Anatomy and Physiology
Purpose: To understand the workings andfunctions of the human nervous system.To successfully identify disease processescom...
   A & P of the Nervous System
Neuron- The functional unit (cell) of the nervoussystem that conducts electrical impulses to thebrain and to other areas o...
Axon and dendrites branch off of the main body ofthe neuron.Axon- Carry impulses away from the cell bodyDendrites – Carry ...
The Central Nervous System (CNS)Made up of the BRAIN and the SPINAL CORD     The Peripheral Nervous System (PNS)Made up of...
The Brain is divided into the Cerebrum,Cerebellum and the Brain Stem.Cerebral Spinal Fluid (CSF) is composed of water,gluc...
The Spinal CordExtends from C1 to L2There are 31 pairs of spinal nerve roots that exitthe spinal cord, each consisting of ...
Autonomic Nervous SystemControls the INVOLUNTARY activities of theviscera including smooth muscle, cardiac muscleand gland...
Complex functions:Initiation of movements, recognition of sensoryinput, higher-order thinking, regulatingemotional behavio...
Divided into two halves: hemispheresEach hemisphere controls the opposite side of thebody: the right hemisphere controls t...
BrainstemIncludes midbrain, pons, medulla, and part of thereticular activating systemControls vital, basic functions, incl...
Uses information received from the cerebrum,muscles, joints, and inner ear to coordinatemovement, balance, and postureUnli...
Carotid SystemBegins as one common artery; later divides into theexternal and internal carotid arteriesThe external caroti...
Carotid SystemBegins as one common artery; later divides into theexternal and internal carotid arteriesThe external caroti...
Vertebral ArteriesOriginate from the subclavian artery, travel upthe anterior neck to merge and form the basilarartery at ...
TYPES OF DISORDERS   Genetic/ Developmental   Trauma   Infection and Inflammation   Neoplasms   Degenerative processe...
Thought to be caused by:     Intracranial vasoconstriction followed be      vasodilation.     TRIGGERED BY:       Menst...
PAIN:   Usually unilateral   Often begins in the temple or eye area   VERY INTENSE   Tearing and nausea and vomiting m...
TREATMENT MEDICATIONS   Mild migraines:       Acetaminophen or aspirin   Severe migraines:     Ergotamine (Cafergot)  ...
Occur in a series of episodes followed by a longperiod with no symptoms.Intensely painful and seem to be related to stress...
TREATMENT MEDICATIONS   Cold application   Indomethacin (Indocin)   Tricyclic antidepressants (Elavil)
Results from prolonged muscle contraction fromanxiety, stress, or stimuli from other sources, suchas brain tumor or an abs...
TREATMENT   Correction of known causes   Psychotherapy   Massage   Heat application   Relaxation techniques
TREATMENT MEDICATIONS   Analgesics (usually non-opiod)   Benzodiazepines to relieve anxiety if severe.
Electrical impulses in the brain are conducted in ahighly chaotic pattern that yields abnormalactivity and behavior.Relate...
MEDICAL DIAGNOSISAccurate history of the seizure disorder     Electroencephalogram (EEG)
Partial SeizureSimple     Part of one cerebral hemisphere; consciousness not     impaired Complex     Consciousness impair...
Generalized seizures     Involves the whole brain     Consciousness lost during the ictal (seizure) periodTYPES   Tonic...
Status Epilepticus    Medical emergency. The continuous seizure or    repeated seizure in rapid succession for 30 minutes ...
MEDICAL TREATMENTResolution of the underlying conditionAnticonvulsant therapy     If good seizure control is not accompli...
SURGICAL TREATMENTRemoval of seizure foci in the temporal lobe andpallidotomy or vagal nerve stimulator.
Assessment   Describe the seizure episode, INCLUDING the post-    ictal period, and documenting drug therapy.
Risk for Injury:     Nursing Interventions       Side rails         Padded bed        .         Suction machine      ...
Ineffective Coping and Knowledge Deficit     Nursing Interventions       Teach family and patient about seizure disorder...
TYPESScalp Injuries     Lacerations, contusions, abrasions, and hematomasConcussion      Trauma with no visible injury to...
TYPESHematoma    Subdural hematoma or epidural hematomaIntracerebral Hemorrhage    From lesions within the tissue of the b...
Surgical TreatmentDirected at evacuating hematomas anddebriding damaged tissue
   Ineffective Tissue Perfusion   Ineffective Breathing Pattern   Risk for Injury   Risk for Infection   Impaired Phy...
Cause and Risk Factors   Some congenital; others may be related to heredity   Drug/environmental factors may play a role...
   Signs and symptoms   Directly related to area of brain invaded by the    tumor   Visual disturbances and headache  ...
Medical Treatment   Surgery often followed by radiation with or without    chemotherapy
Acute PainDisturbed Thought ProcessesDisturbed Sensory PerceptionImpaired Physical MobilitySelf-Care DeficitIneffective Co...
Cause and Risk FactorsInflammation of the meningeal coverings of thebrain and spinal cord caused by either viruses orbacte...
Signs and Symptoms   Headache,   nuchal rigidity (stiffness of the back of the neck)   irritability   diminished level...
Medical TreatmentBacterial infections usually respond toantimicrobial therapy, but no specific drugseffective against most...
Assessment   Assess vital signs   Neurologic status frequently to determine    further deterioration or onset of    comp...
Ineffective Tissue PerfusionIneffective Breathing PatternAcute PainRisk for InjuryDeficient Fluid Volume
Cause and Risk Factors     Inflammation of brain tissue caused by virus            Signs and SymptomsFever                ...
Medical TreatmentEnhance patient comfort and increase strengthBecause seizure activity is a potential problem,take appropr...
The nursing plan of care parallels that of thepatient with meningitis
Cause and Risk FactorsAlthough specific cause unknown, it is believed tobe an autoimmune response to a viral infectionPati...
Initial PhaseSymmetric muscle weakness: begins in lower extremities;ascends to trunk and upper extremitiesVisual and heari...
Plateau PhaseRemains essentially unchangedNo further neurologic deterioration, but noimprovement either              Recov...
Medical DiagnosisCharacteristic onset and pattern of ascendingmotor involvementElevated protein level in the CSFNerve cond...
Medical TreatmentPreserve vital function, particularly respirationRespiratory status is closely monitored and mechanicalve...
Assessment   Health history describes the progression of    symptoms   Note fears, coping strategies, and sources of    ...
Ineffective Breathing PatternDecreased Cardiac OutputRisk for Disuse SyndromeImbalanced Nutrition: Less Than BodyRequireme...
Cause and Risk Factors   Progressive degenerative disorder of the basal    ganglia: an eventual loss of coordination and ...
Signs and SymptomsTremor, rigidity, and bradykinesiaLoss of dexterity and power in affected limbs,aching, monotone voice, ...
Medical DiagnosisFrom health history and physical examinationMRI to rule out other causes of the symptoms
Medical TreatmentControl symptoms: physical therapy and drugtherapyMassage, heat, exercise, and gait retraining
MedicationsDopamine receptor agonists:    Pramipexole (Mirapex)    Ropinirole (Requip);    L-dopa (L-dihydroxyphenylalanin...
AssessmentWeakness, fatigue, muscle cramps, sweating,dysphagia, constipation, difficulty voiding, andunusual movementsNote...
Impaired Physical MobilityRisk for InjuryImbalanced Nutrition: Less Than BodyRequirementsIneffective CopingDeficient Knowl...
CauseChronic, progressive degenerative diseaseAttacks the protective myelin sheath around axons anddisrupts the conduction...
Signs and SymptomsFatigue, weakness, and tingling in one or moreextremities; visual disturbances; problems withcoordinatio...
Relapsing-progressive MS: less stable periodsthan exacerbating-remittingStable MS: stable; no active disease for a yearExa...
Medical DiagnosisBased on the physical examination and history ofcyclic remission-exacerbation periodsMagnetic resonance i...
Medical TreatmentCorticosteroids     (ACTH, prednisone, methylprednisolone)Interferon 1b (Betaseron) and     interferon...
Urinary retention treated with cholinergics, suchas bethanechol (Urecholine) or neostigmine(Prostigmine)
AssessmentOnset and progression of symptoms, especiallythose that affect mobility, vision, eating, andeliminationRange of ...
Impaired Physical MobilityDisturbed Sensory PerceptionSelf-Care DeficitFunctional Urinary IncontinenceRisk for InfectionIn...
CauseAlso known as Lou Gehrig’s disease; adegenerative neurologic diseaseVirus suspected, but exact cause unknown
PathophysiologyDegeneration of the anterior horn cells and thecorticospinal tracts, so patient exhibits upper andlower mot...
Signs and SymptomsWeakness of voluntary muscles of the upperextremities, particularly the handsDifficulty swallowing and s...
Medical DiagnosisHistory and physical examination findingsElectromyography
Medical TreatmentBecause no known cure or treatment, therapy issupportive; focuses on preventing complicationsand maintain...
AssessmentDyspnea, dysphagia, muscle cramps, weakness,twitching, joint stiffness, muscle atrophy,abnormal reflexes and gai...
Ineffective Airway ClearanceImpaired Physical MobilityImbalanced Nutrition: Less Than BodyRequirementsImpaired Verbal Comm...
Inherited degenerative neurologic disorderUsually begins in middle adulthood with abnormalmovements, emotional disturbance...
Cause           May have an autoimmune basis                Pathophysiology   Insufficient receptor sites at the junction...
Signs and Symptoms   Weakness of voluntary muscles, particularly those    of chewing, swallowing, and speaking   Partial...
Medical Diagnosis   Administering edrophonium (Tensilon)   Muscle tone is markedly improved within 1    minute of inject...
Medical Treatment   Anticholinesterase drugs   Neostigmine and pyridostigmine (Mestinon)   Corticosteroids   Cytotoxic...
AssessmentHealth history describes the onset of symptoms:muscle weakness, diplopia, dysphagia, slurredspeech, breathing di...
Ineffective Breathing PatternImpaired Physical Mobility and Self-Care DeficitImpaired SwallowingDeficient Knowledge
Health History   Note speech, behavior, coordination, alertness,    comprehension    Chief Complaint and history of prese...
Past Medical HistoryHead injury, seizures, diabetes mellitus,hypertension, heart disease, and cancerRecord dates and types...
Family History  Have immediate family members had heartdisease, stroke, diabetes mellitus, cancer, seizure disorders, musc...
Review of SystemsFatigue or weakness, headache, dizziness, vertigo,changes in vision/hearing, tinnitus, drainagefrom ears ...
Functional AssessmentDocument whether present symptoms interferewith the patient’s usual activities and occupationExplore ...
Physical ExaminationLevel of consciousness, pupillary evaluation,  neuromuscular response, and vital signs
Risk Factors for StrokeNon-modifiable factors     Risk factors that cannot be changed       Age, race, gender, and hered...
Temporary neurologic deficit caused byimpairment of cerebral blood flowBlood vessels occluded by spasms, fragments ofplaqu...
Signs and SymptomsDizziness, momentary confusion, loss of speech,loss of balance, tinnitus, visual disturbances,ptosis, dy...
Medical DiagnosisHealth history, physical examination findings,and results of brain imaging studiesLaboratory studies, ele...
Medical DiagnosisHealth history, physical examination findings,and results of brain imaging studiesLaboratory studies, ele...
Medical TreatmentDepends on the location of the narrowed vessel and thedegree of narrowingAcetylsalicylic acid (aspirin)Ti...
An abrupt impairment of brain function resultingin a set of neurologic signs and symptoms that arecaused by impaired blood...
PathophysiologyHemorrhagic stroke     Blood vessel in brain ruptures; bleeding into the      brain occursIschemic stroke ...
Signs and SymptomsDifferent signs and symptoms, depending on thetype, location, and extent of brain injuryHemorrhagic stro...
Signs and SymptomsEmbolic stroke     Appear without warning     One or more of the following signs and symptoms:      on...
The number of nerve cells decreasesBrain weight is reduced; ventricles increase in sizeLipofuscin: aging pigment deposited...
Reflexes intact except for Achilles tendon jerk,which is often absentReaction time increases, especially complexreactionsT...
Signs and SymptomsAphasia A defect in the use of language; speech, reading,  writing, or word comprehensionDysarthria Th...
Signs and SymptomsDyspraxia The partial inability to initiate  coordinated voluntary motor actsHemiplegia Defined as par...
Signs and SymptomsSensory impairment Unable to feel touch, pain, or  temperature in affected body partsUnilateral neglect...
Signs and SymptomsHomonymous hemianopsia     Perceptual problem: involves loss of one side of field      of visionElimina...
Medical DiagnosisBlood studies, electrocardiogram (ECG),computed tomography, magnetic resonanceimaging, carotid ultrasound...
ComplicationsConstipation, dehydration, contractures, urinary tractinfections, thrombophlebitis, decubitus ulcers, andpneu...
PrognosisPrognosis for TIA or stroke increasinglyhopefulCritical variables for recovery: patient’scondition before the str...
PrognosisLong-term recovery may depend on the carereceived immediately after the strokeMost recovery takes place in the fi...
Medical Treatment in the Acute PhaseBegins with the onset of signs and symptoms andcontinues until vital signs, particular...
Medical Treatment in the Acute PhaseMajor focus areas     Hypertension     Oxygenation     Hyperthermia     Hyperglyce...
Medical Treatment in the Acute PhaseOther Medications   Mannitol   Nimodipine (Nimotop)   Phenytoin (Dilantin) and phen...
Medical Treatment in the Acute PhaseSurgical intervention     An option for some patients with hemorrhagic      strokesDe...
Medical Treatment in the Acute PhaseFluids and Nutrition   Intravenous fluids   Dietary order based on patient’s    nutr...
Medical Treatment in the Acute PhaseUrine Elimination     Indwelling catheter to manage urinary incontinence     Intermi...
AssessmentEvaluate type and extent of the stroke: time ofonset, symptoms, other detailsCincinnati Pre-hospital Stroke Scale
Health HistoryChief complaint and history of present illnessMedical historyFamily historyReview of systemsFunctional asses...
Physical ExaminationAssess patient’s general appearance,responsiveness, and behaviorRecord restlessness or agitationMeasur...
Physical ExaminationInspect the face for symmetry; mouth formoisture and droolingEvaluate the alert patient’s ability to s...
Physical ExaminationConduct a gross vision assessmentInspect skin color and palpate for moisture and turgorAssess extremit...
Ineffective Airway Clearance and IneffectiveBreathing PatternsRisk for InjuryDeficient Fluid Volume or Excess Fluid Volume...
Impaired Verbal CommunicationImpaired Physical MobilityTotal or Functional Urinary IncontinenceConstipation and/or Bowel I...
AssessmentReassess patient’s abilities, expectations, knowledge, motivation, and resources
Rehabilitation PhaseSelf-Care DeficitRisk for InjuryIneffective CopingImpaired Verbal CommunicationImbalanced NutritionImp...
Patients may be discharged to home or go tospecialized rehabilitation centers for continuedtherapyOutpatient therapy is an...
   During and after the rehabilitation phase,    patients and families need to be made aware of    resources to help them...
Anatomy and PhysiologyConsists of 33 vertebrae   7 cervical (C1 through C7)   12 thoracic (T1 through T12)   5 lumbar (L1 ...
   Vertebral Column
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
My neurological nursing
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My neurological nursing

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My neurological nursing

  1. 1. Anatomy and Physiology
  2. 2. Purpose: To understand the workings andfunctions of the human nervous system.To successfully identify disease processescommon to the human nervous system.To provide proficient care to individuals afflictedwith disease processes or injuries affecting thehuman nervous system.
  3. 3.  A & P of the Nervous System
  4. 4. Neuron- The functional unit (cell) of the nervoussystem that conducts electrical impulses to thebrain and to other areas of the body.Sensory Neurons- Carry information from thedistal parts of the body toward the centralnervous system (CNS)Motor Neurons- Carry motor information fromthe CNS to the periphery.
  5. 5. Axon and dendrites branch off of the main body ofthe neuron.Axon- Carry impulses away from the cell bodyDendrites – Carry impulses to the cell body.Myelin- is a substance that sheaths many axons anddendrites. It enhances conduction along the nervefiber (moves impulse very quickly) and gives theaxons their white appearance.
  6. 6. The Central Nervous System (CNS)Made up of the BRAIN and the SPINAL CORD The Peripheral Nervous System (PNS)Made up of all of the peripheral of the body,including the spinal and cranial nerves
  7. 7. The Brain is divided into the Cerebrum,Cerebellum and the Brain Stem.Cerebral Spinal Fluid (CSF) is composed of water,glucose, sodium chloride and protein.Its FUNCTION is that it acts as a shock absorberfor the brain and spinal cord.
  8. 8. The Spinal CordExtends from C1 to L2There are 31 pairs of spinal nerve roots that exitthe spinal cord, each consisting of an afferent root(posterior sensory)and efferent root (anteriormotor).These roots, along with the 12 cranial nervesmake up the PERIPHERAL NERVOUS SYSTEM.
  9. 9. Autonomic Nervous SystemControls the INVOLUNTARY activities of theviscera including smooth muscle, cardiac muscleand glandsTwo major subdivisions: The SYMPATHETICNERVOUS SYSTEM (SNS) and thePARASYMPATHETIC NERVOUS SYSTEM(PNS).
  10. 10. Complex functions:Initiation of movements, recognition of sensoryinput, higher-order thinking, regulatingemotional behavior and endocrine and autonomicfunctions
  11. 11. Divided into two halves: hemispheresEach hemisphere controls the opposite side of thebody: the right hemisphere controls the left sideof the body, and the left hemisphere controls theright side of the bodyThe cortex of each is divided into the parietal,frontal, temporal, and occipital lobes; each has adifferent area of function
  12. 12. BrainstemIncludes midbrain, pons, medulla, and part of thereticular activating systemControls vital, basic functions, includingrespiration, heart rate, and consciousness
  13. 13. Uses information received from the cerebrum,muscles, joints, and inner ear to coordinatemovement, balance, and postureUnlike the cerebrum, the right side of thecerebellum controls the right side of the body,and the left side of the cerebellum controls the leftside of the body
  14. 14. Carotid SystemBegins as one common artery; later divides into theexternal and internal carotid arteriesThe external carotid arteries divide to supply blood tothe faceThe internal arteries further divide into the middlecerebral artery and the anterior cerebral artery tosupply blood to the brain
  15. 15. Carotid SystemBegins as one common artery; later divides into theexternal and internal carotid arteriesThe external carotid arteries divide to supply blood tothe faceThe internal arteries further divide into the middlecerebral artery and the anterior cerebral artery tosupply blood to the brain
  16. 16. Vertebral ArteriesOriginate from the subclavian artery, travel upthe anterior neck to merge and form the basilarartery at the brainstemSecond division forms posterior cerebral arteryInternal carotid and vertebrobasilar arteries uniteto form the circle of Willis
  17. 17. TYPES OF DISORDERS Genetic/ Developmental Trauma Infection and Inflammation Neoplasms Degenerative processes Vascular Disorders Metabolic and Endocrine Disorders
  18. 18. Thought to be caused by:  Intracranial vasoconstriction followed be vasodilation.  TRIGGERED BY:  Menstruation  Ovulation  Alcohol consumption  Some foods  STRESS
  19. 19. PAIN: Usually unilateral Often begins in the temple or eye area VERY INTENSE Tearing and nausea and vomiting may occur Hypersensitivity to light and sound
  20. 20. TREATMENT MEDICATIONS Mild migraines:  Acetaminophen or aspirin Severe migraines:  Ergotamine (Cafergot)  Sumatriptan tablet (Imitrex)  Sumatriptan autoinjector (for self injection)
  21. 21. Occur in a series of episodes followed by a longperiod with no symptoms.Intensely painful and seem to be related to stressor anxiety.Usually no warning symptoms.
  22. 22. TREATMENT MEDICATIONS Cold application Indomethacin (Indocin) Tricyclic antidepressants (Elavil)
  23. 23. Results from prolonged muscle contraction fromanxiety, stress, or stimuli from other sources, suchas brain tumor or an abscessed tooth.Pain location may vary  May have N/V  Dizziness  Tinnitus  Tearing
  24. 24. TREATMENT Correction of known causes Psychotherapy Massage Heat application Relaxation techniques
  25. 25. TREATMENT MEDICATIONS Analgesics (usually non-opiod) Benzodiazepines to relieve anxiety if severe.
  26. 26. Electrical impulses in the brain are conducted in ahighly chaotic pattern that yields abnormalactivity and behavior.Related to trauma, reduced cerebral perfusion,infection, electrolyte disturbances, poisoning, ortumors.
  27. 27. MEDICAL DIAGNOSISAccurate history of the seizure disorder Electroencephalogram (EEG)
  28. 28. Partial SeizureSimple Part of one cerebral hemisphere; consciousness not impaired Complex Consciousness impaired; may exhibit bizarre behavior
  29. 29. Generalized seizures  Involves the whole brain  Consciousness lost during the ictal (seizure) periodTYPES  Tonic-Clonic (Grand Mal)  Absence (Petit Mal) (Eye Blinking, Lip Smacking, Daydreaming) generally identified in childhood.  Myoclonic (brief jerking or stiffening of extremities)  Atonic (Drop attacks) sudden loss of muscle tone causes patient to collapse
  30. 30. Status Epilepticus Medical emergency. The continuous seizure or repeated seizure in rapid succession for 30 minutes or more.Aura Dizziness, numbness, visual or hearing disturbance, noting an offensive odor, or pain may precede a seizure
  31. 31. MEDICAL TREATMENTResolution of the underlying conditionAnticonvulsant therapy  If good seizure control is not accomplished with one drug, combinations of drugs may be prescribed.
  32. 32. SURGICAL TREATMENTRemoval of seizure foci in the temporal lobe andpallidotomy or vagal nerve stimulator.
  33. 33. Assessment Describe the seizure episode, INCLUDING the post- ictal period, and documenting drug therapy.
  34. 34. Risk for Injury:  Nursing Interventions  Side rails  Padded bed .  Suction machine  Bed in low position  Remove objects away from the patient  DO NOT attempt to restrain the patient
  35. 35. Ineffective Coping and Knowledge Deficit  Nursing Interventions  Teach family and patient about seizure disorder and the therapy  Teaching must be directed toward helping the patient and family adjust to a chronic condition  Encourage questions and concerns
  36. 36. TYPESScalp Injuries  Lacerations, contusions, abrasions, and hematomasConcussion Trauma with no visible injury to the skull or brainContusion Bruising and bleeding in the brain tissue
  37. 37. TYPESHematoma Subdural hematoma or epidural hematomaIntracerebral Hemorrhage From lesions within the tissue of the brain itselfPenetrating Injuries Sharp objects penetrate the skull and brain tissue
  38. 38. Surgical TreatmentDirected at evacuating hematomas anddebriding damaged tissue
  39. 39.  Ineffective Tissue Perfusion Ineffective Breathing Pattern Risk for Injury Risk for Infection Impaired Physical Mobility Disturbed Body Image Ineffective Role Performance
  40. 40. Cause and Risk Factors Some congenital; others may be related to heredity Drug/environmental factors may play a role in development
  41. 41.  Signs and symptoms Directly related to area of brain invaded by the tumor Visual disturbances and headache New-onset seizure activity Difficulties with balance and coordination
  42. 42. Medical Treatment Surgery often followed by radiation with or without chemotherapy
  43. 43. Acute PainDisturbed Thought ProcessesDisturbed Sensory PerceptionImpaired Physical MobilitySelf-Care DeficitIneffective Coping
  44. 44. Cause and Risk FactorsInflammation of the meningeal coverings of thebrain and spinal cord caused by either viruses orbacteria
  45. 45. Signs and Symptoms Headache, nuchal rigidity (stiffness of the back of the neck) irritability diminished level of consciousness photophobia (sensitivity to light) hypersensitivity seizure activity Positive Kernig sign Brudzinski sign
  46. 46. Medical TreatmentBacterial infections usually respond toantimicrobial therapy, but no specific drugseffective against most viral infectionsAnticonvulsants used to control seizure activity ifnecessary
  47. 47. Assessment Assess vital signs Neurologic status frequently to determine further deterioration or onset of complications
  48. 48. Ineffective Tissue PerfusionIneffective Breathing PatternAcute PainRisk for InjuryDeficient Fluid Volume
  49. 49. Cause and Risk Factors Inflammation of brain tissue caused by virus Signs and SymptomsFever AgitationNuchal rigidity (stiff neck) HeadacheConfusion HemiparesisRestlessness Exhibit aphasiaDelirium Facial weaknessComatoseOther alterations in motor activity
  50. 50. Medical TreatmentEnhance patient comfort and increase strengthBecause seizure activity is a potential problem,take appropriate safety precautions
  51. 51. The nursing plan of care parallels that of thepatient with meningitis
  52. 52. Cause and Risk FactorsAlthough specific cause unknown, it is believed tobe an autoimmune response to a viral infectionPatients often report some recent viral infection orvaccination
  53. 53. Initial PhaseSymmetric muscle weakness: begins in lower extremities;ascends to trunk and upper extremitiesVisual and hearing disturbances, difficulty chewing, and lack offacial expressionMild paresthesias or anesthesia in feet and hands in a glove orstocking distribution patternHypertension, orthostatic hypotension, cardiac dysrhythmias,profuse sweating, paralytic ileus, and urinary retention
  54. 54. Plateau PhaseRemains essentially unchangedNo further neurologic deterioration, but noimprovement either Recovery PhaseRemyelinization; muscle strength returns in aproximal-to-distal pattern (head to toes)
  55. 55. Medical DiagnosisCharacteristic onset and pattern of ascendingmotor involvementElevated protein level in the CSFNerve conduction velocity studies reveal slowedconduction speed in the involved nerves
  56. 56. Medical TreatmentPreserve vital function, particularly respirationRespiratory status is closely monitored and mechanicalventilation initiated if vital capacity falls to 15 ml/kg ofbody weightMassive doses of corticosteroids prescribed to suppressthe inflammatory processPlasmapheresis
  57. 57. Assessment Health history describes the progression of symptoms Note fears, coping strategies, and sources of support Physical examination focuses on cranial nerve, motor, respiratory, and cardiovascular function
  58. 58. Ineffective Breathing PatternDecreased Cardiac OutputRisk for Disuse SyndromeImbalanced Nutrition: Less Than BodyRequirementsAnxietyDeficient KnowledgeRehabilitation
  59. 59. Cause and Risk Factors Progressive degenerative disorder of the basal ganglia: an eventual loss of coordination and control over involuntary motor movement
  60. 60. Signs and SymptomsTremor, rigidity, and bradykinesiaLoss of dexterity and power in affected limbs,aching, monotone voice, handwriting changes,drooling, lack of facial expression, rhythmic headnodding, reduced blinking, and slumped postureDepression common; dementia may develop
  61. 61. Medical DiagnosisFrom health history and physical examinationMRI to rule out other causes of the symptoms
  62. 62. Medical TreatmentControl symptoms: physical therapy and drugtherapyMassage, heat, exercise, and gait retraining
  63. 63. MedicationsDopamine receptor agonists: Pramipexole (Mirapex) Ropinirole (Requip); L-dopa (L-dihydroxyphenylalanine); Carbidopa/levodopa (Sinemet) Anticholinergic drugs: Trihexyphenidyl (Artane) Benztropine (Cogentin)
  64. 64. AssessmentWeakness, fatigue, muscle cramps, sweating,dysphagia, constipation, difficulty voiding, andunusual movementsNote lack of facial expression, eyes fixed in onedirection, drooling, slurred speech, tearing,tremors, muscle stiffness, and poor balance andcoordination
  65. 65. Impaired Physical MobilityRisk for InjuryImbalanced Nutrition: Less Than BodyRequirementsIneffective CopingDeficient Knowledge
  66. 66. CauseChronic, progressive degenerative diseaseAttacks the protective myelin sheath around axons anddisrupts the conduction of impulses through the CNSChronic, progressive MS: progresses steadilyExacerbating-remitting MS: exacerbations and remissions
  67. 67. Signs and SymptomsFatigue, weakness, and tingling in one or moreextremities; visual disturbances; problems withcoordination; bowel and bladder dysfunction;spasticity; and depression
  68. 68. Relapsing-progressive MS: less stable periodsthan exacerbating-remittingStable MS: stable; no active disease for a yearExact cause of MS is unknown; viral infectionsand autoimmune processes have been implicated
  69. 69. Medical DiagnosisBased on the physical examination and history ofcyclic remission-exacerbation periodsMagnetic resonance imaging of the brain andspinal cord may reveal plaques characteristic ofMS
  70. 70. Medical TreatmentCorticosteroids  (ACTH, prednisone, methylprednisolone)Interferon 1b (Betaseron) and  interferon 1a (Avonex)Glatiramer acetate (Copaxone)Immunosuppressants:  mitoxantrone (Novantrone)Amantadine (Symmetrel)
  71. 71. Urinary retention treated with cholinergics, suchas bethanechol (Urecholine) or neostigmine(Prostigmine)
  72. 72. AssessmentOnset and progression of symptoms, especiallythose that affect mobility, vision, eating, andeliminationRange of motion and strength, gait abnormalities,tremors, and muscle spasms
  73. 73. Impaired Physical MobilityDisturbed Sensory PerceptionSelf-Care DeficitFunctional Urinary IncontinenceRisk for InfectionIneffective CopingDeficient Knowledge
  74. 74. CauseAlso known as Lou Gehrig’s disease; adegenerative neurologic diseaseVirus suspected, but exact cause unknown
  75. 75. PathophysiologyDegeneration of the anterior horn cells and thecorticospinal tracts, so patient exhibits upper andlower motor neuron symptoms
  76. 76. Signs and SymptomsWeakness of voluntary muscles of the upperextremities, particularly the handsDifficulty swallowing and speakingEventually, respirations shallow; difficulty clearingairway of pulmonary secretionsDeath results from aspiration, respiratory infection,or respiratory failure
  77. 77. Medical DiagnosisHistory and physical examination findingsElectromyography
  78. 78. Medical TreatmentBecause no known cure or treatment, therapy issupportive; focuses on preventing complicationsand maintaining maximum function
  79. 79. AssessmentDyspnea, dysphagia, muscle cramps, weakness,twitching, joint stiffness, muscle atrophy,abnormal reflexes and gait, and paralysis
  80. 80. Ineffective Airway ClearanceImpaired Physical MobilityImbalanced Nutrition: Less Than BodyRequirementsImpaired Verbal CommunicationImpaired Skin IntegrityAnticipatory GrievingSituational Low Self-EsteemInterrupted Family Processes
  81. 81. Inherited degenerative neurologic disorderUsually begins in middle adulthood with abnormalmovements, emotional disturbance, and intellectualdeclineSymptoms progress steadily: increasing disability anddeath in 15 to 20 yearsMedical and nursing care are supportive only; there isno cure
  82. 82. Cause May have an autoimmune basis Pathophysiology Insufficient receptor sites at the junction of the motor nerve with the muscle With repeated stimulation, muscle becomes exhausted; eventually unable to contract at all If respiratory muscles involved, death from respiratory insufficiency or arrest possible
  83. 83. Signs and Symptoms Weakness of voluntary muscles, particularly those of chewing, swallowing, and speaking Partial improvements of strength with rest Dramatic improvement with the use of anticholinesterase drugs Ptosis and diplopia commonly seen
  84. 84. Medical Diagnosis Administering edrophonium (Tensilon) Muscle tone is markedly improved within 1 minute of injection; persists for 4 to 5 minutes
  85. 85. Medical Treatment Anticholinesterase drugs Neostigmine and pyridostigmine (Mestinon) Corticosteroids Cytotoxic therapies Thymectomy Plasmapheresis
  86. 86. AssessmentHealth history describes the onset of symptoms:muscle weakness, diplopia, dysphagia, slurredspeech, breathing difficulties, and loss of balance
  87. 87. Ineffective Breathing PatternImpaired Physical Mobility and Self-Care DeficitImpaired SwallowingDeficient Knowledge
  88. 88. Health History Note speech, behavior, coordination, alertness, comprehension Chief Complaint and history of present illness Document what prompted the patient to seek medical attention Describe any injuries If patient has pain, note the onset, severity, location, and duration
  89. 89. Past Medical HistoryHead injury, seizures, diabetes mellitus,hypertension, heart disease, and cancerRecord dates and types of immunizations
  90. 90. Family History Have immediate family members had heartdisease, stroke, diabetes mellitus, cancer, seizure disorders, muscular dystrophy, or Huntington disease?
  91. 91. Review of SystemsFatigue or weakness, headache, dizziness, vertigo,changes in vision/hearing, tinnitus, drainagefrom ears or nose, dysphagia, neck pain orstiffness, vomiting, bladder or bowel function,sexual dysfunction, fainting, blackouts, tremors,paralysis, incoordination, numbness or tingling,memory problems, mood changes
  92. 92. Functional AssessmentDocument whether present symptoms interferewith the patient’s usual activities and occupationExplore sources of stress, usual coping strategies,and sources of support
  93. 93. Physical ExaminationLevel of consciousness, pupillary evaluation, neuromuscular response, and vital signs
  94. 94. Risk Factors for StrokeNon-modifiable factors  Risk factors that cannot be changed  Age, race, gender, and heredityModifiable factors  Those that can be eliminated or controlled
  95. 95. Temporary neurologic deficit caused byimpairment of cerebral blood flowBlood vessels occluded by spasms, fragments ofplaque, or blood clotsImportant warning signs for the individualexperiencing a full stroke
  96. 96. Signs and SymptomsDizziness, momentary confusion, loss of speech,loss of balance, tinnitus, visual disturbances,ptosis, dysarthria, dysphagia, drooping mouth,weakness, and tingling or numbness on one sideof the body
  97. 97. Medical DiagnosisHealth history, physical examination findings,and results of brain imaging studiesLaboratory studies, electrocardiography (ECG),duplex ultrasonography, and cerebralangiography
  98. 98. Medical DiagnosisHealth history, physical examination findings,and results of brain imaging studiesLaboratory studies, electrocardiography (ECG),duplex ultrasonography, and cerebralangiography
  99. 99. Medical TreatmentDepends on the location of the narrowed vessel and thedegree of narrowingAcetylsalicylic acid (aspirin)Ticlopidine hydrochloride (Ticlid)Extended-release dipyridamole (Aggrenox)Clopidogrel bisulfate (Plavix) decrease platelet clumpingWarfarin (Coumadin) and heparin Carotid endarterectomy and transluminal angioplasty
  100. 100. An abrupt impairment of brain function resultingin a set of neurologic signs and symptoms that arecaused by impaired blood flow to the brain andlast more than 24 hours
  101. 101. PathophysiologyHemorrhagic stroke  Blood vessel in brain ruptures; bleeding into the brain occursIschemic stroke  Obstruction of blood vessel by atherosclerotic plaque, blood clot, or a combination of the two, or by other debris released into vessel that impedes blood flow to an area of the brain
  102. 102. Signs and SymptomsDifferent signs and symptoms, depending on thetype, location, and extent of brain injuryHemorrhagic stroke  Occurs suddenly; may include severe headache described as “the worst headache of my life”  Other symptoms: stiff neck, loss of consciousness, vomiting, and seizures
  103. 103. Signs and SymptomsEmbolic stroke  Appear without warning  One or more of the following signs and symptoms: one-sided weakness, numbness, visual problems, confusion and memory lapses, headache, dysphagia, and language problems
  104. 104. The number of nerve cells decreasesBrain weight is reduced; ventricles increase in sizeLipofuscin: aging pigment deposited in nerve cellswith amyloid, a type of proteinIncreased plaques and tangled fibers in nerve tissueEye pupil often smaller; may respond to light moreslowly
  105. 105. Reflexes intact except for Achilles tendon jerk,which is often absentReaction time increases, especially complexreactionsTremors in the head, face, and hands are commonSome develop dizziness and problems withbalance
  106. 106. Signs and SymptomsAphasia A defect in the use of language; speech, reading, writing, or word comprehensionDysarthria The inability to speak clearlyDysphagia Swallowing difficulty
  107. 107. Signs and SymptomsDyspraxia The partial inability to initiate coordinated voluntary motor actsHemiplegia Defined as paralysis of one side of the body
  108. 108. Signs and SymptomsSensory impairment Unable to feel touch, pain, or temperature in affected body partsUnilateral neglect Do not recognize one side of the body as belonging to them
  109. 109. Signs and SymptomsHomonymous hemianopsia  Perceptual problem: involves loss of one side of field of visionElimination disturbances  Neurogenic bladder  Flaccid bladder  Bowel incontinence
  110. 110. Medical DiagnosisBlood studies, electrocardiogram (ECG),computed tomography, magnetic resonanceimaging, carotid ultrasound studies, cerebral andcarotid angiography, electrocardiography,positron-emission tomography, andsingle-photon emission computed tomography
  111. 111. ComplicationsConstipation, dehydration, contractures, urinary tractinfections, thrombophlebitis, decubitus ulcers, andpneumoniaSensory losses put patient at risk for traumatic andthermal injuriesSwallowing difficulties place patient at risk forpulmonary complications, such as choking andaspiration pneumonia
  112. 112. PrognosisPrognosis for TIA or stroke increasinglyhopefulCritical variables for recovery: patient’scondition before the stroke, time betweenstroke and diagnosis, treatment and supportin acute phase (usually the first 48 hours),severity of patient’s symptoms, and access torehabilitative therapy
  113. 113. PrognosisLong-term recovery may depend on the carereceived immediately after the strokeMost recovery takes place in the first 3 to 6months, but progress often continues long afterthat
  114. 114. Medical Treatment in the Acute PhaseBegins with the onset of signs and symptoms andcontinues until vital signs, particularly blood pressureand neurologic condition, stabilizeThis phase usually lasts 24 to 48 hoursMany medical management interventions are directedat minimizing complications and deterioration of thepatient’s condition after a stroke
  115. 115. Medical Treatment in the Acute PhaseMajor focus areas  Hypertension  Oxygenation  Hyperthermia  HyperglycemiaDrug therapy  Tissue plasminogen activator (rt-PA, alteplase, Activase)  Given to dissolve clots in acute ischemic strokes
  116. 116. Medical Treatment in the Acute PhaseOther Medications  Mannitol  Nimodipine (Nimotop)  Phenytoin (Dilantin) and phenobarbital  Acetylsalicylic acid (aspirin), ticlopidine hydrochloride (Ticlid), Aggrenox, and clopidogrel (Plavix)
  117. 117. Medical Treatment in the Acute PhaseSurgical intervention  An option for some patients with hemorrhagic strokesDecisions about surgery are based on patient’sage, intracranial pressure, and location of thehemorrhage
  118. 118. Medical Treatment in the Acute PhaseFluids and Nutrition  Intravenous fluids  Dietary order based on patient’s nutritional requirements and ability to eat  Regular, soft, or pureed  Total parenteral nutrition may be ordered for the malnourished patient
  119. 119. Medical Treatment in the Acute PhaseUrine Elimination  Indwelling catheter to manage urinary incontinence  Intermittent catheterization: controlling incontinence caused by a flaccid bladder
  120. 120. AssessmentEvaluate type and extent of the stroke: time ofonset, symptoms, other detailsCincinnati Pre-hospital Stroke Scale
  121. 121. Health HistoryChief complaint and history of present illnessMedical historyFamily historyReview of systemsFunctional assessment
  122. 122. Physical ExaminationAssess patient’s general appearance,responsiveness, and behaviorRecord restlessness or agitationMeasure vital signs; weight and height if possible
  123. 123. Physical ExaminationInspect the face for symmetry; mouth formoisture and droolingEvaluate the alert patient’s ability to swallowInspect pupils for size, equality, and reaction tolight
  124. 124. Physical ExaminationConduct a gross vision assessmentInspect skin color and palpate for moisture and turgorAssess extremities for muscle tone and strength, sensation, andvoluntary movementRecord evidence of incontinence or bladder distentionFrequently repeat neurologic checks: evaluating level ofconsciousness, pupil appearance and response to light, the patient’sability to follow commands, and the movement and sensation ofextremities
  125. 125. Ineffective Airway Clearance and IneffectiveBreathing PatternsRisk for InjuryDeficient Fluid Volume or Excess Fluid VolumeImbalanced NutritionDisturbed Sensory PerceptionIneffective ThermoregulationDisturbed Thought Processes
  126. 126. Impaired Verbal CommunicationImpaired Physical MobilityTotal or Functional Urinary IncontinenceConstipation and/or Bowel IncontinenceIneffective CopingInterrupted Family Processes
  127. 127. AssessmentReassess patient’s abilities, expectations, knowledge, motivation, and resources
  128. 128. Rehabilitation PhaseSelf-Care DeficitRisk for InjuryIneffective CopingImpaired Verbal CommunicationImbalanced NutritionImpaired Physical MobilityConstipationTotal and Functional Urinary Incontinence
  129. 129. Patients may be discharged to home or go tospecialized rehabilitation centers for continuedtherapyOutpatient therapy is an option for some patientsWhen able, patients are transitioned back into thehome settingEssential to include family, friends, and significantothers in this process
  130. 130.  During and after the rehabilitation phase, patients and families need to be made aware of resources to help them deal with continuing disabilities In rehabilitation, the patient is respectfully challenged to return to the highest level of function possible
  131. 131. Anatomy and PhysiologyConsists of 33 vertebrae 7 cervical (C1 through C7) 12 thoracic (T1 through T12) 5 lumbar (L1 through L5) 5 sacral (S1 through S5) 4 fused coccygeal
  132. 132.  Vertebral Column

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