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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25


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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25

  1. 1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25 NURSING CARE OF THE CLIENT: NEUROLOGICAL SYSTEM
  2. 2. The Human Nervous System <ul><li>Its purpose is to control motor, sensory, and autonomic functions of the body. </li></ul><ul><li>This is accomplished by coordination and initiation of cellular activity through the transmission of electrical impulses and various hormones. </li></ul>
  3. 3. The Nervous System: Structure <ul><li>The nervous system is divided into: </li></ul><ul><ul><li>The central nervous system, consisting of the brain and spinal cord. </li></ul></ul><ul><ul><li>The peripheral nervous system, which consists of the cranial nerves and spinal nerves. </li></ul></ul><ul><ul><li>The autonomic nervous system, which is part of the peripheral nervous system and consists of sympathetic and para-sympathetic systems. </li></ul></ul>
  4. 4. The Brain <ul><li>Composed of gray matter and white matter, the brain controls, initiates, and integrates body functions through the use of electrical impulses and complex molecules. </li></ul>
  5. 5. Physiology of the Brain <ul><li>The brain is contained within the skull, or cranium. </li></ul><ul><li>Three coverings of the brain, called the meninges. They are the dura mater, arachnoid mater, and pia mater. </li></ul>
  6. 6. The Brain Hemispheres <ul><li>The right side receives information from and controls the left side of the body. Specializes in perception of physical environment, art, music, nonverbal communication, spiritual aspects. </li></ul><ul><li>The left receives information from and controls the right side of the body. Specializes in analysis, calculation, problem solving, verbal communication, interpretation, language, reading, and writing. </li></ul>
  7. 7. The Spinal Cord <ul><li>A continuation of the brain stem. </li></ul><ul><li>Exits the skull through the foramen magnum, an opening in the base of the skull. </li></ul>
  8. 8. Cerebrospinal Fluid <ul><li>Provides for shock absorption and bathes the brain and spinal cord. </li></ul>
  9. 9. Peripheral Nervous System: Cranial Nerves <ul><li>Twelve pairs of cranial nerves have sensory, motor, or mixed functions. </li></ul>
  10. 10. Peripheral Nervous System: Cranial Nerves <ul><li>Twelve pairs of cranial nerves have sensory, motor, or mixed functions. </li></ul>
  11. 11. Cranial Nerves Hypoglossal Tongue Movement Spinal Accessory Motor Vagus Motor and Sensory Glosso- Pharyngeal Taste; Swallowing Acoustic Sensory; Hearing; Equilibrium Facial Motor (facial muscles); Sensory (taste) Abducens Motor; Extraocular eye movement Trigeminal cornea, nose, oral mucosa ; mastication Trochlear Motor;upper eyelid elevation Oculomotor Motor; Pupil Constriction Optic Sensory;Vision Olfactory Sensory;smell
  12. 12. Peripheral Nervous System: Spinal Nerves <ul><li>Cervical 8 </li></ul><ul><li>Thoracic 12 </li></ul><ul><li>Lumbar 5 </li></ul><ul><li>Sacral 5 </li></ul><ul><li>Coccyx 1 </li></ul>NERVES NUMBER OF PAIRS
  13. 13. Peripheral Nervous System: Autonomic Nervous System <ul><li>Main function is to maintain internal homeostasis. </li></ul><ul><li>Two subdivisions of ANS: </li></ul><ul><ul><li>The sympathetic system (activated by stress, prepares body for “fight or flight” response). </li></ul></ul><ul><ul><li>The parasympathetic system (conserves, restores, and maintains vital body functions, slowing heart rate, increasing gastrointestinal activity, and activating bowel and bladder evacuation). </li></ul></ul>
  14. 14. Cerebral Function: Assessment
  15. 15. Cranial Nerve Function Assessment: Motor Function
  16. 16. Cranial Nerve Function Assessment: Sensory Function
  17. 17. Cranial Nerve Function Assessment: Reflexes
  18. 18. Common Diagnostic Tests for Nervous System Disorders <ul><li>Lumbar puncture (LP). </li></ul><ul><li>Electroencephalogram (EEG). </li></ul><ul><li>Electromyogram (EMG). </li></ul><ul><li>Imaging Procedures. </li></ul><ul><li>Cerebral Angiography. </li></ul><ul><li>Brain scan. </li></ul><ul><li>Myelogram. </li></ul>
  19. 19. Head Injuries <ul><li>Scalp. </li></ul><ul><li>Skull. </li></ul><ul><li>Brain. </li></ul>Head injuries involve trauma to the:
  20. 20. Scalp Injuries <ul><li>They bleed profusely because of the abundance of blood vessels in the scalp. </li></ul><ul><li>Infection is of major concern. </li></ul>
  21. 21. Skull Injuries <ul><li>May occur with or without brain injury, </li></ul><ul><li>Fracture usually caused by extreme force, </li></ul><ul><li>Skull fractures considered closed if dura mater is intact; open if dura mater is torn. </li></ul>
  22. 22. Types of Skull Fractures <ul><li>Linear (nondisplaced cracks in the bone). </li></ul><ul><li>Comminuted (bone broken into fragments). </li></ul><ul><li>Depressed (bone fragments pressing into intracranial cavity). </li></ul><ul><li>Basiliar (fractures of the bones in the base of the skull). </li></ul>
  23. 23. Brain Injuries: Causes <ul><li>Acceleration-deceleration force (acceleration injuries caused by moving objects striking the head; e.g. baseball bat. Deceleration injuries result when head is moving and strikes object, e.g. dashboard). </li></ul><ul><li>Rotational (twisting of the cerebrum on the brain stem, e.g. whiplash). </li></ul><ul><li>Penetrating missile (direct penetration of an object, e.g. bullet, into brain tissue). </li></ul>
  24. 24. Brain Injuries: Open <ul><li>Brain injuries resulting from skull fractures and penetrating injuries are referred to as open head injuries. </li></ul><ul><li>Hemorrhaging from the nose, pharynx, or ears; ecchymosis over the mastoid area (Battle’s sign) or blood in the conjunctiva may occur in conjunction with open head injuries. </li></ul>
  25. 25. Brain Injuries: Closed <ul><li>Caused by blunt force to the head. </li></ul><ul><li>Types of closed head injuries include concussion, contusion, and laceration. </li></ul>
  26. 26. Concussion <ul><li>Transient neurological deficits caused by the shaking of the brain. </li></ul><ul><li>Clinical manifestations may include immediate loss of consciousness lasting from minutes to hours, momentary loss of reflexes, respiratory arrest for several seconds, an amnesia afterwards. </li></ul>
  27. 27. Contusions <ul><li>Surface bruises of the brain. </li></ul><ul><li>Skin is cool and pale. </li></ul><ul><li>Pulse, blood pressure, and respirations are below normal. </li></ul><ul><li>Cerebral edema may occur in conjunction with widespread injury. </li></ul>
  28. 28. Cerebral Lacerations <ul><li>Tearing of cortical tissue. </li></ul><ul><li>Symptoms include deep coma from time of impact, decerebate posturing, autonomic dysfunction, nonreactive pupils, respiratory difficulty. </li></ul>
  29. 29. Hemorrhage <ul><li>Intracranial hemorrhage is common complication of any head injury. </li></ul><ul><li>Treatment is surgery to evacuate the hematoma, stop the bleeding, and relieve pressure on the brain. </li></ul>
  30. 30. Brain Tumor <ul><li>Space-occupying intracranial lesions, either benign or malignant. </li></ul><ul><li>Clinical manifestations differ according to area of lesion and rate of growth, but commonly include alterations in consciousness, decreased mental functioning, headaches, seizures, or vomiting (sometimes sudden and projectile), </li></ul>
  31. 31. Cerebrovascular Accident (CVA) <ul><li>Also known as stroke, CVA is a sudden loss of brain function accompanied by neurological deficit. </li></ul><ul><li>Third highest cause of death in U.S. </li></ul><ul><li>Strokes are caused by ischemia (oxygen deprivation) resulting from a thrombus, embolus, severe vasospasm, or cerebral hemorrhage. </li></ul>
  32. 32. Transient Ischemic Attacks (TIAs) <ul><li>Frequently preceding CVAs, TIAs are temporary or transient episodes of neurological dysfunction caused by temporary impairment of blood flow to the brain. </li></ul><ul><li>Classic symptom is fleeting blindness in one eye. </li></ul>
  33. 33. Epilepsy/Seizure Disorder <ul><li>Epilepsy is a disorder of cerebral function in which the client experiences sudden attacks of altered consciousness, motor activity, or sensory phenomenon. </li></ul><ul><li>Most clinicians use the term seizure disorder for epilepsy or seizures </li></ul><ul><li>Seizures are classified as generalized or partial. </li></ul>
  34. 34. Herniated Intervertebral Disk <ul><li>A major cause of chronic back pain. </li></ul><ul><li>Majority of herniated disks occur in lumbar or cervical spine. This can occur either suddenly from trauma, lifting, or twisting, or gradually from aging, osteoporosis, or degenerative changes. </li></ul>
  35. 35. Spinal Cord Injury (SCI) <ul><li>Occurs from trauma to the spinal cord or from compression of the spinal cord due to injury to the supporting structures. </li></ul><ul><li>Each year, almost 10,000 new spinal cord injuries occur. </li></ul><ul><li>Leading causes are motor vehicle accidents, acts of violence, falls, and sporting accidents. </li></ul>
  36. 36. Parkinson’s Disease <ul><li>A chronic, progressive, degenerative disease affecting the area of the brain controlling movement. </li></ul><ul><li>Typical symptoms include muscular rigidity, bradykinesia (slowness of voluntary movement and speech), resting tremors, muscular weakness, and loss of postural reflexes. </li></ul>
  37. 37. Multiple Sclerosis (MS) <ul><li>A chronic, progressive, degenerative disease wherein scattered nerve cells of the brain and spinal cord are demyelinated. </li></ul><ul><li>Symptoms include visual disturbance, numbness, paresthesia, pain, decreased sense of temperature, decreased muscle strength, spasticity, paralysis, bowel and bladder incontinence or retention. </li></ul>
  38. 38. Amyotrophic Lateral Sclerosis (ASL) (Lou Gehrig’s Disease) <ul><li>A progressive, fatal disease characterized by the degeneration of motor neurons in the cortex, medulla, and spinal cord. </li></ul>
  39. 39. Alzheimer’s Disease (AD) <ul><li>A progressive, degenerative neurological disease wherein brain cells are destroyed and the cerebral cortex atrophies. </li></ul><ul><li>Risk factors include advanced age, female gender, head injury, history of thyroid disorders, and chromosomal abnormalities. </li></ul>
  40. 40. Stages of Alzheimer’s Disease
  41. 41. Guillain-Barré Syndrome <ul><li>An acute inflammatory process primarily involving the motor neurons of the peripheral nervous system. </li></ul><ul><li>Clinical manifestations include motor weakness and absence of reflexes (areflexia). </li></ul>
  42. 42. Headache <ul><li>Also known as cephalagia, headache is the condition of pain in the head, caused by stimulation of pain-sensitive structures in the cranium, head, or neck. </li></ul>
  43. 43. Types of Headache: Primary <ul><li>Tension-Type </li></ul><ul><li>Migraine. </li></ul><ul><li>Cluster Headaches. </li></ul>
  44. 44. Types of Headache: Secondary <ul><li>Secondary headaches are the result of pathological conditions such as aneurysm, brain tumor, or inflamed cranial nerves. </li></ul><ul><li>The headache is caused by compression, inflammation, or hypoxia of pain-sensitive structures. </li></ul>
  45. 45. Client Teaching: Headaches <ul><li>Advise clients to: </li></ul><ul><ul><li>Keep a diary of headache history to ascertain pattern. </li></ul></ul><ul><ul><li>Avoid foods that trigger headaches. </li></ul></ul><ul><ul><li>Reduce salt intake. </li></ul></ul><ul><ul><li>Practice relaxation techniques. </li></ul></ul>
  46. 46. Trigeminal Neuralgia (Tic Douloureux) <ul><li>A condition of cranial nerve V that is characterized by abrupt paroxysms of pain and facial muscle contractions. </li></ul>
  47. 47. Encephalitis/Meningitis <ul><li>Encephalitis is inflammation of the brain. </li></ul><ul><li>Meningitis is inflammation of the meninges. </li></ul><ul><li>Most common cause of both is a virus. </li></ul><ul><li>Cerebral edema, hemorrhage, and necrosis of brain tissue can occur. </li></ul><ul><li>Fever, headache, nuchal rigidity, photophobia, irritability, lethargy, nausea, and vomiting are typical symptoms. </li></ul>
  48. 48. Huntington’s Disease or Chorea <ul><li>A chronic, progressive hereditary disease of the nervous system characterized by chorea, abnormal involuntary, purposeless movements of all musculature of the body. </li></ul>
  49. 49. Gilles de la Tourette’s Syndrome <ul><li>A neurological movement disorder that also has prominent behavioral manifestations. </li></ul>