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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