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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25

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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25 ... Myelogram. Head Injuries. Scalp. Skull. Brain. Head injuries involve trauma to the: ... – PowerPoint PPT presentation

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Title: Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 25


1
Medical-Surgical Nursing An Integrated
Approach, 2E Chapter 25
  • NURSING CARE OF THE CLIENT NEUROLOGICAL SYSTEM

2
The Human Nervous System
  • Its purpose is to control motor, sensory, and
    autonomic functions of the body.
  • This is accomplished by coordination and
    initiation of cellular activity through the
    transmission of electrical impulses and various
    hormones.

3
The Nervous System Structure
  • The nervous system is divided into
  • The central nervous system, consisting of the
    brain and spinal cord.
  • The peripheral nervous system, which consists of
    the cranial nerves and spinal nerves.
  • The autonomic nervous system, which is part of
    the peripheral nervous system and consists of
    sympathetic and para-sympathetic systems.

4
The Brain
  • Composed of gray matter and white matter, the
    brain controls, initiates, and integrates body
    functions through the use of electrical impulses
    and complex molecules.

5
Physiology of the Brain
  • The brain is contained within the skull, or
    cranium.
  • Three coverings of the brain, called the
    meninges. They are the dura mater, arachnoid
    mater, and pia mater.

6
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.
  • 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.

7
The Spinal Cord
  • A continuation of the brain stem.
  • Exits the skull through the foramen magnum, an
    opening in the base of the skull.

8
Cerebrospinal Fluid
  • Provides for shock absorption and bathes the
    brain and spinal cord.

9
Peripheral Nervous SystemCranial Nerves
  • Twelve pairs of cranial nerves have sensory,
    motor, or mixed functions.

10
Peripheral Nervous SystemCranial Nerves
  • Twelve pairs of cranial nerves have sensory,
    motor, or mixed functions.

11
Cranial Nerves
Olfactory Sensorysmell Optic SensoryVision Oculomotor Motor Pupil Constriction Trochlear Motorupper eyelid elevation
Trigeminal cornea, nose, oral mucosa mastication Abducens Motor Extraocular eye movement Facial Motor (facial muscles) Sensory (taste) Acoustic Sensory Hearing Equilibrium
Glosso- Pharyngeal Taste Swallowing Vagus Motor and Sensory Spinal Accessory Motor Hypoglossal Tongue Movement
12
Peripheral Nervous SystemSpinal Nerves
NERVES NUMBER OF PAIRS
  • Cervical 8
  • Thoracic 12
  • Lumbar 5
  • Sacral 5
  • Coccyx 1

13
Peripheral Nervous SystemAutonomic Nervous
System
  • Main function is to maintain internal
    homeostasis.
  • Two subdivisions of ANS
  • The sympathetic system (activated by stress,
    prepares body for fight or flight response).
  • The parasympathetic system (conserves, restores,
    and maintains vital body functions, slowing heart
    rate, increasing gastrointestinal activity, and
    activating bowel and bladder evacuation).

14
Cerebral Function Assessment
15
Cranial Nerve Function AssessmentMotor Function
16
Cranial Nerve Function AssessmentSensory
Function
17
Cranial Nerve Function AssessmentReflexes
18
Common Diagnostic Tests for Nervous System
Disorders
  • Lumbar puncture (LP).
  • Electroencephalogram (EEG).
  • Electromyogram (EMG).
  • Imaging Procedures.
  • Cerebral Angiography.
  • Brain scan.
  • Myelogram.

19
Head Injuries
Head injuries involve trauma to the
  • Scalp.
  • Skull.
  • Brain.

20
Scalp Injuries
  • They bleed profusely because of the abundance of
    blood vessels in the scalp.
  • Infection is of major concern.

21
Skull Injuries
  • May occur with or without brain injury,
  • Fracture usually caused by extreme force,
  • Skull fractures considered closed if dura mater
    is intact open if dura mater is torn.

22
Types of Skull Fractures
  • Linear (nondisplaced cracks in the bone).
  • Comminuted (bone broken into fragments).
  • Depressed (bone fragments pressing into
    intracranial cavity).
  • Basiliar (fractures of the bones in the base of
    the skull).

23
Brain Injuries Causes
  • 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).

24
Brain Injuries Open
  • Brain injuries resulting from skull fractures and
    penetrating injuries are referred to as open
    head injuries.
  • Hemorrhaging from the nose, pharynx, or ears
    ecchymosis over the mastoid area (Battles sign)
    or blood in the conjunctiva may occur in
    conjunction with open head injuries.

25
Brain Injuries Closed
  • Caused by blunt force to the head.
  • Types of closed head injuries include concussion,
    contusion, and laceration.

26
Concussion
  • Transient neurological deficits caused by the
    shaking of the brain.
  • 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.

27
Contusions
  • Surface bruises of the brain.
  • Skin is cool and pale.
  • Pulse, blood pressure, and respirations are below
    normal.
  • Cerebral edema may occur in conjunction with
    widespread injury.

28
Cerebral Lacerations
  • Tearing of cortical tissue.
  • Symptoms include deep coma from time of impact,
    decerebate posturing, autonomic dysfunction,
    nonreactive pupils, respiratory difficulty.

29
Hemorrhage
  • Intracranial hemorrhage is common complication of
    any head injury.
  • Treatment is surgery to evacuate the hematoma,
    stop the bleeding, and relieve pressure on the
    brain.

30
Brain Tumor
  • Space-occupying intracranial lesions, either
    benign or malignant.
  • 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),

31
Cerebrovascular Accident (CVA)
  • Also known as stroke, CVA is a sudden loss of
    brain function accompanied by neurological
    deficit.
  • Third highest cause of death in U.S.
  • Strokes are caused by ischemia (oxygen
    deprivation) resulting from a thrombus, embolus,
    severe vasospasm, or cerebral hemorrhage.

32
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.
  • Classic symptom is fleeting blindness in one eye.

33
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.
  • Most clinicians use the term seizure disorder
    for epilepsy or seizures
  • Seizures are classified as generalized or partial.

34
Herniated Intervertebral Disk
  • A major cause of chronic back pain.
  • 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.

35
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.
  • Each year, almost 10,000 new spinal cord injuries
    occur.
  • Leading causes are motor vehicle accidents, acts
    of violence, falls, and sporting accidents.

36
Parkinsons Disease
  • A chronic, progressive, degenerative disease
    affecting the area of the brain controlling
    movement.
  • Typical symptoms include muscular rigidity,
    bradykinesia (slowness of voluntary movement and
    speech), resting tremors, muscular weakness, and
    loss of postural reflexes.

37
Multiple Sclerosis (MS)
  • A chronic, progressive, degenerative disease
    wherein scattered nerve cells of the brain and
    spinal cord are demyelinated.
  • Symptoms include visual disturbance, numbness,
    paresthesia, pain, decreased sense of
    temperature, decreased muscle strength,
    spasticity, paralysis, bowel and bladder
    incontinence or retention.

38
Amyotrophic Lateral Sclerosis (ASL) (Lou Gehrigs
Disease)
  • A progressive, fatal disease characterized by the
    degeneration of motor neurons in the cortex,
    medulla, and spinal cord.

39
Alzheimers Disease (AD)
  • A progressive, degenerative neurological disease
    wherein brain cells are destroyed and the
    cerebral cortex atrophies.
  • Risk factors include advanced age, female gender,
    head injury, history of thyroid disorders, and
    chromosomal abnormalities.

40
Stages of Alzheimers Disease
41
Guillain-Barré Syndrome
  • An acute inflammatory process primarily involving
    the motor neurons of the peripheral nervous
    system.
  • Clinical manifestations include motor weakness
    and absence of reflexes (areflexia).

42
Headache
  • 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.

43
Types of Headache Primary
  • Tension-Type
  • Migraine.
  • Cluster Headaches.

44
Types of Headache Secondary
  • Secondary headaches are the result of
    pathological conditions such as aneurysm, brain
    tumor, or inflamed cranial nerves.
  • The headache is caused by compression,
    inflammation, or hypoxia of pain-sensitive
    structures.

45
Client Teaching Headaches
  • Advise clients to
  • Keep a diary of headache history to ascertain
    pattern.
  • Avoid foods that trigger headaches.
  • Reduce salt intake.
  • Practice relaxation techniques.

46
Trigeminal Neuralgia(Tic Douloureux)
  • A condition of cranial nerve V that is
    characterized by abrupt paroxysms of pain and
    facial muscle contractions.

47
Encephalitis/Meningitis
  • Encephalitis is inflammation of the brain.
  • Meningitis is inflammation of the meninges.
  • Most common cause of both is a virus.
  • Cerebral edema, hemorrhage, and necrosis of brain
    tissue can occur.
  • Fever, headache, nuchal rigidity, photophobia,
    irritability, lethargy, nausea, and vomiting are
    typical symptoms.

48
Huntingtons Disease or Chorea
  • A chronic, progressive hereditary disease of the
    nervous system characterized by chorea, abnormal
    involuntary, purposeless movements of all
    musculature of the body.

49
Gilles de la Tourettes Syndrome
  • A neurological movement disorder that also has
    prominent behavioral manifestations.
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