Download Chapter 25 Neurologic Function

CHAPTER 25
NEUROLOGIC FUNCTION
INTRODUCTION
 Nervous
system and its effect on interactions
with the world
 Every
aspect of activities of daily living (ADLs)
depends on a good neurologic status
 Dysfunction
of the neurologic system has a
profound impact on other body systems and
general well-being
EFFECTS OF AGING ON THE
NERVOUS SYSTEM
 Loss of nerve cell mass
 Atrophy of the brain and spinal cord
 Brain weight decreases
 Number of dendrites declines/each cell has
fewer dendrites
 Demyelinization
− Slower nerve conduction
− Response and reaction times are slower
− Reflexes become weaker
EFFECTS OF AGING ON THE
NERVOUS SYSTEM—(CONT.)
 Plaques,
tangles, atrophy of the brain
 Free radicals accumulate
 Decrease in cerebral blood flow
 Fatty deposits accumulate in blood vessels
 Ability to compensate declines with age
 Intellectual performance maintained until at
least 80 years of age
EFFECTS OF AGING ON THE
NERVOUS SYSTEM—(CONT.)
 Slowing

in central processing
Delay in time required to perform tasks
 Verbal
skills maintained until age 70
 Number and sensitivity of sensory receptors,
dermatomes, and neurons decrease

Dulling of tactile sensation
 Decline
in the function of cranial nerves
affecting taste and smell
QUESTION
Is the following statement True or False?
Cerebral blood flow decreases by 50% in
older adults.
ANSWER
False
Cerebral blood flow decreases about 20% as fatty deposits
gradually accumulate in the blood vessels. Decreases are
even greater in persons with small-vessel cerebrovascular
disease due to diabetes and hypertension; this
contributes to an increased risk of strokes.
NEUROLOGIC HEALTH PROMOTION
 Many
neurologic disorders occur for reasons
beyond a person’s control
 Risk factors: smoking, obesity, ineffective stress
management, elevated cholesterol, HTN
 Preventive measures for neurologic health
 Nurses can detect new or subtle symptoms of
neurologic disorders
 Nursing assessment of neurologic function: page
350, assessment guide 25-1
 Nursing diagnoses: page 351
SUBTLE INDICATIONS OF NEUROLOGIC PROBLEMS
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New headaches that occur in the early morning or
interrupt sleep
Change in vision (e.g., sudden decreased acuity,
double vision, and blindness in portion of
visual field)
Sudden deafness, ringing in ears
Mood, personality changes
Altered cognition or level of consciousness
Clumsiness, unsteady gait
Numbness, tingling of extremity
Unusual sensation or pain over nerve
PARKINSON’S DISEASE (PD)
 Affects
ability of the central nervous system
(CNS) to control body movements
 Role of dopamine: necessary for smooth motor
movement; role in emotions
 Incidence/prevalence: men more common; most
frequently after the 5th decade; increases with
age
 Exact cause unknown; some theories (pg. 352)
 Signs and symptoms


Primary symptoms: faint tremor that progresses over
time; muscle rigidity and weakness, drooling,
Secondary symptoms: depression; sleep disturbances;
dementia; drooling; dysphagia
PD—(CONT.)
 Treatment/management


Anticholinergic medications: close monitoring
Technologies to control symptoms: pulse generators
 Nursing



interventions
Education: AROM, PROM, warm baths and massage
Psychosocial:
Physical
 Goal:
maximum level of independence preserved
Tremors and shuffling gait are characteristic of Parkinson’s disease.
QUESTION
Is the following statement True or False?
Secondary symptoms of PD include
depression, sleep disturbances, dementia,
drooling, and dysphagia.
ANSWER
True
Secondary symptoms of PD include depression,
sleep disturbances, dementia, forced eyelid
closure, drooling, dysphagia, constipation,
shortness of breath, urinary hesitancy, urinary
urgency, and reduced interest in sex.
TRANSIENT ISCHEMIC ATTACKS (TIA)
 Temporary
or intermittent reduction in cerebral
perfusion
 Causes: hyperextension, flexion of the head;
reduced BP; smoking
 Signs and symptoms



Hemiparesis; hemianesthesia; dysphagia; vertigo,
nausea; loss of vision
Minutes to hours
Recovery is usually within 1 day
 Treatment/management
of underlying cause
 Increased risk of cerebrovascular accident
QUESTION
Is the following statement True or False?
Signs and symptoms of a transient
ischemic attack can last for several days
and complete recovery is usual within 1
week.
ANSWER
False
Signs and symptoms of a TIA (hemiparesis,
hemianesthesia, aphasia, unilateral loss of
vision, diplopia, vertigo, nausea, vomiting, and
dysphagia) depend on the location of the area
of ischemia and can last from minutes to
hours and complete recovery is usual
within 1 day.
CEREBROVASCULAR ACCIDENT
 Third
leading cause of death in older adults
 Predisposing factors: HTN; diabetes; gout,
anemia; silent MI; TIAs; dehydration
 Types and cause:


Ischemic: from a thrombus or embolus
Hemorrhagic: ruptured cerebral blood vessel
 Warning
signs
 Drop attack
CEREBROVASCULAR ACCIDENT—(CONT.)
 Prompt
medical evaluation
 Signs and symptoms


Variable
Depend on the area of brain affected
 Nursing
 After
care during the acute phase
patient stabilization, focus is on
rehabilitation
CEREBROVASCULAR ACCIDENT—(CONT.)
 During
rehabilitation, problems vary depending
on the side of the brain affected
 General
observations
 Nursing
interventions
 Community
resources
QUESTION
Which of the following best describes a
drop attack?
a. Fall caused by flaccidity in the legs
b. Fall caused by loss of consciousness
c. Fall caused by incontinence
d. Fall caused by mental instability
ANSWER
a.
Fall caused by flaccidity in the legs
A drop attack is a fall caused by a complete
muscular flaccidity in the legs, without an
alteration in consciousness.
NURSING CONSIDERATIONS FOR NEUROLOGIC
CONDITIONS
 Promoting
independence

Assistive devices

Periodic home visits

Regular contact with family and friends

Promoting self-care

Patience, reassurance, and encouragement
NURSING CONSIDERATIONS FOR NEUROLOGIC
CONDITIONS—(CONT.)
 Promoting
independence—(cont.)
Personality problems may occur
 Depression related to dependence
 Loss of former roles and identities
 Displaced reactions
 Need to educate family members and friends

QUESTION
Is the following statement True or False?
Persons who have experienced a
cerebrovascular accident may experience
depression and irritability toward others.
ANSWER
True
Personality changes often accompany
neurologic problems. Patients may become
depressed as they realize their limitations and
become frustrated by their need to be
dependent on others. Their reactions may be
displaced and evidenced by irritability toward
others, often their loved ones or immediate
caregivers.
NURSING CONSIDERATIONS FOR NEUROLOGIC
CONDITIONS—(CONT.)
 Preventing





injury
High risk of accidents
Avoiding hazards
Safety considerations
Evaluate the environment for danger
Prevention of complications