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Nervous System For Nursing
Nervous System For Nursing
Nervous System For Nursing
Nerve Impulses
Nerve Impulses
Neuron = nerve cell
Electrical signals travel along the neuron
Myelin sheaths increase the speed of
transmission
Anatomy Of the Nervous System
CNS PNS
Brain & Spinal Cord Cranial nerves/Spinal Nerves
Somatic system (voluntary)
Autonomic Nervous System-
Functions to regulates
activities of internal organs
and to maintain and restore
internal homeostasis
Sympathetic- fight or
flight; norepinephrine
Parasympathetic-
conservation, restorative
system ; acetylcholine
Central Nervous System -
The Brain
Three major divisions
Cerebrum
Cerebellum
Brain stem
Circle of Willis
Ensures blood supply
is not compromised
Blood Supply
Brain only uses glucose for energy
In Cerebral Circulation (brain):
1. Veins and arteries are thinner
2.Veins do not have valves (this is different than circulatory
pathways in the body).
Blood Brain Barrier- particles must enter by active transport
Permeable to H2O, CO2, other gasses, lipid soluble
compounds; altered with trauma, cerebral edema
Protective structures
Meninges
Skull
Spinal cord
CSF-immune/metabolic functions
Cerebrum-largest and highest brain
Frontal lobe
section Temporal lobe
Voluntary motor Hearing
function Smell
Conscious thought
Speech Occipital lobe
Reasoning Vision
Parietal lobe
Sensory input
Cerebellum
Balance and coordination
Involuntary motor function
Athletes have a cerebellum that functions at
optimal level
Brainstem
Somatic motor
voluntary
Types of nerves
Efferent:
1.Carry messages from brain/spinal cord to areas
of the body-muscles/glands
2.Carries motor messages
3.Email sent out
Parasympathetic vs. Sympathetic
Responses
Cholinergic
SLUD
Adrenergic
ACTION
Function of Neurotransmitters
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neurotransmitters
Communicate messages from one neuron to another or to a
specific target tissue
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ORM=VIRE4#view=detail&mid=35525F960C528D93A1AD35
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Synapses
Junction between two
neurons
Neurotransmitters
Chemical messengers
Carry impulse across the
synapse
Neurological AssessmentHealth
Pain History
Seizures
Dizziness (abnormal sensation of imbalance
or movement)
Vertigo (illusion of movement, usually
rotation)
Visual disturbances
Motor movements
Cerebellar- movement and coordination
Weakness
Abnormal sensations
Neurological Assessment
Cerebral function: mental status, intellectual function,
thought content, emotional status, perception, motor
ability, and language ability
***Assess impact of any neurologic impairment on
lifestyle and patient abilities and limitations
Meningitis
Kernig s sign
Brudzinkis sign
GCS Scenario- what is the GCS
MS Sykes
The EMS Technicians obtained the first set of vital signs: BP 226/138,
HR 114, Respirations 18, Temp 37.4C, SpO2 96% on room air. She was
agitated but responsive and cooperative; She opened her eyes
spontaneously, was oriented to person, place and time, and followed
requests to move her extremities when asked.
Diagnostic Tests
Computed tomography (CT): with or without contrast dye
Magnetic resonance imaging (MRI): with or without contrast
Cerebral angiography: X-ray of cerebral circulation with contrast
Myelography: X-ray of spinal subarachnoid space with contrast
Noninvasive carotid flow studies: Ultrasound to assess arterial flow
1) Internal Carotid
2) Middle Cerebral
3) Anterior Cerebral
4)Vertebral Artery
Medical and Nursing Management during the Acute
Phase of CVA
7) Teach client to turn head side to side to fully scan visual field if
homonymous hemianopia is present
Bells Palsy
Cranial nerve disorder characterized by
unilateral facial paralysis.
1) Education
3) Malnutrition, constipation, skin breakdown, incontinence, contractures
4) Falls assessment
Parkinsons Disease
TX TX
No cure -goal is to control MAO inhibitors stop
symptoms Dopamine
Levodopa converts to breakdown
Dopamine Surgical options:
Anticholingeric 1. Thalamotomy
tremosr,rigidity 2. Pallidotomy
Antidepressants Deep Brain Stimulation
Dopamine agonist early Neuro Transplantation
disease of when Levodopa 1. Use of fetal brain, or stem cells
ineffective
2. Porcine neuronal cells
Antivirals-rigidity
Meningitis
Inflammation of the meninges (lining of the
brain and spinal cord)
May be bacterial or viral
Signs and Symptoms:
High fever, stiff neck, headache,
seizures, coma, death (untreated)
Meningitis Signs & Symptoms
Opisthotonos (extreme
hyperextension of the head
and arching of the back due
to irritation of the meninges).
Altered level of
+ Kernig & Brudzinskis sign consciousness
Headache (often severe)with (LOC);Seizures
Photophobia. Multiple petechiae on the
Nausea, vomiting. body (meningococcal).
Nuchal rigidity (stiffness of the Rash with Neisseria
neck). meningitidis
S/S of ICP Fever, Chills
Meningitis Causes
Infectious
microorganisms travel to COMMON MICROORGANISMS
meninges via bloodstream
EX: otitis media (ear Meningococcus.
infection) *college dorm living:
Menactra
Exposure to secretions or
aerosal contamination
Streptococcus.
EX: Neisseria meningitis
Microorganisms travel to
Staphylococcus.
meninges from traumatic
injury to facial bones or
from invasive procedure Pneumococcus
EX: Lumbar puncture; Haemophilus influenza B
shunt, head injury. * common in children*
Meningitis-predisposing conditions
Dense community living military; college dorm
Tobacco use
Upper respiratory infection
Otitis media or Mastoiditis
Alter immune system
Ex: AIDS; Cancer patients
Meningitis- DX and TX
DX TX
Absence seizure
generalized lasts 5-30 seconds
blank stare
absence of motor activity
may be accompanied by eyelid fluttering or lip
smacking.
Seizure Types cont
Status epilepticus- Valium, Ativan IV drug of
choice
o life-threatening cycles of tonic clonic phases
o hypoglycemic,
o hyperthermia,
o exhausted
Seizures: Nursing Management
1) Maintain airway 1) Patient Teaching:
lifestyle management
2. Reduce risk of injury
2) Medic Alert
3) Provide support- vocational 3) Driving
4) ETOH- Sleep
4) Medications 5) Discuss treatment
1. Antiepileptics: options-
Dilantin, Depakote,
Depakene, Tegretol, Surgical Interventions
Neurontin, Lamictal 6) Implanted devices to
reduce seizure activity
(connect to Vagus nerve)
Spinal Cord Injuries
Causes:
1.Automobile accidents.
2.Athletic injuries (diving, hard-contact sports).
3.Falls.
4.Gunshot wounds, stab wounds.
5.Industrial accidents
Nursing Considerations
1) Change in alertness or cognition
often first sign of neurological
change
2) The most common causes of
prolonged unconsciousness
(Coma) include:
Cerebrovascular accident (CVA).
Head injury.
Brain tumor.
Drug overdose.
Nursing Care
Maintain a patent airway by proper positioning of the
patient. Position the patient on his side with the chin
extended. This prevents the tongue from obstructing the
airway.
This lateral recumbent position is often referred to as
the "coma position."
It is the safest position for a patient who is left
unattended.
Suction the mouth, pharynx, and trachea as often as
necessary to prevent aspiration of secretions.
Reposition the patient from side-to-side to prevent
pooling of mucous and secretions in the lungs.
Administer oxygen as ordered.
Always have suction available to prevent aspiration of
vomitus.
Nursing care- Airway/Breathing
The bowel should be evacuated regularly to prevent
impaction of stool.
(1) Keep accurate record of bowel movements. Note
time, amount, color, and consistency.
(2) A liquid stool softener may be ordered by the
physician to prevent constipation or impaction. It is
generally administered once per day.
IV fluids
Strict I& O