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Cns Dstics 4th

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    Cns Dstics 4th Cns Dstics 4th Presentation Transcript

    • Anatomy and Physiology of the Neurological System
    • Nervous system
      • Coordinates and controls all activities of the body
      • Divisions:
      • Central nervous system: Including the brain, and the Spinal cord.
      • Peripheral nervous system: Made up of the cranial and spinal nerves.
      • Autonomic nervous system: Regulates action of glands and involuntary smooth muscles in the walls of tubes and hollow organs and heart
    •  
    • Neurotransmitters
      • Communicate messages from one neuron to another or from a neuron to a specific target tissue.
      • Signaling chemicals released when a nerve impulse reaches a synapse.
    • Central nervous system
      • Brain- largest and most complex part of the nervous system. Weighs about 1400g (adult).
        • Cerebrum -is composed of two hemispheres the thalamus and the hypothalamus. Higherst function of the brain starts here.
        • Cerebral cortex- stores knowledge of impulses received and controls voluntary movement, thought association, discrimination and judgment
      • Frontal lobe- personality, behavior and higher intellectual functions( consciousness, learning, abstract, and creative thinking, problem solving, judgment, memory, volition, and values.
      • Parietal lobe- receives sensory impulses from the opposite side of the body (sight, smell, hearing, taste ) and sensory area for interpretation of pain, touch, temperature, pressure.
      • Temporal lobe- contains auditory center and stores sound memories.
      • Occipital lobe- the posterior lobe of the cerebral hemisphere is responsible for visual interpretation.
        • Brainstem- consist of ascending pathways, reticular formation, cranial nerves and nuclei, descending autonomic and motor pathways.
          • Midbrain- conducts impulses between lower and upper centers .
          • Pons - briges or connects many structures, midbrain and medulla oblongata, cerebellum and rest of nervous system. Center of respiration, swallowing and balance.
        • Cerebellum- aids in coordination of voluntary muscles and balance. Maintenance of muscles tone and posture in space( equilibrium).
        • Medulla oblongata - joins brain and spinal cord ( opening in the base of the skull). Contains nerve fibers ( carrying messages up to and down from brain) group together forming tracts ( bundles ) to function.
    •  
    • Peripheral nervous system
      • Cranial nerves- conducts special senses ( smell, visual, auditory). Conducts generalized sense impulses (pain, pressure, touch, vibration, deep muscle sense).
      • Spinal nerves- 31 segments ( 8 cervical, 12 thoracic 5 lumbar, 5 sacral, 1 coccygeal).
      • Autonomic nervous system
      • Control of involuntary bodily functions.
            • Parasympathetic ( cranioscaral )- controls normal body functioning.
            • Sympathetic ( thoracolumbar )- prepares body for “fight” and “flight”.
    •  
    • Assessment: The Neurologic Examination Health History
      • An important aspect of the neurologic assessment is the history of the present illness.
      • The nurse may need to rely on yes or no answers to questions.
      • The health history includes details about the onset, character, severity, location, duration, and frequency of symptoms and signs.
    • Physical Examination
      • Neurologic examinationis often limited to a simple screening.
      • The examiner must be able to conduct a thorough neurologic assessment when the patient’s history or other physical findings warrant it.
      • The brain and spinal cord cannot be examined as directly as other systems of the body.
      • The neurologic assessment is divided into five components: cerebral function, cranial nerves, motor system, sensory system, and reflexes.
    • DIAGNOSTIC EXAMINATION
      • Non-invasive tests of structures
          • SPINAL & SKULL X- RAY
          • films examined for the signs of fracture or bony defects, calcification, erosion of the bone, including the size of sella tursica in the skull.
          • Reveals spinal fractures, dislocation, compression, curvature erosion, narrowed spinal cord & degenerative processes
          • Reveals configuration, density vascular markings.
    • Skull X-ray
    • Nursing Care
      • Remove hairpins, hearing aids
      • BRAIN SCANNING [ Radionucleide Imaging Studies]
        • IV injection of radioactive compound & application of scintillation scanner in the patient’s brain an increase uptake of radioactive material at the site of pathology
        • Used to detect intracranial masses, vascular lesions, infarcts, hemorrhage
    • Brain Scanning
        • Nursing Care for Brain Scanning
          • Check for allergy to iodine
          • Keep NPO 4-6 hours before examination
      • MAGNETIC RESONANCE IMAGING [MRI]
        • visualization of the distribution of hydrogen molecules in the body in 3 dimensions
        • superior imaging of body soft tissues & provides more anatomically detailed pictures than that with CT scan
        • does not use harmful ionizing radiation
    • MRI
      • Purposes:
          • Differentiates types of tissues in normal & abnormal states
          • Clinical applications: brain, tumors/ vascular abnormalities, cardiac anomalies, blood vessels, liver dse.,renal abnormalities, gallbladder & tumor
      • Nursing Care
        • Remove all metallic objects andlet patient lie on platform that will be moved into a table cont’ng the magnet
        • Nothing will be be felt during scanning, but (+) sound of the magnetic coils
        • Closely monitor pt. w/ potential respiratory or cardiac collapse
      • Non-invasive tests of structures
          • OPHTHALMODYNAMOMETRY
          • DOPPLER ULTRASONOGRAPHY
          • DOPPLER SCANNING
          • QUANTITATIVE SPECIAL PHONOANGIOGRAPHY
      • Invasive test of Structures
        • Lumbar Puncture
        • introduction of hollow needle with stylet into the lumbar subarachnoid space of the spinal between L1-L5
        • withdrawal of CSF fluid for diagnostic & therapeutic purposes
      • Purposes:
            • Measures CSF pressure [ n opening P60-150mmH2O]
            • Obtain specimen fore laboratory analysis
            • Check color of CSF & presence of blood
            • Inject air, dye, drugs into spinal canal
    •  
      • -Nursing Care
      • Pretest
          • Have client empty bladder
          • Position to lateral with head & neck flexed on the chest
          • Explain the need to remain still
          • Post- test
              • Ensure labeling of CSF specimens in proper sequence
              • Keep client flat for 12-24 as ordered
              • Force fluids
      • Check puncture sites for bleeding, leakage of CSF
      • Assess sensation and movement in lower extremities
      • Monitor vital signs
      • Administer analgesics for headache as ordered.
        • MYELOGRAPHY
        • injection of dye or air into lumbar or spinal subarachnoid space followed by x-rays of the spinal column.
        • Used to study the spinal canal & subarachnoid space
        • Potential complicatins are the same as for lumbar puncture; cerebral irritation from dye
    •  
      • Nursing Care:
        • Pretest
          • Keep NPO after liquid breakfast
          • Check for iodine allergy
          • Confirm signed informed consent
          • Pos-test
          • Similar with that of lumbar puncture
          • If oil-based dye was used [ Pantopaque], keep pt. flat for 12 hrs.
          • If water-based [ Mtrizamide-Amipaque], elevate head of bed 30-45 degree to prevent upward displacement of dye meningeal irritation & seizures
          • Institute seizure precautions & don’t administer any phenothiazines
        • PNEUMOENCEPHALOGRAPHY
          • introduction of air or O2 subarachnoid space by lumbar or cisternal puncture to outline the ventricular system & intracranial subarachnoid space for special x-ray studies
          • to localize intracranial lesion
        • VENTRICULOGRAPHY
            • Introduction of air or O2 directly into lateral ventricles by ventrular puncture thru opening made in the frontal, post or occipital regions for special x-ray studies
    • Pnuemoencephalography
    • Ventriculography
            • To visualize ventricles; localize tumors
            • Potential complications: HA,N,V, meningitis, increase ICP
      • Nursing Care
        • Post-test
          • Monitor VS
          • Check neurological status
          • Elevate head of bed ( 15-20degree)
        • CISTERNAL PUNCTURE
          • introduction of hollow needle with stylet in the median line below the occipital bone into the cisterna magna
          • remove CSF when possible to obtain at lumbar level
          • potential complication: Respiratory distress
      • Nursing Care
        • Observe for cyanosis, dyspnea & apnea
        • Same as for lumbar puncture
    • Cisternal puncture
        • CEREBRAL ANGIOGRAPHY
          • injection of radiopaque substance into the cerebral circulation [carotid/vertebral arteries on the neck] to visualize by means of x-rays the blood vessels in the head & neck
          • used to localize tumors, abscesses, aneurysms, hematomas & occlusions
          • Potential complications: anaphylactic rxns to dye, local vasospasm, adverse intracranial pressure]
      • Nursing Care
        • Pretest
        • Keep NPO after midnight or clear liquid
        • Check for iodine allergy
        • Take baseline assessment
        • Measure neck circumference
        • Explain warm flushed feeling and salty taste in mouth may be felt during the procedure
        • During & Post-test
        • Have emergency equipment available
        • Monitor neurological status & vital signs for shock, LOC, hemiplegia & aphasia
        • Monitor swelling of the neck, difficulty of swallowing & breathing
        • Administer ice collar/cap intermittently
        • Maintain pressure dressing
        • Bed rest until next morning as ordered
    • Cerebral Angiograhy
      • CERBRAL PERFUSION STUDIES
        • injection of 99 mTc to assess cerebral perfusion in suspected brain death
      • ELECTROENCEPHALOGRAM [EEG]
        • Consists of graphic record of the electrical activity of brain by several small electrodes palced on the scalp
        • Purposes:
            • To detect abnormalities indicative of intracranial pathology or pathological physiology
            • To determine the existence & type of epilepsy
      • Nursing Care
        • Pretest
        • Hair shampoo
        • Withhold sedatives, tranquilizers, stimulant [ 2-3 days]
        • Post test
        • Remove electrode paste with acetone & shampoo hair
    • EEG
      • Peripheral Nerve Studies
        • ELECTROMYELOGRAPHY [EMG]
          • measure & records activity of contracting muscles in response to electrical stimulation
          • helps differentiate muscle disease from motor neuron dysfunction
      • Nursing Care
        • Explain procedure; (+) discomfort due to needle insertion
    • EMG
        • NERVE CONDUCTION STUDIES
          • stimulating a peripheral nerve at several points along its course & recording the muscle action potential or the sensory action potential
      • MUSCLE BIOPSY
        • Used to diagnose neuropathies & myopathies
      • CELLULAR ASSESSMENT
          • Chromosome analysis assists diagnosis of some abnormal neurologic conditions
          • Provides basis for genetic counseling in families w/ evidence of congenital neurologic malformations, mental retardation & seizures.
    •  
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