Transcript neuro
MEDICAL & SURGICAL NURSING NEUROLOGICAL SYSTEM ANATOMY - - - The nervous system consists of 2 division: The central nervous system (CNS): brain, spinal cord The peripheral nervous system (PNS): cranial, spinal cord. PNS also divided into somatic (voluntary)& autonomic (involuntary). Autonomic nervous system (ANS) which is divided into sympathetic and parasympathetic. The nervous system functions: control all motor, sensory, autonomic, cognitive, and behavior. The nervous system has : 10 million sensory neurons (send information about internal& external environment to the brain. 50,000 motor neurons (control muscle & glands). The brain has 20 billions nerve cells that connect motor & sensory pathways, monitor body process, responds to internal & external environment, maintain hemeostasis, direct all physiologic, biologic, physical activities through complex chemical & electrical messages. The basic functional unit of the brain is neurons NEUROTRANSMITTERS - Communicate messages from neurons to another neurons or from a neurons to another a specific target tissue. They enable conduction across nervous system. Their action either to excite or inhibit the target cells activity. Types includes: Acetylcholine: paraysmpthetic NS, vagal nerve (HR) Serotinin: inhibits pain, control pain, sleep Dopamin : inotrops Rx Nepinephrin : vasoconstrist Rx Many of neurological disorders are due to imbalance of neurotransmitters. THE BRAIN The brain consist of cerebum, brain stem, cerebellum - Cerebum 4 lobes brain stem Cerebellum Cerebellum lobs Frontal lobe: involved in: With hypothalmus& thalmus to control BP, GI activity, speech , head, eyes, extrimities. Broccas area (formation of words) #aphasia Parietal Lobe: - Sensory Analyze Space Temporal Lobe : Auditory (allows the person to identify the various sounds and smells) Occipital lobe: - Processes visual information (color and shape) - Damage of this lobe can cause visual deficits THE MENINGES CRANIAL NERVE TESTING Tests involving 12 cranial nerves: Smell (I) Vision and eye movements (II-IV, VI) Jaw (V) Facial Muscles (VII) Hearing (VIII) Swallow (IX) Gag (X) Shoulder strength (XI) Tongue control (XII) - speech CEREBRAL SPINAL FLUID (CSF) Clear & colorless fluid. Produce by choroid plexus, circulate around the brain and spinal cord, and absorbed by arachnoid villi. arachnoid villi is malfunction or the production of CSF, this leads to increase fluid in the brain (hydrocephalus) CSF contains proteins, glucose, WBC, electrolytes, but no RBC. SPINAL CORD - Connection between brain & the peripheral Occupies 2 third of vertebral cord (column) Extend from C1- L1 Covered by meninges as protection Spinal cord contain: Anterior: motor root end (voluntary/ reflex activity ) Posterior: sensory root end (sensory/ reflex pathway) Vertebral column : Bones column & cover spinal cord Vertebrae are separated by disks Vertebral column : Bones column & cover spinal cord Vertebrae are separated by disks ASSESSMENT OF NEUROLOGICAL STATUS Seziure Pain (low back pain) Dizzness (abnoramal sensation of imbalance or movement) Weakness Cerebral function: - (intellectual function, IQ) - emotional (angry, irritable) - agnosia : inability to interept or recognize objects (pensil) Reflexes: involuntary contraction of muscle in response to abrupt stretching near the site of the muscle (on the tendon) Lumbar puncture: needle inserted into the subarachnoid space through 3L- 4L to check the CSF status by collecting specimen ALTERED LEVEL OF CONSCIOUSNESS (LOC) Not oriented, doesn’t follow commands, need continuo stimuli to achieve state of alertness. Fully oriented (conscious) # coma (unconscious), kinetic mutism (unresponsive but sometime open eyes) Pathophysiology : causes could be neurologic (head injury, stroke), toxicologic (overdose, alcohol), or metabolic (renal, hepatic failure). Assessment : - change in pupillary response (reactive, sluggish, fix), coma (doesn’t open eyes, doesn’t responsed to commands) - Glasgow coma scale GCS - CT scan, MRI - EEG (electroencephalogram) Complications: - Renal failure, pneumonia, pressure ulcer, aspiration. Treatment : - Maintain patent airway (ventilator) - Adequate perfusion (BP,HR) - Feeding (NGT, GT) r SEZIURE Abnormal movement due to electrical disturbance in the nerve cells in the brain. Can be partial (one part of the brain) or generalized (whole brain) Most of them are sudden & transit Aura occur before the event Causes: Ideopathic (genitic) Acquired (hypoxia, fever, renal failure, drugs, alcohol) Management: - Most do not last long. - Let the patient lying on the ground on its side. - Don’t put anything in this mouth - Anti-epilepsy medication should be given regularly and on time. - You should avoid factors that may initiate seizure such as sound or lighting or extreme stress and agitation. BRAIN INJURY Trauma to the scalp, skull, and brain including all it’s components.i.e. dura, brain, blood vessels and cranial nerves. Skull contains 3 major components: blood, CSF, and brain tissue. ICP = the pressure exerted by these 3 compartments in the brain. The normal ICP value is : 0 – 10 mmHg Cerebral perfusion (CPP) = MAP- ICP Monroe Kelly Hypothesis If any one compartment increases in volume, one or both of the remaining compartments must decrease in volume to maintain normal ICP. This mechanism is termed compensation. 10% Blood BLOOD BRAIN 80% Brain CSF 10% CSF Skull contains 3 major components BLOOD COMPARTMENT Increase in this will increase ICP which decreases CPP, causes includes: Hypertension, Hypervolaemia, Hyperthermia, High PaCO2, Low PaO2, Vasodilating Drugs (which increase blood supply , thus increase ICP which decrease CPP). Increased abdominal or intrathoracic pressure (coughing, constipation, gagging, suctioning, PEEP). Which Obstructs venous outflow, (which increases blood in the skull, thus increase ICP which decrease CPP). Therefore, pt should be sedated, normothermia, normal PaCO2, PaO2, prevent constipation, HOB 30 deg, low suctioning, low PEEP, control BP& hypovelemia CSF COMPARTMENT Increase in this will increase ICP which decreases CPP, causes includes: Increase in CSF production by tumor of choroid plexus (hydrocephalus) Decrease in CSF reabsorption due to obstruction in arachnoid villi or Obstructed ventricular shunt. SAH (subarachnoid hemorrhage). Therefore, patetency of EVD (Entra Ventricular Device) BRAIN COMPARTMENT Increase in this due to Cerebral oedema Intracerebral haemorrhage Subdural haemorrhage Extradural haemorrhage Therefore, edema should be evaucated, and haemorrhages should be drain out. BRAIN INJURY NURSING CARE Maintain air way, O2 100%, ABG Ventilation required if (poor airway maintenance, inadequate, GCS less than 8. Circulation: CPP, check capillaries refill, normothermia, keep MAP 80-90 mmhg to keep CPP 70 mmhg Pt should be sedated, normothermia, normal PaCO2, PaO2, prevent constipation, HOB 30 deg, low suctioning, low PEEP, control BP& hypovelemia, patency of EVD (Entra Ventricular Device), edema should be evacuated, and hemorrhages should be drain out. Environmental care: when there is light, noise, no sleep this leads for serotenin secretion which cause stress, which increase ICP, and that decreases CPP.( care at one time). Conclusion Any question ?