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Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
Powerpt Mosby Book
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Powerpt Mosby Book

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  • 1. Nervous System
    Anatomy and Physiology Review
    Neurological Assessment
  • 2. Anatomy and Physiology
  • 3. Neurons
    The basic and functional unit
    Central Nervous System
    The spinal cord and brain
    Peripheral Nervous System
    The nerves and nerve ganglia
    Autonomic Nervous System
    Sympathetic and parasympathetic
  • 4. Neurons
  • 5. Types
    Sensory (Afferent) neurons: transmit impulses to spinal cord or brain
    Motoneurons(efferent) : transmit impulses away from brain or spinal cord to muscles or glands
    Interneurons: transmit impulses from sensory neurons to motoneurons
  • 6. Structure
    Cell Body: contains a nucleus and other cytoplasmic matter
    Axon: carries impulse away from cell body
    Dendrites: carry impulses toward cell body
    Myelin: multiple, dense layers of membrane around an axon or
    dendrite; myelinated nerve fibers transmit nerve impulses more rapidly than nonmyelinatedfibers
    Synapse
    Point of contact between axon of one cell and dendrite of another
    Neuroglia: support, defend, and nourish
  • 7. Brain
  • 8. Brain Stem
    Medulla: conducts impulses between the cord and brain
    Pons: conducts impulses between the cord and various parts of the brain
    Midbrain
    Integrates and analyzes sensory input from ears, eyes and various regions of the cerebral cortex
    Cerebellum: exerts synergic control over skeletal muscles
  • 9. Diencephalon
    Thalamus: crudely translates sensory impulses into sensations but does not localize them
    Hypothalamus: makes ADH and oxytocin, which are secreted by the posterior pituitary
    Optic chiasm: the point of crossing over (decussation) of optic nerve fibers
  • 10. Cerebral Cortex
    Frontal lobe: influences abstract thinking, sense of humor, and uniqueness of personality
    Parietal lobe: Interpret sensations; provide appreciation of size, shape, texture, and weight
    Temporal lobes
    Translate nerve impulses into sensations of sound and interpret sounds (Wernicke’s area; usually in dominant hemisphere)
    Occipital lobe
    Translates nerve impulse into sights and interprets sights
  • 11. Brain and Cord Fluid Spaces
    Subarachnoid space around the brain and cord, extending into the fourth and fifth lumbar vertebrae
    Central canal inside the cord
    Ventricles and cerebral aqueduct inside the brain; four cavities known as first, second, third, fourth ventricles
    Cerebrospinal fluid (CFS) formed by plasma filtering from network of capillaries (chronoid plexus) in each ventricle
    CFS circulates throughout ventricles, brain and subarachnoid space and returns to blood via venous sinuses of brain
     
  • 12. Autonomic Nervous
    System
  • 13. Two Divisions
    Sympathetic: adrenergic fibers secrete norepinephrine; influences smooth muscle of blood vessels, hairs, and sweat glands
    Parasympathetic: cholinergic fibers secrete acetylcholine, influences digestive tract and smooth muscle to promote digestive gland secretion, peristalsis, and defecation; influences the heart to decrease rate and strengthen contractility
  • 14. DIAGNOSTIC
    PROCEDURES
  • 15. NEUROLOGIC ASSESSMENT
    Definition: systematic evaluation of the cranial nerves, motor and sensory functioning, and mental status to detect neurologic abnormalities
  • 16. Cranial Nerves
  • 17. Olfactory (I)
    ability to identify familiar odors such as mini or alcohol with eyes closed and one nostrils occluded at a time
  • 18. Optic (II)
    visual acuity measured by use of Snellen chart or by gross estimation with reading material; gross comparison of visual fields with those of examiner; color perception
  • 19. Oculomotor (III), Trochlear (IV) and Abducens(VI)
    ability of the pupils to react equally to light and to accommodate to varying distances
  • 20. Trigeminal (V)
    sensation of the face evaluated by lightly stroking cotton across forehead, chin, and cheeks while the client’s eyes are closed; ability to clench the teeth (jaw closed)
  • 21. Facial (VII)
    symmetry of the facial muscles as the client speaks or is asked to make faces
  • 22. Acoustic or Vestibulocochlear (VIII)
    hearing acuity determined by watch tick or whispered numbers; Weber’s test may be performed by holding the stem of a vibrating tuning fork at midline of the skull (should be heard equally in both ears)
  • 23. Glossopharyngeal (IX) and Vagus (X)
    uvula should hang in midline; swallow and gag reflexes should be intact
  • 24. Spinal accessory (XI)
    symmetric ability to turn the head or shrug the shoulders against counterforce of the examiner’s hands
  • 25. Hypoglossal (XII)
    ability to protrude the tongue without deviation, to left or right, and without tremors
  • 26. Motor function
    Balance
    Observation of gait
    Romberg Test: positive if the client fails to maintain an upright position with feet together when the eyes are closed
    Coordination: ability to touch the finger to the nose when arms are extended or to perform similar tasks smoothly
    Muscle strength: evaluated by having the client move symmetrical muscle groups against opposition supplied by the examiner
  • 27. Sensory function : bilateral testing of the response to light touch with cotton, sharp versus dull stimuli, vibration of a tuning fork
    Mental Status (cerebral functioning)
    Level of consciousness: determined by the response to stimuli (verbal, tactile or painful)
    Orientation to person, place, and time: determined by general conversation and direct questioning
    >Judgment, memory, and ability to perform simple calculations
    >Appropriateness of behaviour and mood
    Reflexes
    Deep tendon reflexes (biceps, triceps, patellar, Achilles) with a reflex hammer; classification from 0 (absent) to 4+ (hyperactive); 2+ is normal
    Plantar: plantar flexion of the foot when the sole is stroked firmly with a hard object such as tongue blade; abnormal adult response (dorsiflexion of the foot and fanning of the toes) is described as a positive Babinski and is indicative of corticospinal tract disease
  • 28. GLASGOW COMA SCALE (GCS)
    Definition : technique of objectifying a client’s level of responses; client’s best response in each are is given a numeric value, and the three values are totalled for a score ranging from 3 (deep coma) to 15 (normal)
    Eye-opening ability: spontaneous (4); to speech (3); to pain (2); no response (1)
    Motor response: obeys commands (6); localizes pain (5); withdraws (4); abnormal flexing (3); extension (2); no response (1)
    Verbal response: oriented (5); confused (4); inappropriate words (3); incomprehensible soundes (2); no response (1)
  • 29. COMPUTERIZED TOMOGRAPHY (CT)
    Definition
    >Cross-sectional visualization of the head or other body cavity determined by computer analysis of relative tissue density as an x-ray beam passes through
    >Provides three-dimensional information about location and extent of tumors, infracted areas, atrophy, and vascular lesions
    >May be done with intravenous injection of dye for contrast enhancement
     
  • 30. MAGNETIC RESONANCE IMAGING (MRI)
    Definition
    >Uses magnetic fields and radio waves to produce cross-sectional images
    >Produces accurate images of blood vessels, bone marrow, gray and white brain matter, spinal cord, globe of the eye, heart, abdominal structures, and breast tissue, and can monitor blood velocity
  • 31. LUMBAR PUNCTURE
    Definition: involves the introduction of a needle into the subarachnoid space below the spinal cord, usually between L3 and L4 or L4 and L5
    Purposes
    >Withdrawal of cerebral spinal fluid for diagnostic purposes or to reduce spinal pressure (normal is 70 to 200 mm H2O)
    >Measurement of spinal pressure (Queckenstedt’s test involves compression of the jugular veins; normally pressure will rise; but it blockage exists, pressure will not change)
    >Injection of medication such as anesthetics
  • 32. POSITRON EMISSION TOMOGRAPHY (PET)
    Definition
    >Client is given strong radioactive tracers that emit signals, computer analysis of the emitted gamma rays forms images
    >Determines blood flow, glucose metabolism, and oxygen extraction
    >Effective in diagnosis of brain attack, brain tumors, epilepsy; can evaluate progress of >Alzheimer’s disease, Parkinson’s disease, bipolar disorders, and head injuries
  • 33. All rights reserved
    ©2007

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