AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of the nervous system.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a patient with a disorder of
the nervous system by correctly responding to written, oral, and experiential
assessment measures
TEACHING POINTS
1. Define key terms related to the nervous
system
2. Describe physiological changes that occur in
the nervous system with aging
3. Determine subjective and objective data that
should be obtained from a patient during a
nursing neurological assessment.
4. Examine the nursing management of the
patient undergoing neurological diagnostic
testing.
5.
6.
7.
8
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Instructional Time: 129
Reference(s):
ISBN 0-323-01728-2
Adult Health Nursing, 4th Edition
01 Jan 2003
Minutes
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
The nervous system is the command and control center of the body. It works
in conjunction with the endocrine system to maintain the body's homeostasis.
Changes in the nervous systems ability to function can be rapid or gradual in
onset. An important role of the nurse is to observe for and detect alterations in
nervous system function.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Define key terms related to the nervous system
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Key Terms
(1) Agnosia- loss of the ability to recognize familiar objects and persons
(2) Aneurysm- localized dilation of the wall of a blood vessel
(3) Apraxia- inability to perform purposeful acts or to use objects properly
(4) Ataxia- abnormal condition characterized by impaired ability to coordinate movement
(5) Bradykinesia- slowing down the initiation or execution of movement
(6) Diplopia- double vision
(7) Flaccid- weak, soft, flabby muscles lacking normal muscle tone
(8) Global cognitive dysfunction- generalized impairment of intellect, awareness, and judgement
1
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
(9) Hemianopia- defective vision or blindness in half of the visual field
(10) Hemiplegia- paralysis of one side of the body
(11) Hyperreflexia- neurologic condition characterized by increased reflex action
(12) Nystagmus- involuntary rhythmic movements of the eye
(13) Paresis- lesser degree of movement deficit than paralysis
(14) Postictal period- rest period after a seizure
(15) Proprioception- sensation of spatial-position and muscular activity stimuli
(16) Spastic- involuntary, sudden movement or muscular contraction
(17) Unilateral neglect- perceptually unaware of one side of the body
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What does hemiplegia mean?
Paralysis on one side of the body.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Describe physiological changes that occur in the nervous system with aging
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Physiological changes of the nervous system that occur with aging
(1) Loss of brain weight and neurons (1% a year after age 50)
(2) Often an altered sleep/wakefulness ratio
(3) Decrease ability to regulate body temperature
(4) Decrease in the velocity of nerve impulses
(5) Decrease blood supply to the spinal cord resulting in decreased reflexes
(6) Decrease in brain metabolism and oxygen utilization
(7) Diminished sense of touch and ability for fine motor coordination
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
(8) Short-term memory is more affected by aging than long-term memory
(9) Incidence of stroke, physiological dementia, organic brain syndrome, and Alzheimer's increases
with age
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Click here to enter the question.
Click here to enter the answer.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Determine subjective and objective data that should be obtained from a patient
during a nursing neurological assessment.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Nursing Assessment
(1) Obtain a comprehensive history
(a) Headaches, pain level and frequency
(b) Clumsiness or loss of function
(c) Changes in visual acuity
(d) New or worsening seizure activity
(e) Pain or numbness
(f) Personality changes/mood swings
(g) Extreme fatigue or tiredness
(2) Mental status
(a) Orientation to person, place, time, and purpose
(b) Mood and behavior
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
(c) General knowledge
1) U.S. presidents
(d) Short and long term memory
(e) Attention span
(f) Ability to concentrate
(3) Assess consciousness
(a) Consciousness: comprises arousal and awareness
1) Arousal: responsiveness to auditory, visual, and tactile stimuli
2) Awareness: reflected in orientation to person, place, and time
(b) Level of consciousness:
1) Alert: Appropriate responsiveness to auditory, visual, and tactile stimuli
2) Disorientation: Unable to follow simple commands, thinking slow, inattentive. Reflected in
orientation to person place and time
3) Stupor: Responds to verbal commands with moans or groans, if at all
4) Semicomatse: Patient can only be aroused with energetic stimulation
5) Comatose: Does not respond to external stimulation
(c) Need to evaluate type and degree of stimulus needed to evoke arousal
(d) Record observation in terms of behavior and signs not as labels such as, disoriented
(e) Anatomically, arousal and awareness require intact cortex, thalamus, and
reticular activating system
(f) Restlessness, lethargy and disorientation are often the first sign of increased intracranial pressure
(4) Assess speech pattern
(a) Aphasia - language function is defective or absent
1) Sensory or receptive - inability to understand the spoken or written word
2) Motor/expressive - inability to use the symbols of speech
3) Global - inability to understand the spoken word or to speak
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
4) Anomia - inability to name objects
(b) Dysarthria - difficult poorly articulated speech
(5) Assess motor function
(a) Be descriptive of observed behavior
1) Gait
2) Coordination
3) Weakness (flaccid)
4) Reflexes
5) Posture
a) graded 0 to 4+ with 4+ being hyperreflexic
b) Most useful in comparing one side of the body to the other
6) Involuntary movements (spastic)
7) Paralysis loss of function
8) Paresis
(b) Most accurate and easiest evaluation is completed when patient is able to follow commands. Can
assess strength bilaterally and make comparisons
(c) When patient is unable to respond to command, need to observe movement in response to
noxious stimuli. Abnormal postures correlate to level of dysfunction
and injury
(d) Focal motor responses may be assessed using the Glasgow Coma Scale as a guide. Must evaluate
all 4 extremities
Note: Vital signs: aberrations in blood pressure, heart rate, and respiratory patterns are reliable indicators
of mental status, but are late signs. Changes will be seen in above parameters at earlier stages
(6) Assess cranial nerves
(a) CN 1 - (olfactory) identification of common odors
(b) CN 2 - (optic) visual acuity and visual fields
(c) CN III (oculomotor)
1) Pupillary responses
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
a) Evaluate size, shape, reactivity bilaterally
b) Size: in mm, represents balance between sympathetic and parasympathetic nervous system
c) Shape: also controlled by CN III, as well as fibers in brainstem
d) Reactivity: light reflex test evaluates integrity of CN II (optic) as the sensory component, and
CN III as the motor component
2) Described as brisk, sluggish, or nonreactive
3) Consensual reflex present or absent. Will be intact when CN III connections are intact. Blind
eye may lose direct response, due to CN II injury, but retain consensual response
4) Inability to move eye in one of the directions may be due to damage to nerve
5) With damage to CN III, the eye cannot move in the appropriate directions and the eye may drift
outward
(d) CN IV - (trochlear) tested with CN III
(e) CN V - (trigeminal)
1) Jaw strength
2) Facial sensation
3) Corneal reflex
(f) CN VI - (abducens) tested with CN III
(g) CN VII - (facial)
1) Facial moves in symmetry
2) Identification of taste
(h) CN VIII - (acoustic) hearing
(i) CN IX (glossopharyngeal) taste
(j) CN X - (vagus)
1) Gag reflex
2) Movement of the uvula and soft palate
(k) CN XI (spinal accessory) shoulder and neck movement
(l) CN XII (hypoglossal) tongue movement
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
(7) Assess sensory and perceptual status
(a) Pain, touch, temperature
(b) Proprioception
(c) Unilateral neglect
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
(d) Hemianopia
Check on Learning
In a knowledge lesson, pose questions to the class.
Consciousness: comprises arousal and awareness.
(1) Arousal: responsiveness to auditory, visual, and tactile stimuli.
(2) Awareness: reflected in orientation to person, place, and time.
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Examine the nursing management of the patient undergoing neurological diagnostic
testing.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Nursing Management of the Patient Undergoing Neurological Diagnostic Testing
(1) Radiographs, Scans, and Grams
(a) Computed Tomography (CT) Scan
1) 30-60 mins of lying still
2) IV line started if contrast medium planned
3) Claustrophobia
4) Allergy to iodine/seafood significant
(b) Brain Scan
1) 45 mins time
2) IV line
(c) MRI
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
1) Remove watches, jewelry, any metal from clothing
2) Questioned about metal in the body
3) Noise
(d) PET
1) IV line
2) 45 mins lying still
(e) Lumbar puncture
1) 10-15 mins
2) Slight pain and pressure
3) Sharp shooting pain down one leg common
4) Patient positioning on side with knee and head flexed
5) Slight bleeding at site
6) Patient to lie flat for several hours after to avoid headaches
(f) Electroencephalography
1) Patient must be quiet and rest before procedure
2) One hour to complete
3) Hair and scalp to be clean
4) Wash hair after to remove collodion in hair
5) Must rest after procedure
(g) Myelogram
1) 2 hours to complete
2) Slight discomfort during procedure
3) May need to assume variety of positions
4) IV
5) Check for allergies to contrast agents
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
6) CT scan to follow
7) Headache, nausea, vomiting common after
8) Patient must rest after for a few hours
(h) Angiography
1) Oral intact restricted- NPO or clear fluids
2) Check for allergy to iodine
3) VS and neurological checks done
4) 2-3 hours to complete
5) Discomfort in lying still that long
6) Hot flush feeling when dye injected
7) Bedrest ordered after procedure
8) Patient assessed routinely for VS, neuro checks, LOC, puncture site
9) High risk for CVA and/or IIP after procedure
(i) Carotid Duplex
1) Noninvasive probe on skin and moved along carotid
(j) Digital Subtraction Angiography
1) Same as angiogram
(k) Electromyography
1) 45 mins to complete
2) Discomfort when electrode inserted and when electrical current is used
3) Muscle ache after procedure
4) Assess for signs of bleeding
5) Provide analgesia
(l) Echoencephalogram
1) Same as brain scan
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
b. Potential nursing diagnosis for a patient undergoing a neurological assessment
(1) Knowledge deficit related to procedure
(2) Anxiety related to procedure
(3) Alteration in comfort related to procedure
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
List 3 nursing considerations for a patient undergoing an MRI
1) Remove watches, jewelry, any metal from clothing
2) Questioned about metal in the body
3) Explain the expected noise
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
You will be tested on this subject at a later date.
You will be expected to review and study the material taught in this session in
order to pass the associated written test. If you have difficulty with the material
please see me so we can review together.
None.
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
Define key terms related to the nervous system
Describe physiological changes that occur in the nervous system with
aging
Determine subjective and objective data that should be obtained from
a patient during a nursing neurological assessment.
Examine the nursing management of the patient undergoing
neurological diagnostic testing.
5.
6.
7.
8
9.
10.
Closing Statement:
10
Nurses work in various health care settings so it is important to gain an
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to the Nervous System
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
11
The nervous system is the command and control center of the body. It works
in conjunction with the endocrine system to maintain the body's homeostasis.
Changes in the nervous systems ability to function can be rapid or gradual in
onset. An important role of the nurse is to observe for and detect alterations in
nervous system function.