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Neurological 1

  1. Neurologic Anatomy and Physiology
    1. Central nervous system (CNS) - coordinates and controls body functions
      1. Brain (illustration 1  illustration 2)
        1. cerebrum (illustration)
          1. hemispheres right and left
          2. frontal lobe - higher intellectual functions, social behavior, personality
          3. parietal lobe - interprets sensory input
          4. temporal lobe - hearing, taste and smell
          5. occipital lobe - vision
        2. cerebellum - provide equilibrium and muscle coordination
        3. 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)
        1. descending tract - anterior portion of cord carrying motor information
        2. ascending tract
          1. the posterior portion of cord, carrying sensory information
          2. 31 segments
            • eight cervical: neck and upper extremities
            • 12 thoracic: thoracic and abdomen
            • five lumbar: lower extremities
            • five sacral: lower extremities, urine and bowel control
            • one coccygeal
    2. Peripheral nervous system - carries information to and from the CNS (illustration 1  illustration 2  illustration 3)
      1. Motor nerves
      2. Sensory nerves
    3. 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
    4. Cranial nerves (illustration)

These nerves are the vital bridges between the brain and the rest of the body.

    1. 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
    2. Findings for increased intracranial pressure (ICP)
      1. Early
        1. change in level of consicousness (LOC): restlessness, disorientation, confusion, lethargy, stupor
        2. pupils: dilated ipsilaterally, react slowly to light
        3. abnormal motor activity: contralateralhemiparesis
        4. abnormal reflexes - hyper or hypo reflexia
        5. vital signs within normal parameters
      2. Late
        1. LOC: semicomatose, coma
        2. pupils: dilated bilaterally and fixed; no reaction to light
        3. motor function: decorticate posturethen decerebrate posture; flaccid muscles at end stage
        4. 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
  1. Degenerative Disorders
    1. Parkinson's disease (illustration)
      1. Definition: degenerative disorder of the dopamine hydrochloride - producing neurons
        1. result: dopamine hydrochloride depletion
        2. usually occurs in older adults and males more than females
        3. etiology unknown
      2. Findings
        1. 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 tremorin which the tremor is action related. 
        2. bradykinesia
        3. fatigue
        4. stiffness and rigidity with movement
        5. signs first unilateral, then bilateral
        6. mask-like facial expression
        7. slow, shuffling walk; gradually more difficult
        8. difficulty rising from sitting position
        9. ultimately confined to a wheelchair
        10. mind stays intact unless other aggravating conditions
        11. echolaliain most cases
      1. Diagnostics
        1. based on finding with history
        2. EEG (illustration)
        3. MRI (illustration)
        4. computerized tomogram (CT scan) (illustration)
      2. Management
        1. outcomes: palliative; postpone dependence
        2. pharmacologic
          1. anticholinergics - minimize extrapyramidal effects
            • benzotropine mesylate (Cogentin)
            • procyclidine (Kemadrin)
          2. dopamine hydrochloridergics: Levodopa (L-Dopa)
          3. antiparkinsonian agent: amantadine hcl (Symmetrel) reduces rigidity and tremor
          4. MAO inhibitors: selegiline (Eldepryl)
        3. therapies
          1. physical
          2. occupational
          3. speech
        4. surgery: stereotaxic thalamotomy to decrease tremor
      1. Nursing interventions
        1. maintain safety of client
        2. prevent effects of immobility
        3. foster independence in activities of daily living (ADL)
        4. reinforce the use of assistive devices for ambulation as indicated
        5. maintain good nutrition
          1. small, frequent meals
          2. soft foods
          3. roughage with sufficient fluids to decrease constipation
        6. monitor effectiveness of administered medications
        7. provide emotional support to client and family members
        8. teach client
          1. when and what side effects of the drugs to report
          2. the benefits of daily exercise