n104 01 alteration in perception and coordination

7/29/2019 N104 01 Alteration in Perception and Coordination

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Luisito P. Yolangco, RN.DVM.MAN.


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CONTROL CENTER &COMMUNICATION

NETWORK of the body Works hand in hand with ENDOCRINE

system to regulate and maintain

homeostasis


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HOW IT WORKS?

Directs the functionsof the bodys organsand systems

Uses rapid & specific electrical impulsesas signaling devices

Allows us to interpret and respond to the

changes in the external environment Thoughts, actions & emotions reflect its

activity


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Sensory Reception(Receptors)

Motor Response(Effector)

INTEGRATION

INPUT

OUTPUT


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NERVOUSSYSTEM

CNS PNS

Brain Spinal Cord 12 CNs 31 SNs

Somatic Autonomic

SNS PSNS

ORGANIZATIONOF THE

NERVOUS SYSTEM


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One of the largestorgans of the body

Weights about 3 lbs Protected by cranial

bones and themeningesDM,

AM, PM

Contains CSF


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CEREBRUM

MIDBRAIN

MEDULLA OBLONGATA

PONS CEREBELLUM

MIDBRAIN

THALAMUS

HYPOTHALAMUS

DIENCEPHALON

BRAINSTEM


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Neurotransmitter

-communicate messages from one neuron toanother or from a neuron to a specific targettissue.


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Neurotransmitters

Acetylcholine major transmitter of the PNSusually excitatory in CNS and NMJ

Inhibitory or excitatory in ANS

Gamma-aminobutyric acid (GABA) - inhibitory

Enkephalin, endorphin excitatory, pleasurablesensation, inhibits pain transmission


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CSF Characteristics

Clear & colorless

Sp. Gr. = 1.007

Approx. 150 ml ( 15-25 ml in each ventricle) Contains:

Albumin 15-30 mg.dl

Glucose 50-75 mg.dl

Glutamine 6-15mg/dl IgG 0-6.6 mg/dl

WBC 0-5 per mm3


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T EPERIPHER L NERV USYSTEM

1. Sensory-Somatic

a. Cranial Nerves

b. Spinal Nerves

a. Parasympathetic

b. Sympathetic


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PNS

Consists ofNERVES, CELL BODIES &PROCESSESoutside the CNS

1. sensory-somatic

2.autonomicnervous system

CN

SN

SNSPSNS


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Cranial Nerves

Sensory-Somatic Nervous System

pairs of CNs Primarily innervate the

except

for which extendsto the thorax &abdomen

Functions:

ensoryotor (Somatic)arasympathetic


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I. OlfactoryII. OpticIII. OculomotorIV. TrochlearV. Trigeminal*VI. AbducensVII. FacialVIII. Acoustic/

Vestibulocochlear

IX. GlossopharyngealX. VagusXI. Accessory/SpinalXII. Hypoglossal

Note: * S,M only


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Olfactory Optic Oculomotor

Trochlear

AbducensTrigeminal

Facial

Acoustic/Vestibulocochlear

Glossopharyngeal

Vagus

Accessory/SpinalHypoglossal

Some Say MarryMoney But My Brother

Says Big Business

Makes Money.

Still can'tremember thenames of thecranial nerves?

Name FunctionType#


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Tongue movementMHypoglossalXII

Accessory

Vagus

Glossopharyngeal

Acoustic

Facial

Abducens

Trigeminal

Trochlear

Oculomotor

Optic

Olfactory

Name

Head & shoulder movementMXI

swallowing; digestive,respiratory, cardiovascularactivities

BX

taste; swallowing; tongue movement; salivationBIX

hearing & balanceSVIII

taste;saliva & tears production; facial expressionBVII

lateral eye movementMVI

sensation from the face & mouth; masticationBV

upward & downward eye movementMIV

extraocular eye movement;pupillary reactionMIII

visionSII

smellSI

FunctionType#


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Spinal Nerves

Sensory-Somatic Nervous System

pairs of SNs Formed by dorsal &

ventral roots of the spinalcord

Divided into dorsal &ventral rami whichcontain both motor &sensory fibers

Named according tosegment of spinal cord

they are attached.


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Nerve Plexuses

Complex networks of nerves

Serve the motor and sensory needs ofthe extremities

Classified into (4):

Cervical

Brachial Lumbar

Sacral
http://www.loweychiropractic.com/neuropathophysiology-1sm.jpg


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Cervical PlexusC1 C5

Brachial PlexusC6 C8; T1

Lumbar PlexusL1 L4

Sacral PlexusL4 L5; S1-S4

neck, shoulder & diaphragm phrenic nerve

lower abdomen, buttocks,anterior/ medial thigh, medialleg & hip

femoral & obturator nerve

upper extremity- shoulder,forearm, wrist & hand

axillary, radial, median,musculocutaneous, & ulnar

lower trunk, posterior thigh &lateral and posterior leg, foot,buttocks & external genitalia

sciatic (peroneal & tibial),pudendal nerve

PLEXUSESRegions supplied/Major nerves


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SNSPSNS


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A utomatically & continuously functionsU nder involuntary controlT wo neurons between CNS & effector organsO ne stimulates and the other inhibitsN eurotransmitters cholinergic & adrenergicO pposite effects on the same organs

M otor impulses

I nnervates smooth & cardiac muscles and glandsC oncerned with vital signs & other visceral activities


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NEUROLOGICASSESSMENT

NVS

Neurovital Signs


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NEUROLOGIC ASSESSMENT

Neurologic Examination Mental Status

Sensation

Cranial Nerves

Motor Function

Reflexes

COMPOSURE quick neurological

assessment..

C i


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LOC

Verbal Tactile Pain

Conscious (+) (+) (+)

Lethargic (+) (+) (+) *Stuporous (-) (-) (+)

Comatose (-) (-) (-)

FORMS OF

STIMULI

VERBAL

VOICE

SHOUT

TACTILE

TOUCH

TAP/ SHAKE

PAIN

SUPERFICIAL

DEEP

Consciousness

* delayed reaction


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Pain Stimulus

IMPLICATION: Consciousness


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1st & MOST sensitive indicator

of neurologic change

IMPLICATION: Consciousness

GLASGOW COMA SCALE


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GLASGOW COMA SCALE Description

Spontaneously To Speech

To Pain

Do not Open

Oriented

Confused

InappropriateSpeech

Unintelligible speech

No verbalization

Obeys Command

Localizes Pain

Withdraws from pain Abnormal Flexion

Abnormal Extension

No Motor Response

Subscale

EYE OPENING

(E)

VERBALRESPONSE

(V)

MOTORRESPONSE

(M)

Score

4 3

2

1

5

4

3

2

1

6 5

4

3

2

1

*


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Oxygenation

Assess respiratory status.

Resp rate, rhythm

Auscultate breath sounds/ air entry.

Maintain patent airway & adequateventilation.

O2 therapy, Mechanical Ventilation

Monitor for S/S of cardiorespiratorydistress

Note for S/S of Hypoxia/ hypoxemia


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Motor Function

Assess integration of consciousness& voluntary movement.

Look for purposeful or non-purposeful response.

Assess muscle tone, size, strength.

Observe for symmetric, spontaneousmovement of arms & legs


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IMPLICATION: Motor Function


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Assessment tool Motor Function

2 5

51

15

42


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Pupils

Assess for size, shape &reaction to light.

Observe for ptosis.


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Ocular Movement

Assess for deviationto one side.

Also assess voluntary

& spontaneousmovement

III, IV, VI


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Signs

Assess V/S.

Observe for significant trends.

Look for Cushings reflex:

PR,

RR,

Widened Pulse Pressure


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Urinary Output

Assess for increased output,possible S/S of impaired waterregulation.

Also assess for electrolyteimbalance

Oliguria = ( below 30 cc)


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Reflexes

Assess for pathologic reflexes,

especially babinski & loss ofcorneal or gag reflex


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controlled by L4 & L5, S1 & S2

N=toe flexion (except in infant)Abn=Dorsiflexion of big Toe,Fanning of Little Toes (exceptin infant) Pyramidal Tract /Upper Motor Neuron Damage


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Biceps, Triceps, Patellar, Achilles,Brachioradialis

DTR GRADING

DTR GRADE Response

0 Absent reflex

1+ Diminished

2+ Normal

3+ Slightly increased

4+ Hyperactive


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Emergency

Evaluate assessment findingsto determine whetheremergency exists.

If so report findings to doctor

STAT


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Ask client to SNIFF &identify aromatic

substances.

CN I : OLFACTORY


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Use of Snellen Chart

Ask client to readprinted materials

CN II : OPTIC


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Assess directions ofgaze by asking client tofollow moving objects.

Measure pupillaryreaction to light reflex& accommodation

CN III : OCULOMOTOR


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Assess directionsof gaze by askingclient to follow

moving objects.

CN IV & VI: TROCHLEAR

and ABDUCENS


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Corneal reflex Assess light touch & pain

sensation across theface

Opening the mouthagainst resistance &moving the jaw from theside to side

CN V : TRIGEMINAL


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CN VII : FACIAL

Ask client to smile,whistle, frown, puff outcheeks, & moveeyebrows

Have client identifysalty & sweet tastes onfront of the tongue


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CN VIII : ACOUSTIC

Air & bone conduction Ability to hear spoken

word


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CN IX : GLOSSOPHARYNGEAL Ask client to identify

sour, salty or sweettastes on back of thetongue

Elicit gag reflex and

assess swallowingreflex.

Ask to speak or cough.


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CN X : VAGUS

Ask client to say ahand assess formovement of thepalate and pharynx

Elicit gag reflex Ask client to speak.


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CN XI : ACCESSORY

Ask client toSHRUG shoulders& turn head

against resistance


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CN XII : HYPOGLOSSAL

Ask client to stick outtongue and move it

from side to side


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DIAGNOSTIC

EVALUATION

1 C d T h S i


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1.Computed Tomography Scanning(CTScan)

2.Positron Emission Tomography (PET)3.Single Photon Emission Computed

Tomography (SPECT)4.Magnetic Resonance Imaging (MRI)

5.Cerebral Angiography6.Myelography7.Noninvasive Carotid Flow Studies8.Transcranial Doppler

9.Electroencephalography (EEG)10.Electromyography (EMG)11.Evoked Potential Studies12.Lumbar Puncture and Examination

of CSF


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Computed Tomography Scanning

-Makes use of a narrow x-ray beam to scan thebody part in successive layers.-Can be performed first without contract followedwith contrast.


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Positron Emission Tomography

--A computer-based nuclear imaging techniquethat produces images of actual organ functioning.-Permits the measurement of blood flow, tissuecomposition and brain metabolism


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Single Photon Emission ComputedTomography

-A three-dimensional imaging technique thatuses radio-nuclides and instruments to detectsingle photons.-A perfusion study that captures a moment of

cerebral blood flow.


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Magnetic Resonance Imaging

-Uses a powerful magnetic field to obtain

images of different areas of the body.-Can be performed with or without contrast-Provides information about the chemicalchanges within the cells


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Cerebral Angiography

-An X-ray study of the cerebral circulation witha contrast agent injected into a selected artery.

-Performed by threading a catheter through thefemoral artery in the groin and up to thedesired vessel.

M l h


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Myelography

-An xray of the spinal subarachnoid space

taken after the injection of a contrast agent intothe spinal subarachnoid space through alumbar puncture.-Outlines the subarachnoid space and showsany distortion of the spinal cord or spinal dural

sac


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Noninvasive Carotid Flow Studies

-Use ultrasound imagery and dopplermeasurements of arterial blood flow toevaluate carotid and deep orbital circulation.

Transcranial Doppler

-Uses the same noninvasive techniques ascarotid flow studies except that it records theblood flow velocities of the intracranial vessels.


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Electroencephalography

-Represents a record of the electrical activitygenerated in the brain.


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Electromyography

-Is obtained by inserting needle electrodes intothe skeletal muscles to measure changes inthe electrical potential of the muscles and thenerves leading to them.


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Evoked Potential Studies

-These studies are based on the concept that

any insult or dysfunction that can alterneuronal metabolism or disturb membranefunction may change evoked responses inbrain waves.

L b P d E i i


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Lumbar Puncture and Examinationof CSF

-Queckenstedts test: lumbar manometric test-Check for post-lumbar headache and othercomplications of lumbar puncture.


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n104 01 alteration in perception and coordination

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