Chapter 24 Neurologic Function

Introduction Nervous system and its effect on interactions with the world Every aspect of activities of daily living (ADLs) depends on a good neurologic status Dysfunction of the neurologic system has a profound impact on other body systems and general well-being

Effects of Aging on the Nervous System Loss of nerve cell mass Atrophy of the brain and spinal cord Brain weight decreases Number of dendrites declines Demyelinization Slower nerve conduction Response and reaction times are slower Reflexes become weaker

Effects of Aging on the Nervous System (cont.) Plaques, tangles, atrophy of the brain Free radicals accumulate Decrease in cerebral blood flow Fatty deposits accumulate in blood vessels Ability to compensate declines with age Intellectual performance maintained until at least 80 years of age

Effects of Aging on the Nervous System (cont.) Slowing in central processing Delay in time required to perform tasks Verbal skills maintained until age 70 Number and sensitivity of sensory receptors, dermatomes, and neurons decrease Dulling of tactile sensation Decline in the function of cranial nerves affecting taste and smell

Question Is the following statement true or false? Cerebral blood flow decreases by 50% in older adults.

Answer False Rationale: Cerebral blood flow decreases about 20% as fatty deposits gradually accumulate in the blood vessels. Decreases are even greater in persons with small-vessel cerebrovascular disease due to diabetes and hypertension; this contributes to an increased risk of strokes.

Neurologic Health Promotion Many neurologic disorders occur for reasons beyond a person’s control Risk factors Preventive measures for neurologic health Nurses can detect new or subtle symptoms of neurologic disorders Nursing assessment of neurologic function Nursing diagnoses

Subtle Indications of Neurologic Problems New headaches that occur in the early morning or interrupt sleep Change in vision (e.g., sudden decreased acuity, double vision, and blindness in portion of visual field) Sudden deafness, ringing in ears Mood, personality changes Altered cognition or level of consciousness Clumsiness, unsteady gait Numbness, tingling of extremity Unusual sensation or pain over nerve

Parkinson’s Disease (PD) Affects ability of the central nervous system (CNS) to control body movements Role of dopamine Incidence/prevalence Exact cause unknown; some theories Signs and symptoms Secondary symptoms

Parkinson’s Disease (PD) (cont.) Treatment/management Anticholinergic medications Technologies to control symptoms Nursing interventions Education Psychosocial Physical Goal: maximum level of independence preserved

Tremors and Shuffling Gait Are Characteristic of Parkinson’s Disease.

Question Is the following statement true or false? Secondary symptoms of PD include depression, sleep disturbances, dementia, drooling, and dysphagia.

Answer True Rationale: Secondary symptoms of PD include depression, sleep disturbances, dementia, forced eyelid closure, drooling, dysphagia, constipation, shortness of breath, urinary hesitancy, urinary urgency, and reduced interest in sex.

Transient Ischemic Attacks (TIA) Temporary or intermittent reduction in cerebral perfusion Causes Signs and symptoms Minutes to hours Recovery is usually within 1 day Treatment/management of underlying cause Increased risk of cerebrovascular accident

Question Is the following statement true or false? Signs and symptoms of a transient ischemic attack can last for several days and complete recovery is usual within 1 week.

Answer False Rationale: Signs and symptoms of a TIA (hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia) depend on the location of the area of ischemia and can last from minutes to hours and complete recovery is usual within 1 day.

Cerebrovascular Accident Third leading cause of death in older adults Predisposing factors Types and cause: Ischemic Hemorrhagic Warning signs Drop attack

Cerebrovascular Accident (cont.) Prompt medical evaluation Signs and symptoms Variable Depend on the area of brain affected Nursing care during the acute phase After patient stabilization, focus is on rehabilitation

Cerebrovascular Accident (cont.) During rehabilitation, problems vary depending on the side of the brain affected General observations Nursing interventions Community resources

Question Which of the following best describes a drop attack? Fall caused by flaccidity in the legs Fall caused by loss of consciousness Fall caused by incontinence Fall caused by mental instability

Answer A. Fall caused by flaccidity in the legs Rationale: A drop attack is a fall caused by a complete muscular flaccidity in the legs, without an alteration in consciousness.

Nursing Considerations for Neurologic Conditions Promoting independence Assistive devices Periodic home visits Regular contact with family and friends Promoting self-care Patience, reassurance, and encouragement

Nursing Considerations for Neurologic Conditions (cont.) Promoting independence (cont.) Personality problems may occur Depression related to dependence Loss of former roles and identities Displaced reactions Need to educate family members and friends

Question Is the following statement true or false? Persons who have experienced a cerebrovascular accident may experience depression and irritability toward others.

Answer True Rationale: Personality changes often accompany neurologic problems. Patients may become depressed as they realize their limitations and become frustrated by their need to be dependent on others. Their reactions may be displaced and evidenced by irritability toward others, often their loved ones or immediate caregivers.

Nursing Considerations for Neurologic Conditions (cont.) Preventing injury High risk of accidents Avoiding hazards Safety considerations Evaluate the environment for danger Prevention of complications