Jane Bordner, Rn, BSN
NURSING INSTRUCTOR
HACC, Central Pennsylvania’s Community College
N100
SPRING 2015

 To detect changes and feel sensations
 To initiate appropriate responses to change
 To organize information for immediate use and store it for future use

 Works with endocrine system to maintain homeostasis
 Two principle divisions:


Central nervous system


Brain
Spinal Cord
Peripheral nervous system


Cranial Nerves
Spinal Nerves

 http://www.youtube.com/watch_popup?v=i-
NgGKSNiNw&pop_ads=null http://www.youtube.com/embed/i-
NgGKSNiNw

 Cell body
 Axon
 Dendrite
 Synapse
 Neurotransmitter

INFO OUT

 Glial cells
 Neurons

INFO IN
INFO OUT

 http://www.youtube.com/w atch_popup?v=i-
NgGKSNiNw&pop_ads=null

 Synapse
 junction between 2 neurons
 Communication
 electrical
 chemical activity
 Neurotransmitters
 chemicals that conduct messages
(impulses) across junction

 http://www.mind.ilstu.edu/curriculum/neurons_intro
/neurons_intro.php
 http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48
&C

 http://www.mind.ilstu.edu/curriculum/neurons_intro
/neurons_intro.php
 http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48
&C

 Sensory- Afferent
 Carry impulses from receptors to the CNS
 Motor – Efferent
 Carry impulses from CNS to effectors
 Confusing because they both sound the
 S ensory= A fferent
 M otor= E fferent SAME

 Brain
 Spinal cord
 Myelin
 Gray Matter
 White Matter

 12 cranial nerves
 31 spinal nerves
 Sensory organs

 3 Major Portions
 Cerebrum
 Cerebellum
 Brain Stem

 http://www.youtube.com/watch?v=snO68aJTOpM

 2 hemispheres
 Corpus callosum:
 White matter
 200 million nerve fibers
 Bridge sending messages between
2 halves

 Cerebral cortex:
 Surface layer of gray matter


Covers each hemisphere
Folded with fissures and sulci
 Most of conscious activity





Frontal


Motor area controlling opposite side of body
Left frontal = Broca’s motor speech area
Parietal


Sensory area
Left side = thought that precedes speech
Occipital
 Visual area
Temporal


Hearing, smell, and taste
Left side = thought that precedes speech

 Basal ganglia





Gray matter
Deep in cerebral hemispheres
Regulates muscle tone
Inhibits tremors
Subconscious voluntary movements

 Muscle movement
 Balance
 Equilibrium
Cerebellum

 Midbrain
 Connects pons and cerebellum
 Pons
 Connects cerebellum with brain stem, spinal cord and cerebrum
 Medulla


Transmits motor impulses from brain to spinal cord
Transmits sensory impulses from peripheral sensory neurons to brain


Cross over of motor and sensory pathways
Respiration and cardiac centers

Midbrain
Hypothalamus
Pituitary gland

 Connective tissue
 Three layers (membranes)
 Dura mater
(outer layer)
 Arachnoid membrane
(middle layer)
 Pia mater
(inner layer
)

 4 hollow structures
 Manufacture and absorb
Cerebrospinal fluid
(CSF)
 Choroid plexus
 CSF acts a shock absorber


 Provides motor activity without sending signals to brain
 Protective

 http://www.bbc.co.uk/schools/gcsebitesize/science/aq a/human/thenervoussystemrev3.shtml

 Pathway for impulses to and from brain
 Somatic Nervous System =
(Voluntary) Conscious control
 Autonomic Nervous System =
(Involuntary) Unconscious control

 2 Divisions
 Work together to maintain homeostasis
 Sympathetic (fight or flight)
 Neurotransmitters = epinephrine/norepinephrine
 Parasympathetic (rest and digest)
 Neurotransmitter = acetylcholine


 12 pairs
 Mostly head and neck
 Sensory, motor, or both
 Attached in brain and pass through openings in skull

 V (trigeminal) & VII (facial) = blink reflex
 IX (glossopharyngeal) & X (vagus) = gag reflex
 II (optic) & III (oculomotor) = pupil size and response
 III (oculomotor) & IV (troclear) & VI
(abducens) = extraocular eye movements

Movements synchronized and smooth without nystagmus

 Spinal nerves
 31 pair
 8 cervical
 12 thoracic
 5 lumbar
 5 sacral
 1 very small coccygeal

Spinal cord
Motor
Sensory

A
T
W
H
S
U
P

 Level consciousness
 Orientation
 Coordination
 Muscle Strength
 Sensation
 Movement
 Speech/Swallowing
 Body Temperature

 Describes state of awareness and response to stimuli
 5 levels of consciousness

 Conscious/Alert/Wakeful
 Lethargic/Drowsy/Obtunded
 Stuporous
 Semi-conscious/semi-comatose
 Comatose/ Unresponsive

 Determined in 3 spheres
 Person
 Place
 Time
 Ability to think and reason
 Terms



Disoriented
Confused
Memory loss (short-term/long-term)

 Ability to move extremities and body parts voluntarily in a balanced coordinated manner
 Problem in one body part or all body parts
 Terms
 Gait


Tremors
Ataxia



 Paresis
 Hemiparasia
 Atrophy
 Contraction
 Contracture
 Flaccid

 Disturbance of sensory perceptions
 Terms
 Paresthesia
 Numbness
 Pain
 Neuropathy
 Radiculopathy




Act of changing position of body or its parts
Active/Passive movement
Terms



Paralysis
Plegia
Hemiplegia


Paraplegia
Quadriplegia

 Controlled by cerebral cortex
 Broca’s speech center
 Terms
 Dysphasia
 Dysarthria
 Dysphonia
 Aphasia

 Types of Aphasia
 Expressive (Broca’s or Motor)
 Receptive (Wernicke’s or Sensory)
 Amnesic
 Global

 Process that moves food from mouth through pharynx and esophagus to stomach
 Complicated act
 Initiated voluntarily
 Must be able to move tongue and palate
 Pharynx must respond appropriately to stimulation
 Terms
 Dysphagia

 Speech Therapy assessment
 Avoid distraction while eating
 Small bites
 Need to stay with client
 High fowlers position
 Avoid straws
 Feed slowly
 Swallow twice after each bite
 Use thickening agents as needed

 Controlled by hypothalamus
 Balance between heat production/heat loss
 Heat Production


Metabolism
Muscle activity
 Heat loss


Sweating
Vasodilation

 Normal range: 97 – 100.4 F
 Elderly lower
 Infants higher
 Lowest in morning
 Highest in late afternoon

 LOC and Orientation
 Cranial nerves
 Motor Response
 Pupils
 Vital Signs

 Arousal (wakefulness)





Alert
Lethargic/somnolent/obtunded
Stuporous
Semi-conscious
Unresponsive/comatose
 Awareness




Orientation
Attention span
Speech (clear/coherent/incoherent/slurred
Memory

 I to XII
 Mnemonic
 Cranial Nerves Review

 http://www.youtube.com/watch?v=-J9QEddbJAU
 http://www.youtube.com/watch?v=0lbwshg_Kj4

 Normal motor response
 Follows verbal commands
 Abnormal
 Localizes pain
 Flexion to pain (decorticate position)
 Extension to pain (decerebrate position)
 No response

BABINSKI RESPONSE



 Normal
 Weak
 None

 Equality


Anisocoria
Grossly unequal is abnormal
 Size:





Always check before shining light in eyes
Measure in millimeters (mm)
Constricted
Normal
Dilated

 Reaction


Turn pen light on only when directly in front of pupil
Remember blind eyes will not react
 Record results:
 Normal = brisk reaction, pupil goes from dilation to constriction rapidly
 Abnormal = sluggish or no reaction

 Accommodation
 Pupils adjust to let in more or less light given distance of object from eye
 Assess
 Have patient focus on a distant object
 Have client look at close object

 Blood pressure
 Heart rate
 Respirations
 Temperature
 Late and serious sign
 Cushing’s Triad
 Widening pulse pressure SBP DBP


Bradycardia
Cheyne-Stoke Respirations

 Glasgow Coma Scale

 http://www.bt.cdc.gov/masscasualties/pdf/glasgowcoma-scale.pdf

 CT SCAN
 PET SCAN
 MRI
 OTHERS

Normal Myelogram
Abnormal Myelogram

 Result of pressure from contents of skull
 Amount of brain tissue
 Intracranial blood volume
 Intracranial CSF volume
 Change in any one change in pressure
 Normal range is small

 Minor changes cause no difficulty
 Sustained and continuous increased ICP
 permanent brain damage
 death

 Increased pressure in skull
 Compresses brain tissue



Impairs circulation of blood and CSF
Swelling of brain cells (cerebral edema)
Eventually death
 Result from
 Brain tissue injury (CVA, head trauma)



Tumors
Aneurysms
Surgery to head and face

 Change in LOC ***
 Behavior changes; restlessness, irritability ***
 Headache
 Nausea and Vomiting (projectile)
 Changes in speech pattern ***
 Pupillary changes
 Cranial nerve dysfunction
 Ataxia
***Earliest Signs***

 Seizures
 Cushing’s Triad
 Abnormal posturing
 Chronic elevated ICP
 Blindness



Deafness
Paralysis
Mental retardation

 GOAL : quickly lower pressure in skull
 Drugs to decrease edema in brain
 Osmotic diuretic (mannitol)
 Loop diuretic (Lasix)
 Corticosteroids
 Restrict fluids
 Hyperventilation: induce respiratory alkalosis and vasoconstriction

 HOB elevated at all times
 Control fever
 Complete bedrest
 Decreased environmental stimuli
 Padded siderails
 Prevent vomiting, coughing, straining
 May need surgery to relieve

 Trauma
 Accidents
 Assults

 Concussion
 Hemorrhage
 Epidural hematoma
 Subdural hematoma

 Convulsion/Seizure : episode of abnormal motor, sensory, or autonomic activity or any combination, that causes sudden excessive discharge from cerebral neurons
 Part or all of brain may be involved

 Idiopathic
 Genetic
 Developmental
 Head Injury
 Tumors
 Fever
 Hypoglycemia
 Hypoxia

 Describe circumstances before
 Time of seizure
 Type of movement seen?
 Did patient experience an aura?
 Incontinence of urine or feces?
 Confusion afterward and how long it took to clear?




 DO NOT try to restrain
 NEVER force anything into mouth

 Vital signs
 Assess LOC
 Reorient
 Pad siderails
 Offer emotional support
 Allow sleep and rest
 Attempt to determine cause
 Call physician

 Absence (petite mal)
 Usually seen in children
 Loses consciousness momentarily
 May see twitching of eyes and mouth
 Brief lapse of attention
 Blank empty facial expression


 Seizure activity limited to a certain group of muscles
 On one side of body
 No loss of consciousness

 Complex Partial Seizures
(psychomotor)
 Loss of consciousness
 Perform repetitive purposeless movements
 May make unintelligible sounds

 Generalized seizures (tonic-clonic,
Grand mal)
 Involves both hemispheres of brain
 Intense rigidity of body with jerking movements

 Status Epilepticus
 Seizure activity lasting longer than 30 min
 Medical Emergency
 IV Valium or Ativan

 Treat underlying cause
 Drug therapy
 phenytoin (Dilantin)
 phenobarbitol (Luminal)
 carbamazepine (Tegretol)
 valproic acid (Depakote)
 gabapentin (Neurontin)
 topiramate (Topamax)

 DO NOT discontinue drug therapy suddenly
 Therapeutic blood levels must be reached and maintained to control seizures
 Major side effect = Sedation





 Persistent muscle contraction
 Cerebral vasodilation maybe involved
 Causes
 musculoskeletal abnormalities
 psychosocial stressors

 Symptoms
 Pain
 Pressure
 Aching
 Tightness
 Treatment
 Symptom management

 Due to cerebral vasoconstriction followed by vasodilation
 Tendency is hereditary
 Triggers

 Symptoms
 Aura
 Neck pain
 Throbbing
 Boring
 Pounding
 Unilateral
 Noise and light exacerbate

 Classic
 Prodromal phase
 Common
 No prodromal phase

 Prophylactic
 Dietary restriction
 Medications that prevent vaso changes
 NIFEdipine (Procardia)
 propranolol (Inderal)
 amitriptyline (Elavil)

 Direct
 Vasoconstrictor
 ergotamine (Cafergot)
 Serotonin receptors
 sumatriptan (Imitrex)
 zolmitriptan (Zomig)

 H/A occurs in clusters
 Unilateral throbbing and excruciating
 Quiet, dark and cold compresses
 NSAIDS and tricyclic antidepressants

 History and symptoms
 MRI
 CT
 X-ray
 Arteriogram
 EEG
 Lumbar puncture

 Assess – WHAT’S UP
 ID triggers/aggravating factors
 Stress reduction
 Relaxation
 Heat or cold therapy
 Quiet/dark environment
 Teach about medications

 Disruption of nerve tracts
 Sensory loss
 Altered activity
 Autonomic nervous system dysfunction

 Loss of all reflex activity below the level of the injury
 Lasts a few weeks
 Resolution=reflex activity returns

 Immobilize head and spine
 Maintain airway
 Decrease inflammation
 Skin care
 ROM
 Bladder/bowel

 Reflex response to stimulation of the symapthetic nervous system.
 Seen in injuries above T-6
 Rise in BP
 Noxious stimuli
 Over distended bladder,bowel,decubitus,ulcer,chilling

 Headache
 Hypertension blurred vision
 Bradycardia
 Goose bumps
 convulsions

 HOB elevated to decrease ICP
 Find source of stimuli
 Monitor BP
 Administer antihypertensives as ordered

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