• Zona fasciculata, the middle zone of the adrenal cortex secretes Maintains normal electrical excitation of the heart,
l excitation of the heart, blood
TOPICS:
Midterm Week -Anatomy and Physiology of Adrenal &
Parathyroid Glands
-Adrenal & Parathyroid Gland Disorders
7-8 -Assessment, Diagnostic Tests,
Treatment, and Nursing Interventions
ADRENAL GLANDS
- Also known as suprarenal gland, small triangular-shaped
gland.
- 2 adrenal glands, one attached to the upper portion of
each kidney, 4-5 grams in weight.
- 2 endocrine glands w/ separate independent function.
Adrenal medulla- located at the center of the gland secretes
catecholamines - a type of neurohormone (a chemical that is made
by nerve cells and used to send signals to other cells).
Ex. Epinephrine, Nor-epinephrine, dopamine.
Adrenal cortex- located at the outer portion of the gland and also
the largest part of adrenal gland which secretes steroid hormones.
Ex. Glucocorticoids, mineralocorticoids, sex hormones.
Consist of:
• Zona glomerulosa is the outermost region of the adrenal cortex
and is the only zone of the adrenal gland that contains the enzyme
aldosterone synthase (CYP11B2).
glucocorticoids which are important for carbohydrate, protein and lipid
metabolism. (Regulates blood sugar)
• Zona reticularis produces androgens (sex hormones)
FUNCTION
Produce hormones that help regulate metabolism, immune system, blood
pressure and response to stress.
Metabolism- too much or too little productions of certain hormones may
affect the metabolism of a human being. Payat or Mataba.
Immune System- Patient with adrenal dysfunction may result to weak
immune system which leads the pt. prone to infection.
Blood Pressure- ↑ Production ↑ BP
↓ Production ↓ BP
Stress- ↑ Production ↑ Active/Hyper
↓ Production ↓ Fatigue
ADRENALINE (EPINEPHRINE)
- A hormone that helps in preparing for stressful or dangerous
situations. Fight-or-flight response.
- ↑ HR, BP
- Maximize blood glucose level to provide energy.
- Expanding the air passages of the lungs to breathe more
efficiently.
- Enlarging the pupil in the eye.
- This causes blood vessels to send more blood to the brain and
muscles that makes the brain more alert.
- Extra energy in response to stress or emergency.
- Unnoticed sudden feeling of strength and decreased sensitivity
to pain
ALDOSTERONE
- A hormone that helps in regulating blood pressure by balancing
the levels of sodium (salt) and water in the kidney by keeping
sodium in and releasing potassium from the body.
- Too much aldosterone can cause ↑BP and a build-up of fluid
(edema) in body tissue.
CORTISOL
- Primary stress hormone
- ↑ sugars (glucose) in the bloodstream
- Enhances brain's use of glucose, since it is the essential metabolic
fuel for the brain, you can think, memorize, and learn well. Emotion
stability
- Responsible for metabolism which controls body’s use of fats,
proteins and carbohydrates and immune response and
inflammation.
- It also increases the availability of substances that repair tissues.
- Triggers the fight-or-flight response.
glucose level, nerve cell conduction, and adequate
circulatory volume.
- Highest concentration (6 to 8am) in the morning, lowest in
the evening (4 to 6pm).
CUSHING’S DISEASE/ SYNDROME
- A serious condition of an excess of the steroid
hormone cortisol in the blood level caused by a
pituitary tumor secreting adrenocorticotropic
hormone (ACTH)-responsible for producing cortisol.
ACTH is a hormone produced by the normal pituitary
gland. If there is an abnormal production of ACTH due
to pituitary gland dysfunction there is also an abnormal
production of Cortisol.
Causes:
• Overproduction of ACTH- hyperpituitarism
• Benign or malignant tumors
• Prolonged/Overuse corticosteroids (artificial cortisol that
mimics cortisol) therapy
• Exogenous
• Excessive glucocorticoid production secondary to hyperplasia
of the adrenal cortex.
Risk Factors:
• Adrenal or pituitary tumors.
• Long-term therapy with corticosteroids.
• Diabetes mellitus- because of ↑ cortisol levels
• High blood pressure.
• Serious infections.
• Fractures due to osteoporosis.
• Kidney stones.
• Enlargement of pituitary tumor.
Signs and symptoms:
Take note: The signs and symptoms of Cushing’s syndrome are
primarily a result of over secretion of glucocorticoids and
androgens, although mineralocorticoid secretion may be affected
as well.
• Weight gain – alteration of metabolism that causes the patient to
gain weight, especially in the upper body.
• Rounded face and extra fat on the upper back and above
collarbones
• A fatty hump between the shoulders (buffalo hump)
• Thin, fragile skin, easy bruising, -because of alterations in
protein metabolism, loss of collagen support in the skin.
• Wide purple stretch marks, mainly on the abdomen, breasts,
hips, and under the arms.
• Weak muscles and Osteoporosis that cause generalized
weakness and fatigue -Due to excessive protein catabolism.
• Obese trunk with thin arms and legs, (Pendulous abdomen)- due
to the redistribution of fat to the body and face.
•Other changes in appearance may include hirsutism, acne, oily
skin, and purple striae. Virilization in female patient-
characterized by the appearance of masculine traits and the • Ketoconazole-may be used to reduce hyperadrenalism if the syndrome is • Sudden cessation of exogenous adrenocortical hormonal
recession of feminine traits. caused by ectopic ACTH secretion by a tumor that cannot be eradicated therapy -this suppresses the body’s normal response
• Irritability, depression, frequent mood swings • Metyrapone [Metopirone] to stress and interferes with normal feedback mechanisms
• Signs of masculinization in women; menstrual dysfunction, • Insulin
decreased libido in both men and women. Risk Factors:
• Decreased resistance to infection and slow wound healing Nursing Intervention: • Cancer
• Hypertension-because of increased circulating volume or increased • Maintain muscle tone (Provide ROM exercises, assist with • Patients who take anticoagulants (blood thinners)
sensitivity of arterioles to circulating catecholamines (neck vein ambulation) there is instability because of muscle weakness. • Have chronic infections like tuberculosis
distention may be present) • Prevent accidents or falls and provide adequate rest • Histoplasmosis
• Edema (Peripheral Edema) - from water and sodium retention as a • Protect client from exposure to infection • Had surgery to remove any part of adrenal gland
result of ↑ mineralocorticoid activity. This also produces hypertension • Maintain skin integrity. • Have an autoimmune disease, like type 1 diabetes or
and heart failure. • Provide meticulous skin care. Grave’s disease
•Hyperglycemia- • Prevent tearing of skin: use paper tape if necessary.
• Minimize stress in the environment Key Concept: Know the functions of the hormones and
• Monitor VS: observe for hypertension, edema you will know the signs & symptoms.
• Measure I&O and daily weights - Mineralocorticoids (Aldosterone)
• Provide diet that is: • Promotes Na & H2O reabsorption & K+ excretion.
- low in calories and sodium - Glucocorticoids (Cortisol)
- high in protein, K+, Ca++ • Affects CHO, CHON, Fat metabolism.
- vitamin supplements - Body’s response to STRESS
• Monitor urine for glucose and acetone; administer insulin if • Emotion stability
ordered • Immune Function
• Provide psychological support and acceptance. - Sex Hormones
• Prepare client for hypophysectomy or radiation if condition • Major source of androgen in women
is caused by a pituitary tumor.
• Prepare client for an adrenalectomy if condition is caused Signs and Symptoms:
by an adrenal tumor or hyperplasia. • Extreme fatigue, lethargy, and muscle weakness
• Provide client teaching D/C planning concerning: • Weight loss and anorexia, decreased appetite
- Diet modifications • Darkening of skin and mucous membrane (hyperpigmentation),
- Importance of adequate rest especially of the knuckles, knees, and skin folds. - ↑ in levels of
- Need to avoid stress and infection ACTH
- Change in medication regimen (alternate day therapy or • Low blood pressure, weak pulse even fainting
reduced dosage) if the cause of the condition is prolonged corticosteroid •Hyponatremia and Salt craving - The loss of mineralocorticoids
Assessment and Diagnostic Test:
therapy. leads to increased excretion of sodium, chloride, and water with
• Measurement of midnight plasma cortisol
increased retention of potassium
• 24-hour urinary free cortisol test ADDISON’S DISEASE • Low blood sugar (hypoglycemia)
• Dexamethasone suppression screening test
• Nausea, diarrhea or vomiting (gastrointestinal symptoms)
• Magnetic resonance imaging (MRI) - Also called adrenal insufficiency, is an uncommon disorder • Pallor, complain of headache, abdominal pain and may show
• ↑cortisol levels, slight hypernatremia, hypokalemia, hyperglycemia that occurs when the body doesn't produce enough of certain signs of confusion and restlessness.
When Cushing’s is suspected, a blood sample will be taken for laboratory hormones. In Addison's disease, adrenal glands, located just • Hyperkalemia – due to ↑ excretion of sodium that may lead to a
analysis. above the kidneys, produce too little cortisol and, often, too
1) ACTH- 7.2- 52 pg/ml deficiency in extracellular fluid causing decreased cardiac output.
little aldosterone. • Hypovolemia
2) Plasma cortisol - 10-20mcg/dl - It is the result of dysfunction of the hypothalamus–pituitary
- It decreases in the evening- during early phase of • Acidosis
gland–adrenal gland feedback loop which results in insufficient • Hypoglycemia- caused by the loss of glucocorticoids
sleep production of steroids by the adrenal glands.
3) Dexamethasone suppression test (Confirmatory test)
-Hypofunction of the adrenal cortex resulting to a decreased secretion of
- Measures the response of adrenal glands to ACTH.
the
Dexamethasone 1mg is given oral at 11pm.
•Mineralocorticoids
- Plasma cortisol is obtained at 8am...>50% reduction in
plasma cortisol •Glucocorticoids
•Sex hormones
Management/Treatment Causes:
• Surgical resection of the causative tumor • Idiopathic atrophy of the adrenal cortex possibly due to an autoimmune
• Transsphenoidal hypophysectomy surgery process
• Adrenalectomy- treatment choice in patients with unilateral • Destruction of the gland secondary to tuberculosis or fungal infection
primary adrenal hypertrophy. • Tumor (not secreting adequate hormone–hypopituitarism)
• Bilateral adrenalectomy • Damage to adrenal glands
• Mitotane- [Lysodren] to decrease production of • Medications such as rifampin, barbiturates, ketoconazole,
glucocorticoids and tyrosine kinase inhibitors
• Korlym [Mifepristone]- Cortisol Receptor blocker • Not enough of the hormone cortisol
• Not enough aldosterone
 • Early morning serum cortisol and plasma ACTH- to differentiate primary - Seen more frequently in women (30-50 y/o)
adrenal insufficiency from secondary adrenal insufficiency and from - Cause by a tumor or hyperplasia of adrenal gland
normal adrenal function. - Key Concept: Mineralocorticoids (Aldosterone) – Promotes Na+
Primary insufficiency has a greatly increased plasma ACTH level & H2O reabsorption & K+ excretion
and a serum cortisol concentration lower than the normal range.
Assessment and Diagnostic:
• Headache
• Hypertension
• Muscle weakness
• Polyuria, polydipsia
• Metabolic alkalosis
• Cardiac arrhythmias (due to hypokalemia)

• ↓ Serum K+
• Alkalosis
↓ Blood Cortisol results in ↑pituitary ACTH production and ↑ blood beta- • Urinary aldosterone levels elevated
lipotropin, which has melanocyte-stimulating (MSH) activity and, together • Plasma aldosterone- in supine position with normal sodium diet
Emergency Condition: Patients with Addison’s disease are at risk • 2-9 ng/dl or 55-250 pmol/L, with upright /standing position
with ACTH, causes the hyperpigmentation of skin and mucous membranes
of developing an Addisonian crisis, a life-threatening complication characteristic of Addison disease. or seated for at least 2hrs is 2-5x supine value.
in which severe hypotension, cyanosis, fever, nausea, vomiting, and Management/Treatment • Urine aldosterone - 14-56 nmol/24 hrs
signs of shock develop. • Combination of glucocorticoids medications
• Hormone replacements Nursing Interventions:
Take note! Even slight overexertion, exposure to cold, acute • Oral corticosteroids • Monitor VS, I&O, daily weigh
infection, or a decrease in salt intake may lead to circulatory, • Hydrocortisone • Maintain sodium restriction as ordered
collapse, shock, and death, if untreated. The stress of surgery or • Administer spironolactone (Aldactone) and potassium
dehydration resulting from preparation for diagnostic tests or surgery Nursing Intervention: supplements as ordered.
may precipitate an Addisonian or hypotensive crisis because of the • Administer HRT as ordered. (kung kulang ng hormone, edi bigyan ng • Prepare the client for an adrenalectomy if indicated
inhibited feedback loop. hormone, HRT – Hormonal Replacement Therapy) • Provide client teaching and discharge planning concerning:
- Glucocorticoids (Cortisone, Hydrocortisone) – simulate diurnal rhythm of - Use and side effects of medication if the client is being
cortisol release, give 2/3 of dose in early morning and 1/3 of dose in maintained on spironolactone therapy.
afternoon. - Signs of symptoms of hypo/ hyperaldosteronism
- Mineralocorticoids (Fludrocortisone acetate) - Need frequent blood pressure checks and follow-up care.
• Monitor VS
• Decrease stress in the environment. PHEOCHROMOCYTOMA
• Provide rest periods; prevent fatigue.
• Prevent exposure to infection. - A rare tumor that is usually benign and originates from
• Monitor I&O, weigh daily. the chromaffin cells of the adrenal medulla. Hyper-
• Provide proper nutrition in small, frequent feedings of diet high in Sugar functioning tumor of the adrenal medulla resulting to
(carbohydrate), Salt (sodium) and Protein excessive secretion of epinephrine & norepinephrine.
• Monitoring and managing Addisonian Crisis-shock; hypotension; rapid, - Produce high levels of chemicals called
weak pulse; rapid respiratory rate; pallor; and extreme weakness. catecholamines, which are strong hormones
- Immediate treatment with IV administration of fluid, glucose, associated with stress, and they act on the
and electrolytes, especially sodium; replacement of missing cardiovascular system to increase heart rate, blood
steroid hormones; and vasopressors. pressure, and blood flow.
Assessment and Diagnostic Test: • Restoring fluid balance - Pheochromocytoma may occur at any age, but its
• Low cortisol levels - Assist in restoring and maintaining fluid and electrolyte balance
• Leukocytosis- ↑ WBC count which in turn maintains adequate cardiac output. CATECHOLAMINES
• Frequent hypoglycemic reactions • Provide client teaching and D/C planning concerning:
• Bronze like pigmentation of the - Use of prescribed medications for lifelong replacement therapy; never - Help the body respond to stress or fright and prepare
skin - Due to ↑ MSH (Melanocyte- omit medications. the body for "fight-or-flight" reactions. The adrenal
stimulating hormone) 2° to - Need to avoid stress, trauma, and infections, and to notify physician if glands make large amounts of catecholamines as a
loss of adrenal-hypothalamic- these occur as medication dosage may need to be adjusted reaction to stress. The main catecholamines are
pituitary feedback system - Stress management techniques epinephrine (adrenaline), norepinephrine
• Decreased capacity to deal with - Diet modification (noradrenaline), and dopamine.
stress. - Use of salt tablets (if prescribed) or ingestion of salty foods (potato chips)
• Medical history if experiencing increased sweating. Risk Factors:
• Symptoms that the patient is - Importance of alternating regular exercise with rest periods, avoidance • Hereditary
experiencing. of strenuous exercise especially in hot weather. • Age
• Physical examination Signs and Symptoms:
CONN’S SYNDROME (HYPERALDOSTERONISM) Typical triad of symptoms
- Excessive aldosterone secretion from the adrenal cortex
• Headache ordered; observe post adrenalectomy client carefully for regulating and maintaining a balance of two minerals
• Profuse sweating shock due to drastic drop in catecholamine level. in the body — calcium and phosphorus.
• Palpitations (Rapid heartbeat) and tachycardia • Provide client teaching and discharge planning: same as
• Apprehension (Anxiety or fear) - Deficiency of PTH that leads to hypocalcemia and
for adrenalectomy.
• Nausea, vomiting, diarrhea, abdominal pain, and a feeling of impending produces neuromuscular symptoms ranging from
doom. PARATHYROID GLAND paresthesia to tetany.
• Hypertension may be intermittent or persistent - Results in Hyperphosphatemia (increased blood
- Are four small glands of the endocrine system which regulate
• Hyperglycemia- may result from conversion of liver and muscle phosphate levels) and hypocalcemia (decreased blood
the calcium in the body. Parathyroid glands are located in the
glycogen to glucose due to epinephrine secretion calcium levels).
neck behind the thyroid (posterior surface of the thyroid gland)
• Dilation of pupils
• Flushing where they continuously monitor and regulate blood calcium Causes:
• Cold extremities levels. • Congenital absence
• Tremors - Produces parathyroid hormone (PTH) or parathormone which • Destruction of the parathyroid glands (surgical removal or
• Paleness in the face regulates calcium and phosphorous balance by affecting GI autoimmune response)
• Shortness of breath absorption if calcium, bone resorption (removal if bone tissue • Removal of the parathyroid glands- most common cause which
• Panic attack-type symptoms by absorption) of calcium, and renal regulation of both calcium results in inadequate secretion of parathormone.
The patient may experience headache, vertigo, blurring of vision, and phosphorus. • Post-thyroidectomy
tinnitus, air hunger, and dyspnea. • Massive thyroid radiation therapy
• Hyperparathyroidism – Hypercalcemia • Neck surgery
Assessment and Diagnostic Test: • Hypoparathyroidism – Hypocalcemia • Abnormal parathyroid development
• ↑ plasma levels of catecholamines • Low levels of magnesium in the blood
• ↑ blood sugar - Increased secretion of parathormone results in increased • Extensive cancer radiation treatment of face or neck
• Glycosuria calcium absorption from the kidney, intestine, and bones, which • Iodine deficiency
• ↑ urinary catecholamines and urinary vanillylmandelic acid (VMA) raises the serum calcium level. Risk Factors
levels - Parathormone also tends to lower the blood phosphorus level. • Recent neck surgery, particularly if the thyroid was involved
• Presence of tumor on x-ray • A family history of hypoparathyroidism
- Some actions of this hormone are increased by the presence of • Having certain autoimmune or endocrine conditions, such as
Just remember the “5 Hs”: vitamin D.
Hypertension Addison's disease — which causes a decrease in the hormones
Headache that adrenal glands produce.
Hyperhidrosis (excessive sweating)
Hypermetabolism Signs and symptoms:
Hyperglycemia • +Chvostek’s sign -is positive when a sharp tapping over the
facial nerve just in front of the parotid gland and anterior to the
• Plasma free metanephrine test ear causes spasm or twitching of the mouth, nose, and eye
Laboratory result: • +Trousseau’s sign- is positive when carpopedal spasm
• Serum epinephrine – 0-140 pg/ml [764.3 pmol/L (involuntary contraction of the muscles in the hand and wrist) is
• Norepinephrine – 70- 1700pg/ml or 413.8- 10048.7pmol/L induced by occluding the blood flow to the arm for 3minutes with
• Catecholamine test uses a sample of blood or urine to measure a blood pressure cuff.
levels of some adrenal hormones. • Tetany -general muscle hypertonia, with tremor and spasmodic
• Normetanephrine – 18- 111 pg/ml or uncoordinated contractions occurring with or without efforts to
• Metanephrine – 12-60 pg/ml make voluntary movements.
• Urine catecholamines – 14-110mcg/24 hrs • Paresthesia (Tingling or burning in fingertips, toes and lips)
• VMA – Vanillyl Mandelic Acid is produced in the liver and is a • INCREASED neuromuscular irritability, ↑ DTR
major product of epinephrine and norepinephrine metabolism which • Involuntary tremors and muscle spasms
is excreted in the urine. • Psychosis, irritability, depression, and even delirium.
- Preparation: No food and fluid with coffee, tea, cocoa, chocolate for • Dysphagia, abdominal pain, nausea, vomiting, diarrhea and
48 hours before the test anorexia
- Normal level 2-7 mg/24 hours • Photophobia “abnormal sensitivity to light, especially of the
eyes”
Management: FUNCTION • Cardiac arrhythmias, bronchospasm, laryngospasm-further
•Surgery to remove the tumor- adrenalectomy (removal of one or complications may cause respiratory obstruction.
• Release of calcium by bones into the bloodstream.
both adrenal glands) • Cataracts
• Absorption of calcium from food by the intestines. • Hair loss, brittle nails, dry, course skin
Nursing Intervention: • Weakened tooth enamel
• Monitor vital signs, especially blood pressure. • Conservation of calcium by the kidneys.
• Administer medications as ordered to control hypertension. • Stimulates cells in the kidney to transform weaker forms of vitamin D
• Promote rest; decrease stressful stimuli. into the form that is strongest at absorbing calcium from the intestines.
• Monitor urine tests for glucose and acetone
• Provide high-calorie, well-balanced diet; avoid stimulants HYPOPARATHYROIDISM
such as coffee and tea. - Is an uncommon condition in which the body produces
• Provide care for the client with an adrenalectomy as abnormally low levels of parathyroid (PTH). PTH is key to
 • Encourage to take high calcium and low phosphate diet early in the
disease process.
• Creams and lotions can be used to sooth dry skin.
• Keep environment free of noise, drafts, bright lights, or sudden
movement especially to those pt w/ hypocalcemia and tetany- because
of neuromuscular irritability.
• A diet high in calcium and low in phosphorus is prescribed.
Although milk, milk products, and egg yolk are high in calcium, they are
restricted because they also contain high levels of phosphorus.
• Spinach also is avoided because it contains oxalate, which would form
insoluble calcium substances.
HYPERPARATHYROIDISM
- Is a condition in which one or more of the parathyroid glands
become overactive and release (secrete) too much parathyroid
hormone (PTH). This causes the levels of calcium in the blood
to rise, a condition known as hypercalcemia.
- Characterized by bone decalcification and the development of
Assessment and Diagnostic Test: renal calculi (kidney stones) containing calcium. -↑ levels of
• Blood test that measures levels of calcium, phosphorus, magnesium extracellular calcium that has been deposited in the soft tissues of
Risk Factor:
and PTH the body and kidney, this may also lead to renal insufficiency, UTI,
Age- Older than 50 years old
• Urine test and renal failure.
Gender- affects women more than men. Postmenopausal women.
• X-ray - Primary hyperparathyroidism occurs two to four times
- ↓PTH <10 pg/dL more often in women than in men and is most common in
Signs and Symptoms:
- ↓serum calcium <8.5 mg/dL people between 60 and 70 years of age.
The patient may have no symptoms or may experience signs and
- ↑serum phosphate - Secondary hyperparathyroidism occurs in patients who
symptoms resulting from involvement of several body systems.
- X-ray reveals increased bone density. Calcification is detected on x- have chronic kidney failure and the so-called renal rickets
• Joint pain, skeletal pain and tenderness.
rays of the subcutaneous or paraspinal basal ganglia of the brain. as a result of phosphorus retention, increased stimulation of the
• Muscle weakness, fatigue.
- ECG- prolonged QT intervals and QRS complex and ST parathyroid glands, and increased parathormone secretion.
• Feeling tired
segment changes. - Hypercalcemia is the identifiable result of
• Depression
hyperparathyroidism. Calcium excess and phosphorus
• Trouble concentrating
Management/Treatment: deficiency. Since the bones hold the majority of the body’s
• Loss of appetite
• Oral calcium carbonate tablets. Oral calcium supplements can calcium, extracellular hypercalcemia is a result to
• Apathy
increase calcium levels in the blood. Calcium Citrate, Caltrate Plus, demineralization of the bones.
• Hypertension and cardiac arrhythmias.
Calcium carbonate, given with meals bec. It requires stomach acid to - Calcium in the bones is replaced by cysts and fibrous tissue,
Assessment:
dissolve and absorb it. thus leading to severe osteoporosis and osteopenia.
• CNS – psychomotor and personality disturbances, loss of
- Life-threatening hypocalcemia and tetany are managed by memory, depression, psychosis, confusion, disorientation, stupor
IV calcium gluconate to raise calcium levels. Causes:
and coma- caused by the direct action of calcium on the brain
• Vitamin D supplements • A noncancerous (benign) growth, called an adenoma, forms on a single
and nervous system. An increase in calcium produces a decrease
• Magnesium parathyroid gland. The adenoma causes the gland to overact and make
in the excitation potential of nerve and muscle tissue.
• Thiazide diuretics more PTH. This is the most common cause.
• GI – abdominal pain, anorexia, nausea, vomiting, dyspepsia and
• Parathyroid hormone • Two or more of the parathyroid glands become enlarged, a condition
constipation. Peptic ulcer and pancreatitis are increased w/
• Sedatives (Pentobarbital) and anti-convulsant are used to prevent called hyperplasia, and produce too much hormone.
hyperparathyroidism.
seizures. • Radiation treatment to the head and neck area.
• Neuromuscular – fatigue, marked muscle weakness and
•Aluminum hydroxide gel or aluminum carbonate also is given after • Inherited conditions, such as multiple endocrine neoplasia type 1. This is
atrophy-
meals to bind phosphate and promote its excretion through the GI a rare cause. -a group of disorders that affect the body’s network of
• Renal – nephrolithiasis, renal insufficiency
tract. hormones producing glands.
• Skeletal – chronic lower back pain, fractures, bone tenderness
• Pancreatic and pituitary cancer
and joint pain, deformities, and shortening of body
Nursing Intervention: • Cancer of a parathyroid gland (rare)
stature. - musculoskeletal symptoms may be caused by
• Maintain a patent IV line & keep calcium gluconate 10% solution • Secondary hyperparathyroidism can occur due to
demineralization of the bones or by bone tumors composed of
available o rickets (softening of the bone)
benign giant cells resulting from overgrowth of osteoclasts.
• Administer prescribed sedatives, anticonvulsants & calcium o vitamin D deficiency
• Vision impairment – scleritis/ red eye keratopathy,
gluconate (slow IV) o chronic renal failure
asymptomatic conjunctival
• Institute seizure precaution o phenytoin and laxative abuse
• Calcification and conjunctivitis
• Keep a tracheostomy set and endotracheal tube available- if the
patient develops respiratory distress a mechanical ventilation may
become necessary.
• Administer medications that cause bronchodilation in order to
provide respiratory support- in case there is respiratory distress.
• Watch out for cardiac arrhythmias and decreased cardiac output
 • Medications – Furosemide and ethacrynic acid, oral calcitonin, oral The nervous system is an exceedingly complex arrangement of
potassium phosphate nerve cells and their fibers that extends throughout the body;
•Don’t take thiazide diuretics or lithium because these drugs can increase main functions include:
the level of calcium in the blood- because they decrease the renal A. Receives, processes, and interprets sensory stimuli.
excretion of calcium and further elevate serum calcium levels. B. Initiates and coordinates voluntary muscular
• Vitamin D supplement if vitamin D level is low. movement.
C. Regulates autonomic processes such as:
Nursing Interventions: 1.Heartbeat
- Record I&O accurately 2.Vascular constriction and dilatation
- Strain all urine to check for stones 3.Bronchiolar caliber
- Monitor electrolyte levels (Na+, K+, Mg++) 4.Sweating
- Be alert for pulmonary edema if IVF therapy is initiated 5.Gastrointestinal secretion and motility
- Prevent injury due to fracture: Provide a safe environment
to ensure against complications related to potential osteoporosis and joint
and bone pain. D. Carries out complex mental functions and
- Monitor for cardiac arrhythmias and decreased cardiac operations including:
output 1. Memory and recall of past events
- Increase fluids, 2-3 L, cranberry juice. Drink more water. - to help 2. Recognition of persons and objects
Diagnostic Test: prevent calculus formation. 3. Abstract reasoning
• A blood test to check vitamin D level - Encourage mobility. Keep active and get more exercise to keep the 4. Practical problem solving
• A bone density test to check for bone loss bones strong. Bones subjected to the normal stress of walking give up less 5. Judgement- if you’re doing what is right
• An ultrasound or other imaging test of the kidneys to check for calcium. Bed rest increases calcium excretion and the risk of renal calculi. or wrong
kidney stones (Nephrolithiasis) -related to the ↑ urinary excretion of 6. Language production
calcium and phosphorus. 7. Comprehension
• A 24-hour urine collection test to measure the amount of calcium E. Set of mood and emotions
and other chemicals in the urine to help determine the cause of ANATOMY AND PHYSIOLOGY
hyperparathyroidism NEURON - basic functional unit of the brain composed of
• Blood tests to check how well the kidneys are working dendrites, a cell body (soma) and an axon.
• ↑ serum calcium, with decreased level of phosphate a. Dendrites - receives electrochemical messages. AFFERENT
• ↑ concentration of parathormone. (toward)
• X-rays will show diffuse demineralization of bones, bone cysts, b. Axon - carries electric impulses Away from the cell.
erosions. EFFERENT (away)
• ↑ urine and serum calcium c. Myelin Sheath - increases speed of conduction. Some axons
• ↑ alkaline phosphatase levels have a myelinated sheath. -like insulating layer
• UTZ, MRI Midterm Week TOPICS:
• Normal Values -Anatomy and Physiology of Nervous
- PTH- 10-55 pg/ml System
- Serum Calcium- 8.6- 10 mg/dl
- Serum phosphate- 2.5-4.5 mg/dl
- Alkaline phosphatase- 44- 147 IU/L

Management/ Treatment:
09 -Assessment, Diagnostic Tests,

• Surgery to remove the adenoma NERVOUS SYSTEM

• Increased fluids to force diuresis The function of the nervous system is to control motor, sensory,
autonomic, cognitive, and behavioral activities. The brain itself
contains more than 100 billion cells that link the motor and sensory
pathways, monitor the body’s processes, respond to the internal and
external environment, maintain homeostasis, and direct all psychological,
biologic, and physical activity through complex chemical and electrical • All nerve tissue is made up of nerve cells
messages. • Each nerve cell (neuron) consists of a cell like body containing a
nucleus, one or more short treelike processes called
1. Central Nervous System (CNS) dendrites, and a single long, straight process, called the
• Brain axon.
• Spinal cord • Dendrites conduct nerve impulses toward the cell body and are
2. Peripheral Nervous System (PNS) therefore called afferent processes.
• Cranial nerves • Axons conduct impulses away from the cell and are therefore
• Spinal nerves called efferent processes.
• Autonomic nervous system- this system works automatically • The point of contact between processes of two different cells is
without a person’s conscious effort. called a synapse.
• Dietary restrictions of calcium • Ganglia or nuclei- Nerve cell bodies occurring in clusters.
• Center – A cluster of cell bodies with the same function. (E.g., • ↓ or insufficient production of dopamine can cause depression.
respiratory center) NOREPINEPHRINE
• Neurons are supported, protected, and nourished by glial cells, -Norepinephrine (heart ↑preload)
which are 50 times greater in number than neurons. • Major transmitter of SNS
• Usually, excitatory
NEUROTRANSMITTER • Affects mood and overall activity
- Communicate messages from one neuron to another neuron or to a ↑ Force of skeletal muscle contraction
specific target tissue, such as muscle or endocrine cells. ↑ HR and Contractions
- Manufactured and stored in synaptic vesicles ↑ BP and Blood glucose – due to vasoconstriction
- Diffuses/transported across the synapse, binding to receptors in the ↑ Extra energy – somewhat similar with ADRENALINE
post-synaptic cell membrane Indicated to pt. w/ life-threatening HYPOTENSION.
Action: -Do not exceed to 10 ampoules
- Potentiates – Releases/Activates
- Terminates - Stop GAMA-AMINOBUTYRIC ACID (GABA)
- Modulates - Regulates • Inhibitory -Blocks or inhibits certain brain signals and decreases
- Excite- Increase energy, mood & emotions activities of Nervous system.
- Inhibit activity of the target cell- Decrease actions • Treatment ADHD
- Usually, multiple neurotransmitters are at work in the neural • Stabilized BP
synapse. Once released, enzymes either destroy the • Improve Mood and Relax
neurotransmitter or reabsorb it into the cell for future use. • Relieve Anxiety
• Relieve pain CEREBRUM
- Ongoing research is evaluating diagnostic tests that can detect
• Helps the body to sleep - The cerebrum is composed of two hemispheres, the thalamus,
abnormal levels of neurotransmitters in the brain. Positron
ENKEPHALIN and ENDORPHIN the
emission tomography (PET), for example, can detect dopamine,
• Enkephalin (spinal cord), endorphin (brainstem) hypothalamus, and the basal ganglia.
serotonin, and acetylcholine. Single photon emission computed
tomography (SPECT), similar to PET, can detect changes in some • Excitatory
neurotransmitters such as dopamine in Parkinson’s disease. • Pleasurable sensations
-Many neurologic disorders are, at least in part, to an imbalance in • Inhibits pain transmission
neurotransmitters. • Bind w/ the opioid/opiate receptor on nerve cells
-All brain functions are modulated through neurotransmitter receptor
site activity, including memory and other cognitive processes.

ACETYLCHOLINE
• Major transmitter of PNS
• Usually excitatory (increased);
• PARAsympathetic (Rest and Digest) effect
• Sometimes inhibitory (stimulation of heart by vagal nerve)
• It causes muscles to contract
• Activates pain responses
• Carries signals from motor neurons to the body’s skeletal muscles
THALAMUS
• Foods rich in Acetylcholine- Whole egg, meat, fish, and whole
- lies on either side of the third ventricle and acts primarily as a
grains.
relay station for all sensation except smell. All memory,
• Responsible for enhancing memory, learning, and attention.
sensation, and pain impulses pass through this section of the
• When there is an ↑ level of Acetylcholine to the brain and body it
brain.
may cause muscle cramps and muscle weakness.
HYPOTHALAMUS
SEROTONIN
-is located anterior and inferior to the thalamus, and beneath and
• Happy chemicals
CENTRAL NERVOUS SYSTEM lateral to the third ventricle.
• Inhibitory
- Approx 2% of the total body weight, 1400g (average young adult) 1200g - The hypothalamus plays an important role in the
• Mood control and sleep
(elder persons). endocrine system because it regulates the pituitary
• Inhibits pain pathways
Divided into 3 parts: secretion of hormones that influence metabolism,
• ↑ level causes the pt to laugh more overly happy
• Cerebrum reproduction, stress response, and urine production.
• ↓ level causes sadness, depression, irritable and being anxious
• Not too much, not too little. • Cerebellum
• Brainstem - It works with the pituitary to maintain fluid
DOPAMINE
balance through hormonal release and maintains
• Usually, inhibitory
temperature regulation by promoting
• Affects behavior (attention and emotion)
vasoconstriction or vasodilatation.
• *Fine movements ↓ dopamine causes Parkinson’s Disease due to
resting tremors
- Site of the thirst and hunger center and is involved
• Feeling of pleasure, satisfaction, and motivation.
in appetite control.
• Responsible for happiness.
• Associated with wakefulness.
 - It contains centers that regulate the sleep–wake cycle,
blood pressure, aggressive and sexual behavior, and
emotional responses (ie, blushing, rage, depression,
panic, and fear).
- The hypothalamus also controls and regulates the
autonomic nervous system. The optic chiasm (the point at
which the two optic tracts cross) and the mamillary bodies
(involved in olfactory reflexes and emotional response to
odors) are also found in this area.
BASAL GANGLIA
-are masses of nuclei located deep in the cerebral hemispheres that
are responsible for control of fine motor movements, including those
of the hands and lower extremities.
Parkinson’s disease- resting tremors
CORPUS CALLOSUM
- A thick collection of nerve fibers that connects the two hemispheres
of the brain, is responsible for the transmission of information from
one side of the brain to the other.
- Information transferred includes sensation, memory, and
learned discrimination.
- Right-handed people and some left-handed people have
cerebral dominance on the left side of the brain for verbal,
linguistic, arithmetic, calculation, and analytic functions.
CEREBRAL CORTEX
- • Frontal, Temporal, Parietal, Occipital, Sphenoid
Made up of gray matter approximately 2 to 5 mm in depth; it
contains billions of neuron cell bodies, giving it a gray appearance.
• Gray matter (outer portion)
• White matter (innermost layer)
- White matter makes up the innermost layer and is composed of
myelinated nerve fibers and neuroglia cells that form tracts or
pathways connecting various parts of the brain with one another.
- These pathways also connect the cortex with lower portions of the
brain and spinal cord. The cerebral hemispheres are divided into
pairs of lobes.
FRONTAL LOBE
-The largest lobe, located in the front of the brain. The major functions PONS
of this lobe are concentration, abstract thought, information storage - The pons is situated in front of the cerebellum between the
or memory, and motor function. It contains Broca’s area, which is midbrain and the medulla and is a bridge between the two halves
located in the left hemisphere and is critical for b. The frontal lobe is also of the cerebellum, and between the medulla and the midbrain.
responsible in large part for a person’s affect, judgment, personality, - It also contains motor and sensory pathways. Portions of the
and inhibitions. pons help regulate respiration.
- Cranial nerves V through VIII originate here.
PARIETAL LOBE
- A predominantly sensory lobe posterior to the frontal lobe. This lobe MEDULLA OBLONGATA
analyzes sensory information and relays the interpretation of this - Motor fibers from the brain to the spinal cord and sensory
information to other cortical areas and is essential to a person’s awareness fibers from the spinal cord to the brain are located in the
of body position in space, size and shape discrimination, and left-right medulla.
orientation. Spatial awareness. -. Reflex centers for respiration, blood pressure, heart rate,
coughing, vomiting, swallowing, and sneezing are located in
TEMPORAL LOBE the medulla as well.
- Located inferior to the frontal and parietal lobes, this lobe contains - Cranial nerves IX through XII originate here.
the auditory receptive areas and plays a role in memory of sound - The reticular formation, responsible for arousal and the sleep–
and understanding of language and music. wake cycle, begins in the medulla and connects with numerous
higher structures.
OCCIPITAL LOBE -Decussation (the action of intersecting or crossing nerve
-Located passing from center to the opposite side of the brain) of motor
posterior to the and sensory pathways.
parietal lobe, this
lobe is PROTECTIVE STRUCTURES:
responsible for SKULL
visual
interpretation - Rigid protection for injury
and memory. Major bones of the skull:
CEREBELLUM - These bones join at the suture lines and form the base of the
- The cerebellum skull.
is posterior to - Indentations in the skull base are known as fossae.
the midbrain • Anterior fossa- contains frontal lobe.
and pons, and • Middle fossa- contains the temporal lobe.
below the • Posterior fossa- contains the cerebellum and brain
occipital lobe. stem.
The cerebellum MENINGES
integrates:
-Sensory information to provide smooth coordinated movement. - Fibrous connective tissues that cover the brain and spinal cord
- It controls fine movement - It provides protection, support, and nourishment.
- Position (postural) sense - The layers of the meninges are the ff:
- Proprioception (awareness of where each part of the body.
-Involves balance, maintenance of muscle tone, and coordination of DURA MATER
Fine motor movements. - outermost layer; covers the brain and the spinal cord.
-Loss of coordination in motor movement has unstable gait and has - It is tough, thick, inelastic, fibrous, and gray.
difficulty in walking (swaying while walking). NI: Wide-based gait walking - There are three major extensions of the dura:
to prevent injury/fall. • falx cerebri-which folds between the two
Ataxia- Uncoordinated movement. hemispheres
• tentorium- which folds between the occipital lobe
BRAINSTEM and cerebellum to form a tough, membranous shelf;
- The brain stem consists of the midbrain, pons, and medulla oblongata. and the
•falx cerebelli- which is located between the right
and left side of the cerebellum.
MIDBRAIN
- The midbrain connects the pons and the cerebellum with the cerebral ARACHNOID
hemispheres. - middle membrane; an extremely thin, delicate membrane that
- It contains sensory and motor pathways and serves as the center for closely resembles a spider web (hence the name arachnoid).
auditory and visual reflexes. -The arachnoid membrane has cerebrospinal fluid (CSF) in the
- Cranial nerves III and IV originate here. space below it, called the subarachnoid space. This membrane
has unique fingerlike projections, called arachnoid villi, that
absorb CSF into the venous system. When blood or bacteria enter - The thinner posterior (upper horns) portion contains cells with fibers that • Transmit sensory impulses, Somatic (pain, temp, touch),
the subarachnoid space, the villi become obstructed and enter over the posterior (sensory) root and thus serve as a relay station in Visceral (internal organs)
communicating hydrocephalus (increased size of ventricles) may the sensory/reflex pathway. VENTRAL ROOT
result. PERIPHERAL NERVOUS SYSTEM • Transmit motor impulses
PIA MATER - The nerves of the peripheral nervous system are responsible for relaying • Visceral (autonomic fibers) - cardiac muscles or glandular
- Innermost, thin, transparent layer information between the body and the brain. This includes involuntary
- Hugs the brain closely and extends into every fold of the brain’s body functions such as breathing, blood flow, and heartbeat as well as
surface. sensory information and control of voluntary movement.
Divided into three parts:
1. Cranial nerves
2. Spinal nerves
3. Autonomic nervous system

CEREBROSPINAL FLUID (CSF)

- Clear and colorless fluid that is produced in the choroid plexus of
the ventricles and circulates around the surface of the brain and the
spinal cord. AUTONOMIC NERVOUS SYSTEM
- Protects brain and spinal cord from trauma - Regulates the activities of internal organs such as the
- Supplies nutrients to nervous system tissue heart, lungs, blood vessels, digestive organs, and
- Removes waste products from cerebral metabolism glands.
- There are four ventricles: the right and left lateral and the third and - Maintenance and restoration of internal homeostasis
fourth ventricles. The two lateral ventricles open into the third
ventricle at the interventricular foramen or the foramen of Monro. 2 MAJOR DIVISION:
- CSF is important in immune and metabolic functions in the brain. It - Sympathetic Nervous System -with predominantly
is produced at a rate of about 500 mL/day; the ventricles and excitatory responses (i.e., the “fight-or-flight” response)
subarachnoid space contain approximately 150 mL of fluid. - Parasympathetic Nervous System- which controls
- A laboratory analysis of CSF indicates color (clear), specific gravity mostly visceral functions. (“Rest” or “Digest”)
(normal 1.007), protein count, white blood cell count, glucose, and
other electrolyte levels.
- The CSF may also be tested for immunoglobulins or presence of ASSESSMENT OF THE NERVOUS SYSTEM
bacteria.
z- Normal CSF contains a minimal number of white blood cells and - Assessment is a primary function of the nurse to identify
no red blood cells. abnormalities in the client. Thorough history, physical
examination and neurological assessment are necessary to
BLOOD BRAIN BARRIER identify nervous system disorders.
- Protects the brain making it inaccessible for other substances
- Formed by endothelial cells of the brain’s capillaries, forming • Assessment starts from identifying clinical manifestations seen
continuous tight junctions creating barriers to macromolecules in the patient.
• A systematic head to toes assessment is done with neurologic
SPINAL CORD examination. Diagnostic tests are included, and nursing
- Connects the brain to the periphery preparation is an important part of diagnostic procedures.
- Approximately 45 cm (18 inches) long and about the thickness of a • Nurses do not interpret diagnostic tests, but nurses should know
finger the significant findings and correlated them with certain
SPINAL NERVES disorders.
- Ends at the L2 (2nd lumbar vertebra)
- 31 pairs of spinal nerves
- The anterior horns contain cells with fibers that form the anterior
● 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal HEALTH HISTORY
(motor) root and are essential for the voluntary and reflex activity of
DORSAL ROOT
the muscles they innervate.
• Past health history, family history and social history may contribute done from stimulation to impulse transmission and integration of sensory
to the development of diseases in client with neurologic disorders. impulses.
• A good interview would result to complete understanding of the
patient’s condition. All of these must be presented in a paragraph • Reflexes are tested, especially deep tendon reflexes. Alterations in
form with full description on how the patient experienced these sensory function can be determined during assessment.
manifestations.
The health history therefore includes details about the: NEUROLOGICAL ASSESSMENT
• Onset, character, severity, location, duration, and frequency of 1. Level of Consciousness (LOC)
signs and symptoms • Patient’s wakefulness and ability to respond to environment
• Associated complaints. • Most sensitive indicator of neurologic function
• Precipitating, aggravating, and relieving factors • LOC is the EARLIEST sign of increasing intracranial pressure
• Progression, remission, and exacerbation; and
• The presence or absence of similar symptoms among family Confusion- UNABLE TO UNDERSTAND CLEARLY
members. Disorientation- LOST
Common signs and symptoms associated with neurologic Lethargy- LACK OF INTEREST
disease: Obtundation- DULLNESS/ MENTALLY SLOW
• Pain- considered and unpleasant sensory perception and emotional Stuporous- UNABLE TO THINK NORMALLY
experience associated with actual or potential tissue damage or Coma- PROFOUND UNCONSCIOUSNESS
describe in terms of such damage. SUBJECTIVE
• Balance and coordination- Cerebellar and basal ganglia
• Seizures- are the result of abnormal electrical discharges in the
influence on the motor system is reflected in balance control and
cerebral cortex, which then manifest as an alteration in sensation,
coordination.
behavior, movement, perception, or consciousness.
- Romberg’s test (assess patient’s ability to stand with the feet
• Dizziness & vertigo- abnormal sensation of imbalance or
parallel and together with the eyes open and then close foe 30s)
movement.
- Checks for ataxia incoordination
• Visual disturbances
• Muscle weakness- common manifestation of neurologic disease.
4. Examine sensory system
It frequently coexists with other symptoms of disease and can affect
• Agnosia- is the general loss of ability to recognize objects
a variety of muscles, causing a wide range of disability.
through a particular sensory system
• Abnormal sensation- neurologic manifestation of both central
and peripheral nervous system disease. It is frequently associated
5. Examine reflexes
with weakness or pain and is potentially disabling.
• Deep tendon reflexes
Symptoms may be subtle or intense, fluctuating or permanent,
- Biceps reflex
inconvenient or devastating.
- Triceps reflex
- Brachioradialis reflex
- Patellar reflex
Past Health, Family, and Social History
- Achilles reflex
• The nurse may inquire about any family history of genetic diseases.
• A review of the medical history, including a system-by- system
evaluation, is part of the health history.

• The nurse should be aware of any history of trauma or falls that

may have involved the head or spinal cord. 2. Examine Cranial Nerves
• Questions regarding the use of alcohol, medications, and il- licit Cranial nerves are assessed when level of consciousness is decreased,
drugs are also relevant. with brain stem pathology, or in the presence of peripheral nervous
- The history-taking portion of the neurologic assessment is critical system disease.
and, in many cases of neurologic disease, leads to an accurate
diagnosis. 3. Examine motor system
• Motor ability- A thorough examination of the motor system includes an
PHYSICAL ASSESSMENT assessment of muscle size and tone as well as strength, coordination, and
5 Components of Neurologic Assessment: consciousness and balance.
cognition, cranial nerves, motor system, sensory system, and • Motor strength- Assessing the patient’s ability to flex or extend the
reflexes. extremities against resistance tests muscle strength.
• Neurologic assessment is a systematic process which include a - 5-point scale
variety of tests and observations designed to evaluate neurologic
functions.
•This will start from assessing consciousness and cognition of the
client, mental status, intellectual function, thought content, emotional
status and level of consciousness. Cranial nerve assessment follows.
• All cranial nerves functions are assessed and evaluated for
abnormalities. Examining the motor system include motor ability,
muscle strength, balance and coordination which sensations are
 - Plantar reflex ● This test identifies different tissues in
the brain, the skull, cortical tissues,
subcortical areas and the ventricles.
Assesses
- Tumor
- Ischemia/Infarction
- Bleeding
- Lesion
- Edema

Superficial reflexes
- Corneal reflex

Pathologic reflexes
- Babin
Magnetic Resonance Imaging (MRI)
-Non-invasive imaging technique thatuses magnetic field
-Uses powerful magnetic field to visualize body parts, does not involve
ionizing radiation and does not use anycontrast.
-This test can identify cerebral abnormalities such as brain tumor,
stroke and multiple sclerosis

• much clearer than CT scan.

Assesses

- Gag reflex - Tumor

- Ischemia/Infarction
- Bleeding
- Lesion
- Edema
Nurse Assess for:
- Claustrophobia
- (+) sedation
Instruct
- Remain still
- Normal to hear loudsound
- Cremasteric reflex Contraindicated
- (+) implants
- (+) clips
- (+) peacemakers

Remove
- Metallic jewelries
- Credit cards
Computed Tomograpic Scan (CT Scan)
● Shows a detail in a specific plane in thebody using
radiation
● imaging procedure the machine uses anarrow x
ray beam to scan the body parts in successive
layers.
 Anesthesia
Lumbar Puncture
- Local
● CSF analysis will be done after
aspirating CSF from the lumbar area. Consent
● Lumbar puncture is not done if there is - Secured by RN
an increased ICP.
● CSF analysis is useful to check the Contraindication
presence of infection in the CNS. - Patients with
Antibodies may also be checked to rule increased ICP Post
out possibility of autoimmune disease.
Procedure
● Patient will be place side lying with
- Prone position
knees on the chest.
● Local anesthesia will be given and - Flat on bet with only 1 pillow
patient is advised not to move as (>20 0f csf isremoved)
discomfort maybe felt during the
procedure. Positron Emission Tomography
Position ● is a computer-based nuclear imagingtechnique that
produces images of actual organ functioning.
- Lateral position ● Patient either inhales a radioactive gas or is injected
- C position with a radioactive substance that emits positively
- Shrimp position chargedparticles.
- Geno-pectal position ● This test allows measurement of bloodflow and brain
metabolism and
- Fetal
indirectly evaluate brain function.
position Site of
Nursing Preparation
Insertion
- includes explaining the test to
- Between: L3-L4 or the patientand teach clients
L techniques on
4- inhaling and the sensations that
L mayoccur.
5 - IV injection of radioactive
- Spinal cord ends substances may produce
atL1 effects likedizziness,
lightheadedness andheadaches.

Cerebral Angiography
● An x-ray study of cerebral circulation with contrast
agent injected into theselected artery
● dye is used and injected to the vesselto visualize
obstruction in the blood supply of the brain.
 patient that
● The test is used to diagnosed vascular 2. Electroencephalography (EEG)
pain may be
abnormalities in the brain. ● Represents a record of felt
Nursing Intervention electricalactivity generated in when
the brain
- explaining the electrodes are
procedure to the client ● most definitive diagnostic
inserted. (like
(pre-procedure) test toidentify seizure
disorders. IM
- Check kidney injection)
function ● EEG may last for 45 – 60 minutes.
doctor maygive
- Proper hydration (2 Nursing Intervention
days prior) NPO (8 analgesic to
- Deprivation of decrease the
hours prior) sleep(night
- The patient will be pain.
before)
asked for history of - Avoid
allergy to sea food or caffeinated
iodine because the dye beverages
that will be - No NPO -
injected is iodinated. altered
- Baseline vital signs bloog
- DURING glucose can
PROCEDURE - local alter brain
anesthesia will be done waves
and a catheter will be - Clean hair
inserted usually in the Hold (24-48 hrs) may alter
groin area, a catheter is theresult
inserted where the - Antisezure
dye is injected. agents
- Normal sensation of - Tranquilizers
warmth in the face, - Stimulants
behind eyes, jaw,
teeth, tounge, lips, and - Depre
metallic taste ssants Post
when contrast is
Procedure
injected
- Shampooing
- POST PROCEDURE
- Acetone
- monitoring the client
(colloidon glue
for pain and vs - Sleep EEG’s )
- Check injection sitefor
bleeding/hematoma 3. Electromyography (EMG)
- Patient must remain ● Obtaining by inserting a needle
lying for at least 4 electrodes in the skeletal muscles
hours as ordered. tomeasure chamges in the
- Rest for 3 days at electrical potential of muscles
home ● this test assesses muscle function.
● Useful in determining the presence
ofneuro muscular disorders and
myopathies
Nursing Intervention
- Instruct

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* ADDITIONAL TESTS
4. Myelography
● is an Xray of the spinal cord.
● This uses a dye that is injected
to visualize the tissues of the
spinal cord.
● This is used to identify tumors
in the spinal cord especially
those patients who cannot
undergo MRI. This is notvery
popular today because of the
advent of CT scan and MRI.
Nursing Intervention
- Asking the
client for
history of
allergy to
iodine
because
the dye to
be used is
iodinated.

5. Nerve Conduction Studies

● test is stimulating the nerves at
certainpoint toassess impulse
conduction.
● Several nerve disorders
and neuromuscular
abnormalities are
diagnosed with this test.
Nursing Intervention
- explains
the
procedure
and tells
the patient
to relax
and
remain
still all
througho
ut the
test.

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