Nervous system- Health Alterations
What is some treatment for a back pain or slipped disc?
-Deep needling, massage, acupuncture. -Surgery to help with the disks to shave them down and inject things into the area and we want to make sure we do a log roll to move them as a unit. This help protects the back No sciatic pain? No bed rest is recommended because walking improves recovery -Discectomy to decompress the nerve root
What are the three functions of the spinal cord?
1) Ascending tracts- Carries info TO the brain 2) Descending tracts- Carries info from brain to spinal cord 3) Reflex Arc- Connection between the two tracts. This helps us pull away from a hot stove
What are signs and symptoms of a head injury?
1) Bruising 2) Swelling 3) Change in LOC 4) inward signs (tinnitus, heading difficulty, facial paralysis,) 5)fluid out of nose or ear which may be CSF (outward sign)
What is the treatment of a head injury?
1) Conservative monitoring and assessments 2) ICP monitoring inside skull 3) Stabilize head and keep it straight with a cervical collar
How can you get neurological disorders?
1) Genetics/developmental 2) Trauma 3) Tumor 4) Infection 5) Degenerative 6) Cranial nerves
What are the three important parts of a brain?
1) Meninges- Protect the covering of the brain 2) Ventricles- Spaces inside the brain where the cerebral spinal fluid is produced and housed. This fluid makes the brain not so heavy. 3) Cerebral spinal fluid- Clear free flowing. Cushions brain and spinal cord. Protects it from trauma. Provides oxygen and nourishment to tissues.
What are the three types of aphasia?
1) Receptive- Can't communicate and can't interpret written or spoken language. They can recccieeeeveee it 2)Expressive- They can't do the speaking or writing 3) Combination of both
For preventing neurological disorders what do we want to tell our patient?
1) Wear safety gear (Helmet) 2) Be careful driving and swimming 3) Wear seat belts 4) Wear PPE when spraying insecticide 5) Refrain from drugs
What kind of injuries of the spine or spinal cord be from?
Accident wounds from a gun or a vehicle, Disease, infections
What does the central nervous system made up of?
Brain and spinal cord
What diagnostic test assesses for any brain abscesses, tumors or hemorrhage. Radioactive isotope in the veins. Sit while the study is done
Brain scan
What diagnostic test is done after trauma, tumors, and hemorrhage. And IV is inserted if they want to use iodine contrast. If they need more detailed response they will give them an MRI. Please note that no magnets should go around the head or any metal in their body they have to take out because the metal will try to get pulled out by their body from the MRI. This is to study the tissues.
CT scan
What is efferent?
Carries impulses away from CNS
What is afferent?
Carries impulses to CNS *Aaaaaa bring that to me**
What diagnostic test shows images of the blood flow pattern of the brain that is light up like a Christmas tree. It is looking for a particular blood flow problem in the brain.
Cerebral angiography
What are hematomas?
Deep brain bruises where the blood gathers
What are some treatments for increased cranial pressure?
Diuretics Steroids Supportive care for blood pressure Watch for seizures Cooling or warming the body Watch respirations Watch for elevated intracranial pressure could develop diabetes insipidus
What are two important nursing diagnosis for neurological disorders?
Dysphasia and aphasia
What diagnostic test is abnormal electrical activity in the brain to diagnose seizure. Electrodes attached to the skull. The computer measures the electrical activity. They try to evoke a seizure in the brain. Have them sleep deprived, stimulate the seizure with strobe lights, or anything that they know the trigger is there a seizures. No pain with this test but the glue is really sticky in their hair.
EEG (Electroencephalography)
What diagnostic test places electrodes on muscles in the muscle response is generated by the computer and tells you if the muscle is responding to stimuli. The test is done if there is a nerve or neuromuscular disorder. This test is brief by only one or two hours and it's not painful
Electromyography
What cranial nerve do you observe face for symmetry. You ask them to smile, frown, and raise eyebrows?
Facial nerve
Head injuries are caused by what?
Falls, bullet to the head
What cranial nerve do you test by asking them to say Ahhh And have them swallow water to test the pharynx and assess the gag reflex?
Glossopharyngeal and vagus nerve
What are some signs and symptoms of an intracranial pressure
Hemiparesis (Weakness on one side) Hemiplegia (Paralysis on one side)- loss of motor function because nerves are pressed Abnormal posturing (outward sign when people have intracranial pressure Alters in respiratory pattern
What cranial nerve do you ask to open the mouth wide, stick tongue out, and rapidly move it from side to side and in and out. Apply pressure to cheek and ask patient to push tongue against hand to check for strength.
Hypoglossal nerve
What is the first indicator for intracranial pressure?
If the patient has change in level of consciousness. They become lethargic, less alert, speech change, slow response time, and that response to verbal cues briskly
Cloudy cerebrospinal fluid is a sign of?
Infection
What is a halo traction vest for Cervical stabilization
It is what Forrest Gump wore
What are some surgical interventions of a head injury?
Keep neck and spine in alignment, any suctioning needs to be done cautiously, watch for any clear fluid because it could be cerebrospinal fluid. And please test it. Environment quiet and non-stimulating for brain rest.
If you found someone with a spine or spinal cord injury what do you do?
Keep the head and neck stable and in alignment
What is some nursing management for a head injury
Let the brain rest, 20 to 30° venous drainage for head, ear with cars and look at the panel of year to determine if any cerebral spinal fluid. Don't block any drainage. Don't change positions because it could rise intracranial pressure.
What is the most important assessment when assessing for neurological disorders?
Level of consciousness also perrla
How can you get back pain or a ruptured intervertebral disc
Lifting or moving incorrectly Obesity (Extra pressure can lead to injury) Lack of excersize
What are some age related changes in the nervous system?
Loss of neuron function Decreased blood flow to the brain Body homeostasis difficult to regain or maintain Short term memory is affected Decreased secretion of norepinephrine and dopamine Myelin sheath degenerates Dull reflexes Slow response time Pupils size decrease May need more time to process stuff Keep brain fresh with activity and crossword puzzles!
What diagnostic test do they place a large needle between the vertebrae and take a sample of cerebral spinal fluid to look for any abnormal cells or evidence of infection. Tests for presence of glucose, protein, and white blood cells. Complaints of headache after this procedure is normal. And is treated with a blood patch which encourages healing of area where the needle went through. Watch site and for a drainage leak
Lumbar puncture
What cranial nerve do you assess Perla and direction of gaze or cardinal fields?
Oculomotor Trochlear Abducens
What cranial nerve do you have a patient smell coffee grounds versus pickle juice?
Olfactory nerve
What are signs and symptoms of a slipped disk or back pain
Pain radiating down to sciatic nerve into buttocks and below the knee Muscle weakness and parenthesia Cervical herniated disk causes neck and shoulder pain which radiates down the arm with numbness and tingling in the hand Muscle tightening and spams in the area of injury
Anything from C1 to C6 is what
Paraplegic
Who is most likely to develop hematomas?
People with head injuries. Also elderly because they are on an anticoagulant therapy and their blood is easier to leak in the space as well as shouldn't.
C7 seven or more is what
Problems with Paul, bladder, and sexual dysfunction
What is a late sign of intracranial pressure?
Pupils become dilated or fixed
What is some nursing management for head injury
Report any change in LOC Outward signs of ICP Watch for headache with projectile vomiting or regular vomiting Pupils checked in a dark room Check for leaking CSF Get rid of extra pressure We want body to regulate own temperature Observe patient in a semi-Fowler's position no stress on the brain Glasgow coma scale- severity of brain injury (higher the scores better between 0-15)
What is one of the most important things to check when someone has a spinal cord injury
Respiratory management
What are some complications of a spinal cord injury
Shock (disrupts nerve pathways) Muscle spasms or become paralyzed Autonomic dysreflexia (Exaggerated response of autonomic nervous system where the blood pressure goes very high from inserting a cath or an enema. A sudden construction causes this hypertension so high that a stroke, hemorrhage, or seizure could either walk. These people can get goosebumps. Treat high blood pressure quickly Circulation impairment Heterotropicossification: Bonnie overgrowth over the muscle. Long-term in mobility. Allow swelling to go down which could take several days before assessment.
What cranial nerves do you ask the patient to elevate their shoulders with and without resistance, turn head to each side, resist attempts to pull chain back towards midline and push head forwards against resistance?
Spinal accessory nerve
What are the three types of hematoma's?
Sub dural, epidural, and intracerebral hematoma
What happens with back pain or a slipped disk
Swelling or herniation between vertebrae which is the padding. A slipped disk is when disk content leak out into canal and the body thinks it is a foreign substance and causes inflammation with pain
What is intracranial pressure
Swelling related to surgery, excessive production of cerebral spinal fluid result in tumor or abscess.
What is pulse pressure increased look like?
Systolic number increases and diastolic stays the same and you don't want that because you don't want an elevated pulse pressure which is a widening blood pressure you should be worried
What is a widening blood pressure
Tachycardia with a weak thready pulse
What is afferent and efferent part of?
The reflex arc
What are Roto Rest Beds?
They are beds you are placed in and it positions and rolls itself
What are Crutchfield tongs for cervical traction
They are metal screws that screw in the patient's skull and they are bedrest
What cranial nerve do you ask a patient to clamp jaw shut, open mouth against resistance, chewing motions....test sensation by asking if they feel warm or cold?
Trigeminal
The higher the spinal cord the more severe true or false
True
What cranial nerve do you whisper from varying distances and locations behind the patient and ask what you said. Test equilibrium with Rhomberg test and asked to stand with feet slightly apart and eyes closed. Observe if they sway?
Vestibulocochlear or acoustic nerve
What are coupe or counter coupe injuries?
When the head is moving and hits a stationary object like a windshield, the contents in your head bounce on your skull and bounces back. The bounce is the coop and when it hits back on the opposite side it is a counter coop. This causes trauma to the brain.
What should you not do with back pain or a slipped disk
You don't want to lean over without bending knees, reach to left items or lift heavy items higher than elbows, stand or sit for long periods, sleep with legs out straight without pillow cushioning under the thighs or between the legs went on the side, or bend from Waist to pick up an item
If you have an injury to the spine and can't breathe well what will happen
You will be intubated up until swelling goes down and then you may assess further function
What is a neuron?
a nerve cell; the basic building block of the nervous system
What is a contusion?
a region of injured tissue or skin in which blood capillaries have been ruptured; a bruise.
What is the structure of a neuron?
dendrite, cell body, axon, myelin sheath, synapse (dendrites receive messages, axons deliver them)
