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Jane Bordner, Rn, BSN NURSING INSTRUCTOR HACC, Central Pennsylvania’s Community College N100 SPRING 2015 To detect changes and feel sensations To initiate appropriate responses to change To organize information for immediate use and store it for future use Works with endocrine system to maintain homeostasis Two principle divisions: Central nervous system Brain Spinal Cord Peripheral nervous system Cranial Nerves Spinal Nerves http://www.youtube.com/watch_popup?v=i- NgGKSNiNw&pop_ads=null http://www.youtube.com/embed/iNgGKSNiNw Cell body Axon Dendrite Synapse Neurotransmitter INFO OUT Glial cells Neurons INFO IN INFO OUT http://www.youtube.com/w atch_popup?v=iNgGKSNiNw&pop_ads=null Synapse junction between 2 neurons Communication electrical chemical activity Neurotransmitters chemicals that conduct messages (impulses) across junction http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C Sensory- Afferent Carry impulses from receptors to the CNS Motor – Efferent Carry impulses from CNS to effectors Confusing because they both sound the Sensory=Afferent Motor=Efferent SAME Brain Spinal cord Myelin Gray Matter White Matter 12 cranial nerves 31 spinal nerves Sensory organs 3 Major Portions Cerebrum Cerebellum Brain Stem http://www.youtube.com/watch?v=snO68aJTOpM 2 hemispheres Corpus callosum: White matter 200 million nerve fibers Bridge sending messages between 2 halves Cerebral cortex: Surface layer of gray matter Covers each hemisphere Folded with fissures and sulci Most of conscious activity Frontal Motor area controlling opposite side of body Left frontal = Broca’s motor speech area Parietal Sensory area Left side = thought that precedes speech Occipital Visual area Temporal Hearing, smell, and taste Left side = thought that precedes speech Basal ganglia Gray matter Deep in cerebral hemispheres Regulates muscle tone Inhibits tremors Subconscious voluntary movements Muscle movement Balance Equilibrium Cerebellum Midbrain Connects pons and cerebellum Pons Connects cerebellum with brain stem, spinal cord and cerebrum Medulla Transmits motor impulses from brain to spinal cord Transmits sensory impulses from peripheral sensory neurons to brain Cross over of motor and sensory pathways Respiration and cardiac centers Hypothalamus Midbrain Pituitary gland Connective tissue Three layers (membranes) Dura mater (outer layer) Arachnoid membrane (middle layer) Pia mater (inner layer) 4 hollow structures Manufacture and absorb Cerebrospinal fluid (CSF) Choroid plexus CSF acts a shock absorber Reflex action Provides motor activity without sending signals to brain Protective http://www.bbc.co.uk/schools/gcsebitesize/science/aq a/human/thenervoussystemrev3.shtml Pathway for impulses to and from brain Somatic Nervous System = (Voluntary) Conscious control Autonomic Nervous System = (Involuntary) Unconscious control 2 Divisions Work together to maintain homeostasis Sympathetic (fight or flight) Neurotransmitters = epinephrine/norepinephrine Parasympathetic (rest and digest) Neurotransmitter = acetylcholine Cranial nerves 12 pairs Mostly head and neck Sensory, motor, or both Attached in brain and pass through openings in skull V (trigeminal) & VII (facial) = blink reflex IX (glossopharyngeal) & X (vagus) = gag reflex II (optic) & III (oculomotor) = pupil size and response III (oculomotor) & IV (troclear) & VI (abducens) = extraocular eye movements Movements synchronized and smooth without nystagmus Spinal nerves 31 pair 8 cervical 12 thoracic 5 lumbar 5 sacral 1 very small coccygeal Sensory Spinal cord Motor W U H P A T S Level consciousness Orientation Coordination Muscle Strength Sensation Movement Speech/Swallowing Body Temperature Describes state of awareness and response to stimuli 5 levels of consciousness Conscious/Alert/Wakeful Lethargic/Drowsy/Obtunded Stuporous Semi-conscious/semi-comatose Comatose/ Unresponsive Determined in 3 spheres Person Place Time Ability to think and reason Terms Disoriented Confused Memory loss (short-term/long-term) Ability to move extremities and body parts voluntarily in a balanced coordinated manner Problem in one body part or all body parts Terms Gait Tremors Ataxia Always assess bilaterally Terms Paresis Hemiparasia Atrophy Contraction Contracture Flaccid Disturbance of sensory perceptions Terms Paresthesia Numbness Pain Neuropathy Radiculopathy Act of changing position of body or its parts Active/Passive movement Terms Paralysis Plegia Hemiplegia Paraplegia Quadriplegia Controlled by cerebral cortex Broca’s speech center Terms Dysphasia Dysarthria Dysphonia Aphasia Types of Aphasia Expressive (Broca’s or Motor) Receptive (Wernicke’s or Sensory) Amnesic Global Process that moves food from mouth through pharynx and esophagus to stomach Complicated act Initiated voluntarily Must be able to move tongue and palate Pharynx must respond appropriately to stimulation Terms Dysphagia Speech Therapy assessment Avoid distraction while eating Small bites Need to stay with client High fowlers position Avoid straws Feed slowly Swallow twice after each bite Use thickening agents as needed Controlled by hypothalamus Balance between heat production/heat loss Heat Production Metabolism Muscle activity Heat loss Sweating Vasodilation Normal range: 97 – 100.4 F Elderly lower Infants higher Lowest in morning Highest in late afternoon LOC and Orientation Cranial nerves Motor Response Pupils Vital Signs Arousal (wakefulness) Alert Lethargic/somnolent/obtunded Stuporous Semi-conscious Unresponsive/comatose Awareness Orientation Attention span Speech (clear/coherent/incoherent/slurred Memory I to XII Mnemonic Cranial Nerves Review http://www.youtube.com/watch?v=-J9QEddbJAU http://www.youtube.com/watch?v=0lbwshg_Kj4 Normal motor response Follows verbal commands Abnormal Localizes pain Flexion to pain (decorticate position) Extension to pain (decerebrate position) No response BABINSKI RESPONSE Strength Can only test if they have normal motor response Normal Weak None Equality Anisocoria Grossly unequal is abnormal Size: Always check before shining light in eyes Measure in millimeters (mm) Constricted Normal Dilated Reaction Turn pen light on only when directly in front of pupil Remember blind eyes will not react Record results: Normal = brisk reaction, pupil goes from dilation to constriction rapidly Abnormal = sluggish or no reaction Accommodation Pupils adjust to let in more or less light given distance of object from eye Assess Have patient focus on a distant object Have client look at close object Blood pressure Heart rate Respirations Temperature Late and serious sign Cushing’s Triad Widening pulse pressure SBP Bradycardia Cheyne-Stoke Respirations DBP Glasgow Coma Scale http://www.bt.cdc.gov/masscasualties/pdf/glasgow- coma-scale.pdf CT SCAN PET SCAN MRI OTHERS Abnormal Myelogram Normal Myelogram Result of pressure from contents of skull Amount of brain tissue Intracranial blood volume Intracranial CSF volume Change in any one Normal range is small change in pressure Minor changes cause no difficulty Sustained and continuous increased ICP permanent brain damage death Increased pressure in skull Compresses brain tissue Impairs circulation of blood and CSF Swelling of brain cells (cerebral edema) Eventually death Result from Brain tissue injury (CVA, head trauma) Tumors Aneurysms Surgery to head and face Change in LOC*** Behavior changes; restlessness, irritability*** Headache Nausea and Vomiting (projectile) Changes in speech pattern*** Pupillary changes Cranial nerve dysfunction Ataxia ***Earliest Signs*** Seizures Cushing’s Triad Abnormal posturing Chronic elevated ICP Blindness Deafness Paralysis Mental retardation GOAL: quickly lower pressure in skull Drugs to decrease edema in brain Osmotic diuretic (mannitol) Loop diuretic (Lasix) Corticosteroids Restrict fluids Hyperventilation: induce respiratory alkalosis and vasoconstriction HOB elevated at all times Control fever Complete bedrest Decreased environmental stimuli Padded siderails Prevent vomiting, coughing, straining May need surgery to relieve Trauma Accidents Assults Concussion Hemorrhage Epidural hematoma Subdural hematoma Convulsion/Seizure: episode of abnormal motor, sensory, or autonomic activity or any combination, that causes sudden excessive discharge from cerebral neurons Part or all of brain may be involved Idiopathic Genetic Developmental Head Injury Tumors Fever Hypoglycemia Hypoxia Describe circumstances before Time of seizure Type of movement seen? Did patient experience an aura? Incontinence of urine or feces? Confusion afterward and how long it took to clear? Protect airway Prevent injury Provide privacy DO NOT try to restrain NEVER force anything into mouth Vital signs Assess LOC Reorient Pad siderails Offer emotional support Allow sleep and rest Attempt to determine cause Call physician Absence (petite mal) Usually seen in children Loses consciousness momentarily May see twitching of eyes and mouth Brief lapse of attention Blank empty facial expression Simple Partial Seizures (Jacksonian) Seizure activity limited to a certain group of muscles On one side of body No loss of consciousness Complex Partial Seizures (psychomotor) Loss of consciousness Perform repetitive purposeless movements May make unintelligible sounds Generalized seizures (tonic-clonic, Grand mal) Involves both hemispheres of brain Intense rigidity of body with jerking movements Status Epilepticus Seizure activity lasting longer than 30 min Medical Emergency IV Valium or Ativan Treat underlying cause Drug therapy phenytoin (Dilantin) phenobarbitol (Luminal) carbamazepine (Tegretol) valproic acid (Depakote) gabapentin (Neurontin) topiramate (Topamax) DO NOT discontinue drug therapy suddenly Therapeutic blood levels must be reached and maintained to control seizures Major side effect = Sedation Primary vs. Secondary Transient Recurrent Persistent muscle contraction Cerebral vasodilation maybe involved Causes musculoskeletal abnormalities psychosocial stressors Symptoms Pain Pressure Aching Tightness Treatment Symptom management Due to cerebral vasoconstriction followed by vasodilation Tendency is hereditary Triggers Symptoms Aura Neck pain Throbbing Boring Pounding Unilateral Noise and light exacerbate Classic Prodromal phase Common No prodromal phase Prophylactic Dietary restriction Medications that prevent vaso changes NIFEdipine (Procardia) propranolol (Inderal) amitriptyline (Elavil) Direct Vasoconstrictor ergotamine (Cafergot) Serotonin receptors sumatriptan (Imitrex) zolmitriptan (Zomig) H/A occurs in clusters Unilateral throbbing and excruciating Quiet, dark and cold compresses NSAIDS and tricyclic antidepressants History and symptoms MRI CT X-ray Arteriogram EEG Lumbar puncture Assess – WHAT’S UP ID triggers/aggravating factors Stress reduction Relaxation Heat or cold therapy Quiet/dark environment Teach about medications Disruption of nerve tracts Sensory loss Altered activity Autonomic nervous system dysfunction Loss of all reflex activity below the level of the injury Lasts a few weeks Resolution=reflex activity returns Immobilize head and spine Maintain airway Decrease inflammation Skin care ROM Bladder/bowel Reflex response to stimulation of the symapthetic nervous system. Seen in injuries above T-6 Rise in BP Noxious stimuli Over distended bladder,bowel,decubitus,ulcer,chilling Headache Hypertension blurred vision Bradycardia Goose bumps convulsions HOB elevated to decrease ICP Find source of stimuli Monitor BP Administer antihypertensives as ordered C:\Documents and Settings\User\My Documents\Neuroscience For Kids - Explore the nervous system.mht