NEUROLOGY

Any
NEUROLOGY
ChS
-
central nervous system
-brain (most complex organ)
spinal cord
-

ANS
-
autonomic nervous
system
PNS
peripheral nervous system
-

-types:
a) Spinal nerve
-types:1) Sensory nerve
tracts
ascending-
nerve
posterior
at

2) motor nerve
anterior
descending nere tracts at
-

Gyni
·

the
-the more
gynmeans more
intelligent you are

Posterior
sensory posterior
-

can affect our sensation

·
Anterior CS

-motor nerves

·
Brain
it is more active when
asleep
-

Cerebrospinal Fluid
-

50% glucose (use dip stick todetectit)

-

reflection of bacteria:PROEI (infection)

Involuntary
·

heart rate, respiratory rate, and blood

pressure
-

Symphatetic Nervous Response Parasymphatetic Merous

Response
go stop
- -

↑ heart rate -

↓ heartrate
-
↑
respiratory rate -

↓ respiratory rate
-
↑ blood pussun
-

↓ blood pressure
GIT
↑peristalc movement] diarrhea A peristaltic movementt
- - -

↑ salivation
A urination ↑
GUT
urinary output
- - -
·

Cerebrum
for sensory and motor function
responsible
-

(control leftside
-left(control side of the body) and lighthemisphere ofthe body)
·
Tentorium
seperates lower
- it the
upper and
partof the brain.

·
Cerebral Cortex
divides the differentlobes ofthe brain
-

↳ frontal

temporal
parietal
occipital

LOBES OFTHE
BRGI

Frontal temporal Parietal occipital

personality Smelling tactile sensation visual center the brain

- -

of
- -

↳
Intelligence get grade:
-Hearing
-

-en
0-no sensation atall

1
Speech impaired
-
-

↳ Broca's ↳ Wemicke's
Aphasia 2
Aphasia Intact
-

Cunexpressive aphasial (
receptives

·
Thalamus

clay station.
sensory
-

Hypothalamus
thermo regulation of
-
the brain
emotions casponsible)
-

Hippocampus
·

of
storage memory
-

Oxygenation
·

2 to 3 liters per minute

·
Brainstem
-

divided in 3 portions:
1) Pons

presidentfor respiration
-rice

-changes the character

ofrspiration
-drop or shallow

a) Medulla
Oblongata
-

presidentfor respiration
respiratory sender of the brain (maintains
hypoxic drivel
-
 midbrain
3)
station
-motor rlay
·
cerebellum
-responsible for posture, balance, and coordination ofmuscle
promote:safety
-

↳example:assistthe clientin getting out ofbed

assess:
ways
-

to

a) Rhonberg's Test
-

balance with one leg

b) Heel toe Test
to

-walk in a line
c) Finger nose Test
to

check muscle coordination

d) Dysdiadochokinesia
-

rapid alternating of
movement the palm

CRANIAL MERVES

I- Olfactory nerve
↳
non-irritating orders:coffee
tea

toothpaste

It -

Optic Nere
↳ Vision
smellen chart(20120) numerator =

(patient)
denominator (normal people)
·
distance of 20/00
·distance of 20/40: normal
people
distance of 20/200:if blindness
cannotsee, its
legal
·

# oculomotor

IV-Trochlear
V - Trcheuminal
↳a
sponsible for chewing
difficultyof chewing, so the
priority is Airway because the
possibilityofAspiration
# -

Abducens
#- Facial
-

↳instructthe patienttoshow the teeth

# -

Acoustic/ Vestibulocochlear
↳
ticking clock

whisper

#-
Glossopharyngeal (End)
↳responsible for swallowing
 is airway because
priority of aspiration
"gay flex"is nonal

1- vagus
↳ decrease heartrate

increase hydrochloric acid

Accessory
#

↳
Spinal:
a) Scalene
-

lift the firsttwo ribs

-

because
we never assess it it was inside the clavice

b) Tropezius
-

liftthe shoulder

c) Sternoclei domastoid
-
liftthe Sternum

#I -

Hypoglossal
of the
tounge
↳ movement

no cranial nere , you will be in pronouncing , 5, D. L

difficulty
night

ligmite
CLASGOW COma ScalE (GCS)
tool to of brain
a assess the
type injury
-

3 CATEGORLES SCORES

a) Motor
b) Verbal ⑤
d Eye 4

Motor Responses:
·

6
-

it obeys command

the clientcan localized pain

-

-apply supraorbital pressure

4
-

normal flexion

-apply nail bed pressure

when then's there's alway
means a
pain
-

pussure
 3
-

decorticate
-non-functional cortex
-

mild

2
-

decerebrate
-

more worse than motor 3 and ithas lesion in brainstem

1
no
response
-

·
Verbal Responses:
5
-
oriented
-

answered correct answer

-question: ma'am where are

you?
answered:hospital
-

4
-

confused
answered: place
-

inappropriatewords
-

incomprehensible sounds
-

no response
-

Eye Responses
·

4
-

spontaneous

3
-

response to voice

pain
-response to
-apply trap squeeze
1
no
response
-

·
SCOR 13-15

-Mild Brain Injury

 ·
Score 9-12
-moderate Brain
Injury
·
SCON 3-8
-

Severe Brain Injury

-

3: lowest PreSSUR

·
Increase Intracranial Pressure
-normal & ust
pressure:7-ll minty
8-18
mmhy & motion

19 mmhy
-

20
mmhg -

Bon
21 mmg -
UCLEX

·
Monroe Kelly Hypothesis
-itis an enclosed hypothesis
if often, build up
no
pressure
-

if enclosed, there's a
pressure build up
-

CAUSES OF IICP

a) Tumor
b) Inflammation of the Brain
-

trauma
-

infection

manIFESTATIONS OF IICP

NICP -

Pain
↓
Headache
↓
confusion
↓
Abnormal Vital
Sign
·
There's a
hypertension:Abnormal Vital
Sign
bradycardia
bradyphea
] formulate
the
Cushing Trad

Hypertension 2
Bradycardia 2

I
X
Ej TRADS

ABORMAL RESPIRATION
a) Chene Strokes Respiration
-

normal
rhythmic aspiration followed with
period of apnea.
 b) Neurologic Respiration
-increased in rate and depth

C) Apheustic Respiration
pauses in
every inhalation and exhalation
-

d) Ataxic Respiration
totally irregular in rate, rhythm, and depth
-

e) Cluster Respiration
shallow and
clumped together
-

INCREASEIRRACRANIAL PRESSURE
a) Blurring of Vision
-

normal in ICP

b) Vomiting
-

projectile vomiting (indication of intracranial pressure)

c) Positive Babinski Reflex

a) Decorticate / Decerticate

-possible for pressure

MANAGEMENT OFIICP

a) position
-

avoid
I
in flaton bed position
-

avoid flexion on the neck

avoid the neck
twisting
-

avoid extreme flexion of the

his
3
-

-applicable the
to
patient:semi-fowlers position

b) Activities
avoid
coughing
-

avoid sneezing
avoid vomiting
-

avoid straining
-

-
avoid
shivering
-

avoid exercises
applicable the
to
patient:passive range of motion
-

OFI (maximum 1200 cal

day)
~ ↓

MEDICATIONS OF IICP

a) Morphine as
Sulfate Ordered -

lead rspiratory
to arrest

I
instead
give Alfentanil
 b) Anti-hy pertensive as ordered
d) Anti-pyretics as ordered
d) Stool-softeners as ordered
e) Diuretics as ordered
↳ Osmotic (mannitol)

SURGERY OFIICP
a) Shunting
-

infection
contraindication:peritonitis

-types:a) Atrioventricular
b) Ventricubperitoneal
-less invasive and more accessible
d) Peritonitis

b) Craniotomy
types:a) supratentorial
-head elevation
b) Infratentorial
-flaton bed position
c) Craniectomy
-removal of the of the head (curatives
cup
-

after putin: $ Bone Bank

↳ E:appliances will
abdomen

-highestpriority:Safetyofthe Patient

SEIZURES
-

aka convulsions
↳ aka epilepsy
-

abnormal electrical conduction: brain

DIAGNOSAC OF SEIEURES

a) Electroencephalogram (EEG)
-

measures electrical conduction

-

do not: Shave
shampoo (not a contraindicated and not a
priority)
instruct the patientto remain still
-

avoid:Stimulant
coffee
tobacco

TYPES OFSEIEURES
a) Generalized
1) Grandmal
-

aka tonic clonic

↳
spasm jerky
 Petit -mal
2)
-

absence seizures
normal
type in children
-

blank
staring
-

drooling
-

-10-20 seconds

3)Febrile Seizure
-

associated with fever

the fever the seizure
managing means
managing
-

b) Partial
1) Jacksonian
-one distal extremitytothe adjacent area

a)
Psychomotor
-

associated with head trauma

MANAGEMENT OF SEIEURES
1) Airway
-

suction secretion as ordered

-

seizure
suction done after

during the seizure, turn the

patienthead to the side
-

do not
tongue depressor
"ingnatcatamation"
use
7
-

do notuse
tongue blade paddled
-

2) safety
ofthe Client
defends if on the onsetof seizure
your
-

-raise the side rails of the bed

up
-

aura (sign thatthe patientwill have a seizure and itis a subjective datal
↳ the aura, putthe patienton (Cradle the head of the patients
during the floor

MEDICATIONS OFSFIEURES

1) Phenobarbital
a) Phenytoin (Dilantin)
-

mostly given medication

sign and
symptoms:
-

a) Gingiva Hyperplasia
-use of
frequentoral care
-

use brittle toothbrush

STROKE
↓
BRAA ATTACK
↓
CUA (talks about the circulation)
·
Stroke
decrease tissue in the brain of the patient
perfusion
-

causes:
a) thrombus formation
b) Hypertension
dI Transient
DM-viscosity
-
-

Ischemia
-

sigh and
symptoms:
a) Hypertension
b) Slow and bounding pulses
d) widened
pulse pressure
d) Aphasia
·
Stroke Vital Sign
-

180/100 (minus)
-so of the heart8
pumping pressure
RightBrain Attack Left Brain Attack
-

lefthemi pledia/hemipeusis -righthemipedial hemipersis

impaired judgement impaired performance
-
-

rapid movement slow/sluggish movement

-

deficits
unaware of awar of
deficiency
-
-

unilateral
neglect left
anxiety
-
-

injury (nursing diagnosis depression (nuying diagnosis)

-

CRAIGL HERES
- difficultyin chewing
- facial newe
#

-facial
asymmetry
#- difficultyswallowing
-

aphasia
# hemianopsia
-

↳ loss of 50% of dients visual field

MANAGEMENT OF CRANIAL HERLES

1) Airway
-

suction (for 10-15 seconds) or Cless than 10 seconds)

↳
your introducing hypoxia
the
patientshould be in uprightin feeding
-

in feeding the client, itshould be thickened

-

2)
Positioning
-

affected or unaffected side

↳20 mins ↳ 2 hours
 a) Unilateral Left neglect
-approach affected side
belongings (affected side)
-

-food (unaffected sidel

and
beverages
b) He mianopsia
-

approach (unaffected side)

-

belongings (unaffected Side)

lost visual field to
scan
promote safety
-

d) Aphasia
-speak on the
patient slowly
-allow time for your clientto communicate
doesn'thave clot
by giving aspirin preventclotting if a
yet
-

to

anti-coagulants if
you already have a clot or
existing clot

thrombolytics (dissolved the dlot)

MYSERIG GRIVIG

↓acethylcholine
-

weakness (descending body weakness)

-

autoimmune
-

system

DIAGNOSAC EXAM OFMYASERIG GRIVIA

a) tension (Edrophorium)
drug
-

-shortterm relief (10-15 minutes)

-

if not effective, torule out

my
SIGN and Symptoms OFMyaSTHEIG GRIVIA
a) weakness and
fatigue
b) ptosis
-

dropping of the
eyelids
the levator
-weakness of
pelpabrae
c) Difficulty in chewing
swalthing
lowinget
speaking

diray
·

is the Grivia
-it
highestpriority in
myasthenia
PRIORIT AND INERVENTION OFMYASTHEGIG GRIVIA
1) Airway

assess chemning]
-

with hold the feeding

one

2)
Breathings the breathing of the patient
 -

mechanical ventilator

3) Prolong - Rest
-

cluster

MEDICAMOUS OF MYSTERIG GRIVIA

1) heostigmine (Prostigmine)
a) Pyridostigmine (Mestinon)
-

common board exam question

right (timel
-

( dosel
-
watch out for CRISIS:

a) myasthenic crisis
b) crisis
Cholinergic

myasthenic Crisis Cholinergic Crisis

↓ Underdosed Overdosed t
↑ dose as ordered stipped Doubled At SOA

en
↓
Severe Weakness
↓
↑- Relief- Tension -
Worsen-

PARKISOn'S DISEASE
-
in
↓ dopamine
-

causes:
a) KURU VIRUS
b) MPTP

d) Aluminum theory
a) Boxer's Poligistica
basal
ganglia
-

substancia (Prioritize itand dopaminel

higra specific part of basal
ganglia thatproduces
-

sign and
symptoms:
-

a) TRMOB
priority
-

early sign
-

-types:
1) Intentional Tumor

2) Tumor/Unintentional Tumor
Resting
-more Common thmor

-Pill-Rolling (mostcommon usting thmor)

b) Bradykinesia
d) Shuffling Gait
high risk for injury
-

-leans forward while walking

↳
 d) Mask-like face
e) monotonous Speech (only one tonel
f)
Handwriting thatbecomes smaller

-management:
1) Safety
-change the diet in finger-foods
any foods that utensils
↳ does not
require
example: funch fries
cheese stick

burger
pizza
-

startmovementwith bradykinesia
-

liftfeet while walking

-

low-heeled shoes
2) Wear shoes without laces (slip ons)
3) Shirtwithoutbuttons
-

medications:
because itdowns blood brain barrier.
Never
*
give Dopamine off

a) Dopaninergies
levodopa
I
-

Sinemet
carbidopa
-

toxicity of levodopa and carbidopa ale: severe dizziness

heartbeat
irregular
Good or mental changes
MULTIPLE SCLEROSIS
Sheathel
demyelinization (Myelin
-

autoimmune disorder that affects

myelin sheathe

Diagnostic:
-

·
EEG

-Sign and Symptoms:

·
Decreased perception to
pain and
temperature
-

abnormal emotions:
a) Euphoria
-

sudden state of well being

b) Apathy
d) Anxiety
a) Depression
Pathognomonic Sign:
-

a) scanning Speech
b) Intentional TrMOB
d)
hystagmus
a) Weakness and Intique
el Diplopia (
naduduling si patient)
-

Abnormal Bowel and Blood Function:

a) Frequency (a lott

b) Urgency (go now)

d) Retention
 a) Incontinence

Abnormal Reflexes
-

hypo or
hyper a flexia

positive BabinskiReflex
-

management:
-

a) safety
priority
-

-because of temperature (avoid extreme temperatures

b) Diplopia
leftand
alternating lighteye patch
-

-done 2 hours
every
c)
Support client
emotionally
-accentuate the
positivity (t)
d) Bowel and Bladder Retraining
-observe
proper scheduling of elimination
-"regular times ofelimination"
increase fluid intake (3 to 4 liters
per day)
-

increase fiber

·
TREMORS
-

give Valium
·
SPASMS
-give Baclofen as ordered
·

hERVES (Pain and Inflammation)

USAIDS
give
-

Guillain-Barre Syndrome
-

antonym Myasthenia Gravis (descending

of weakness)
-

demyelinization of the Myelin Sheath

·
is (central nervous
System)
(peripheries or motor neues)
GBS
·

↑Paralysis (ascending) characteristics and manifestation

=

reversible
-

no exact cure

-palliative approach ( months/ will be gonel

-breathing (highestpriority)
Respiratory Treatment:
-

a) Oxy genation I

dont give nebulizer to

liquify
-

is
I

airway:obstruction
-

ifbreathing:injury in the diaphragm

-

b) Mechanical Ventilators
2) Don'tgive Bronchodilators
d) Ett

·
Paceeded by:1) Mild
Upper Respiratory TractInfection
2) GIT (2-4 weeks)