Transcript File
Jane Bordner, Rn, BSN
NURSING INSTRUCTOR
HACC, Central Pennsylvania’s Community College
N100
SPRING 2015
To detect changes and feel sensations
To initiate appropriate responses to
change
To organize information for immediate
use and store it for future use
Works with endocrine system to maintain
homeostasis
Two principle divisions:
Central nervous system
Brain
Spinal Cord
Peripheral nervous system
Cranial Nerves
Spinal Nerves
http://www.youtube.com/watch_popup?v=i-
NgGKSNiNw&pop_ads=null
http://www.youtube.com/embed/iNgGKSNiNw
Cell body
Axon
Dendrite
Synapse
Neurotransmitter
INFO OUT
Glial cells
Neurons
INFO IN
INFO OUT
http://www.youtube.com/w
atch_popup?v=iNgGKSNiNw&pop_ads=null
Synapse
junction between 2 neurons
Communication
electrical
chemical activity
Neurotransmitters
chemicals that conduct messages
(impulses) across junction
http://www.mind.ilstu.edu/curriculum/neurons_intro
/neurons_intro.php
http://media.pearsoncmg.com/bc/bc_campbell_biolo
gy_7/media/interactivemedia/activities/load.html?48
&C
http://www.mind.ilstu.edu/curriculum/neurons_intro
/neurons_intro.php
http://media.pearsoncmg.com/bc/bc_campbell_biolo
gy_7/media/interactivemedia/activities/load.html?48
&C
Sensory- Afferent
Carry impulses from receptors to the CNS
Motor – Efferent
Carry impulses from CNS to effectors
Confusing because they both sound the
Sensory=Afferent
Motor=Efferent
SAME
Brain
Spinal cord
Myelin
Gray Matter
White Matter
12 cranial nerves
31 spinal nerves
Sensory organs
3 Major Portions
Cerebrum
Cerebellum
Brain Stem
http://www.youtube.com/watch?v=snO68aJTOpM
2 hemispheres
Corpus callosum:
White matter
200 million nerve
fibers
Bridge sending
messages between
2 halves
Cerebral cortex:
Surface layer of gray matter
Covers each hemisphere
Folded with fissures and sulci
Most of conscious activity
Frontal
Motor area controlling opposite side of body
Left frontal = Broca’s motor speech area
Parietal
Sensory area
Left side = thought that precedes speech
Occipital
Visual area
Temporal
Hearing, smell, and taste
Left side = thought that precedes speech
Basal ganglia
Gray matter
Deep in cerebral
hemispheres
Regulates muscle tone
Inhibits tremors
Subconscious
voluntary movements
Muscle movement
Balance
Equilibrium
Cerebellum
Midbrain
Connects pons and cerebellum
Pons
Connects cerebellum with brain stem, spinal cord and
cerebrum
Medulla
Transmits motor impulses from brain to spinal cord
Transmits sensory impulses from peripheral sensory
neurons to brain
Cross over of motor and sensory pathways
Respiration and cardiac centers
Hypothalamus
Midbrain
Pituitary gland
Connective tissue
Three layers (membranes)
Dura mater
(outer layer)
Arachnoid membrane
(middle layer)
Pia mater
(inner layer)
4 hollow structures
Manufacture and absorb
Cerebrospinal fluid
(CSF)
Choroid plexus
CSF acts a shock
absorber
Reflex action
Provides motor
activity without
sending signals
to brain
Protective
http://www.bbc.co.uk/schools/gcsebitesize/science/aq
a/human/thenervoussystemrev3.shtml
Pathway for impulses to and from brain
Somatic Nervous System =
(Voluntary) Conscious control
Autonomic Nervous System =
(Involuntary) Unconscious control
2 Divisions
Work together to maintain homeostasis
Sympathetic (fight or flight)
Neurotransmitters =
epinephrine/norepinephrine
Parasympathetic (rest and digest)
Neurotransmitter = acetylcholine
Cranial nerves
12 pairs
Mostly head and neck
Sensory, motor, or both
Attached in brain and pass through
openings in skull
V (trigeminal) & VII (facial) = blink reflex
IX (glossopharyngeal) & X (vagus) = gag
reflex
II (optic) & III (oculomotor) = pupil size
and response
III (oculomotor) & IV (troclear) & VI
(abducens) = extraocular eye movements
Movements synchronized and smooth without nystagmus
Spinal nerves
31 pair
8 cervical
12 thoracic
5 lumbar
5 sacral
1 very small
coccygeal
Sensory
Spinal cord
Motor
W U
H P
A
T
S
Level consciousness
Orientation
Coordination
Muscle Strength
Sensation
Movement
Speech/Swallowing
Body Temperature
Describes state of awareness and
response to stimuli
5 levels of consciousness
Conscious/Alert/Wakeful
Lethargic/Drowsy/Obtunded
Stuporous
Semi-conscious/semi-comatose
Comatose/ Unresponsive
Determined in 3 spheres
Person
Place
Time
Ability to think and reason
Terms
Disoriented
Confused
Memory loss (short-term/long-term)
Ability to move extremities and body
parts voluntarily in a balanced
coordinated manner
Problem in one body part or all body
parts
Terms
Gait
Tremors
Ataxia
Always assess bilaterally
Terms
Paresis
Hemiparasia
Atrophy
Contraction
Contracture
Flaccid
Disturbance of sensory perceptions
Terms
Paresthesia
Numbness
Pain
Neuropathy
Radiculopathy
Act of changing position of body or its
parts
Active/Passive movement
Terms
Paralysis
Plegia
Hemiplegia
Paraplegia
Quadriplegia
Controlled by cerebral cortex
Broca’s speech center
Terms
Dysphasia
Dysarthria
Dysphonia
Aphasia
Types of Aphasia
Expressive (Broca’s or Motor)
Receptive (Wernicke’s or Sensory)
Amnesic
Global
Process that moves food from mouth through
pharynx and esophagus to stomach
Complicated act
Initiated voluntarily
Must be able to move tongue and palate
Pharynx must respond appropriately to
stimulation
Terms
Dysphagia
Speech Therapy assessment
Avoid distraction while eating
Small bites
Need to stay with client
High fowlers position
Avoid straws
Feed slowly
Swallow twice after each bite
Use thickening agents as needed
Controlled by hypothalamus
Balance between heat production/heat loss
Heat Production
Metabolism
Muscle activity
Heat loss
Sweating
Vasodilation
Normal range: 97 – 100.4 F
Elderly lower
Infants higher
Lowest in morning
Highest in late afternoon
LOC and Orientation
Cranial nerves
Motor Response
Pupils
Vital Signs
Arousal (wakefulness)
Alert
Lethargic/somnolent/obtunded
Stuporous
Semi-conscious
Unresponsive/comatose
Awareness
Orientation
Attention span
Speech (clear/coherent/incoherent/slurred
Memory
I to XII
Mnemonic
Cranial Nerves Review
http://www.youtube.com/watch?v=-J9QEddbJAU
http://www.youtube.com/watch?v=0lbwshg_Kj4
Normal motor response
Follows verbal commands
Abnormal
Localizes pain
Flexion to pain (decorticate position)
Extension to pain (decerebrate position)
No response
BABINSKI RESPONSE
Strength
Can only test if they have normal
motor response
Normal
Weak
None
Equality
Anisocoria
Grossly unequal is abnormal
Size:
Always check before shining light in eyes
Measure in millimeters (mm)
Constricted
Normal
Dilated
Reaction
Turn pen light on only when directly in
front of pupil
Remember blind eyes will not react
Record results:
Normal = brisk reaction, pupil goes from
dilation to constriction rapidly
Abnormal = sluggish or no reaction
Accommodation
Pupils adjust to let in more or less light
given distance of object from eye
Assess
Have patient focus on a distant object
Have client look at close object
Blood pressure
Heart rate
Respirations
Temperature
Late and serious sign
Cushing’s Triad
Widening pulse pressure SBP
Bradycardia
Cheyne-Stoke Respirations
DBP
Glasgow Coma Scale
http://www.bt.cdc.gov/masscasualties/pdf/glasgow-
coma-scale.pdf
CT SCAN
PET SCAN
MRI
OTHERS
Abnormal Myelogram
Normal Myelogram
Result of pressure from contents of skull
Amount of brain tissue
Intracranial blood volume
Intracranial CSF volume
Change in any one
Normal range is small
change in pressure
Minor changes cause no difficulty
Sustained and continuous increased ICP
permanent brain damage
death
Increased pressure in skull
Compresses brain tissue
Impairs circulation of blood and CSF
Swelling of brain cells (cerebral edema)
Eventually death
Result from
Brain tissue injury (CVA, head trauma)
Tumors
Aneurysms
Surgery to head and face
Change in LOC***
Behavior changes; restlessness, irritability***
Headache
Nausea and Vomiting (projectile)
Changes in speech pattern***
Pupillary changes
Cranial nerve dysfunction
Ataxia
***Earliest Signs***
Seizures
Cushing’s Triad
Abnormal posturing
Chronic elevated ICP
Blindness
Deafness
Paralysis
Mental retardation
GOAL: quickly lower pressure in skull
Drugs to decrease edema in brain
Osmotic diuretic (mannitol)
Loop diuretic (Lasix)
Corticosteroids
Restrict fluids
Hyperventilation: induce respiratory
alkalosis and vasoconstriction
HOB elevated at all times
Control fever
Complete bedrest
Decreased environmental stimuli
Padded siderails
Prevent vomiting, coughing, straining
May need surgery to relieve
Trauma
Accidents
Assults
Concussion
Hemorrhage
Epidural hematoma
Subdural hematoma
Convulsion/Seizure: episode of abnormal
motor, sensory, or autonomic activity or any
combination, that causes sudden excessive
discharge from cerebral neurons
Part or all of brain may be involved
Idiopathic
Genetic
Developmental
Head Injury
Tumors
Fever
Hypoglycemia
Hypoxia
Describe circumstances before
Time of seizure
Type of movement seen?
Did patient experience an aura?
Incontinence of urine or feces?
Confusion afterward and how long it took to
clear?
Protect airway
Prevent injury
Provide privacy
DO NOT try to restrain
NEVER force anything into mouth
Vital signs
Assess LOC
Reorient
Pad siderails
Offer emotional support
Allow sleep and rest
Attempt to determine cause
Call physician
Absence (petite mal)
Usually seen in children
Loses consciousness momentarily
May see twitching of eyes and mouth
Brief lapse of attention
Blank empty facial expression
Simple Partial Seizures
(Jacksonian)
Seizure activity limited to a certain group
of muscles
On one side of body
No loss of consciousness
Complex Partial Seizures
(psychomotor)
Loss of consciousness
Perform repetitive purposeless
movements
May make unintelligible sounds
Generalized seizures (tonic-clonic,
Grand mal)
Involves both hemispheres of brain
Intense rigidity of body with jerking
movements
Status Epilepticus
Seizure activity lasting longer than 30 min
Medical Emergency
IV Valium or Ativan
Treat underlying cause
Drug therapy
phenytoin (Dilantin)
phenobarbitol (Luminal)
carbamazepine (Tegretol)
valproic acid (Depakote)
gabapentin (Neurontin)
topiramate (Topamax)
DO NOT discontinue drug therapy
suddenly
Therapeutic blood levels must be reached
and maintained to control seizures
Major side effect = Sedation
Primary vs. Secondary
Transient
Recurrent
Persistent muscle contraction
Cerebral vasodilation maybe involved
Causes
musculoskeletal abnormalities
psychosocial stressors
Symptoms
Pain
Pressure
Aching
Tightness
Treatment
Symptom management
Due to cerebral vasoconstriction followed by
vasodilation
Tendency is hereditary
Triggers
Symptoms
Aura
Neck pain
Throbbing
Boring
Pounding
Unilateral
Noise and light exacerbate
Classic
Prodromal phase
Common
No prodromal phase
Prophylactic
Dietary restriction
Medications that prevent vaso
changes
NIFEdipine (Procardia)
propranolol (Inderal)
amitriptyline (Elavil)
Direct
Vasoconstrictor
ergotamine (Cafergot)
Serotonin receptors
sumatriptan (Imitrex)
zolmitriptan (Zomig)
H/A occurs in clusters
Unilateral throbbing and excruciating
Quiet, dark and cold compresses
NSAIDS and tricyclic antidepressants
History and symptoms
MRI
CT
X-ray
Arteriogram
EEG
Lumbar puncture
Assess – WHAT’S UP
ID triggers/aggravating factors
Stress reduction
Relaxation
Heat or cold therapy
Quiet/dark environment
Teach about medications
Disruption of nerve tracts
Sensory loss
Altered activity
Autonomic nervous system
dysfunction
Loss of all reflex activity below the level
of the injury
Lasts a few weeks
Resolution=reflex activity returns
Immobilize head and spine
Maintain airway
Decrease inflammation
Skin care
ROM
Bladder/bowel
Reflex response to stimulation of the
symapthetic nervous system.
Seen in injuries above T-6
Rise in BP
Noxious stimuli
Over distended
bladder,bowel,decubitus,ulcer,chilling
Headache
Hypertension blurred vision
Bradycardia
Goose bumps
convulsions
HOB elevated to decrease ICP
Find source of stimuli
Monitor BP
Administer antihypertensives as
ordered
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