Medical Surgical Nursing

1. Medical Surgical Nursing Lecture 13 Neurology

2. The nervous system consists of: • Brain • Spinal Cord • Peripheral Nerves

3. Divided system • Central Nervous System (CNS) • Brain & Spinal Cord • Peripheral Nervous System (PNS) • Nerves (peripheral & Cranial)

4. Nervous System • Controls and coordinates all parts of the body • By transmission of electrical impulses

5. Purpose of the Nervous System • Control • Coordinate • Communication • Stimulation of Movement

6. Purpsose of the Nervous System • Maintains Homeostasis • Along with the what system? • Endocrine

7. Neuron • Basic functional unit

8. Synaptic Junction • Neuron connect to each other end to end • Synaptic junction • Synapse

9. Central Nervous System • Brain • Spinal Cord • Control center for entire system

10. Protection • Brain: • Encased by the Skull • Spinal Cord • Encased in vertebral column

11. The Meninges • Function • Support • Protect • Nourish • Dura mater • Arachnoid • Cerebral Spinal Fluid • Pia Mater

12. Brain – 3 main areas • Cerebrum • Coordination of stimuli • Cerebellum • Control muscle movement • Brainstem • Vital Reflexes

13. Brainstem • Connects brain with spinal cord • Vital reflexes • Relay for sight and hearing

14. Cerebellum • “Lesser brain” • Controls skeletal muscles  coordinated

15. Spinal Cord – CNS • Continuous with brain stem • Extend to L-1orL-2 • Lumbar Punctures  • L3-4

16. Peripheral Nervous System • Contains • Cranial nerves • Spinal nerves • Location • Function • Sensory impulses from PNS  CNS • Motor response from CNS  PNS • Key word: • Nerves

17. PNS  Somatic & Autonomic NS • Somatic Nervous System • Conscious activities • Autonomic Nervous System • Connects CNS to visceral organs • Unconscious activities • Divided • Sympathetic nervous system • Fight or flight • Parasympathetic nervous system • Rest & digest

18. History • Family member present • Vaccination • Major injuries • Childhood illnesses • Family • Present illness

19. Complaints specific to neurology • Pain • Location • Quality • Severity • Duration • Precipitating factors • Assoc. symptoms • Exasperation / diminished pain • Onset

20. Pain assessment: The 5th vital sign

21. Headaches • Multiple causes • Nota good indicator of neuro trouble

22. Vertigo • Sensation of moving around in space or objects moving around them

23. Paresthesia • Definition • Unusual sensation • Examples • Numbness • Tingling • Burning • Assessment • ? Weak • ? Intermittent or constant

24. Vision Dysfunction • Diplopia • Double vision • Clarity • Nystagmus • Eye twitching

25. Disturbances in… • Thinking • Memory • Personality

26. Nausea and vomiting • Projectile

27. Assessing Cerebral Function - PE • Mental status • Intellectual function • Thought content • Emotional status • Perception • Motor ability • Language ability

28. Level of Consciousness • Alert • Open eyes spontaneously • Lethargic • Opens eyes to verbal stimuli • Slow to respond, but appropriate • Stupor • Responds to physical stimuli with moans and groans

29. Semi Comatose • Responds to painful stimuli • Coma • Unresponsive except to severe pain • Absent Protective reflexes

30. Types of Stimuli  response • Voice • Touch • Shaking • Voice + Shaking • Noxious/painful stimuli

31. Nature of response • Eye opens • Remove stimuli • Abnormal posturing • No response

32. Glasgow Coma Scale • Eye Opening • Spontaneous – 4 • To speech – 3 • To pain – 2 • Nil – 1

33. Glasgow Coma Scale • Best Motor Response • Obeys -6 • Localizes – 5 • Withdraws – 4 • Abnormal flexion – 3 • Extension response – 2 • Nil - 1

34. Glasgow Coma Scale • Verbal response • Oriented – 5 • Confused conversation – 4 • Inappropriate words – 3 • Incomprehensible sounds – 2 • Nil - 1

35. Glasgow Coma Scale A strong predictor of outcome • 13: mild brain injury • 9-12: Moderate brain injury • < 8: Severe brain injury (coma)

36. Sample Question • The nurse is caring for an adult client who was admitted unconscious. The initial assessment utilized the Glasgow Coma Scale. The nurse knows that the Glasgow Coma Scale is a systemic neurological assessment tool that evaluates all of the following EXCEPT • Eye opening • Motor response • Pupillary reaction • Verbal performance

37. What is the lowest score you can get on the GCS? • 0 • 1 • 3 • 5 • None of the above

38. What is the highest score you can get on a GCS? • 0 • 3 • 13 • 15 • None of the above

39. Orientation • x 3 • Person • Place • Time

40. General Appearance • How do they look? • Grooming • Dress • Aids • Eye deviation • Skin

41. Vital Signs • Temperature • With head trauma  increased

42. Vital Signs • Pulse • Increased ICP  • Bradycardia

43. Vital Signs • Respirations • Ataxic • Damage to medulla • Cheyne-stokes • Lesion deep in cerebral cortex • Hyperventilation • Metabolic problems

44. Vital Signs • Blood Pressure • Orthostatic hypotension • > 20mmHg  • cerebral ischemia

45. Vital Signs • Pulse Pressure formula: • Systolic – diastolic 120 ------ = ? 80

46. Vital Signs • Pulse Pressure • Systolic – diastolic 120 ------ = 40 80 • Normal Pulse pressure = 40 • Widening pulse pressure = Increased ICP

47. Neuro Checks • LOC • Pupils • PERRLA • Pupils • Equal • Round • Reactive to • Light • Accommodation

48. Neuro Check • Pupils • Anisocoria • Inequality in the size of the pupils • Nystagmus • Progressive dilation •  Increase ICP • Fixed & dilated • Poor prognosis

49. Computer Tomography Scan - CT • X-rays • Distinguishes tissue density • Tumors

50. Computer Tomography Scan - CT • Nursing Considerations • Explain procedure • 30-60 minutes • Lying still • If contrast medium is used • P for iodine & shellfish allergies • NPO • Push fluids after procedure • watch for S&S of hICP