University:
York University
Course:
NURSING 2534 | Pathophysiology
Academic year:

2023
Views:

363

Pages:

3
Author:

Niklas

NERVOUS SYSTEM ASSESSMENT Nervous System: Primary functional unit: neurons CNS: brain, spinal cord PNS: cranial nerves, spinal nerves Nerve repair: PNS more successful than CNS Neurotransmitters: excitatory (epi, norepi, glutamate), inhibitory (GABA, glycine) GLIAL CELLS: provide support, nourishment, and protection to neurons Microglia: protect neurons Macroglia a. Astrocytes: grey matter, carry information from cerebral cortex to spinal cord b. Oligodendrocytes: white matter, spasticity, hypertonia c. Ependymas: CSF CENTRAL NERVOUS SYSTEM: SPINAL CORD Upper Motor Neurons: carry information from cerebral cortex to spinal cord Lower Motor Neurons: carry information from spinal cord to skeletal muscles CENTRAL NERVOUS SYSTEM: BRAIN Cerebrum: largest part, 2 hemispheres Cerebral cortex: lobes (frontal, parietal, occipital, temporal, limbic system) Thalamus: relay center for sensory input Hypothalamus: body temperature, circadian rhythm, expression of emotion, water balance Cerebellum: balance, coordination Brainstem: breathing center SPINAL NERVES: cervical (8), thoracic (12), lumbar (5), sacral (5), coccygeal (1) CRANIAL NERVES: Olfactory (I) Optic (II) Oculomotor (III) Trochlear (IV) Trigeminal (V) Abducens (VI) Facial (VII) Vestibulocochlear (VIII) Glossopharyngeal (IX) Vagus (X) Accessory (XI) Hypoglossal (XII) NEUROLOGICAL ASSESSMENT Brain Cerebral blood flow Cerebral perfusion pressure Oxygenation, glucose, ventilation Cranial nerves Mental status Level of consciousness Motor function: finger-to-nose test, pronator drift, Babinski reflex Sensory system: light touch, pain, temperature, vibration, position sense, stereognosis Reflexes: normal: 2+, +1 sluggish, deep tendon reflexes may be reduced Coordination: finger-to-nose test, heel-to-shin test, Romberg test Gait: observe for ataxia, unsteady gait Speech: articulation, fluency, comprehension Cranial nerves: see below Diagnostic Studies Lumbar Puncture Procedure: empty bladder, lateral recumbent position, sitting leaning forward During: sterile technique, local anesthetic, maintain still Complications: spinal headache, hematoma, infection, herniation Glasgow Coma Scale Eyes open: 1-4 Verbal response: 1-5 Motor response: 1-6 Total: 3-15 NIH Stroke Scale 0-42 Cranial Nerve Assessment I. Olfactory: smell II. Optic: vision III. Oculomotor: constricts pupils, moves eyes IV. Trochlear: moves eyes downward inward V. Trigeminal: corneal reflex, sensation VI. Abducens: moves eyes outward VII. Facial: smiling, blowing out cheeks VIII. Acoustic: hearing IX. Glossopharyngeal: swallowing X. Vagus: gag, swallow XI. Accessory: head turn, shrug XII. Hypoglossal: tongue movement DIAGNOSTIC STUDIES: NERVOUS SYSTEM 1. Electrographic Studies EEG: brainwave activity 2. EMG 3. EEG before: non-invasive withhold meds: stimulants, anticonvulsants, tranquilizers after: resume meds wash electrode paste out of hair 4. Skull & Spine Radiographs before: support remove metal thicken/increase hair (may affect x-rays) after: maintain immobility until results 5. Cerebral Angiography catheter into femoral artery or carotid artery; iodine contrast before: check allergies, kidney function NPO neuro assessment after: monitor neuro status monitor VS bedrest, keep bed flat, limb immobilization, pressure dressing