1 unit 43-nervous system adonis k. lomibao, rn 11/21/11
TRANSCRIPT
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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 =]