* NLE * NCLEX * CGFNS * HAAD * PROMETRICS * DHA * MIDWIFERY * LET * RAD TECH * CRIMINOLOGY * DENTISTRY * PHARMACY *
NEUROLOGY
Prepared By: Prof. Kenneth Arzadon, RN, UKRN
NOVEMBER 2022 PHILIPPINE NURSE LICENSURE EXAMINATION
THE CENTRAL NERVOUS SYSTEM
A. Brain
Cerebellum – for balance and posture
Cerebrum – knowledge, movement, and emotions
Diencephalon
- Epithalamus (secretes melatonin)
- Thalamus (for alertness)
- Hypothalamus
LIMBIC SYSTEM:
Hippocampus (memory)
Amygdala (aggression, emotions, sex)
Brain stem
- Midbrain (postural reflexes)
- Pons (pneumotaxic center)
- Medulla (vomiting, coughing, breathing, gagging)
LOBES OF THE BRAIN
Frontal
Parietal
Occipital
Temporal
B. Vertebral Column (protects the spinal cord – for transmission of impulses)
Cervical
Thoracic
Lumbar
Sacrum
Coccyx
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THE AUTONOMIC NERVOUS SYSTEM (Peripheral Nervous System)
CRANIAL NERVES
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Auditory
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
INTRACRANIAL PRESSURE
Normal Intracranial Pressure (ICP): _____________________________
Mean Arterial Pressure (MAP):
Cerebral Perfusion Pressure (CPP): amount of pressure needed to supply adequate oxygen to the brain.
CPP = MAP – ICP
Normal CPP: ____________________
If: MAP = ICP (NO CPP)
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Kellie Monro Hypothesis: If one of the contents of the cranium increase in size, the other 2 will decrease to
q b ”
HERNIATION SYNDROME
Intracranial Cranial Pressure Monitoring:
Equipment:
Technique:
Complication:
Tubing:
Prevent:
SUBDURAL BOLT:
EPIDURAL BOLT:
SUBARACHNOID BOLT:
VENTRICULOSTOMY:
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Mangement for Increased Intracranial Pressure:
1. To decrease CSF:
2. To decrease blood volume:
3. To decrease brain size:
4. To decrease blood pressure:
5. Diet:
AVOID!
1.
2.
3.
4.
5.
CEREBROVASCULAR ACCIDENT
- Sudden neurologic deficit due to insufficient blood supply to the brain.
Transient Ischemic Attack (TIA)
Reversible Ischemic Neurologic Deficit (RIND)
Associated Lab:
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Signs and Symptoms of Cerebrovascular Accident:
1. BRAIN
L
C
R
E
A
T
I
V
E
A
A
B
C
D
E
2. EYES
a. ’
- Ptosis of the upper lid
- Elevation of the lower lid
- Pupil constriction
- Lack of tearing
b. Homonymous Hemianopia (loss of one half of the visual field)
c. Amaurosis Fugax – temporary brief period of blindness
3. MOUTH
Dysarthria, Dysphagia, Drooling of Saliva
4. BODY
Contralateral Paralysis
Cause: DECUSSATION – crossing of nerve fibers at the level of medulla
5. BOWEL and BLADDER (Incontinence)
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Assessment:
F
A
S
T
Management:
Anticoagulants Thrombolytics
Increased ICP: __________________________
Hemianopia: Priority – SAFETY
Approaching the client: _____________
Serving food: ______________________
Hemiplegia:
Diet: _________________
Communication: Picture board
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’
Signs and Symptoms:
1. ____________________________ tremors
2. Cogwheel Rigidity
3. Shuffling, Propulsive, and Fistinating gait
4. Mask like facial appearance
5. Dysarthria
6. Dysphagia and Drooling of Saliva
7. Microphonia and Micrographia
8. Constipation
NON-PHARMACOLOGIC MANAGEMENT:
TREMORS: Squeeze a rubber ball/hold hands in the pocket
Use both hands to accomplish tasks
Sleep on the side with tremors (flat firm surface)
SHUFFLING GAIT: Walk in an imaginary line
Throw object in front of him
DYSARTHRIA: Pause in between words
Exaggerate pronunciation of words
DYSPHAGIA: _________________________ with small frequent feedings
Assess swallowing ability before feeding
MACROPHONIA: Ask the client to speak loud
PHARMACOLOGIC MANAGEMENT:
A. DOPAMINE AGONIST
B. DOPAMINERGIGS
Precursor:
Converted by:
AVOID -
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C. CATHELCO-O-METHYLTRANSFERASE
D. ANTICHOLINERGIC DRUGS
P
A
T
C
H
MYASTHENIA GRAVIS
CONFIRMATORY TEST: __________________________ TEST
MANAGEMENT: ___________________________
Best time to give: ___________________
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GUILLAIN BARRE SYNDROME
Autoimmune: Antibodies attacks the _________________ on the ______________.
Triggering factor:
NOTE: (for Myasthenia and Guillain Barre Syndrome)
MULTIPLE SCLEROSIS
DRUG OF CHOICE:
For spasticity:
For Paresthesia
For Ataxia
AVOID! _____________________________________
NOTE: PLAMAPHERESIS – removal of antibodies
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AUTONOMIC DYSREFLEXIA
Priority Nursing Actions:
- ______________________________
- Loose tight clothing on the client
- Check for bladder distention and
other noxious stimulus
- Administer an antihypertensive
medication
Z ’
Causes:
- Low ___________________
- Neurofibrillary tangles
- Amyloid plaques
Manifestations:
Amnesia
Apraxia
Agnosia
Aphasia
Anomia
STAGES:
Stage 1 – Normal outward behavior
Stage 2 – VERY MILD Decline
Stage 3 – MILD Decline
Stage 4 – MODERATE Decline
Stage 5 – MODERATELY SEVERE Decline
Stage 6 – SEVERE Decline
Stage 7 – VERY SEVERE Decline
Management:
Priority: __________________
Environment:
CARE GIVER:
Therapy:
Medical Management: Cholinesterase Inhibitors
Donepezil
Galantamine
Rivastigmine
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SEIZURE – presence of abnormal impulses in the brain
Risk factors: Hypoxia, Hyponatremia, Hypoglycemia
AURA (unusual sensation): epigastric pain, flashes of light
Priority: Safety
Nursing Responsibilities before seizure:
a.
b.
2 major types:
1. Generalized Seizures (affects both side of the brain)
• Absence / Petit Mal – rapid blinking / staring (5-10 seconds)
• Tonic-Clonic / Grand Mal – stiffness followed by jerking
NOTE: Patient becomes exhausted and disoriented after seizure
2. Focal Seizures (affects one area of the brain)
• Simple – twitching with strange taste or smell
• Complex – confusion and dazing
• Secondary generalized seizures - begins with one area of the brain then spread to both
sides (focal followed by a generalized)
Nursing Responsibilities after seizure:
a.
b.
c.
STATUS EPILEPTICUS:
Main causes:
Children – fever
Adult – stroke, hypoglycemia, alcohol withdrawal
Management: ANTICONVULSANTS
Phenytoin (Dilantin)
Therapeutic Level:
Side effects:
Adverse effect:
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GLAGOW COMA SCALE
EYE OPENING
4
3
2
1
VERBAL RESPONSE
5
4
3
2
1
MOTOR RESPONSE
6
5
4
3
2
1
Mild head injury:
Moderate head injury:
Severe Head injury:
Unresponsive:
UPDATES: GCS-40
Thank you. – Sir Ken
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