MedicalSurgical Nursing An Integrated Approach 2 E Chapter

Medical-Surgical Nursing: An Integrated Approach, 2 E Chapter 25 NURSING CARE OF THE CLIENT: NEUROLOGICAL SYSTEM

The Human Nervous System Its purpose is to control motor, sensory, and autonomic functions of the body. n This is accomplished by coordination and initiation of cellular activity through the transmission of electrical impulses and various hormones. n

The Nervous System: Structure n The nervous system is divided into: The central nervous system, consisting of the brain and spinal cord. n The peripheral nervous system, which consists of the cranial nerves and spinal nerves. n The autonomic nervous system, which is part of the peripheral nervous system and consists of sympathetic and para-sympathetic systems. n

The Brain n Composed of gray matter and white matter, the brain controls, initiates, and integrates body functions through the use of electrical impulses and complex molecules.

Physiology of the Brain The brain is contained within the skull, or cranium. n Three coverings of the brain, called the meninges. They are the dura mater, arachnoid mater, and pia mater. n

The Brain Hemispheres The right side receives information from and controls the left side of the body. Specializes in perception of physical environment, art, music, nonverbal communication, spiritual aspects. n The left receives information from and controls the right side of the body. Specializes in analysis, calculation, problem solving, verbal communication, interpretation, language, reading, and writing. n

The Spinal Cord A continuation of the brain stem. n Exits the skull through the foramen magnum, an opening in the base of the skull. n

Cerebrospinal Fluid n Provides for shock absorption and bathes the brain and spinal cord.

Peripheral Nervous System: Cranial Nerves n Twelve pairs of cranial nerves have sensory, motor, or mixed functions.

Peripheral Nervous System: Cranial Nerves n Twelve pairs of cranial nerves have sensory, motor, or mixed functions.

Cranial Nerves Olfactory Optic Sensory; smell Sensory; Vision Trigeminal Oculomotor Trochlear Motor; Pupil Constriction Motor; upper eyelid elevation Abducens Facial Acoustic cornea, nose, oral mucosa; mastication Motor; Extraocular eye movement Motor (facial muscles); Sensory (taste) Sensory; Hearing; Equilibrium Glosso. Pharyngeal Vagus Spinal Accessory Hypoglossal Taste; Swallowing Motor and Sensory Motor Tongue Movement

Peripheral Nervous System: Spinal Nerves NERVES Cervical n Thoracic n Lumbar n Sacral n Coccyx n NUMBER OF PAIRS 8 12 5 5 1

Peripheral Nervous System: Autonomic Nervous System n n Main function is to maintain internal homeostasis. Two subdivisions of ANS: n The sympathetic system (activated by stress, prepares body for “fight or flight” response). n The parasympathetic system (conserves, restores, and maintains vital body functions, slowing heart rate, increasing gastrointestinal activity, and activating bowel and bladder evacuation).

Cerebral Function: Assessment

Cranial Nerve Function Assessment: Motor Function

Cranial Nerve Function Assessment: Sensory Function

Cranial Nerve Function Assessment: Reflexes

Common Diagnostic Tests for Nervous System Disorders Lumbar puncture (LP). n Electroencephalogram (EEG). n Electromyogram (EMG). n Imaging Procedures. n Cerebral Angiography. n Brain scan. n Myelogram. n

Head Injuries Head injuries involve trauma to the: Scalp. n Skull. n Brain. n

Scalp Injuries They bleed profusely because of the abundance of blood vessels in the scalp. n Infection is of major concern. n

Skull Injuries May occur with or without brain injury, n Fracture usually caused by extreme force, n Skull fractures considered closed if dura mater is intact; open if dura mater is torn. n

Types of Skull Fractures Linear (nondisplaced cracks in the bone). n Comminuted (bone broken into fragments). n Depressed (bone fragments pressing into intracranial cavity). n Basiliar (fractures of the bones in the base of the skull). n

Brain Injuries: Causes n n n Acceleration-deceleration force (acceleration injuries caused by moving objects striking the head; e. g. baseball bat. Deceleration injuries result when head is moving and strikes object, e. g. dashboard). Rotational (twisting of the cerebrum on the brain stem, e. g. whiplash). Penetrating missile (direct penetration of an object, e. g. bullet, into brain tissue).

Brain Injuries: Open Brain injuries resulting from skull fractures and penetrating injuries are referred to as open head injuries. n Hemorrhaging from the nose, pharynx, or ears; ecchymosis over the mastoid area (Battle’s sign) or blood in the conjunctiva may occur in conjunction with open head injuries. n

Brain Injuries: Closed Caused by blunt force to the head. n Types of closed head injuries include concussion, contusion, and laceration. n

Concussion Transient neurological deficits caused by the shaking of the brain. n Clinical manifestations may include immediate loss of consciousness lasting from minutes to hours, momentary loss of reflexes, respiratory arrest for several seconds, an amnesia afterwards. n

Contusions Surface bruises of the brain. n Skin is cool and pale. n Pulse, blood pressure, and respirations are below normal. n Cerebral edema may occur in conjunction with widespread injury. n

Cerebral Lacerations Tearing of cortical tissue. n Symptoms include deep coma from time of impact, decerebate posturing, autonomic dysfunction, nonreactive pupils, respiratory difficulty. n

Hemorrhage Intracranial hemorrhage is common complication of any head injury. n Treatment is surgery to evacuate the hematoma, stop the bleeding, and relieve pressure on the brain. n

Brain Tumor Space-occupying intracranial lesions, either benign or malignant. n Clinical manifestations differ according to area of lesion and rate of growth, but commonly include alterations in consciousness, decreased mental functioning, headaches, seizures, or vomiting (sometimes sudden and projectile), n

Cerebrovascular Accident (CVA) Also known as stroke, CVA is a sudden loss of brain function accompanied by neurological deficit. n Third highest cause of death in U. S. n Strokes are caused by ischemia (oxygen deprivation) resulting from a thrombus, embolus, severe vasospasm, or cerebral hemorrhage. n

Transient Ischemic Attacks (TIAs) Frequently preceding CVAs, TIAs are temporary or transient episodes of neurological dysfunction caused by temporary impairment of blood flow to the brain. n Classic symptom is fleeting blindness in one eye. n

Epilepsy/Seizure Disorder Epilepsy is a disorder of cerebral function in which the client experiences sudden attacks of altered consciousness, motor activity, or sensory phenomenon. n Most clinicians use the term seizure disorder for epilepsy or seizures n Seizures are classified as generalized or partial. n

Herniated Intervertebral Disk A major cause of chronic back pain. n Majority of herniated disks occur in lumbar or cervical spine. This can occur either suddenly from trauma, lifting, or twisting, or gradually from aging, osteoporosis, or degenerative changes. n

Spinal Cord Injury (SCI) Occurs from trauma to the spinal cord or from compression of the spinal cord due to injury to the supporting structures. n Each year, almost 10, 000 new spinal cord injuries occur. n Leading causes are motor vehicle accidents, acts of violence, falls, and sporting accidents. n

Parkinson’s Disease A chronic, progressive, degenerative disease affecting the area of the brain controlling movement. n Typical symptoms include muscular rigidity, bradykinesia (slowness of voluntary movement and speech), resting tremors, muscular weakness, and loss of postural reflexes. n

Multiple Sclerosis (MS) A chronic, progressive, degenerative disease wherein scattered nerve cells of the brain and spinal cord are demyelinated. n Symptoms include visual disturbance, numbness, paresthesia, pain, decreased sense of temperature, decreased muscle strength, spasticity, paralysis, bowel and bladder incontinence or retention. n

Amyotrophic Lateral Sclerosis (ASL) (Lou Gehrig’s Disease) n A progressive, fatal disease characterized by the degeneration of motor neurons in the cortex, medulla, and spinal cord.

Alzheimer’s Disease (AD) A progressive, degenerative neurological disease wherein brain cells are destroyed and the cerebral cortex atrophies. n Risk factors include advanced age, female gender, head injury, history of thyroid disorders, and chromosomal abnormalities. n

Stages of Alzheimer’s Disease

Guillain-Barré Syndrome An acute inflammatory process primarily involving the motor neurons of the peripheral nervous system. n Clinical manifestations include motor weakness and absence of reflexes (areflexia). n

Headache n Also known as cephalagia, headache is the condition of pain in the head, caused by stimulation of pain-sensitive structures in the cranium, head, or neck.

Types of Headache: Primary Tension-Type n Migraine. n Cluster Headaches. n

Types of Headache: Secondary headaches are the result of pathological conditions such as aneurysm, brain tumor, or inflamed cranial nerves. n The headache is caused by compression, inflammation, or hypoxia of pain-sensitive structures. n

Client Teaching: Headaches n Advise clients to: n Keep a diary of headache history to ascertain pattern. n Avoid foods that trigger headaches. n Reduce salt intake. n Practice relaxation techniques.

Trigeminal Neuralgia (Tic Douloureux) n A condition of cranial nerve V that is characterized by abrupt paroxysms of pain and facial muscle contractions.

Encephalitis/Meningitis Encephalitis is inflammation of the brain. n Meningitis is inflammation of the meninges. n Most common cause of both is a virus. n Cerebral edema, hemorrhage, and necrosis of brain tissue can occur. n Fever, headache, nuchal rigidity, photophobia, irritability, lethargy, nausea, and vomiting are typical symptoms. n

Huntington’s Disease or Chorea n A chronic, progressive hereditary disease of the nervous system characterized by chorea, abnormal involuntary, purposeless movements of all musculature of the body.

Gilles de la Tourette’s Syndrome n A neurological movement disorder that also has prominent behavioral manifestations.