1. Neurological Function, Assessment, and Therapeutic Measures

2. Review of Normal Anatomy CNS- brain and spinal cord (transmits impulses to and from the brain) PNS- Peripheral Nervous System- contains SNS- 12 cranial nerves ANS- controls involuntary bodily functions, contains Sympathetic (Fight or Flight) and Parasympathetic NS (rest and digest)

3. Cross Section of Spinal Cord

4. Impulse Transmission Nerve tissue consist of neurons (have a cell body with axons and dendrites) Myelin sheath electrically insulates the neurons. Neurotransmitters (acetylcholine, norepinephine, dopamine, serotonin) carry nerve impulses at the synapse and there generates an electrical impulse that is carried on.

5. Brain

6. Brain stem- consists of Medulla- controls HR, R, sneezing, swallowing, vomiting, coughing. Pons- resp center. Midbrain controls motor coordination, visual/auditory Cerebellum-muscle movement/tone Hypothalamus-regulates ANS, production of hormones Thalamus-sensations Cerebrum- R and L hemisphere, 4 lobes

7. Meninges Dura mater- thick outermost fibrous layer Arachnoid- middle web-like strands of connective tissue Subarachnoid space- contains CSF Pia Mater- very thin membrane on surface of brain and spinal cord.

8. Cranial Nerves Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Accessory Hypoglossal

9. Aging

10. Basic Neurological Assessment Glasgow Coma Scale- LOC Vital Signs Pupil Response to Light Extremity Strength and Movement Sensation

11. Subjective Data Symptoms Medication use Surgical History Family History Life style/ memory Pain

12. Physical Assessment Level of Consciousness Mental State Examination Pupillary Response Muscle Function Cranial Nerve Function

13. Glasgow Coma Scale Eye Opening Verbal Response Motor Response Decorticate posturing- legs rotated inward, elbows and fingers flexed Decerebrate posturing- forearms pronated, wrists and fingers flexed. Flaccid posturing posturing- pt shows no motor response in any extremity

14. Abnormal Posturing

15. Pupil Assessment Pupils Equal Round Reactive to Light and Accommodation

16. Diagnostic Tests Laboratory Tests Thyroid ESR WBC Electrolytes Cortisol Prolactin Liver Function Renal Function

17. Lumbar Puncture Needle inserted into Arachoid space between L3 andL4 vertebrae, withdraw 8-10 ml. Not done on pts with increased ICP. CSF- normal is clear, watery (yellow halo) Blood- indicates hemorrhage Protein- degenerative disease/ brain tumor Glucose decreased- bacterial infection WBC’s- infection

18. Lumbar Puncture Pre-Procedure Nursing Care Verify Informed Consent, have pt void Assist with Positioning (side-lying) Post-Procedure Care Maintain Flat Bedrest 6 – 8 Hours Encourage Fluids Monitor Puncture Site Monitor Vs, Movement, Sensation, HA, I&O

19. Lumbar Puncture

20. CT Scan Pre-Procedure Administer Contrast if Ordered Check Allergies Check BUN, Cr Request order for sedation if indicated Instruct must lie still and flat, hold head still Teach Contrast may cause feeling of warmth S&S of allergic reaction to report Post Procedure Encourage Fluids if Dye Used

21. MRI Test uses magnetic energy to visualize internal parts. Pre-Procedure Nursing Care Assure no pacemaker or metal on patient Administer analgesic or sedative as ordered Teach relaxation Post-Procedure Care No Special Care

22. Angiogram Injects contrast through femoral artery into carotid arteries to visualize cerebral arteries, will detect vascular lesions of the brain Pre-Procedure Nursing Care Verify Informed Consent, must lie still Give Clear Liquid Diet Insert IV Needle Check BUN/Cr, PT and PTT Administer Sedation as Ordered

23. Angiogram Continued Post-Procedure Care Keep Flat in Bed 6 – 8 hr Monitor VS Catheter Insertion Site- pressure dsg, keep affected leg straight Pulses Encourage Fluids

24. Myelogram Injection of dye or air into subarachnoid spaces to detect abnormalities of cord or vertebrae Pre-Procedure Nursing Care Check Allergies to Contrast Assess History of Seizures Verify Informed Consent Post-Procedure Care Bedrest with head elevated Encourage Fluids, VS, neuro checks

25. Electroencephalogram Records brain electrical activity Pre-Procedure Nursing Care Assure Hair Clean and Dry Check Medication Orders- no stimulants or depressants before test Post-Procedure Care Wash Hair- adhesive will harden

26. Therapeutic Measures Moving and Positioning Maintain Functional Positions Avoid Injury Prevent Contracture- often complications of neuro conditions Mobilize ASAP

27. Communication Problems Dysarthria-difficulty speaking Expressive Aphasia- inability to express self Receptive Aphasia- inability to understand Interventions Use Care with Yes-No Questions Correct Substituted Words Anticipate Needs Use Gestures Be Patient!

28. Nutrition Evaluate Swallowing Interventions for Impaired Swallowing Thicken Liquids Position Upright for Eating- prevent aspiration Monitor Meals Tube Feedings