neuro
NERVOUS SYSTEM
Components of the Nervous System
Central Nervous System (CNS)
Composed of:
Brain
Spinal Cord
Peripheral Nervous System (PNS)
Composed of:
Nerves of the Autonomic Nervous System
The Brain and Nervous System
Major Components of the Brain
Cerebrum
Brain Stem
Midbrain
Pons
Medulla Oblongata
Diencephalon
Thalamus
Hypothalamus
Pituitary Gland
Cerebellum
Spinal Cord
Spinal Nerves and Their Functions
Cervical Nerves
C1-C3: Neck Muscles
C4: Diaphragm
C5: Deltoid (Shoulder)
C6: Wrist
C7: Triceps
C7-C8: Fingers
T1: Hand
Thoracic Nerves
T2-T12: Intercostals (Trunk), Abdominals
T11-L2: Ejaculation
Lumbar Nerves
L2: Hips
L3: Quadriceps
L4-L5: Foot
Sacral and Coccygeal Nerves
S2: Penile Erection
S2-S3: Bowel and Bladder
Peripheral Nervous System (PNS)
Divided into:
Autonomic Nervous System (ANS)
Sympathetic:
Stress Response
Parasympathetic:
Peaceful State
Neuro Assessment
Key Components of Neuro Assessment:
Health history
Vital Signs (V.S.)
Level of Consciousness (LOC)
Orientation
Pupils Exam
Motor Function Assessment
“What's UP?” evaluation
Cerebellar Function (Romberg test)
Coordination
Sensory Exam
Reflexes Examination
Glasgow Coma Scale (GCS)
Eye Opening:
Spontaneous: 4
To Sound: 3
To Pain: 2
Never: 1
Motor Response:
Obeys Commands: 6
Localizes Pain: 5
Normal Flexion (Withdrawal): 4
Abnormal Flexion: 3
Extension: 2
None: 1
Verbal Response:
Oriented: 5
Confused Conversation: 4
Inappropriate Words: 3
Incomprehensible Sounds: 2
None: 1
Highest Possible Score: 15
Diagnostics for Nervous System Disorders
Types of Diagnostics:
Lab Tests
Lumbar Puncture
X-Ray
CT Scan
MRI Scan
Angiogram
Myelogram
EEG (Electroencephalogram)
Risk Factors for Nervous System Disorders
Potential Risk Factors:
Trauma
Hemorrhage
Tumors
Infection
Toxicity
Metabolic Disorders
Hypoxic Conditions
Hypertension
Cerebral Artery Disease
Smoking
Aging
Chemical Exposure
Increased Intracranial Pressure (ICP)
Causes of Increased ICP:
Trauma
Hemorrhage
Tumor
Edema
Inflammation
Signs and Symptoms (S/S):
Altered LOC
Restlessness/Irritability
Headache
Vomiting
Posturing
Hemiparesis
Dilated Pupils
Seizures
Increased Temperature
Cushing's Triad (Hypertension, Bradycardia, Irregular Respirations)
Prevention of Increased ICP:
Head of Bed (HOB) elevated 30-45 degrees
Avoid hip flexion
Keep head neutral
Avoid straining or stress
Regulate temperature
Maintain fluid balance
Decrease overall stress and metabolic demand
Clinical Scenarios for Nursing Care
Romberg Sign:
Indicates significant sway when standing erect with feet together, arms at the side, and eyes closed.
ICP Monitoring:
Observe for increased temperature, decreased pulse, decreased respiration, and increased blood pressure.
Patient Positioning:
Avoid turning the head to one side; maintain head midline and elevated to 30-45 degrees.
Client Education for Recovery:
Educate clients to avoid activities such as blowing the nose or coughing vigorously to prevent elevations in ICP.
Emergency Signs Post-Concussion:
Watch for vomiting, difficulty speaking, and difficulty awakening to know when to return to ER.
Central Nervous System Disorders
Infections
Inflammation from Bacteria or Virus
Signs and Symptoms:
Fever/Chills
Irritability
Nuchal Rigidity
Headache
Photophobia
Encephalopathy
Seizures/Lethargy
Meningitis
Definition: Inflammation of the meninges surrounding the brain and spinal cord.
Types: Bacterial or Viral
Signs and Symptoms (S/S):
High fever
Nuchal rigidity
Photophobia
Encephalopathy
Diagnosis: Lumbar Puncture (LP) is key.
Treatment: Antibiotics for bacterial meningitis and symptom management.
Encephalitis
Definition: Inflammation of brain tissue, most commonly viral.
Signs and Symptoms (S/S):
Headache
Malaise
Nausea/Vomiting
Fever
Nuchal Rigidity
Ataxia
Photophobia
Confusion
Decreased LOC
Diagnosis: CT scan, MRI, LP
Treatment: Control symptoms effectively.
Headaches
Types of Headaches:
Migraine:
Symptoms include pain, nausea, and visual changes.
Tension:
Described as a band squeezing the head.
Cluster:
Pain in and around one eye.
Management of Headaches:
Use NSAIDs, antidepressants, or triptans for symptom control.
Identification and removal of aggravating factors.
Seizures
Definition: Can signal epilepsy or other neurologic disorders; characterized by abnormal electrical discharge.
Convulsions: Involuntary contractions of voluntary muscles.
Recovery Period: Varies; monitoring is essential.
Diagnostics: EEG is used to rule out underlying causes (CT).
Management: Use anticonvulsant medications, consider surgical options for control, and be prepared for emergency status epilepticus.
Seizure First Aid**:
Stay calm and with the patient; note the time.
Keep the patient safe, turn them on their side, and do not put anything in their mouth.
Do not restrain and loosen clothing until they are fully awake and alert.
Spinal Cord Injury (SCI)
Spinal Column Structure:
7 Cervical Vertebrae
12 Thoracic Vertebrae
5 Lumbar Vertebrae
5 Sacral Vertebrae
4 Coccygeal (fused together)
Impacts of SCI:
C4: Quadriplegia/Tetraplegia (complete paralysis below the neck)
C6: Partial paralysis of hands and arms as well as lower body
T6: Paraplegia (paralysis below the chest)
L6: Paraplegia (paralysis below the waist)
Complications of SCI
Potential Complications:
Spinal Shock
Infection
Deep Vein Thrombosis (DVT)
Orthostatic Hypotension
Skin Breakdown
Urinary Tract Infection (UTI)
Depression
Autonomic Dysreflexia
Nursing Care Plan For SCI:
Impaired gas exchange
Ineffective airway clearance
Risk for autonomic dysreflexia
Alteration in bowel and bladder function
Impaired mobility
Self-care deficits
Impaired skin integrity
Neurodegenerative Disorders
Parkinson’s Disease
Definition: Destruction of cells leading to decreased dopamine production impacting semi-automatic movements.
Symptoms:
Primary:
Bradykinesia
Mask-like Expression
Soft Voice
Shuffling Gait
Difficulty Initiating Movements
Stooped Posture
Tremors in Hands
Secondary:
Generalized Weakness
Muscle Fatigue
Muscle Cramping
Diaphoresis
Constipation
Drooling
Orthostatic Hypotension
Slowed Mental Function
Huntington’s Disease
Characteristics: Progressive, hereditary, degenerative disorder affecting deep nuclei of the brain leading to loss of movement and intellect.
Symptoms:
Personality changes
Inappropriate behavior
Involuntary, irregular, jerky dance-like movements
Hesitant speech and eye blinking
Irregular trunk movements and constant motion
Wide gait
Alzheimer’s Disease
Definition: Most common type of dementia characterized by loss of mental functioning impacting memory, thinking, and daily activities.
Stages:
Stage 1: Lasts 2-4 years; increased forgetfulness.
Stage 2: Lasts 2-12 years; increased forgetfulness leads to irritability and inability to perform routine tasks, depression, sleep disruption, and hallucinations.
Stage 3: Progresses to complete dependency, loss of conversation ability, bowel/bladder control, and decreased mobility.
Peripheral Nervous System Disorders
Multiple Sclerosis (MS)
Definition: Chronic progressive degeneration affecting the myelin sheath around nerves.
Signs and Symptoms (S/S):
Numbness/tinkling (61.5%)
Cognitive Dysfunction (13.4%)
Depression (14.7%)
Dizziness (23.2%)
Vision Problems (40.2%)
Pain (19.3%)
Fatigue (40.1%)
Bladder Dysfunction (11.1%)
Muscle Spasms (17.2%)
Weakness (25.3%)
Walking Difficulty (48.9%)
Management: Lifestyle changes, symptom control, energy conservation, stress reduction, physical therapy, medications.
Myasthenia Gravis (MG)
Definition: An acquired autoimmune neuromuscular junction disorder causing antibodies to target skeletal muscle acetylcholine (Ach) receptors.
Symptoms:
Weakness and fatigue
Difficulty chewing and swallowing (Dysphagia)
Ptosis (drooping eyelids)
Diplopia (double vision)
Weak or hoarse voice
Difficulty breathing
Management:
Medications: Anticholinesterase drugs (Prostigmine, Mestinon)
Steroids and immunosuppressants
Plasmapheresis
Myasthenic and Cholinergic Crises
Myasthenic Crisis: Exacerbation of MG weakness leading to respiratory failure, commonly precipitated by respiratory infection.
Cholinergic Crisis: Caused by excess anticholinesterase leading to bradycardia, muscle twitches, muscle weakness, sweating, excessive secretions, and small pupils.
Amyotrophic Lateral Sclerosis (ALS)
Definition: A degenerative disease characterized by neuron degeneration and loss of the ability to initiate/control muscle movements.
Symptoms: Muscles weaken, atrophy, and twitch (fasciculations) as neurons die.
Management: Focus on diagnosis, management of symptoms, and slowing disease progression (e.g., Rilutek).
Guillain-Barré Syndrome
Definition: An acute inflammatory demyelinating polyneuropathy often following an infection leading to rapidly progressing flaccid paralysis.
Signs and Symptoms (S/S): Symmetrical ascending motor weakness; starts in the toes and ascends upward.
Management: May require oxygen/mechanical ventilation; immunoglobulin therapy/plasmapheresis, physiotherapy/occupational therapy for supportive care.
Cranial Nerve Disorders
Bell's Palsy
Symptoms: Loss of forehead and brow movements, inability to close eyes, drooping eyelids, loss of nasolabial folds, drooping of lower lip.
Management: Prevent complications with Prednisone, antivirals, analgesics, and heat/massage.
Trigeminal Neuralgia
Definition: A chronic pain condition affecting the trigeminal nerve.
Management: Medications to control pain, possibly surgical removal of irritant vessels, and additional treatments such as Botox/acupuncture.