Nervous System/ Vision and Hearing

main function of the cerebrum is to

store information for use and control voluntary movement.

reflex pathway

withdrawing from something painful (like stepping a lego)

The Meninges

connective tissue coverings that enclose the brain and spinal cord. (are what are affected in limes disease)

Cerebral spinal fluid

Clear, watery liquid that fills the ventricles of the brain and surrounds the spinal cord. Is very rich in glucose and dries as a clear stain with a dark ring around it.

VI-Trigeminal:

(Ophthalmic, maxillary, mandibular branches) sensation to the corneas, nasal, and Oral mucosa and facial skin test-client close eyes clench jaws and try to open the jaw with a piece of cotton - lightly touch the cornea with a cotton wisp--corneal reflex (make a 3 on the side of your face with fingers) SENSORY NERVE

VII-Facial:

controls all facial muscles and the anterior portion of the tongue. Test-smile, show his teeth, and puff out cheeks, raise and lowers his eyebrows also have them identify substance placed on anterior portion of the tongue MOTOR NERVE (involved in balls palsy)

VIII-Auditory

(Acoustic)hearing controlled by the cochlear division of this nerve equilibrium controlled by the vestibular division

(Acoustic)hearing controlled by the cochlear division of this nerve equilibrium controlled by the vestibular division

swallowing and sensation to the mucous membranes of the pharynx taste perception on the posterior third of the tongue and salivation Test-use a tongue depressor to cause the gag reflex the viscera of the thorax and abdomen speech and swallowing

autonomic nervous system

controls information to the smooth muscle of the heart, lungs, intestines and bladder as well as to the glands

sympathetic NS

adenergetic response: fight or flight response: increases heart rate, BP, and blood to the brain and muscles.

parasympathetic NS

is responsible for the body's rest and digestion response when the body is relaxed, resting, or feeding. It basically undoes the work of sympathetic division after a stressful situation (aceytocoline ) ------ Cholinergic response: slows: decreases the heart rate. Balances the effect of the sympathetic system to create homeostasis

normal ICP is

0-15

Cerebrospinal fluid--provides

moisture, lubrication, and protects the brain and spinal cord. Clear, colorless, odorless,

Romberg's Test: balance and equilibrium

Have client stand erect with eyes closed. Raise hands and see if the patient "drifts to one side or another.

where is the needle inserted into the spine during a lumbar puncture?

the L3-L4 level.

Cisternal puncture

The needle is placed just below the occipital bone and CSF is withdrawn form the cerebellomedullary cistern. It is another method of obtaining cerebrospinal fluid.(back of the head)

Treatment for spinal H/A:

ice, analgesics, supine position and initiate seizure precautions.

burr holes are

holes drilled into the skull.

codeine is the number 1 pain med for

spinal headache

what is important to remember with CT scans

remember to check for allergies and hold Metformin (glucophage)

pre- Electroencephalography

No stimulant or depressants should be administered.

migraines

caused by vasoconstriction of cerebral arteries followed by vasodilation. For an acute attack, Ergot or cafergot, which is a potent vasoconstrictor (caffeine) can be used if it is taken within 30 minutes of onset of symptoms. ****Imitrex is the newest drug which works at the serotonin receptors in the brain.****Home oxygen use

cluster headache tx

moist compresses, a quiet environment, NSAIDS

glasgow scale is used to diagnose

a coma.

Eye opening Best motor response Best verbal response A score of 7 or less indicates coma. The highest possible score is 15

Position to prevent

foot drop, wrist drop, contractors

if pt is in a coma and their eyes are open we

tape them shut, otherwise the corneas will dry out, use lubricating drops as well

Early signs of ICP (intracranial hypertension)

change in LOC, Personality changes, Irritability, Unequal pupils, Sluggish pupils, Muscle weakness, Decreased grasp, Blurred vision, Diplopia

late signs of ICP (intracranial hypertension)

changes in VS (increased SBP, tachypnea, bradycardia)

Decorticate (bad) posturing

arms bent at elbows and wrists, legs may be flexed. Damage is to the cortex of the brain. Draws towards the cord.

Decerebrate (worse) posturing

arms extended and internally rotated, legs extended and feet are in plantar flexion. Seen with compression of the brainstem.

ICP tx

corticosteroids, osmotic diuretics (Mannitol). HOB is elevated to 30 degrees to promote cerebral drainage

building fontanelle

sign of increased cranial pressure in a baby

Increased ICP signs

(opposite of shock) increased systolic bp, decreased pulse and respirations

subdural hematoma

bleeding into the subdural space caused by rupture of small venous blood vessels. (RUPTURE IN THE VENOUS)

epidural hematoma

hemorrhage into the potential space between the inner table of the skull and the dura. This type of bleed is usually caused by a skull fracture and is arterial in nature

Intracranial Hemorrhage

of any type is a potentially serious condition. Causes may be; trauma, which causes lacerations, and contusions, spontaneous bleeds from hypertension, or cerebral aneurysm for example.

Cerebral Artery Aneurysm S/S

EXPLOSIVE HEADACHE, N/V, motor weakness, seizures, and decreased LOC

Cerebral Artery Aneurysm NC

aimed at close monitoring of Neuro status, VS, and seizure activity, repositioning, and general supportive care of the immobile or unconscious patient.

Cerebral Artery Aneurysm Diagnosis:

CT scan-precise diagnosis requires a cerebral angiogram. The dye will fill up the aneurysm if one exists. The patient may require sedation.

Cerebral Artery Aneurysm Treatment:

surgery will be indicated if this disorder is to be treated. Must correct the cause of the bleed. The aneurysm can be clipped or encased in a sheath of muslin in order to stop the hemorrhage. Post-surgical care is aimed at reducing or controlling cerebral edema (inc. ICP

when a pt is on Dilantin and phenobarb they need

good oral hygiene

Transient Ischemic Attacks

May have all the s/s of a full-blown stroke, but there are normally no long-term effects and the s/s may dissipate within 24 hours.

These individuals are more likely to develop an ischemic CVA

cerebral Embolis

(ischemic) usually is seen in patients in the 50-70 age group with the history of arteriosclerosis and atherosclerosis.

cerebral hemorrhage

(hemorrhagic) Rupture of the blood vessels causing stroke is usually seen in the client with the hx. of hypertension or with rupture of cerebral aneurysm or AV malformation.

main symptoms of a stroke

Hemiplegia: (on side opposite the infarct. They may have facial droop and flaccid muscle tone.) Dysphagia:( difficulty speaking, chewing and swallowing is another complication of CVA involving the 9th and 10th cranial nerves.) Homonymous Hemianopsia, Bowel and Bladder incontinence, Perceptual Problems, Unilateral Neglect, Neurological deterioration, Emotional lability/impaired judgment

Right side infarct CVA

hen the right side of the brain is affected the patient will have left sided hemiplegia with perceptual problems.

Left side infarct CVA

A left brain CVA will cause right sided hemiplegia, difficulty in speaking or understanding the spoken word (aphasia.) Depression is common.

If the patient is determined to have an embolic stroke then several things may also be done:

start on heparin therapy, then coumadin

anti-platelet drugs-Ticlid and aspirin

Hemorrhagic Stroke

is treated by controlling hypertension/thus bleeding.

Seizures and Convulsions causes

trauma, elevated temp especially in children, Increased ICP, etc.

meds for seizures

Anticonvulsant drugs(Dilantin), Sedative/Hypnotic(Valium,Ativan), and barbiturates (Phenobarbital). Patient should be observed for toxic effects of these drugs.

POSTICTAL PHASE of a seizure

may remain unconscious or very drowsy with a deep sleep of several hours following the seizure.

How is epilepsy diagnosed?

EEG

s/s of meningitis

headache, rigid and stiff neck (nuchal rigidity), elevated temperature, lethargy, confusion, photophobia, and nausea/vomiting.

s/s of Encephalitis

High temperature, HA, N/V, tremor hands/tongue/lips, stiff neck, speech difficulty, lethargic, coma, seizures, and death from herniation of brain tissue.

complications of Encephalitis

cognitive disabilities, blindness, personality changes.

Post-polio syndrome

is characterized by a return of symptoms including fatigue, muscle weakness, or paralysis.

diagnosis of MS

elevated protein in CSF

Parkinson's disease

progressive disease affecting the basal ganglia (group of nerve cell bodies deep in the cerebral hemispheres). esults from depletion of dopamine with resulting involuntary movements and disturbance in the body posture and muscle tone.

Anti Parkinson's drugs:

Sinemet, Artane or Cogentin is given with L-dopa.

May need to have a low protein diet and decrease the amount of vitamin B-6 if on L-dopa because it decreases the effect of L-dopa.

Give L-dopa with meals to help decrease nausea.

L-dopa side effects:

hypotension, N/V, and dysrhythmias

PT is an important intervention to maintain optimum mobility

Riluzole

shown to slow the progression of Amyotrophic Lateral Sclerosis (ALS)

Mental status changes may be the first sign of

Huntington's Chorea

Myasthenia Gravis

is autoimmune and has revisions and exabberations

s/s of Myasthenia Gravis

Ptosis (drooping eyelids), diplopia (double vision), and difficulty in chewing and swallowing. Severe muscle weakness is the outstanding symptom of the disorder.

patients with Myasthenia Gravis

should not be given any form of morphine, tranquilizers or barbiturates because they act on the neuromuscular junction.

Myasthenic Crisis

inability to swallow, breathe, move affected area, this is an emergency. Patient must be given a large amount of an anticholinesterase drug.

Cholinergic crisis:

caused by giving too much of the anticholinesterase drug

Neuralgia

Severe pain along the route of a nerve.

multiple peripheral neuritis:

clinical syndrome produced by widespread involvement of peripheral nerves with resultant sensory loss and reflex impairment.

related to toxic or metabolic conditions (degenerative changes, Vitamin B deficiency, and Alcoholism)

Guillain-Barre Syndrome

Most rapidly developing and potentially fatal form of polyneuropathy. Usually affects young adults: thirty to forty. DOesn't hurt but pt's will have paralyzing symptoms. Many individuals have a history of a recent viral illness or vaccination (swine flu vaccine). Usually only abnormal lab finding is marked increase CSF protein. Lasts from 24 hours to 2-3 weeks. lasts 2-14 days once weakness reaches maximum. Give IV IG.

plasmapheresis

removal of plasma (from withdrawn blood)

(rhizotomy)

nerve is cut

7th cranial nerve is the

motor facial nerve that is affected during bells palsy

involved eye of bells palsy always

tears; side of face that is affected droops.

spinal cord interventions

Early intervention is aimed at maintaining alignment and stabilization of the spine.

Observe for signs of shock and circulatory collapse.

spinal shock

is temporary but the symptoms can last from 1 week to several months which include paralysis

Thoracic/lumbar/sacral injuries

patient is affected in the legs, bowel & bladder.

They will have paralysis and paresthesia below the level of injury, paraplegia.

Cervical injuries-injuries above C3 or above:

normally fatal if the patient does not have immediate intubation and mechanical ventilation.

If they live and it is a complete lesion then they will have paralysis and paresthesia in all four extremities-quadriplegia. will be dependent on caregivers.

Autonomic Dysreflexia

This is an emergency condition that occurs in the client with cervical or high (above T6) thoracic injuries. It is a result of an exaggerated and uncontrolled response of the sympathetic system to stimuli. The parasympathetic system is unable to bring the body back into homeostasis. You must find the reason for dysreflexia and fix it promptly. Lopressor needs to be given. Pounding HA, hypertension (sbp 300/), flushed face, hypothermia, and bradycardia.

causes of Autonomic Dysreflexia

bladder or bowel distention, enemas, digital rectal stimulation, bladder irrigations or infection. Check patency of catheters.

poikliothermia

cannot regulate their own temp so they will be the same as the room temp. if its hot in the room they will be hot, if its cold they will be cold

hyyper/hypothermia interventions

rectal temps, blankets

a person with nerve damage is actually better to be able to feel pain

bc that means they have some feeling

Laminectomy:

surgical procedure to remove bone (laminae), cartilage, projecting intervertebral disk, or tumor.

relieve edema on the brain

mannitol

post op care for a person who underwent a surgery for brain or spinal tumors

elevated to 30 degrees or semi fowlers

Ophthalmologist

Doctor who specializes in diagnosis and treatment of all eye diseases.

Optometrist

is trained in testing and prescribing lenses.

Optician-

grinds lens and fills lens prescription.

Mydriatics

(dilate the pupil, [big word, big pupil])

Mitotics

cause pupil constriction [small work, small pupil])

Extrinsic:

there are 6 voluntary muscles that are attached to the outside of the sclera and control the movements of the eyes.

Intrinsic:

these are involuntary muscles within the eye that control the shape of the lens and the size of the pupil.

Optic:

carries visual impulses from the retinal rods and cones.

Oculomotor:

regulates voluntary and involuntary muscle control.

Abducens:

controls external rectus muscle of the eye

20/20 vision

if letters can be read at 20 feet you have 20/20 vision

nearsightedness- myopia

they can see near things, and distant object become blurred

farsightedness- hyperopia

you can see distant things but not close things