Chapter60 - Assessment of Neurologic Function 2.pptx

Brain

1. Chapter 60 Assessment of Neurologic Function

2. Structure and Function of the Nervous System Central nervous system Brain and spinal cord Peripheral nervous system Includes cranial and spinal nerves Autonomic and somatic systems Basic functional unit—neuron Controls all motor, sensory, autonomic, cognitive, and behavioral activities

3. Question #1 Is the following statement true or false? The spinal cord is part of the central nervous system.

4. Answer to Question #1 True Rationale: The nervous system consists of two major parts: the central nervous system (CNS), including the brain and spinal cord, and the peripheral nervous system, which includes the cranial nerves, spinal nerves, and autonomic nervous system.

5. Neuron

6. Neurotransmitters Communicate messages from one neuron to another or to a specific target tissue Neurotransmitters can potentiate, terminate, or modulate a specific action or can excite or inhibit a target cell Many neurologic disorders are caused by an imbalance in neurotransmitters Refer to Table 60-1

7. Brain

8. Medial View of the Brain

9. Bones and Sutures of the Skull

10. Meninges and Related Structures

11. Arterial Blood Supply of the Brain

12. Cross-Section of the Spinal Cord Showing the Major Spinal Tracts

13. Cranial Nerves

14. Dermatome Distribution

15. Autonomic Nervous System Functions to regulate activities of internal organs and to maintain and restore internal homeostasis Sympathetic nervous system “Fight-or-flight” responses Main neurotransmitter is norepinephrine Parasympathetic nervous system Controls mostly visceral functions Regulated by centers in the spinal cord, brainstem, and hypothalamus

16. Anatomy of the Autonomic Nervous System

17. Neurologic Assessment: Health History Pain Seizures Dizziness (abnormal sensation of imbalance or movement) and vertigo (illusion of movement, usually rotation) Visual disturbances Weakness Abnormal sensations Past health, family, social history

18. Neurologic Assessment Consciousness and cognition: mental status, intellectual function, thought content, emotional status, language ability, impact on lifestyle Cranial nerves Motor system: muscle size, muscle tone and strength, coordination and balance, Romberg test Sensory system: tactile sensation, superficial pain, temperature, vibration and position sense (proprioception) Reflexes: DTRs, biceps, triceps, brachioradialis, patellar Achilles, superficial, pathologic, plantar (Babinski)

19. Figure Used to Record Muscle Strength

20. Question #2 How many cranial nerves does the nurse have to assess? 10 11 12 13

21. Answer to Question #2 C. 12 Rationale: There are 12 pairs of cranial nerves that emerge from the lower surface of the brain and pass through the foramina in the skull.

22. Gerontologic Considerations Important to distinguish normal aging changes from abnormal changes Structural and physiologic changes Motor and sensory alterations Temperature regulation and pain perception Determine previous mental status for comparison. Assess mental status carefully to distinguish delirium from dementia

23. Diagnostic Tests Computed tomography (CT) Positron emission tomography (PET) Single-photon emission computed tomography (SPECT) Magnetic resonance imaging (MRI) Cerebral angiography Myelography Noninvasive carotid flow studies Transcranial Doppler Electroencephalography (EEG) Electromyography (EMG) Nerve conduction studies, evoked potential studies Lumbar puncture, Queckenstedt test, and analysis of cerebrospinal fluid

24. Question #3 Is the following statement true or false? Cerebral angiography is a radiograph of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture.

25. Answer to Question #3 False Rationale: Myelography is a radiograph of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Cerebral angiography is a radiography study of the cerebral circulation with a contrast agent injected into a selected artery.