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Neurological

Neurological

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NEUROLOGICAL
I.
Neurologic Anatomy and Physiology
A.
Central nervous system (CNS) - coordinates and controls body functions
1.
Brain (illustration 1
illustration 2
)
a.
cerebrum (illustration
)
i.
hemispheres right and left
ii.
frontal lobe - higher intellectual functions, social behavior,
personality
iii.
parietal lobe - interprets sensory input
iv.
temporal lobe - hearing, taste and smell
v.
occipital lobe - vision
b.
cerebellum - provide equilibrium and muscle coordination
c.
brain stem - midbrain, pons and medulla oblongata; controls basic body
functions and relays impulses to and from spinal cord
2.
Spinal cord (illustration 1
illustration 2
)
a.
descending tract - anterior portion of cord carrying motor information
b.
ascending tract
i.
the posterior portion of cord, carrying sensory information
ii.
31 segments
\u2022
eight cervical: neck and upper extremities
\u2022
12 thoracic: thoracic and abdomen
\u2022
five lumbar: lower extremities
\u2022
five sacral: lower extremities, urine and bowel control
\u2022
one coccygeal
B.
Peripheral nervous system - carries information to and from the CNS (illustration 1
illustration 2
illustration 3
)
1.
Motor nerves
2.
Sensory nerves
C.
Autonomic nervous system - regulates body's internal environment (illustration
)
1.
Sympathetic - prepares body for fight or flight; used only as needed
2.

Parasympathetic - controls normal body functioning for day to day activities, e.g.,
increases muscle tone, maintains secretions; maintains heart rate within normal limits;
maintains peristalsis

D.
Cranial nerves (illustration
)
These nerves are the vital bridges between the brain and the rest of the body.
To remember the cranial nerves, remember this sentence:
On Old Olympus Towering Top A Frenchman And German Viewed Some Hops
OR Oscar Osmond Ought To Try To Find A Girl's Voice Singing High

E. Physiology - nervous system coordinates and controls all activities of the body
1. Receives internal and external stimuli
2. Processes information to determine appropriate response
3. Transmits information over varied motor pathways to effector organs

F. Findings for increased intracranial pressure (ICP)
1. Earlya. change in level of consicousness (LOC): restlessness, disorientation, confusion,
lethargy, stupor
b.pupils: dilated ipsilaterally
, react slowly to light
c.abnormal motor activity: contralateral hemiparesis
d. abnormal reflexes - hyper or hypo reflexia
e. vital signs within normal parameters
2. Late
a. LOC: semicomatose, coma
b. pupils: dilated bilaterally and fixed; no reaction to light
c.motor function: decorticate posture then decerebrate posture; flaccid muscles at
end stage

d. vital signs - increased systolic pressure to result in a widened pulse pressure,
decreased respirations with bradycardia, temperature initially may rise then fall
below mornal parameters

Don\u2019t let the testing procedure overwhelm you. Take it one step at a time and remain focused.
Say to yourself "I will make decisions about at least 75 clients with individual needs," rather than "this is THE TEST!"
II.
Degenerative Disorders
A.
Parkinson's disease (illustration
)
1.
Definition: degenerative disorder of the dopamine hydrochloride - producing neurons
a.
result: dopamine hydrochloride depletion
b.
usually occurs in older adults and males more than females
c.
etiology unknown
2.
Findings
a.

resting tremors of the lips, jaw, tongue, and limbs, especially a resting pill-
rolling tremor of one hand that is absent during sleep. This is different from an
essential or intention tremor in which the tremor is action related.

b.
bradykinesia
c.
fatigue
d.
stiffness and rigidity with movement
e.
signs first unilateral, then bilateral
f.
mask-like facial expression
g.
slow, shuffling walk; gradually more difficult
h.
difficulty rising from sitting position
i.
ultimately confined to a wheelchair
j.
mind stays intact unless other aggravating conditions
k.
echolalia in most cases
3.
Diagnostics
a.
based on finding with history
b.
EEG (illustration
)
c.
MRI (illustration
)
d.
computerized tomogram (CT scan) (illustration
)
4.
Management
a.
outcomes: palliative; postpone dependence
b.
pharmacologic
I.
anticholinergics - minimize extrapyramidal effects
I.
benzotropine mesylate (Cogentin)
II.
procyclidine (Kemadrin)
II.
dopamine hydrochloridergics: Levodopa (L-Dopa)
III.
antiparkinsonian agent: amantadine hcl (Symmetrel) reduces rigidity
and tremor
IV.
MAO inhibitors: selegiline (Eldepryl)
c.
therapies
I.
physical
II.
occupational
III.
speech
d.
surgery: stereotaxic thalamotomy to decrease tremor
5.
Nursing interventions
a.
maintain safety of client
b.
prevent effects of immobility
c.
foster independence in activities of daily living (ADL)
d.
reinforce the use of assistive devices for ambulation as indicated
e.
maintain good nutrition
I.
small, frequent meals
II.
soft foods
III.
roughage with sufficient fluids to decrease constipation
f.
monitor effectiveness of administered medications
g.
provide emotional support to client and family members
h.
teach client
I.
when and what side effects of the drugs to report
II.
the benefits of daily exercise
B.
Huntington's disease
1.
Definition
a.
progressive atrophy of basal ganglia and some parts of cerebral cortex
b.
etiology - genetic disorder, autosomal dominant
2.
Findings: increased involuntary movements, progressive decline in cognitive, findings
usually occur in middle age
a.
motor
I.
impaired chewing and swallowing
II.
chorea
III.
dystonic posture
IV.
gradually becomes bedridden
b.
cognitive: less able to organize, plan and sequence behavior
c.
mental: personality changes, depression, even psychosis
3.
Diagnostics: history and physical exam
4.
Management
a.
outcomes: postpone dependence
b.
supportive care for findings
c.
therapies: speech, physical
d.
genetic counseling
5.
Nursing interventions
a.
foster independence in ADL (activities of daily living)
b.
reinforce the use of assistive devices for ambulation as needed
c.
teach client to:
I.
maintain good nutrition

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