Cns Dstics 4th

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Cns Dstics 4th

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

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