Download The Nervous System

Unit 43-Nervous system
Adonis K. Lomibao, RN
11/21/11
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The Male & Female Brain
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Objectives
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Understand the basic structure and function of
the components of the Nervous System.
Understand common conditions that may affect
the Nervous System.
Identify nursing care specific to each condition.
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Structure & Function
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Controls & coordinates all body
activities,including production of hormones
Special Parts maintain normal day-to-day
functions
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Other parts act during emergency situations
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Others control voluntary activities
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Neurons
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The cells of the nervous system
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Conduct electriclike impulses
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Impulses enter through the DENDRITE and exit
through the AXON.
Synapse-the space between neurons
Myelin- insulation that covers the axon &
dendrite
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The Neuron
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Neurotransmitters & Nerves
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Neurotransmitters-chemicals that enable nerve
impulses to pass from one cell to another.
Chemicals not produced in the right amount->
message pathway is confused or blocked
Nerve-bundle of axons & dendrites held
together by connective tissue
Different kinds- Sensory & Motor
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CNS & PNS
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Central Nervous System- Brain & Spinal Cord
Peripheral Nervous System-12 pairs of cranial
nerves and 31 pairs of spinal nerves that reach
throughout the body.
Nervous system is interwoven with millions of
neurons.
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The Central Nervous System
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Composed of brain and spinal cord
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Surrounded by bone
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Protected by membranes called meninges
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Cushioned by cerebrospinal fluid
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The Brain
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Composed of grey & white matter
Cerebrum-largest part of the brain, separated
into lobes,lobes named after surrounding skull
bones
All mental activities-thought,voluntary
movements,interpretation of
sensations,emotions----carried out by cerebral
cells.
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The Brain Cont.
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Cerebellum-coordinates muscular activities and
balance
Brain Stem-midbrain, pons, medulla.
Control involuntary, life-sustaining functions of
the Heart, Blood vessels, Lungs, Stomach, &
Intestines.
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The Lobes & Function
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The Spinal Cord
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Extends from the Medulla to the 2nd Lumbar
Vertebra (above the small of the back) (~17 in.)
Nerves enter and leave spinal cord carry
impulses to and from control centers.
Reflexes are controlled in the cord...i.e...pulling
hand away when touching something hot.
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The Spinal Cord
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Meninges & CSF
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Meninges- surround brain and spinal cord.
Consists of dura mater, arachnoid mater, pia
mater.
Cerebrospinal Fluid-flows around the brain and
spinal cord
Cushions CNS against shock & possible injury
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Autonomic Nervous System
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Control center in brain stem
Consists of 2-parts:Sympathetic and
Parasympathetic fibers
Sympathetic fibers-prepare the body to deal
with emergency situations. “Fight or Flight”.
Parasympathetic fibers-control functions of
heartbeat,digestion,elimination,respiration,glan
dular activity.
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Sensory Receptors
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Carry sensations to CNS.
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In joints-relay body positions to brain
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In the skin- relay sensations of pain, heat,
pressure, & cold.
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In the nose-smell
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In the tounge-taste
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Sensory rec. stimulated through the eye and
ear
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Increased Intercranial Pressure
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The amount of pressure exerted by structures
in the skull. (Nervous tissue, CSF, Blood
through cerebral vessels.)
Changes in size or amount change pressure.
Increased ICP can result from-Head injury,
Hemorrhage, Inflammation, Toxins, High
temperature
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S&S of increased ICP
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Alteration in pupil size and reaction to light
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Headache
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Vomiting
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Loss of consciousness and sensation
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Paralysis
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convulsions
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External Ventricular Drain
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Glascow Coma Scale
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Used to monitor neurological problems after
trauma, stroke, etc.
Higher point values indicate increased
awareness and arousal.
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Less than 8=neurological crisis
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9-13= moderate dysfunctions
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13-15 moderate to minor dysfunction.
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GCS
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Transient Ischemic Attack
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Temporary period of diminished bloodflow to
the brain.
Attack may last 2 min up to 24 hours
Symptoms are similar to stroke, but are
temporary and reversible.
Those suffer from TIA-at risk for suffering a
stroke.
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Stroke
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Cerebrovascular Accident (CVA)-complete or
partial loss of blood flow to the brain tissue.
Result of atherosclerosis or brain hemorrhage.
Damage on one side of brain result in S&S on
the opposite sides of the body.
Damage to R-Spatial-perceptual deficitsdifficulty distinguishing R&L and Up&Down.
Damage to L-Aphasia
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Stroke-Nursing Care
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Maintain skills and abilities patient has left.
Prevent complications caused by immobilitycontractures, pressure ulcers, pneumonia,
blood clots.
Help patient regain functional activities.
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Parkinson's Disease
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Caused by not having enough
neurotransmitters in the brain stem &
cerebellum.
Symptoms are progressive over many years
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Freddie Roach
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Parkinson's Disease S&S
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Tremors- uncontrolled trembling
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Muscle Rigidity- loss of flexibility
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Akinesia-difficulty and slowness in carrying out
voluntary muscular activities.
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Loss of autonomic control
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Mood swings & behavioral changes.
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Parkingson's Disease Nursing Care
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Maintain calm environment
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Assist and supervise in ADL's.
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Provide emotional support and encouragement
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Exercise program
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Provide protection for patients with dementia
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Huntington's Disease
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Hereditary-genetic test available to detect gene.
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Progressive with no cure.
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Disability and death occur within 15-20 years.
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Characterized by abnormal movements called
chorea.
Pt. is restless, moves frequently, involuntary
movements, rapid jerking.
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Multiple Sclerosis
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The result of insulation(myelin) around nerve
fibers. Interferes with the ability to function.
Generally in young adults-Unknown causeGenerally normal life-span.
Symptoms include Vertigo, Lhermitte's
sign,Nystagmus, Paraplegia or Quadriplegia,
intention tremor, affected speech,incontinence
Fatigue!
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MS-Nursing Care
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Pressure ulcer prevention
Contracture prevention -PROM & position
changes
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Catheter Care
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Encourage Independence
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Help maintain balanced schedule of rest n act.
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Emotional support and encouragement
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Post Polio Syndrome
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Polio-caused by virus that attacks motor
neurons in spinal cord. Results in weakness
and paralysis.
PPS-marked by weakness & muscle fatigue in
those who had polio previously.
30%-70% of polio survivors will develop PPS
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PPS-S&S
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Fatigue
New Joint & Muscle pain
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New muscle weakness, spasms,cramps
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New dyspnea & respiratory problems
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Cold intolerance
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Difficulty swallowing
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Difficulty sleeping, frequent awakening
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Amyotrophic Lateral Sclerosis
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Also called Lou Gehrig's Disease
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Progressice neuromuscular disease
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Causes muscle weakness and paralysis.
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Disease of the motor nerves that control
voluntary movement.
No cure, almost always fatal.
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S&S of ALS
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Difficulty walking-stumbling, tripping, falling
Loss of strength & muscle control in
hands,arms,& legs.
Difficulty in speaking & swallowing,Drooling
Muscle aches, cramps, twitching, weakness,
atrophy
Etc. P. 764
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ALS-Nursing care
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Upright position to ease respirations
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ROM-prevent deformities & maintain strength
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Assist in use of Incentive Spirometer
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Rest before meals-conserve muscle strength &
reduce choking risk.
Small, frequent feedings. Take swallow
precautions when feeding to prevent choking.
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Seizure Disorder (Epilepsy)
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Recurrent attacks of disturbed brain funtion
Seizure characteristics may include: altered
state of consciousness, convulsive uncontrolled
movements,disturbances of feeling or behavior.
May experience Aura-involves the senses, may
hear or smell-usually consistent & remains the
same.
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Types of seizures
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Partial-may not have loss of cons.,begin in one
part of body and involve only one side.
Generalized tonic-clonic-loss of consciousness
& convulsive movements.
Absence seizures-uncons. But no conv. ,short
in nature, begins without warning and ends
abruptly.
Status epilepticus-lasts for a long time. Medical
Emergency may result in death if not treated. 39
Seizures-Nursing care
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PREVENT INJURY-stay with person, assist to
lay, DO NOT restrain or put anything in
mouth,move objects patient may hit.
MAINTAIN AIRWAY- loosen clothing around
neck,turn head to side if drool or vomit present,
head-tilt chin-lift if necessary.
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Spinal Cord Injuries
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Result in loss of function and sensation below
injury.
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Prone to contractures and pressure ulcers
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Commonly associated with Paralysis.
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Nursing care include listening,patient approach,
restoring highest degree of independence,Skin
care!,Elimination needs, ROM, Prevent
infection.
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Autonomic Dysreflexia
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Potentially life-threatening complication of
spinal cord injury
Occurs in patients with injuries above the midthoracic area.Indicates uncontrolled
sympathetic nervous system act.
Triggered by injuries that would normally cause
pain below level of spinal injury. i.e. Overfull
bladder, UTI,Fecal impaction, etc. (P.768-9)
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Autonomic Dysreflexia S&S
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Extemely high BP 200/100
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Severe headache
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Red, flushed face
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Red blotches on skin above spinal injury
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Bradycardia
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p. 769
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Glaucoma
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Increased pressure in the eye.
Causes peripheral vision loss. Untreated, may
progress to central vision loss and blindness.
S&S may include eye pain, difficulty adjusting
to darkness, color-blindness, halos around
lights, N&V,headache, tiredness, blurred vision
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Glaucoma Nursing Care
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Monitor I & O
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Check vital signs q2-4 hours
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Report eye pain
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Keep patient from stooping or lifting
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Avoid tight, constrictive clothing
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P. 770-771
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Other conditions
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Meningitis- inflammation of the meninges.
Caused by virus or bacteria. S&S:
Headache,nausea,stiff-neck,seizures,chills,elev.
Temp.
Cataracts-causes the lens of the eye to be
cloudy.
Retinal Degeneration-loss of central vision due
to damage of the macula.
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Other Conditions Cont.
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Otitis media- infection of the middle ear.
Otosclerosis- progressive form of deafness due
to abnormal bone growth.
Unit 7-reviews communication with the hearingimpaired.
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Diagnostic Tests
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MRI-magnetic resonance imaging
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CAT-computerized axial tomography
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EEG-measure electrical activity of brain
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Myelogram-X-Ray of spinal cord with dye
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Tonometry-measures intra-ocular pressure
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Audiometry-evaluate hearing
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Spinal Puncture
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Spinal Puncture
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Done to withdraw CSF for examination or to
introduce medication/anesthetic into the spinal
column.
Needle inserted between the lumbar vertebrae
into the fluid-filled space.
After procedure, head of bed should be flat for
8 hours.
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Spinal Puncture
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Study Tips
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Concentrate on NAT Unit 43.
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Flip through MT Ch. 10
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Know S&S specific to each condition
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Know nursing care specific to each condition.
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Thank You =]
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