The document provides information on neuroanatomy and physiology, including the structure and function of the central and peripheral nervous systems, brain anatomy and lobes, spinal cord anatomy, and various diagnostic assessments for the neurologic system such as lumbar puncture, CT scan, EEG, and evoked responses. Key areas covered include the brainstem, cerebellum, meninges, cranial nerves, increased intracranial pressure manifestations and treatment, and aphasia.

1. PERCEPTION & COORDINATION

2. NEUROSENSORY SYSTEM MUSCULOSKELETAL SYSTEM

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

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….