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Unit 43-Nervous system

Adonis K. Lomibao, RN

11/21/11

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The Male & Female Brain

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Objectives

Understand the basic structure and function of the components of the Nervous System.

Understand common conditions that may affect the Nervous System.

Identify nursing care specific to each condition.

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Structure & Function

Controls & coordinates all body activities,including production of hormones

Special Parts maintain normal day-to-day functions

Other parts act during emergency situations Others control voluntary activities

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Neurons

The cells of the nervous system Conduct electriclike impulses Impulses enter through the DENDRITE and exit

through the AXON. Synapse-the space between neurons Myelin- insulation that covers the axon &

dendrite

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The Neuron

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Neurotransmitters & Nerves

Neurotransmitters-chemicals that enable nerve impulses to pass from one cell to another.

Chemicals not produced in the right amount-> message pathway is confused or blocked

Nerve-bundle of axons & dendrites held together by connective tissue

Different kinds- Sensory & Motor

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CNS & PNS

Central Nervous System- Brain & Spinal Cord Peripheral Nervous System-12 pairs of cranial

nerves and 31 pairs of spinal nerves that reach throughout the body.

Nervous system is interwoven with millions of neurons.

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The Central Nervous System

Composed of brain and spinal cord Surrounded by bone Protected by membranes called meninges Cushioned by cerebrospinal fluid

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The Brain

Composed of grey & white matter Cerebrum-largest part of the brain, separated

into lobes,lobes named after surrounding skull bones

All mental activities-thought,voluntary movements,interpretation of sensations,emotions----carried out by cerebral cells.

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The Brain Cont.

Cerebellum-coordinates muscular activities and balance

Brain Stem-midbrain, pons, medulla. Control involuntary, life-sustaining functions of

the Heart, Blood vessels, Lungs, Stomach, & Intestines.

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The Lobes & Function

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The Spinal Cord

Extends from the Medulla to the 2nd Lumbar Vertebra (above the small of the back) (~17 in.)

Nerves enter and leave spinal cord carry impulses to and from control centers.

Reflexes are controlled in the cord...i.e...pulling hand away when touching something hot.

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The Spinal Cord

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Meninges & CSF

Meninges- surround brain and spinal cord. Consists of dura mater, arachnoid mater, pia

mater. Cerebrospinal Fluid-flows around the brain and

spinal cord Cushions CNS against shock & possible injury

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Autonomic Nervous System

Control center in brain stem Consists of 2-parts:Sympathetic and

Parasympathetic fibers Sympathetic fibers-prepare the body to deal

with emergency situations. “Fight or Flight”. Parasympathetic fibers-control functions of

heartbeat,digestion,elimination,respiration,glandular activity.

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Sensory Receptors

Carry sensations to CNS. In joints-relay body positions to brain In the skin- relay sensations of pain, heat,

pressure, & cold. In the nose-smell In the tounge-taste Sensory rec. stimulated through the eye and

ear

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Increased Intercranial Pressure

The amount of pressure exerted by structures in the skull. (Nervous tissue, CSF, Blood through cerebral vessels.)

Changes in size or amount change pressure. Increased ICP can result from-Head injury,

Hemorrhage, Inflammation, Toxins, High temperature

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S&S of increased ICP

Alteration in pupil size and reaction to light Headache Vomiting Loss of consciousness and sensation Paralysis convulsions

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External Ventricular Drain

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Glascow Coma Scale

Used to monitor neurological problems after trauma, stroke, etc.

Higher point values indicate increased awareness and arousal.

Less than 8=neurological crisis 9-13= moderate dysfunctions 13-15 moderate to minor dysfunction.

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GCS

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Transient Ischemic Attack

Temporary period of diminished bloodflow to the brain.

Attack may last 2 min up to 24 hours Symptoms are similar to stroke, but are

temporary and reversible. Those suffer from TIA-at risk for suffering a

stroke.

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Stroke

Cerebrovascular Accident (CVA)-complete or partial loss of blood flow to the brain tissue.

Result of atherosclerosis or brain hemorrhage. Damage on one side of brain result in S&S on

the opposite sides of the body. Damage to R-Spatial-perceptual deficits-

difficulty distinguishing R&L and Up&Down. Damage to L-Aphasia

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Stroke-Nursing Care

Maintain skills and abilities patient has left. Prevent complications caused by immobility-

contractures, pressure ulcers, pneumonia, blood clots.

Help patient regain functional activities.

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Parkinson's Disease

Caused by not having enough neurotransmitters in the brain stem & cerebellum.

Symptoms are progressive over many years

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Freddie Roach

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Parkinson's Disease S&S

Tremors- uncontrolled trembling Muscle Rigidity- loss of flexibility Akinesia-difficulty and slowness in carrying out

voluntary muscular activities. Loss of autonomic control Mood swings & behavioral changes.

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Parkingson's Disease Nursing Care

Maintain calm environment Assist and supervise in ADL's. Provide emotional support and encouragement Exercise program Provide protection for patients with dementia

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Huntington's Disease

Hereditary-genetic test available to detect gene. Progressive with no cure. Disability and death occur within 15-20 years. Characterized by abnormal movements called

chorea. Pt. is restless, moves frequently, involuntary

movements, rapid jerking.

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Multiple Sclerosis

The result of insulation(myelin) around nerve fibers. Interferes with the ability to function.

Generally in young adults-Unknown cause-Generally normal life-span.

Symptoms include Vertigo, Lhermitte's sign,Nystagmus, Paraplegia or Quadriplegia, intention tremor, affected speech,incontinence Fatigue!

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MS-Nursing Care

Pressure ulcer prevention Contracture prevention -PROM & position

changes Catheter Care Encourage Independence Help maintain balanced schedule of rest n act. Emotional support and encouragement

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Post Polio Syndrome

Polio-caused by virus that attacks motor neurons in spinal cord. Results in weakness and paralysis.

PPS-marked by weakness & muscle fatigue in those who had polio previously.

30%-70% of polio survivors will develop PPS

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PPS-S&S

Fatigue New Joint & Muscle pain New muscle weakness, spasms,cramps New dyspnea & respiratory problems Cold intolerance Difficulty swallowing Difficulty sleeping, frequent awakening

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Amyotrophic Lateral Sclerosis

Also called Lou Gehrig's Disease Progressice neuromuscular disease Causes muscle weakness and paralysis. Disease of the motor nerves that control

voluntary movement. No cure, almost always fatal.

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S&S of ALS

Difficulty walking-stumbling, tripping, falling Loss of strength & muscle control in

hands,arms,& legs. Difficulty in speaking & swallowing,Drooling Muscle aches, cramps, twitching, weakness,

atrophy Etc. P. 764

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ALS-Nursing care

Upright position to ease respirations ROM-prevent deformities & maintain strength Assist in use of Incentive Spirometer Rest before meals-conserve muscle strength &

reduce choking risk. Small, frequent feedings. Take swallow

precautions when feeding to prevent choking.

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Seizure Disorder (Epilepsy)

Recurrent attacks of disturbed brain funtion Seizure characteristics may include: altered

state of consciousness, convulsive uncontrolled movements,disturbances of feeling or behavior.

May experience Aura-involves the senses, may hear or smell-usually consistent & remains the same.

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Types of seizures

Partial-may not have loss of cons.,begin in one part of body and involve only one side.

Generalized tonic-clonic-loss of consciousness & convulsive movements.

Absence seizures-uncons. But no conv. ,short in nature, begins without warning and ends abruptly.

Status epilepticus-lasts for a long time. Medical Emergency may result in death if not treated.

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Seizures-Nursing care

PREVENT INJURY-stay with person, assist to lay, DO NOT restrain or put anything in mouth,move objects patient may hit.

MAINTAIN AIRWAY- loosen clothing around neck,turn head to side if drool or vomit present, head-tilt chin-lift if necessary.

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Spinal Cord Injuries

Result in loss of function and sensation below injury.

Prone to contractures and pressure ulcers Commonly associated with Paralysis. Nursing care include listening,patient approach,

restoring highest degree of independence,Skin care!,Elimination needs, ROM, Prevent infection.

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Autonomic Dysreflexia

Potentially life-threatening complication of spinal cord injury

Occurs in patients with injuries above the mid-thoracic area.Indicates uncontrolled sympathetic nervous system act.

Triggered by injuries that would normally cause pain below level of spinal injury. i.e. Overfull bladder, UTI,Fecal impaction, etc. (P.768-9)

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Autonomic Dysreflexia S&S

Extemely high BP 200/100 Severe headache Red, flushed face Red blotches on skin above spinal injury Bradycardia p. 769

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Glaucoma

Increased pressure in the eye. Causes peripheral vision loss. Untreated, may

progress to central vision loss and blindness. S&S may include eye pain, difficulty adjusting

to darkness, color-blindness, halos around lights, N&V,headache, tiredness, blurred vision

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Glaucoma Nursing Care

Monitor I & O Check vital signs q2-4 hours Report eye pain Keep patient from stooping or lifting Avoid tight, constrictive clothing P. 770-771

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Other conditions

Meningitis- inflammation of the meninges. Caused by virus or bacteria. S&S: Headache,nausea,stiff-neck,seizures,chills,elev. Temp.

Cataracts-causes the lens of the eye to be cloudy.

Retinal Degeneration-loss of central vision due to damage of the macula.

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Other Conditions Cont.

Otitis media- infection of the middle ear. Otosclerosis- progressive form of deafness due

to abnormal bone growth. Unit 7-reviews communication with the hearing-

impaired.

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Diagnostic Tests

MRI-magnetic resonance imaging CAT-computerized axial tomography EEG-measure electrical activity of brain Myelogram-X-Ray of spinal cord with dye Tonometry-measures intra-ocular pressure Audiometry-evaluate hearing Spinal Puncture

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Spinal Puncture

Done to withdraw CSF for examination or to introduce medication/anesthetic into the spinal column.

Needle inserted between the lumbar vertebrae into the fluid-filled space.

After procedure, head of bed should be flat for 8 hours.

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Spinal Puncture

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Study Tips

Concentrate on NAT Unit 43. Flip through MT Ch. 10 Know S&S specific to each condition Know nursing care specific to each condition.

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Thank You =]