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CNS Ppt

CNS Ppt

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  • 1. PERCEPTION & COORDINATION
  • 2. NEUROSENSORY SYSTEM MUSCULOSKELETAL SYSTEM
  • 3.  
  • 4. ANATOMY & PHYSIOLOGY
    • NERVOUS SYSTEM (NS)
    • CENTRAL NS
      • BRAIN & SPINAL CORD
    • PERIPHERAL NS
      • CRANIAL & SPINAL NERVES
    • AUTONOMIC
      • SYMPATHETIC - THORACO- LUMBAR
      • PARASYMPATHETIC – S2,3,4
  • 5. ANATOMY & PHYSIOLOGY
    • BRAIN:
    • CEREBRUM
    • DIENCEPHALON
    • BRAIN STEM
    • CEREBELLUM
  • 6. ANATOMY & PHYSIOLOGY
    • CEREBRUM
    • HEMISPHERES
    • LOBES
    • CORPUS CALLOSUM
    • BASAL GANGLIA
    • FRONTAL
    • PARIETAL
    • TEMPORAL
    • OCCIPITAL
  • 7. ANATOMY & PHYSIOLOGY
    • FRONTAL LOBE:
    • PERSONALITY, BEHAVIOR
    • HIGHER INTELLECTUAL FUNCTIONING
    • PRECENTRAL GYRUS: MOTOR FXN
    • BROCA’S AREA – MOTOR SPEECH
    WERNICKE’S AREA OF TEMPORAL: SENSORY SPEECH
    • PARIETAL LOBE:
    • POST CENTRAL GYRUS : GENERAL SENSATION
    • INTEGRATES SENSORY INFO
    BROO---M
  • 8. ANATOMY & PHYSIOLOGY
    • TEMPORAL LOBE
    • HEARING, TASTE & SMELL
    • WERNICKE’S AREA – SENSORY SPEECH
    BROCA’S AREA OF FRONTAL LOBE – MOTOR SPEECH
    • OCCIPITAL LOBE
    • VISION
    • BASAL GANGLIA
    • REGULATE & INTEGRATE MOTOR ACTIVITY
    • PART OF EPS
  • 9. ANATOMY & PHYSIOLOGY
    • DIENCEPHALON
    • THALAMUS
    • HYPOTHALAMUS
    • BRAINS STEM
    • MIDBRAIN, PONS, MEDULLA
    • NUCLEI OF CN’s - 12
    • VITAL CENTERS OF: REPIRATORY, VASOMOTOR & CARDIAC FXNS
    • CEREBELLUM
    • MUSCLE TONE & EQUILIBRIUM
    PRIMITIVE EMOTIONS: RAGE & FEAR CONTROL CENTER FOR PITUITARY REGULATION OF VITAL FXN : BP, SLEEP, FOOD INTAKE, BODY TEMP
  • 10. ANATOMY & PHYSIOLOGY
    • SPINAL CORD
    • GRAY MATER
      • H SHAPED
      • INTERIOR
    • WHITE MATER
      • EXTERIOR
    • CENTER OF REFLEX ACTIONS
    • 31 SEGMENTS :
      • 8 CERVICAL
      • 12 THORACIC
      • 5 LUMBAR
      • 5 SACRAL
      • 1 COCCYGEAL
  • 11. ANATOMY & PHYSIOLOGY
    • MENINGES
    • SEROUS MEMBRANE OF CRANIOSPINAL CAVITY
    • 3 LAYERS:
      • DURA
      • ARACHNOID
      • PIA
    -CS FLUID
  • 12. ANATOMY & PHYSIOLOGY
    • NERVES
    • FIBERS WHICH EXTEND BEYOND CNS
    • NEURON
    -BASIC UNIT REFLEX ARC BASIC FXNAL UNIT OF N.S.
    • SENSORY/MOTOR
    • MIXED
    • PERIPHERAL
  • 13. ASSESSMENT FACTORS
    • HEADACHE
    • SYNCOPE
    • VERTIGO
    • SEIZURES
    • NEUROLOGIC PAIN
    • INCREASED ICP
    • ABN BODY TEMP ALTERATIONS
    • APHASIA
  • 14. HEADACHE/ CEPHALGIA
    • CAUSE:
    • TENSION
    • DISPLACEMENT/ INFLAMMATION/ DIRECT PRESSURE ON PAIN-SENSITIVE STRUCTURES
    • DILATATION OF ARTERIES
    • CLASSIFICATION:
    • MUSCLE CONTRACTION H/A
    • VASCULAR H/A
    • MUSCLE CONTRACTION HEADACHE
    • MTC
    • PSYCHOGENIC : ANXIETY / DEPRESSION
    • MANAGEMENT:
    • WARM COMPRESS
    • GENTLE MASSAGE
    • ANALGESICS, TRANQUILIZERS
    • VASCULAR HEADACHE
    • PRECIPITANTS:
    • ALLERGIES
    • TYRAMINE
    • EMOTIONAL STRESS
    • FATIGUE
    • VASODILATING DRUGS
    • TYPES:
    • 1. MIGRAINE 2. CLUSTER 3. INFLAMMATORY
    • MIGRAINE (SICK H/A)
    • PERFECTIONISTS & HARDWORKING
    • STRESS
    • CAUSE:
    • CONSTRICTION, THEN DILATION OF CEREBRAL VESSELS
    • TREATMENT:
    • VASOCONSTRICTORS – ERGOTAMINE TARTRATE
    • ICE PACK
    • QUIET, DARKENED ROOM
    • PSYCHOTHERAPY
    • CLUSTER HISTAMINE HEADACHE
    • SEVERE
    • ORGANIC IN NATURE
    • INFLAMMATORY/ TRACTION HEADACHE
    • VERY RARE
    • OCCURS IN AM
    • INVOLVES THE ENTIRE HEAD
  • 15. SYNCOPE/FAINTING
    • TRANSIENT LOSS OF CONSCIOUSNESS
    • INADEQUATE BRAIN PERFUSION
    • CAN BE EVOKED BY :
    • EMOTION
    • PAIN
    • SUDDEN DECREASE IN CO OR VENOUS RETURN FROM ANY CAUSE
    • MANAGEMENT:
    • DANGLE FEET FOR 30 SEC BEFORE STANDING
    • SPIRITS OF AMMONIA
  • 16. VERTIGO
    • SENSATION OF:
      • ROTATING SURROUNDINGS
      • CLIENT IS ROTATING
    • SEEN IN:
      • NEURO DSE
      • OTOLOGIC DSE
      • CARDIOVASC DSE
    • DIZZINESS
    • NYSTAGMUS
  • 17. SEIZURE/EPILEPSY
    • TYPES:
    • GRAND MAL
    • PETIT MAL PSYCHOMOTOR
    • MYOCLONIC
    • FOCAL
    GRAND MAL CLINICAL SEQUENCE: AURA CRY LOSS OF CONSCIUOSNESS FALL TONIC-CLONIC CONVULSION INCONTINENCE
    • AFTER THE SEIZURE:
    • GROGGY & CONFUSED, DEEP SLEEP
    • PETIT MAL
    • LITTLE SICKNESS/ ABSENCE
    • MOMENTARY EPISODE OF L.O.C.
    • LASTS 10-20 SEC
    • CLIENT UNAWARE
    • CHILDREN & ADOLESCENTS
    • PSYCHOMOTOR SEIZURE
    • PERFORMANCE OF AUTOMATIC ACTIVITIES
    • IMPAIRMENT OF CONSCIOUSNESS:
      • LOC
      • AMNESIA
    • NO APPARENT CONVULSION
    • MYOCLONIC SEIZURE
    • SUDDEN INVOLUNTARY CONTRACTION OF A
    • SINGLE OR SMALL GROUPS OF MUSCLE
    • MAY OCCUR DURING PETIT MAL
    • FOCAL MOTOR/ JACKSONIAN
    • ARISE INITIALLY IN THE MOTOR AREAS
    • OF THE BRAIN
    • FROM LOCAL CLONIC MOVEMENTS TO
    • GENERALIZED SEIZURE
    • MEDICAL TREATMENT:
    • GENETIC COUNSELLING
    • ANTICONVULSANTS
    • - TAKEN FOR LIFE
    • FREQUENT CAUSES OF FAILURE IN TREATMENT:
    • POOR COMPLIANCE
    • INADEQUATE DOSAGE ( ACCORDING TO WEIGHT )
    • NURSING INTERVENTION:
    • PRIMARY RESPONSIBILITY:
      • PROTECT PATIENT FROM INJURY
      • OBSERVE & RECORD THE SEIZURE EPISODE
    • DO NOT RESTRAIN THE PATIENT
    • PADDED SIDE RAILS, NO PILLOWS
    • MAINTAIN AIRWAY
    • PATIENT EDUCATION
    • PATIENT EDUCATION:
    • CARRY ID CARD AS AN EPILEPTIC
    • REST, REGULAR MEALS, WELL-BALANCED DIET
    • AVOIDANCE OF:
      • EXTREME PHYSICAL EXERTION
      • INFECTION
      • EMOTIONAL STRESS
    • ALCOHOL
    • MODERATE COFFEE, TEA & COLA
    • STIMULANT DRUGS
  • 18. NEUROLOGIC PAIN
    • ARISE FROM NEUROLOGIC LESIONS CONCERNING PAIN SENSATION
    • SURGERY:
      • NEURECTOMY – 5 TH NERVE RESECTON IN TRIGEMINAL NEURALGIA
      • RHIZOTOMY- RESECTION OF THE POSTERIOR NERVE ROOT
      • CORDOTOMY – LATERAL SPINOTHALAMIC TRACT
  • 19. INCREASED INTRACRANIAL PRESSURE
  • 20. INCREASED INTRACRANIAL PRESSURE
    • THE SKULL IS A CAVITY
    • CONTAINING THE
    • BRAIN TISSUE, CSF, & BLOOD…
    ALL OF WHICH MAINTAIN A NORMAL PRESSURE INSIDE THE SKULL. AN ELEVATION IN THE AMOUNT OF ANY OF THEM WOULD MEAN AN ELEVATION IN THE PRESSURE INSIDE THE CRANIUM CONSIDERING THAT THE SKULL IS RIGID..
  • 21. INCREASED INTRACRANIAL PRESSURE
    • CAUSES:
    • TUMOR
    • HEAD INJURY
    • INFLAMMATORY DSES OF THE NERVOUS SYSTEM
    • CONDITIONS WITH ARTERIOLAR SPASM (e.g.MALIGNANT HPN)
    • ANYTHING THAT BLOCKS PARTLY OR COMPLETELY THE NORMAL COURSE OF CSF
  • 22. INCREASED INTRACRANIAL PRESSURE
    • TREATMENT:
    • CONSERVATIVE:
    • HYPERBARRIC O2 / HYPERVENTILATION– VASOCONSTRICTION DUE TO HYPOCAPNIA
    • ELEVATE HOB
    • MEDICATIONS
      • MANNITOL
      • STEROIDS- DECADRON – ONLY STEROID THAT CAN CROSS THE BBB
    • 4. FLUID RESTRICTION
    • AGGRESSIVE: MECHANICAL DECOMPRESSION
      • CRANIOTOMY – BRAIN TISSUE EXPANSION
      • VENTRICULAR DRAINAGE
  • 23. INCREASED INTRACRANIAL PRESSURE
    • MANIFESTATIONS:
    • HEADACHE
    • VOMITING
    • WIDENING PULSE PRESSURE
    • SLOWING OF RESPIRATION
    • FALLING PULSE RATE
    • PAPILLEDEMA
    • LOSS OF MOTOR FUNCTION
    • SEIZURE
    • LOSS OF SPHINCTER CONTROL
    • TEMPERATURE VARIATIONS
    • CHANGES IN LOC
    • BULGING OF FONTANELS
    • TENSION ON INTRACRANIAL
    • VESSELS
    • NURSING CARE:
    • KEEP HOB ELEVATED
    • POST: NO TRENDELENBERG
    • ASPIRIN AS ORDERED
    • NO NARCOTICS
      • ( PUPILLARY CHANGES)
    • UNRELATED TO MEALS
    • OR NAUSEA
    • PROJECTILE
    • PRESSURE STIMULATION OF
    • MEDULLA OBLONGATA
    • NURSING CARE :
    • I & O
    • WITHHOLD ORAL FLUIDS
    • SUCTION IF NEEDED
    • REFLEX EFFECT OF
    • CEREBRAL ANOXIA
    • NURSING CARE:
    • MONITOR VS HOURLY
    • REPORT WIDENING OF
    • PULSE PRESSURE
    • PRESSURE & ANOXIA
    • OF MEDULLA
    • UNCAL HERNIATION
    • NURSING CARE:
    • MONITOR VS HOURLY
    • RR IN 1 FULL MIN
    • REFLEX EFFECT OF RISING BP
    • NURSING CARE:
    • MONITOR VS HOURLY
    • PULSE IN 1 FULL MIN
    • UNCAL HERNIATION
    • CHOKED DISC
    • VISUAL IMPAIMENT
    • IRREGULAR SIZE & PUPILLARY
    • RESPONSE
    • PUPILS UNILATERALLY FIXED
    • DILATED & LATER, BILATERALLY
    • VENOUS ENGORGEMENT OF
    • CENTRAL RETINA
    • NURSING CARE:
    • PUPILLARY CHECKS : EQUALITY
    • & REACTION TO LIGHT
  • 24. INCREASED INTRACRANIAL PRESSURE
    • HEADACHE
    • VOMITING
    • WIDENING PULSE PRESSURE
    • SLOWING OF RESPIRATION
    • FALLING PULSE RATE
    • PAPILLEDEMA
    • MANIFESTATIONS:
    • LOSS OF MOTOR FUNCTION
    • SEIZURE
    • LOSS OF SPHINCTER CONTROL
    • TEMPERATURE VARIATIONS
    • CHANGES IN LOC
    • BULGING OF FONTANELS
    • DECORTICATE
    • DECEREBRATE
    • PRESSURE ON MOTOR
    • CENTERS
    • NURSING CARE:
    • RECORD HEMIPARESIS
    • CN CXS
    • CHECK REFLEXES
    • INTRACRANIAL
    • STIMULATION TO BRAIN
    • NURSING CARE:
    • CARRYOUT SEIZURE
    • PRECAUTION
    • CEREBRAL PRESSURE
    • INTERFERE WITH
    • SPHINCTER INHIBITORY
    • CONTROL
    • NURSING CARE:
    • RECORD I & O
    • CHECK DISTENTION/
    • INCONTINENCE
    • CATHETERIZE
    • DAMAGE TO
    • HYPOTHALAMUS
    • METABOLIC CHANGES
    • DEVELOPMENT OF
    • MENINGITIS
    • NURSING CARE:
    • ANTIPYRETICS
    • ICE BAG
    • REMOVE EXCESSIVE
    • CLOTHING
    • PREVENT CHILLS
    • LETHARGY – EARLIEST SIGN
    • OF INCREASED ICP
    • PRESSURE ON CEREBRAL
    • CORTEX & RAS
    • NURSING CARE:
    • NOTE RESTLESSNESS
    • EVALUATE
    • CONSCIOUSNESS
    • RECORD DISORIENTATION
    • & HALLUCINATIONS
    • MECHANICAL PRESSURE
    • NURSING CARE:
    • REPORT CSF LEAKAGE
    • REINFORCE WITH
    • DRESSINGS
  • 25. INCREASED INTRACRANIAL PRESSURE
    • GENERAL MEASURES:
    • AVOID STRAINING WITH DEFECATION
    • PREVENT COUGHING
    • REDUCE ENVIRONMENTAL STIMULI
    • RESTRAIN CLIENT PRN
    • ALWAYS ASSUME THAT CLIENT CAN HEAR
  • 26. ABNORMAL BODY TEMPERATURE
    • HYPERTHERMIA/ HYPERPYREXIA
    • > or = 41 o C or 106 o F
    • The temperature-regulatory center in the hypothalamus can be disturbed by:
      • CEREBRAL EDEMA
      • CEREBROVASCULAR DISEASE
      • INTRACRANIAL SURGERY
      • HEAD INJURY
      • BRAIN TUMORS
    EACH O C OF RISE IN TEMP = 13 % INCREASE IN O 2 REQIREMENT OF BODY TISSUES… BRAIN TISSUE IS HIGHLY SUSCEPTIBLE TO HYPOXIA…..
    • NURSING MANAGEMENT:
    • MAINTAIN ROOM TEMP
    • INCREASE FLUIDS 3000 ML/DAY
    • ANTIPYRETICS
    • COMFORT MEASURES
    • MONITOR VS
    • ICE BAGS TO GROIN, AXILLA
  • 27. APHASIA OR DYSPHASIA
    • ORGANIC DISTURBANCE IN LANGUAGE FROM CORTICAL TISSUE DAMAGE
    • TEMPORAL LOBE
    • HEARING, TASTE & SMELL
    • WERNICKE’S AREA – SENSORY SPEECH
    • FRONTAL LOBE:
    • PERSONALITY, BEHAVIOR
    • HIGHER INTELLECTUAL FUNCTIONING
    • PRECENTRAL GYRUS: MOTOR FXN
    • BROCA’S AREA – MOTOR SPEECH
    • NURSING CARE:
    • REHAB 6-12 WKS AFTER STROKE
    • FORMAL SPEECH THERAPY
    • VERBAL STIMULATION
    • TALK SLOWLY & IN A NATURAL TONE
    • SIMPLE WORDS & PHRASES
    • USE CARDS, PICTURES, SLATE BOARDS
  • 28. DIAGNOSTIC ASSESSMENT
    • LUMBAR PUNCTURE
    • QUICKENSTEDT TEST
    • CISTERNAL & VENTRICULAR PUNCTURES
    • ISOTOPE SCANNING OF THE BRAIN
    • COMPUTERIZD AXIAL TOMOGRAPHY
    • EEG
    • ECHOENCEPHALOGRAPHY
    • EVOKED RESPONSES
    • RADIOLOGOC STUDIES
  • 29. LUMBAR PUNCTURE
    • NEEDLE IS INSERTED BETWEEN L3-L4 OR L4-L5
    BELOW THE LEVEL OF THE SPINAL CORD
    • CONTRAINDICATION:
    • INCREASED ICP
    • SEPTICEMIA OR INFECTION
    • USE OF ANICOAGULANT
    • SPACE OCCUPYING LESION
    • NORMAL CSF CHARACTERISTICS :
    • PRESSURE : 6-13 mmHg
    • APPEARANCE : clear & colorless
    • RBC : none
    • WBC : 0-5 cells/mm
    • Protein: very little
    • Glucose: 40-80 mg /dl
    • Chlorides: 720-750 mg/dl
    • Complications:
    • HEADACHE
    • HYPOTENSION
    • MENINGITIS
    • SUBARACHNOID HEMATOMA
  • 30. DIAGNOSTIC ASSESSMENT
    • LUMBAR PUNCTURE
    • QUICKENSTEDT TEST
    • CISTERNAL & VENTRICULAR PUNCTURES
    • ISOTOPE SCANNING OF THE BRAIN
    • COMPUTERIZD AXIAL TOMOGRAPHY
    • EEG
    • ECHOENCEPHALOGRAPHY
    • EVOKED RESPONSES
    • RADIOLOGOC STUDIES
    Assess CSF circulation & any obstruction in the subarachnoid space
    • Detect subarachnoid block
    • & increased ICP
    • Decrease danger of herniation
  • 31. DIAGNOSTIC ASSESSMENT
    • LUMBAR PUNCTURE
    • QUICKENSTEDT TEST
    • CISTERNAL & VENTRICULAR PUNCTURES
    • ISOTOPE SCANNING OF THE BRAIN
    • COMPUTERIZD AXIAL TOMOGRAPHY
    • EEG
    • ECHOENCEPHALOGRAPHY
    • EVOKED RESPONSES
    • RADIOLOGOC STUDIES
    • Initial assessment of intracranial
    • lesion & vascular abnormalities
    • Client’s head is scanned @ various angles
    • Complete brain study
    • Dye
    • Record of electrical activity patterns of the
    • brain using Scalp electrode
    • Prep:
      • 1-2 days before: no tranquilizers, anticonvulsants,
      • stimulants including alcohol
      • Omit tea. Coffee & cola; regular meals & sleep
    • Use of ultrasonic waves to pick up
    • echoes from various intracranial tissues
    • Electrical responses of the brain to
    • external stimulus
    • Diagnosis of:
    • Multiple sclerosis
    • Localized brain lesion
    • Death
      • ANGIOGRAPHY
      • PNEUMOENCEPHALOGRAM
      • MYELOGRAM
      • DISCOGRAPHY
      • VENTRICULOGRAM
    • Injection of radiopaque dye
    • Study of cerebrovascular activity
    • Lumbar puncture
    • Injection of air into the subarachnoid space
    • Contrast picture of subarachnoid cisterns & ventricles
    • Films showing the outline of subarachnoid space
    • Dye or air contrast
    • Locate pathological dse of SC
    • Contrast media to the intervertebral disk
    • Locate abn configurations, characteristics & damages
    • Dye into lateral ventricles through burr holes
    • Detect blockade
  • 32. VENTRICULOGRAM
    • NURSING CARE :
    • PRESURGICAL:
    • SEDATIVE
    • SHAVING
    • CAROTID/VERTEBRAL PUNCTURE: MX NECK CIRCUMFERENCE
    • RECORD BASELINE NEUROLOGIC DATA
    • EXPLAIN THE PROCEDURE
    • POST COMPLETION OF TEST:
    • FLAT OR SEMIFOWLER’S
    • FORCE FLUIDS – ABSORPTION OF CONTRAST MEDIA
    • INCREASED SALIVATION & PERSPIRATION IS NORMAL
    • REDUCE ENVIRONMENTAL STIMULI
    • PAIN RELIEF FOR HEADACHE
    • NO ANTIPYRECTICS : MAY MASK INFECTION
  • 33.  
  • 34. THE UNCONSCIOUS CLIENT
    • UNCONSCIOUSNESS:
    • STATE OF DEPRESSED CEREBRAL FUNCTION
    • NO REACTION TO STIMIULI
    • RESPONSES IS ON THE REFLEX LEVEL ONLY.
    • CAUSE:
    • INTERFERENCE WITH OXYGEN SUPPLY
    • INTERFERENCE WITH GLUCOSE SUPPLY
    • INTERFERENCE WITH TRANSMISSION OF NEURONS
    NURSING CARE:
    • MAINTAIN PATENT AIRWAY
    • HIGHEST PRIORITY
    • LOWER JAW & TONGUE FALLS BACKWARD
    • SUCTIONING
    • POSITIONING
    NURSING CARE
    • MONITOR VS & NEURO STATUS
    • ASSESS THE RATE, QUALITY & RHYTHYM OF
    • PULSE AND RESPIRATION
    • NO ORAL TEMP
    • NEURO CHECKS: LOC, PUPILS,MOTOR STRENGTH
    • & SENSORY FUNCTION
    • NURSING CARE:
    • MAINTAIN SKIN INTEGRITY
      • BLANCHING INDICATES ISCHEMIA
      • MORE FREQUENT POSITION CHANGE
    NURSING CARE
    • MAINTAIN JOINT MOBILITY
      • PROPER POSITIONING
      • FREQUENT TURNING & EXERCISE
      • USE MECHANICAL AIDS:
        • FOOTBOARD
        • TROCHANTER ROLLS
        • HAND ROLLS
    NURSING CARE
    • Maintain sensory function
      • Special ophthalmic solutions : loss of blinking reflex
      • Talk to client- hearing is the last faculty to be lost
    NURSING CARE
    • Maintain fluid & intestinal status
      • Unconscious period: 3L/day of fluid
      • Prolonged coma: NGT feeding
      • Observe client for incontinence, constipation
      • & impaction
      • DIARRHEA – early sign of fecal impaction
      • No rectal stimulation- increase ICP
    NURSING CARE
    • MAINTAINING PSYCHOSOCIAL FUNCTION
      • ASSESS CLIENT’S STATE
      • EXPLAIN IN SIMPLE TERMS
      • THE PROCEDURES & THERAPIES
  • 35. CARE OF NEUROSURGICAL CLIENTS POSITIONING VITAL SIGNS FOODS & FLUIDS SEMIFOWLER’S FLAT ON EITHER SIDE KEEP OFF OPERA- TIVE SITE TURN Q 2H NO SPECIFIC OBSRVE FOR RESPIRATORY DIFFICULTY MONITOR VS OBSERVE FOR SHOCK & INCREASE ICP LIMIT TO 1.5L/DAY DAT AFTER RETURN OF SWALLOWING & GAG NPO X 24 HRS PO FLDS - DAT AFTER RETURN OF SWALLO WING & GAG I & O COMMONALI- TIES INFRA TENTORIAL SUPRA TENTORIAL
  • 36. CARE OF NEUROSURGICAL CLIENTS
    • OTHER MEASURES :
    • DRESSING
    • SUCTION AS NECESSARY
    • DEEP BREATHING, NO COUGHING
    • ICE BAG TO HEAD
    • BOWEL & BLADDER ELIMINATION
    • ANALGESIC, ANTICONVULSANT, STIMULANTS, STEROIDS
    • EYE CARE
    • CLEAR DRAINAGE
    • RESTRAINT CLIENT
    • CATHETERIZE
    • AVOID ENEMA- MAY INCREASE
    • ICP
  • 37. NEUROLOGIC DISORDERS
    • DEGENERATIVE DISEASES
    • CEREBROVASCULAR DISEASES
    • TRAUMATIC INJURIES
    • NEUROPATHIES
    • NEOPLASMS
      • PREMATURE SENESCENCE OF CELLS
    • MULTIPLE SCLEROSIS
    • PARKINSON’S DSE
    • MYASTHENIA GRAVIS
    • ARTERIOSCLEROSIS
    • ANEURYSM, HEMORRHAGE
    • INFARCTION
    • HEAD INJURY
    • SPINAL INJURY
    • TRIGEMINAL NEURALGIA
    • BELL’S PALSY
  • 38. MULTIPLE SCLEROSIS
    • DEGENERATIVE, PROGRESSIVE
    • DEMYELINATION OF MOTOR NERVE FIBERS WITHIN THE BRAIN & SPINAL CORD
    • ETIOLOGY: UNKNOWN;
    • AUTOIMMUNE; VIRUSES
    • S/SX : CHARCOT’S TRIAD:
    • NYSTAGMUS
    • INTENTION
    • TREMOR
    • SCANNING
    • SPEECH
    • MANAGEMENT:
    • PREVENT & TREAT MUSCLE SPASTICITY
      • MUSCLE RELAXANT
      • SLEEP PRONE
    • AVOID SKIN PRESSURE & IMMOBILITY
      • DECUBITUS ULCERS
    • MANAGEMENT:
    • ASSIST TO OVERCOME EFFECTS OF
    • INCOORDINATION
      • WALK WITH FEET WIDER APART
    • SUPPORTIVE MEASURES FOR BLADDER
    • DISTURBANCE
      • ATROPINE & PROBATHINE
    • BLADDER PROGRAM
    • MANAGEMENT:
    • HELP PATIENT WITH OPTIC AND SPEECH
    • DEFECTS
      • CRANIAL NERVES FOR SIGHT &
    • SPEECH ARE AFFECTED BY MS
      • EYE PATCH
    • TRAIN IN ACTIVITIES OF DAILY LIVING
  • 39. PARKINSON’S DISEASE
    • PROGRESSIVE
    • INVOLVES DYSFXN OF BASAL GANGLIA
    • BASAL GANGLIA
    • REGULATE & INTEGRATE MOTOR ACTIVITY
    • PART OF EPS
    • DEFICIENCY OF DOPAMINE FROM
    • SUBSTANTIA NIGRA
    DOPAMINE ACETYLCHOLINE
  • 40. PARKINSON’S DISEASE
    • S/SX:
    • PILL ROLLING & MUSCLE RIGIDITY
    • MASKLIKE APPEARANCE
    • SHUFFLING PROPULSIVE GAIT (FESTINATING GAIT)
    • COGWHEEL MOTION OF JOINTS
    • MANAGEMENT
    • DRUG THERAPY
      • LEVODOPA
      • ANTICHOLINERGICS – COGENTIN, ARTANE
    • PHYSICAL THERAPY
      • COMBAT MUSCLE RIGIDITY
      • GAIT TRAINING
    • SURGICAL – THALAMOTOMY
      • ALLEVIATE TREMOR & RIGIDITY
  • 41. MYASTHENIA GRAVIS
    • ACETYLCHOLINE DEFICIENCY
    • FAILURE OF IMPULSE TRANSMISION
    • WEAKNESS
    • CAUSE:
      • UNKNOWN
      • AUTOIMMUNE
      • INCREASED CHOLINESTERASE
    • SSX:
    • SKELETAL
    • MUSCLE
    • WEAKNESS
    • WEAKNESS OF THE MUSCLES OF :
      • EXTERNAL OCULAR
      • PHARYNGEAL
      • JAW
      • SHOULDER
      • ARM
    • DIAGNOSIS:
    • EDROPHONIUM
    • OR TENSILON
    • TEST
    • MANAGEMENT :
    • DRUGS
    • RADIATION OF THYMUS/ THYMECTOMY
    • QUININE, MORPHNE, NEOMYCIN, LARGE
    • DOSES OF BARBITURATES
  • 42. MYASTHENIA GRAVIS
    • COMPLICATIONS:
    • MYASTHENIC CRISIS
    • CHOLINERGIC CRISIS
    • BRITTLE CRISIS
    MYASTHENIA CRISIS SUDDEN INABILITY TO SPEAK OR MAINTAIN PATENT AIRWAY
    • WEAKNESS OF THE MUSCLES OF:
      • RESPIRATION
      • LARYNX
      • PHARYNX
      • BULBAR
    RESPIRATORY DEPRESSION & AIRWAY OBSTRUCTION CEREBRAL HYPOXIA CNS INJURY & DEATH
    • CAUSES:
    • TEMPORARY RESISTANCE TO ANTICHOLINESTERASE
    • NEED FOR INCREASE IN DOSAGE
    • ACTH THERAPY
    • SIGNS & SYMPTOMS:
    • INITIAL: DYSPHAGIA
    • DIFFICULTY IN SPEAKING
    • EYELID PTOSIS
    • RESPIRATORY ARREST
    • CHOLINERGIC CRISIS
    • OVERMEDICATION WITH ANTICHOLINESTERASE
    • TOO MUCH ACETYLCHOLINE
    • SIGNS & SYMTOMS:
    • SE OF ANTICHOLINESTERASE DRUGS:
      • ABDOMINAL CRAMPS
      • DIARRHEA
      • INCREASE SALIVATION
      • INCREASE SWEATING
      • INCREASE BRONCHIAL SECRETION
    • BRITTLE CRISIS
    • INSENSITIVITY OF ACETYLCHOLINE RECEPTORS
  • 43. CEREBRO-VASCULAR DISEASE CEREBRAL ARTERIOSCLEROSIS & ANEURYSM CEREBRAL INFARCTION & HEMORRHAGE CEREBROVASCULAR ACCIDENT
  • 44.
    • CEREBRAL ARTERIOSCLEROSIS
    • ATHEROMA IN TH BLOOD VESSELS
    • LOSS OF MEMORY FOR RECENT EVENTS
    • CONFUSION
    • PERSONALITY CXS
    • VERTIGO TIA’s
    • CEREBRAL ANEURYSM
    • LOCALIZED OUTPOUCHING OF THE WALL OF AN ARTERY
    • CEREBRAL EMBOLISM
    • OCCLUSION OF THE CEREBRAL VESSEL
  • 45. CEREBROVASCULAR ACCIDENT
    • EFFECTS & MANIFESTATIONS:
    • PREMONITORY SYMPTOMS:
    • LOC
    • CONVULSION
    • HEADACHE & VOMITING
    • VITAL SIGNS CXS
    • MOTOR & SENSORY DEFICITS
    • SPEECH DEFECTS
    • HEADACHE
    • NUCHAL RIGIDITY
    • DIZZINESS
    • THICKENED TONGUE
    NURSING CARE:
    • EMERGENCY CARE:
    • TURNING TO SIDE
    • ELEVATE HEAD
    • QUIET ENVIRONMENT
    • GENERAL CARE:
    • ADEQUATE OXYGENATION
    • VS
    • FLUID & ELEC BALANCE
    • PROPER POSITIONING
    • ADEQUATE ELIMINATION
    • PROTECT EYES
    • MOBILIZATION & REHAB
    • WHEN CONSCIOUSNESS REGAINED
  • 46. BIG…
  • 47. HEAD INJURY
    • CLASSIFICATION:
    • LACERATION OF THE SCALP
    • SKULL INJURY
    • BRAIN INJURY
    • INTRACRANIAL
    • HEMORRHAGE
    • EPIDURAL
    • SUBDURAL
    • INTRACEREBRAL OR
    • SUBARACHNOID
      • CONCUSSION
      • CONTUSION
      • LACERATION
      • COMPRESSION
  • 48.
    • INTRACRANIAL
    • HEMORRHAGE
    • EPIDURAL
    • SUBDURAL
    • INTRACEREBRAL OR
    • SUBARACHNOID
    • RESULT FROM TEAR IN THE
    • WALL OF MIDDLE
    • MENINGEAL ARTERY
    • S/SX:
    • LOC
      • REGAIN CONSCIOUSNESS
      • (LUCID INTERVAL)
        • LOC
    • VENOUS IN ORIGIN
    • S/SX:
    • ACUTE
    • UNCONSCIOUSNESS
    • IMMEDIATELY AFTER
    • SURGERY
    • CHRONIC
    • CONSCIOUS FOR SEVERAL
    • WEEKS OR MONTHS, THEN
    • PATIENT SHOWS
    • NEUROLOGIC SIGNS
    MOST COMOON CAUSE: LEAKING CONGENITAL ANEURYSM
  • 49. HEAD INJURY
    • NURSING CARE:
    • EMERGENCY CARE:
    • AIRWAY
    • SUPINE STRAIGHT, THEN TURNED TO LATERAL OR SEMIPRONE
    • POSSIBLE CERVICAL FX: NO NECK FLEXION & HYPEREXTENSION
    • KEEP PX COVERED, QUIET & UNDISTURBED
    • GENERAL CARE:
    • AIRWAY
    • PREVENT ASPIRATION
    • PN
    • CHECK CARDIOVASC
    • COMPLICATIONS
    • SEARCH EVIDENCE OF
    • SPINAL INJURY
    • CHECK SKULL & SCALP
    • INJURIES
    • PROPHYLACTIC TETANUS
    • OBSERVE CSF LEAKAGE:
      • OTORRHEA, RHINORRHEA
      • BATTLE’S SIGN
    • OBSERVE FOR S/SX OF INCREASED ICP
    • CONTROL RESTLESS-
    • NESS & PAIN: NO NARCOTICS
    • MAINTAIN F&E, ACID- BASE BALANCE
    CAUGHT
  • 50. SPINAL CORD INJURIES
    • CAUSES:
    • TRAUMA
    • FALLS
    • GSW
    • TUMORS
    • TYPES:
    • CONCUSSION
    • COMPRESSION
    • CONTUSION & TRANSECTION
    • LACERATION
    • HEMORRHAGE
    • (HEMATOMYALIA)
    • COMPRESSION OF BLOOD SUPPLY TO THE CORD
  • 51. CLINICAL EFFECTS OF SCI
    • SPINAL SHOCK
    • REFLEX ACTIVITY
    • WHIPLASH INJURY
    • HERNIATED NUCLEUS PULPOSUS
  • 52. SPINAL SHOCK
    • IMMEDIATE FLACCID PARALYSIS & SENSORY LOSS BELOW THE LEVEL OF LESION
    • PRIAPISM
    • BULBOCAVERNOUS REFLEX IS LOST BUT REUTRNS AFTER A FEW HRS
    • OTHER REFLEXES REMAIN ABSENT
    • 3-6 WKS
    • AUTONOMIC DISTURBANCES:
    • SWEATING IS ABOLISHED
    • BELOW THE LEVEL OF INJURY
    • URINE & FECES RETAINED
    • GASTRIC ATONY
    • ORTHOSTATIC HYPOTENSION
    • SLOW, & STEADY PULSE
  • 53. REFLEX ACTIVITY
    • REPLACE SPINAL SHOCK AFTER 2-3 WEEKS IF LUMBO-SACRAL SEGMENTS ARE UNDAMAGED
    • OCCURS IN ACUTE SPINAL INJURY, NOT IN PROGRESSIVE ONES
    • AUTOMATIC BLADDER; REFLEX SWEATING & DEFECATION
    • FIRST SIGN OF WEARING OFF:
      • CONTRACTION OF HAMSTRING
      • FLEXION/ EXTENSION OF TOES WITH PLANTAR STIMULATION
  • 54. WHIPLASH INJURY
    • VIOLENT HYPEREXTENSION & FLEXION OF THE NECK
    • USUALLY WITH AUTOMOBILE ACCIDENT
    • CERVICAL SPINE DAMAGE:
      • MUSCLES
      • DISKS
      • LIGAMENTS
      • NERVOUS TISSUE
    • SIGNS & SYMPTOMS :
    • PALE
    • LOC
    • WEAK
    • GAIT DISTURBANCE
    • DIZZINESS
    • VOMITING
    • SEVERE OCCIPITAL
    • HEADACHE
    • PAIN RADIATES TO THE
    • ARMS
    • NUCHAL RIGIDITY
    MANAGEMENT: BED REST ANALGESIC HOT PACKS PLASTIC COLLAR FOR SEVERAL WEEKS
  • 55. HERNIATED NUCLEUS PULPOSUS
    • CAUSE:
    • LIFTING OF HEAVY OBJECTS
    • FALL ON THE BACK
    • IMPROPER BODY MECHANICS – LUMBAR
    • S/SX :
    • BACK PAIN WITH RADIATION TO THE BACK OF THE
    • LEG
    • DIFFICULTY IN WALKING
    • MUSCLE SPASM
    • DISORDERS OF SENSATION
    • NEAR THORACIC OR CERVICAL REGION: NUCHAL
    • RIGIDITY RADIATING DOWN THE ARM TO THE
    • FINGER
  • 56. VERTEBRA INTER- VERTEBRAL DISK SPINAL CORD HERNIATED DISK
    • MANAGEMENT:
    • CONSERVATIVE:
      • BRACE
      • CAST
      • TRACTION
      • PROLONGED BEDREST
      • PT
    • AGGRESSIVE:
    • SINGLE DISK:
    • REMOVAL WITHOUT
    • FUSION
    • SEVERAL DISKS:
    • SPINAL FUSION
    • WITH BRACE
  • 57. TRIGEMINAL NEURALGIA
    • TIC DOULOREAUX
    • 5 TH CN : OPHTHALMIC, MAXILLARY, MANDIBULAR
    • AGONIZING PAIN
    • ETIOLOGY : UNKNOWN
    • PRECIPITAN T: PRESSURE ON TRIGGER POI NTS :
    • SHAVING
    • TALKING
    • WASHING
    • COLD WIND
    • MANAGEMENT
      • CONSERVATIVE:
        • AVOID SERVING TOO
        • HOT FOODS
        • DRUG TX:
          • ANTIEPILEPTIC
            • DILANTIN
          • CARBAMAZEPINE
            • TEGETROL
    • AGGRESSIVE
    • -SURGICAL
      • INTRACRANIAL
      • RESECTIONING
      • OF PAIN FIBERS
      • PERIPHERAL
      • INJECTION
      • WITH ALCOHOL
      • OF PAIN
      • GANGLIONS
  • 58. BELL’S PALSY
    • CN 7
    • UNILATERAL
    • WEAKNESS & PARALYSIS
    • CAUSE: UNKNOWN
    • S/SX:
    • FACIAL NUMBNESS
    • DISTORTION
    • SPEECH DIFFICULTY
    • DIFFICULTY WITH EATING
    • PAIN BEHIND THE EAR OR FACE
    • MANAGEMENT:
      • RECOVERY : 3-5 WKS
      • FACIAL MASSAGE
      • PAIN RELIEF
      • PROTECT INVOLVED EYE
      • ACTH – MINIMIZE DENERVATION AND PERMANENT
      • SEQUELAE
      • TEACH PATIENT FACIAL EXERCISES :
        • WHISTLE
        • WRINKLE FOREHEAD
        • BLOWOUT & PUFF CHEEKS
  • 59.
    • Which of the following reduces cerebral edema by constricting the cerebral vessels?
    • Dexamethasone (Decadron)
    • Mechanical Hyperventilation
    • Mannitol
    • Ventriculostomy
  • 60. RELAX….