n104 01 alteration in perception and coordination
TRANSCRIPT
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Luisito P. Yolangco, RN.DVM.MAN.
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CONTROL CENTER &COMMUNICATION
NETWORK of the body Works hand in hand with ENDOCRINE
system to regulate and maintain
homeostasis
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HOW IT WORKS?
Directs the functionsof the bodys organsand systems
Uses rapid & specific electrical impulsesas signaling devices
Allows us to interpret and respond to the
changes in the external environment Thoughts, actions & emotions reflect its
activity
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Sensory Reception(Receptors)
Motor Response(Effector)
INTEGRATION
INPUT
OUTPUT
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NERVOUSSYSTEM
CNS PNS
Brain Spinal Cord 12 CNs 31 SNs
Somatic Autonomic
SNS PSNS
ORGANIZATIONOF THE
NERVOUS SYSTEM
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One of the largestorgans of the body
Weights about 3 lbs Protected by cranial
bones and themeningesDM,
AM, PM
Contains CSF
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CEREBRUM
MIDBRAIN
MEDULLA OBLONGATA
PONS CEREBELLUM
MIDBRAIN
THALAMUS
HYPOTHALAMUS
DIENCEPHALON
BRAINSTEM
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Neurotransmitter
-communicate messages from one neuron toanother or from a neuron to a specific targettissue.
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Neurotransmitters
Acetylcholine major transmitter of the PNSusually excitatory in CNS and NMJ
Inhibitory or excitatory in ANS
Gamma-aminobutyric acid (GABA) - inhibitory
Enkephalin, endorphin excitatory, pleasurablesensation, inhibits pain transmission
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CSF Characteristics
Clear & colorless
Sp. Gr. = 1.007
Approx. 150 ml ( 15-25 ml in each ventricle) Contains:
Albumin 15-30 mg.dl
Glucose 50-75 mg.dl
Glutamine 6-15mg/dl IgG 0-6.6 mg/dl
WBC 0-5 per mm3
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T EPERIPHER L NERV USYSTEM
1. Sensory-Somatic
a. Cranial Nerves
b. Spinal Nerves
a. Parasympathetic
b. Sympathetic
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PNS
Consists ofNERVES, CELL BODIES &PROCESSESoutside the CNS
1. sensory-somatic
2.autonomicnervous system
CN
SN
SNSPSNS
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Cranial Nerves
Sensory-Somatic Nervous System
pairs of CNs Primarily innervate the
except
for which extendsto the thorax &abdomen
Functions:
ensoryotor (Somatic)arasympathetic
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I. OlfactoryII. OpticIII. OculomotorIV. TrochlearV. Trigeminal*VI. AbducensVII. FacialVIII. Acoustic/
Vestibulocochlear
IX. GlossopharyngealX. VagusXI. Accessory/SpinalXII. Hypoglossal
Note: * S,M only
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Olfactory Optic Oculomotor
Trochlear
AbducensTrigeminal
Facial
Acoustic/Vestibulocochlear
Glossopharyngeal
Vagus
Accessory/SpinalHypoglossal
Some Say MarryMoney But My Brother
Says Big Business
Makes Money.
Still can'tremember thenames of thecranial nerves?
Name FunctionType#
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Tongue movementMHypoglossalXII
Accessory
Vagus
Glossopharyngeal
Acoustic
Facial
Abducens
Trigeminal
Trochlear
Oculomotor
Optic
Olfactory
Name
Head & shoulder movementMXI
swallowing; digestive,respiratory, cardiovascularactivities
BX
taste; swallowing; tongue movement; salivationBIX
hearing & balanceSVIII
taste;saliva & tears production; facial expressionBVII
lateral eye movementMVI
sensation from the face & mouth; masticationBV
upward & downward eye movementMIV
extraocular eye movement;pupillary reactionMIII
visionSII
smellSI
FunctionType#
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Spinal Nerves
Sensory-Somatic Nervous System
pairs of SNs Formed by dorsal &
ventral roots of the spinalcord
Divided into dorsal &ventral rami whichcontain both motor &sensory fibers
Named according tosegment of spinal cord
they are attached.
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Nerve Plexuses
Complex networks of nerves
Serve the motor and sensory needs ofthe extremities
Classified into (4):
Cervical
Brachial Lumbar
Sacral
http://www.loweychiropractic.com/neuropathophysiology-1sm.jpg -
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Cervical PlexusC1 C5
Brachial PlexusC6 C8; T1
Lumbar PlexusL1 L4
Sacral PlexusL4 L5; S1-S4
neck, shoulder & diaphragm phrenic nerve
lower abdomen, buttocks,anterior/ medial thigh, medialleg & hip
femoral & obturator nerve
upper extremity- shoulder,forearm, wrist & hand
axillary, radial, median,musculocutaneous, & ulnar
lower trunk, posterior thigh &lateral and posterior leg, foot,buttocks & external genitalia
sciatic (peroneal & tibial),pudendal nerve
PLEXUSESRegions supplied/Major nerves
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SNSPSNS
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A utomatically & continuously functionsU nder involuntary controlT wo neurons between CNS & effector organsO ne stimulates and the other inhibitsN eurotransmitters cholinergic & adrenergicO pposite effects on the same organs
M otor impulses
I nnervates smooth & cardiac muscles and glandsC oncerned with vital signs & other visceral activities
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NEUROLOGICASSESSMENT
NVS
Neurovital Signs
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NEUROLOGIC ASSESSMENT
Neurologic Examination Mental Status
Sensation
Cranial Nerves
Motor Function
Reflexes
COMPOSURE quick neurological
assessment..
C i
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LOC
Verbal Tactile Pain
Conscious (+) (+) (+)
Lethargic (+) (+) (+) *Stuporous (-) (-) (+)
Comatose (-) (-) (-)
FORMS OF
STIMULI
VERBAL
VOICE
SHOUT
TACTILE
TOUCH
TAP/ SHAKE
PAIN
SUPERFICIAL
DEEP
Consciousness
* delayed reaction
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Pain Stimulus
IMPLICATION: Consciousness
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1st & MOST sensitive indicator
of neurologic change
IMPLICATION: Consciousness
GLASGOW COMA SCALE
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GLASGOW COMA SCALE Description
Spontaneously To Speech
To Pain
Do not Open
Oriented
Confused
InappropriateSpeech
Unintelligible speech
No verbalization
Obeys Command
Localizes Pain
Withdraws from pain Abnormal Flexion
Abnormal Extension
No Motor Response
Subscale
EYE OPENING
(E)
VERBALRESPONSE
(V)
MOTORRESPONSE
(M)
Score
4 3
2
1
5
4
3
2
1
6 5
4
3
2
1
*
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Oxygenation
Assess respiratory status.
Resp rate, rhythm
Auscultate breath sounds/ air entry.
Maintain patent airway & adequateventilation.
O2 therapy, Mechanical Ventilation
Monitor for S/S of cardiorespiratorydistress
Note for S/S of Hypoxia/ hypoxemia
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Motor Function
Assess integration of consciousness& voluntary movement.
Look for purposeful or non-purposeful response.
Assess muscle tone, size, strength.
Observe for symmetric, spontaneousmovement of arms & legs
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IMPLICATION: Motor Function
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Assessment tool Motor Function
2 5
51
15
42
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Pupils
Assess for size, shape &reaction to light.
Observe for ptosis.
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Ocular Movement
Assess for deviationto one side.
Also assess voluntary
& spontaneousmovement
III, IV, VI
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Signs
Assess V/S.
Observe for significant trends.
Look for Cushings reflex:
PR,
RR,
Widened Pulse Pressure
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Urinary Output
Assess for increased output,possible S/S of impaired waterregulation.
Also assess for electrolyteimbalance
Oliguria = ( below 30 cc)
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Reflexes
Assess for pathologic reflexes,
especially babinski & loss ofcorneal or gag reflex
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controlled by L4 & L5, S1 & S2
N=toe flexion (except in infant)Abn=Dorsiflexion of big Toe,Fanning of Little Toes (exceptin infant) Pyramidal Tract /Upper Motor Neuron Damage
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Biceps, Triceps, Patellar, Achilles,Brachioradialis
DTR GRADING
DTR GRADE Response
0 Absent reflex
1+ Diminished
2+ Normal
3+ Slightly increased
4+ Hyperactive
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Emergency
Evaluate assessment findingsto determine whetheremergency exists.
If so report findings to doctor
STAT
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Ask client to SNIFF &identify aromatic
substances.
CN I : OLFACTORY
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Use of Snellen Chart
Ask client to readprinted materials
CN II : OPTIC
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Assess directions ofgaze by asking client tofollow moving objects.
Measure pupillaryreaction to light reflex& accommodation
CN III : OCULOMOTOR
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Assess directionsof gaze by askingclient to follow
moving objects.
CN IV & VI: TROCHLEAR
and ABDUCENS
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Corneal reflex Assess light touch & pain
sensation across theface
Opening the mouthagainst resistance &moving the jaw from theside to side
CN V : TRIGEMINAL
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CN VII : FACIAL
Ask client to smile,whistle, frown, puff outcheeks, & moveeyebrows
Have client identifysalty & sweet tastes onfront of the tongue
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CN VIII : ACOUSTIC
Air & bone conduction Ability to hear spoken
word
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CN IX : GLOSSOPHARYNGEAL Ask client to identify
sour, salty or sweettastes on back of thetongue
Elicit gag reflex and
assess swallowingreflex.
Ask to speak or cough.
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CN X : VAGUS
Ask client to say ahand assess formovement of thepalate and pharynx
Elicit gag reflex Ask client to speak.
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CN XI : ACCESSORY
Ask client toSHRUG shoulders& turn head
against resistance
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CN XII : HYPOGLOSSAL
Ask client to stick outtongue and move it
from side to side
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DIAGNOSTIC
EVALUATION
1 C d T h S i
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1.Computed Tomography Scanning(CTScan)
2.Positron Emission Tomography (PET)3.Single Photon Emission Computed
Tomography (SPECT)4.Magnetic Resonance Imaging (MRI)
5.Cerebral Angiography6.Myelography7.Noninvasive Carotid Flow Studies8.Transcranial Doppler
9.Electroencephalography (EEG)10.Electromyography (EMG)11.Evoked Potential Studies12.Lumbar Puncture and Examination
of CSF
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Computed Tomography Scanning
-Makes use of a narrow x-ray beam to scan thebody part in successive layers.-Can be performed first without contract followedwith contrast.
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Positron Emission Tomography
--A computer-based nuclear imaging techniquethat produces images of actual organ functioning.-Permits the measurement of blood flow, tissuecomposition and brain metabolism
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Single Photon Emission ComputedTomography
-A three-dimensional imaging technique thatuses radio-nuclides and instruments to detectsingle photons.-A perfusion study that captures a moment of
cerebral blood flow.
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Magnetic Resonance Imaging
-Uses a powerful magnetic field to obtain
images of different areas of the body.-Can be performed with or without contrast-Provides information about the chemicalchanges within the cells
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Cerebral Angiography
-An X-ray study of the cerebral circulation witha contrast agent injected into a selected artery.
-Performed by threading a catheter through thefemoral artery in the groin and up to thedesired vessel.
M l h
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Myelography
-An xray of the spinal subarachnoid space
taken after the injection of a contrast agent intothe spinal subarachnoid space through alumbar puncture.-Outlines the subarachnoid space and showsany distortion of the spinal cord or spinal dural
sac
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Noninvasive Carotid Flow Studies
-Use ultrasound imagery and dopplermeasurements of arterial blood flow toevaluate carotid and deep orbital circulation.
Transcranial Doppler
-Uses the same noninvasive techniques ascarotid flow studies except that it records theblood flow velocities of the intracranial vessels.
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Electroencephalography
-Represents a record of the electrical activitygenerated in the brain.
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Electromyography
-Is obtained by inserting needle electrodes intothe skeletal muscles to measure changes inthe electrical potential of the muscles and thenerves leading to them.
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Evoked Potential Studies
-These studies are based on the concept that
any insult or dysfunction that can alterneuronal metabolism or disturb membranefunction may change evoked responses inbrain waves.
L b P d E i i
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Lumbar Puncture and Examinationof CSF
-Queckenstedts test: lumbar manometric test-Check for post-lumbar headache and othercomplications of lumbar puncture.
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lpy