electrochemical

RESPONSES TO ALTERED PERCEPTION ● Receiver of electrical impulses and

messages
(NEUROLOGICAL DYSFUNCTIONS
INTRODUCTION) Cell body
WEEK ● center; contains the nucleus
10
Axon
● A long projection that carries electrical
impulses away from the cell body. Nag
kaka access sa cell body. Portion of the
neuron that conducts impulses away from the
cell body.
● Some axons have a myelinated sheath
that increases speed of conduction.
(Some axon have or do not have myelin
sheath)
NERVOUS SYSTEM
Ganglia / Nuclei
● Nerve cells in cluster
○ A nerve cell bodies occuring in a
ANATOMY AND PHYSIOLOGY OF THE cluster called ganglia or nuclei.
NERVOUS SYSTEM ○ A cluster of cell bodies with the
NERVOUS SYSTEM same function is called a center
2 major parts Central nervous system & (e.g., the respiratory center)
Peripheral nervous system. ○ Neurons are supported,
Function of the nervous system is to control protected, and nourished by
motor, sensory, anatomic, cognitive & behavioral glial cells, which are 50 times
activities. greater in number than neurons.

Central nervous system NERVOUS SYSTEM

● Brain Neurotransmitters
● Spinal Cord ➔ It communicates messages from one
Peripheral nervous system neuron to another or from a neuron to a
● Somatic nervous system (SNS) target cell, such as muscle or endocrine
➢ Cranial nerve: are the 12 cells.
nerves of the peripheral nervous ➔ Neurotransmitters are manufactured
system and stored in synaptic vesicles.
➢ Spinal nerves: has a 31 nerves ➔ Neurotransmitters can be excitatory or
inhibitory activity of the target cell.
● Autonomic nervous system (ANS)
- Sympathetic nervous system Acetylcholine
(PNS): predominantly excitatory; Major transmitter of the parasympathetic nervous
arouses the body system inhibitory
● Source: Neurons in many areas of the
- Parasympathetic nervous brain; autonomic nervous system
system (PNS): predominantly ● Action: Usually excitatory (stimulated
inhibitory; calm after arousal by the cns), parasympathetic effects
NERVOUS SYSTEM sometimes inhibitory (stimulation of
Neuron heart by vagal nerve)
● A basic functional unit of the CNS
Serotonin
PARTS OF NEURON ● Source: Brain stem, hypothalamus,
Dendrites dorsal horn of the spinal cord
● receive electrical messages. ● Action: Inhibitory; helps control mood
branch-type structures for receiving and sleep, inhibits pain pathways
Dopamine
● Source: neurons on the substantia nigra
and basal ganglia
● Action: usually inhibitory; affects
behavior (attention, emotions) and fine
movement

Norepinephrine
Major transmitter of the sympathetic nervous system
● Source: Brain stem, hypothalamus,
postganglionic neurons of the
sympathetic nervous system
● Action: usually excitatory; affects mood
and overall activity

Gamma-aminobutyric acid (GABA)

● Source: nerve terminals of the spinal
cord, cerebellum, basal ganglia, some
cortical areas
● Action: inhibitory

Enkephalin, endorphin
● Source: nerve terminals in the spine,
brain stem, thalamus, and
hypothalamus, pituitary gland
Parasympathetic Sympathetic
● Action:excitatory; pleasurable
sensation, inhibits pain transmission Brain activity Brain activity
decreases increases
NERVOUS SYSTEM
Cerebral circulation Decreased Increased metabolic
● Brain receives 15% (approximately 750 metabolic rate rate
mL/min) of the total cardiac output
Constrict pupils Dilate pupils
NERVOUS SYSTEM
Blood-brain barrier (BBB) Stimulates saliva Inhibits saliva
● Filters substances that enters the CSF production production
● Has a protective action but can be
altered by trauma, cerebral edema, Slow heartbeat Accelerates
cerebral hypoxemia heartbeat

Constrict bronchi Dilates bronchi

Stimulates Inhibits peristalsis

peristalsis and and secretions
secretions

Stimulates release Glycogen → glucose

of bile

Secretion of
adrenaline and
noradrenaline
 4. Dizziness and vertigo (rotating)
Contracts the Inhibits bladder - Dizziness: Abnormal sensation
bladder contractions of balance or movement
- 50% of pts w/ dizziness has
Stimulates arousal, Stimulates orgasm, vertigo
erection ejaculation - Determine activity: Snellen chart

5. Visual disturbances Usually concerned

with diseases visual acuity
● Aging, glaucoma, cataract, tumor,
lesions in the visual cortex
- Glaucoma: Increase pressure in
eyeball, hypertension of the
eyes
- Catara: clouding ng senses, no
pain
6. Muscle weakness
7. Abnormal sensation (both cns & pns)

Neurological Assessment
Physical assessment
Indirect evaluation → Indirect evaluation of
brain and spinal cord: brain and spinal cord it
cannot directly assess of neurologic function.
Sympathetic: ↓ CO = dilation of blood
Inaasses yung affected part of body which
vessels towards vital organs; constricts controls the nervous system
towards less vital organs ● 5 components of neurological
assessment
Consciousness & cognition
Piloerection → goosebumps/ “pagtaas ng
Mental status, Intellectual functioning, thought
balahibo” content, emotional status, language abilities
● Intellectual functioning
Assessment of Neurologic Function - Simple math, repeat seven
Health hx consecutive digits without falter,
● Systematically explore the pts. condition recite five digits backwards
● Mental status
Observing - Assess for appearance,
● Overall appearance, mental status, behavior, orientation (time,
posture, movement, affect place, person), remote and
recent memory
Interviewing ● thought content
● COLDSPA, frequency of s/sx, associated - Thoughts must be clear,
complaints, precipitating factors, coherent with no delusion or
aggravating factors, relieving factors fixed ideas
● language abilities
Most common s/sx - Can communicate verbally and
● Pain (acute & chronic) write without difficulty

1. Acute (e.g. tic douloureux) spinal disk Cranial nerves

injury, affectation mg trigeminal nerve ● Assess when LOC ↓, brain stem
(cranial nerve #5 traffic pain pathology, presence of PNS disease
douloureux) - I.e., diabetic foot, neuropathy,
lower extremities
2. Chronic (e.g. multiple sclerosis)
3. Seizures Motor system
● Muscle size, tone, strength, coordination,
balance
 ● Ability to flex or extend against a Lethargic
resistance ● Appears drowsy, may drift off to sleep
during examination
Sensory system
● Subjective and needs pts cooperation Stuporous
● Requires vigorous (shaking, shouting) for
Reflexes a response
● DTR (deep tendon reflexes)
- neuro hammer Comatose
● Superficial reflexes ● Does not respond appropriately to either
- Corneal reflex, gag reflex, verbal or painful stimuli
abdominal
● Pathologic reflexes Neurological Assessment
- Babinski reflex in adults (grasp, Examine cranial nerves
sucking reflex, etc) ● I, II, VIII (1, 2 8) are sensory

Neurological Assessment ● III, IV, VI, XI, XII (3, 4, 6, 11, 12) are
Assessing LOC motor
most common tool: Glassgow’s coma
scale (GCS) ● V, VII, IX, X (5, 7, 9, 10) are mixed
● Pts wakefulness & ability to respond to sensory-motor
environment
● Most sensitive indicator of neurologic Examine motor system
function; earliest indicator of increased ● Motor ability
Intracranial Pressure - papalakarin: to Balance,
posture, deep
GCS Score indications: Motor strength
● 15 → conscious and coherent (best ● 5-point scale
response) - ability to flex or extend
● n < 7 → comatose state extremity of against resistance 5
● 3 → totally unresponsive points scale
Behaviors to assess eye opening, verbal
response, motor response Balance and coordination
● Romberg’s test
- Checks for ataxia
- Instruct patient to stand then
close eyes then assess swaying
for 20 seconds for presence of
abnormal movement.
- Support pt sa likod and nasa
tabi pt. Mali yung romberg test
yung tumayo pumikit tas tinaas
ang 2 kamay.

ALERT
● Follows command in a timely fashion
 Muscle Strength Testing Scale - Hold the pt thumb and move it
up / down and ask patient to
identify the movement
Rating Observation
● Tactile identification
0 No muscle contraction is detected.
➢ Tactile agnosia
(astereogenesis)
1 A trace contraction is noted in the
★ Let the patient touch an object
muscle by palpating the muscle while
and identify it with eyes closed
the patient attempts to contract it.
★ AFFECTED: Parietal lobe
2 The patient is able to actively move the
➢ Visual agnosia
muscle when gravity is eliminated.
★ Let the patient touch an object
and identify it with eyes open
3 The patient may move the muscle
★ AFFECTED: Occipital lobe
against gravity but not against
resistance from the examiner.
Examine reflexes
1. DTR (deep tendon reflexes)
4 The patient may move the muscle group
- Biceps, triceps, brachioradialis,
against some resistance from the
patellar, Achilles
examiner.

5 The patient moves the muscle group

and overcomes the resistance of the
examiner. This is normal muscle
strength.

Neurological Assessment
Examine sensory system
● Be familiar w/ dermatomes first
○ A dermatome is an area of skin that
sends information to the brain via a
single spinal nerve.

○ Dermatomes are areas of your skin

Biceps Reflex:
that rely on nerves that connect to
your spinal cord. That means that ● Cervical C5 & C6 reflex
dermatomes cover your entire body ● NORMAL FINDINGS: Elbow flexion,
except for your face. biceps contraction
Triceps reflex
● Tactile sensation ● C7 and C8 spinal nerves
○ Use Cotton tip applicator then ● NORMAL FINDINGS: Elbow extension,
touch the side of face triceps contraction
magkabilaan, cheek, forehead,
chin and as if they feel the touch Brachioradialis reflex
○ Compare ni pt yung touch sa left ● C5 and C6 spinal cord disease
at right ● NORMAL FINDINGS: Flexion, supination
of the forearm
● Superficial pain
○ Identify sharp / dull sensation Patellar reflex
with the two ends of a cotton ● If decreased or absent, L2, L3, L4
applicator compression
● Temperature ● NORMAL FINDINGS: Knee extension,
- By touch and palpation quadriceps contraction
● Vibration
- Assess with the use of a tuning Achilles reflex
fork ● Diminished or absent seen in
● Proprioception (position sense) hypothyroidism, diabetes
 ● NORMAL FINDINGS: Plantar flexion → and knees.
towards the shin

2. Superficial reflexes
- Corneal, palpebral, gag,
abdominal, cremasteric,
perianal

Corneal Reflex: using a cotton tip applicator,

touch the outer corner of sclera
● ABSENCE: may indicate damage to the
ophthalmic branch of CN V, stroke, brain
injury
Gag reflex
● Absence may indicate damage to the CN
IX, CN X, or brain

Cremasteric reflex
● Absence may mean
○ Spine injury (T12, L1, L2)
○ Testicular torsion
○ Upper and lower motor neuron
disorder
Plantar reflex
● ABNORMAL FINDINGS + Babinski →
fanning of toes
● NORMAL FINDINGS: Flexion of toes

3. Pathologic reflexes (abnormal reflexes)

● Babinski reflex in adults
○ Abnormal in adults
○ May indicate CNS disease
(motor), progressive NS
degeneration
○ Fanning of toes, sucking, snout,
palmar

● Brudzinski sign
- used to evaluate an individual
for a suspected case of
meningitis
- A viral, bacterial, parasitic, or
fungal infection typically
causes meningitis.
- a physical symptom of
meningitis that involves the
resistance of the leg muscles to
extension.
Diagnostic Tests
● Kernig’s sign Magnetic Resonance Imaging (MRI)
- has low sensitivity but high ● Noninvasive, uses magnetic fields to
specificity for detecting attract protons
meningitis ● w/or w/o contrast agent
- a physical sign that suggests ● No ionizing radiation
meningitis when neck flexion ● Useful in the dx of brain tumor, CVA,
causes reflex flexion of the hips ischemia, infarction, bleeding, lesion,
 edema
Nursing considerations
● Assess if pt has claustrophobia
● Instruct to remain still, tell clients that
they will hear loud sounds
● Review if client has metal devices
● Implants, clips, pacemaker
● Remove all metal objects
Diagnostic Tests
Computed Tomography (CT) scan
● Provides a cross-sectional views of the
brain, different tissue densities of the
skull, cortex, and ventricles
● An IV contrast may be administered
● Can detect Tumor/masses, infarction,
hemorrhage, lesions, displacement of the
ventricles of the brain, cortical atrophy
● Post-procedure
- Supine, FOB w/ only 1 pillow
(>20mL of CSF is removed
Diagnostic Tests
Positron emission tomography (PET)
● A computer-based nuclear imaging
technique that produces images of
actual organ functioning
● Permits measurement of blood flow and
brain metabolism, can detect brain
glucose use
Can detect
● Alzheimer’s dse
● Epileptogenic lesions
● Brain tumor
● Identify blood flow and O2 metabolism
● Determine biochemical abnormalities

Nursing considerations Nursing interventions

● Contraindicated to pregnant ● Same w/ CT scan
● Pt needs to lie still throughout the
procedure Diagnostic Tests
● Teach relaxation techniques if pt is Cerebral Angiography
claustrophobic ● A x ray study of the cerebral circulation
● Sedation may be necessary using a contrast agent injected into a
● Assess for allergy on iodine or shellfish selected artery
● Assess kidney function ● Useful in detecting vascular diseases
● For safety
- Wear lead apron Nursing interventions
After the procedure ● Check kidney function prior procedure
- Inc OFI ● Proper hydration
● Instruct the client to not move
Diagnostic Tests throughout the procedure!
Lumbar puncture (spinal tap) ● Inform client of sensations when
● Detect contrast is injected
- Bacterial, fungal, viral CNS - Warmth in the face, behind
infections eyes, jaw, teeth, tongue, lips,
● Subarachnoid hemorrhage metallic taste
● CNS malignancies ● Check injection site for
● Demyelinating diseases Guillain-Barré bleeding/hematoma
syndrome
Diagnostic Tests
Purposes Electroencephalography (EEG)
● Withdraw CSF for examination ● Represents a record of the electrical
● Measure and reduce CSF pressure activity generated in the brain
● Determine blood in the CSF ● Electrodes are applied on the scalp or
● Intrathecal administration of meds microelectrodes placed in the brain
tissue
Nursing considerations
● Consent Purpose
● Position Lateral, C-position, shrimp, fetal ● Record electrical activity of the brain
● Site of insertion Between L2-L3, L3-L4, ● Detect seizure disorders, coma,
L4-L5 organic brain syndrome, brain death
● Prepare local anesthesia CI to pts w/ ↑
Intracranial Pressure Nursing interventions
● Deprive sleep (night before EEG)
● Withheld meds for 24-48 hrs
- Anticonvulsants, tranquilizers,
stimulants, depressants
● Will not cause an electric shock
● EEG is diagnostic not therapeutic
● Lie still
● Sedation is not advisable
● Avoid caffeinated beverages
● No NPO
● Control blood glucose
● Clean hair for electrodes
- Electrodes attached using
water soluble – remove by
shampooing
- If sleep EEG, collodion glue is
used for electrode contact –
remove w/ acetone

Diagnostic Tests
Electromyography (EMG)
● Measure changes in the electrical
potential of muscles by inserting a
needle electrodes into the skeletal
muscles
● Determine presence of neuromuscular
disorders

Nursing interventions
● Sensation similar w/ IM injection