, Alzheimer's), dysphagia and weak swallowing increase aspiration risk; require assessment of gag reflex, positioning semi-Fowler's, and careful monitoring during feeding; some patients need thickened liquids or feeding tubes

To

Progressive Functional Decline

From

Degenerative Disorders

Strength

strong

Relationship

All degenerative neurologic conditions show progressive, irreversible functional decline; nursing care must adapt to changing abilities, maintain safety and dignity, plan for advance care decisions, and provide robust caregiver education and support

To

Normal Saline Only

From

Phenytoin Administration

Strength

strong

Relationship

Critical IV phenytoin safety rule: must be diluted and infused in normal saline only (NS), never in dextrose solutions (D5W, D5NS), as phenytoin precipitates in dextrose; infuse slowly at no faster than 50 mg/min to prevent hypotension and dysrhythmias

To

Bacterial vs. Viral Meningitis Differentiation

From

Lumbar Puncture CSF Analysis

Strength

strong

Relationship

CSF analysis is diagnostic: bacterial meningitis shows cloudy CSF with high protein, LOW glucose, high neutrophils (PMN), and high pressure; viral meningitis shows CLEAR CSF with normal glucose, lymphocytes, and normal pressure; distinguishes need for immediate antibiotics vs. supportive care

To

Meningococcal and H. influenzae Meningitis

From

Droplet Precautions

Strength

strong

Relationship

Droplet precautions are required for meningococcal and Haemophilus meningitis until 24 hours of effective IV antibiotics have been given; prevents respiratory transmission to healthcare workers and other patients; standard precautions remain for viral meningitis

To

Multiple Sclerosis Relapse Prevention

From

Disease-Modifying Therapy

Strength

moderate

Relationship

Interferon beta, glatiramer, and other disease-modifying agents reduce the frequency and severity of MS relapses; must be continued consistently even when asymptomatic; combined with trigger avoidance (heat, stress, infection) and corticosteroids for acute relapses

To

Guillain-Barré Syndrome Emergency Preparedness

From

Vital Capacity Monitoring

Strength

strong

Relationship

Serial vital capacity measurements in GBS detect early respiratory muscle weakness before respiratory failure occurs; declining vital capacity is an indicator for mechanical ventilation; allows time for preparation rather than emergency intubation

To

Myasthenia Gravis Symptom Management

From

Anticholinesterase Medication Timing

Strength

strong

Relationship

Pyridostigmine must be given on precise schedule, especially before meals to optimize swallowing and chewing ability; patients learn to self-time doses; timing errors increase risk of myasthenic crisis from underdosing or cholinergic crisis from overdosing

To

Atropine Availability

From

Cholinergic Crisis Antidote

Strength

strong

Relationship

Atropine is kept at bedside for any patient on anticholinesterases; used to reverse cholinergic crisis symptoms (SLUDGE, miosis, fasciculations, bradycardia); nursing staff must know location and be ready to administer if crisis identified

To

Phenytoin Long-Term Use

From

Gingival Hyperplasia

Strength

strong

Relationship

Phenytoin chronic therapy causes gingival hyperplasia (gum overgrowth); requires meticulous oral hygiene including frequent brushing, flossing, and dental visits; patient education on this side effect is essential; other antiseizure drugs do not have this effect