Overview of Anatomy and Physiology Disorders.pdfOverview of Anatomy and Physiology Structural...

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11Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1

Care of the Patient with a Neurological Disorder

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2

Overview of Anatomy and Overview of Anatomy and PhysiologyPhysiology

Structural divisionsStructural divisions Central nervous system (CNS)Central nervous system (CNS)

•• Brain and spinal cordBrain and spinal cord Peripheral nervous systemPeripheral nervous system

•• Somatic nervous systemSomatic nervous system Sends messages from the CNS to the skeletal muscles; Sends messages from the CNS to the skeletal muscles;

voluntaryvoluntary•• Autonomic nervous systemAutonomic nervous system

Sends messages from the CNS to the smooth muscle, Sends messages from the CNS to the smooth muscle,

cardiac muscle and certain glands; cardiac muscle and certain glands; involuntaryinvoluntary


Figure 54Figure 54--11

A, Diagram of a typical neuron. B, Scanning electron micrograph of a neuron. C, Myelinated axon.

(A, C, from Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby. B, Courtesy of Brenda Russell, PhD, University of Illinois at Chicago.)

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Overview of Anatomy and Overview of Anatomy and PhysiologyPhysiology

Central nervous systemCentral nervous system BrainBrain

•• Cerebrum; Cerebrum; •• Diencephalon; contains the thalamus and Diencephalon; contains the thalamus and

hyopothalamushyopothalamus•• Cerebellum; Cerebellum; •• Brain stemBrain stem

Midbrain; Midbrain; ponspons; medulla oblongata; coverings of the ; medulla oblongata; coverings of the brain and spinal cord; ventriclesbrain and spinal cord; ventricles

•• Spinal cordSpinal cord


Common Disorders of the Common Disorders of the Neurological SystemNeurological System

HeadachesHeadaches•• High blood pressure headachesHigh blood pressure headaches•• Migraine headachesMigraine headaches•• Tension headachesTension headaches•• Cluster headachesCluster headaches



•• Migraine headachesMigraine headaches Early signs/symptomsEarly signs/symptoms

•• Visual field defects, unusual Visual field defects, unusual smellssmells

During headacheDuring headache

•• Nausea, vomiting, light sensitivityNausea, vomiting, light sensitivity

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Internet Internet

Migraine headaches seem to be caused in Migraine headaches seem to be caused in part by changes in the level of a body part by changes in the level of a body chemical called serotonin. Serotonin plays chemical called serotonin. Serotonin plays many roles in the body, and it can have an many roles in the body, and it can have an effect on the blood vessels. When effect on the blood vessels. When serotonin levels are high, blood vessels serotonin levels are high, blood vessels constrict (shrink). When serotonin levels constrict (shrink). When serotonin levels fall, the blood vessels dilate (swell). This fall, the blood vessels dilate (swell). This swelling can cause pain or other problems.swelling can cause pain or other problems.


As a kid, I did miss a lot of school because I would As a kid, I did miss a lot of school because I would periodically dehydrate myself periodically dehydrate myself —— I would vomit a lot with I would vomit a lot with each migraine and it would be really hard to stop. It each migraine and it would be really hard to stop. It would often continue that way for hours and hours would often continue that way for hours and hours —— 12 12 hours sometimes.hours sometimes.

Migraine headaches are simply dreadful. A white hot ice Migraine headaches are simply dreadful. A white hot ice pick of pain thrusting into your brain pick of pain thrusting into your brain –– over and over over and over again. A pulsing, pounding, throbbing torture again. A pulsing, pounding, throbbing torture –– sucking sucking the very fiber of your being dry. Then the nausea kicks in the very fiber of your being dry. Then the nausea kicks in …… with you throwing up with you throwing up –– until thereuntil there’’s nothing left to rid. s nothing left to rid. Leaving you virtually entombed in your room Leaving you virtually entombed in your room -- a curled a curled up ball of misery. up ball of misery.

Avoiding light, avoiding sound, avoiding movement Avoiding light, avoiding sound, avoiding movement ––even avoiding your own husband and children.even avoiding your own husband and children.



Medical management/nursing interventionsMedical management/nursing interventions

•• Diet: limit MSG, vinegar, chocolate, yogurt, Diet: limit MSG, vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, ripened cheese, cured sandwich meat, caffeine, and porkcaffeine, and pork

•• MedicationsMedications Migraine headachesMigraine headaches

•• Aspirin, acetaminophen, ibuprofenAspirin, acetaminophen, ibuprofen•• Ergotamine Ergotamine tartratetartrate•• Codeine; Codeine; InderalInderal

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•• Tension headachesTension headaches Comfort measuresComfort measures NonNon--narcotic analgesicsnarcotic analgesics Cold packs to forehead or base of skullCold packs to forehead or base of skull Dark room; limit auditory stimulationDark room; limit auditory stimulation


Increased intracranial pressureIncreased intracranial pressure•• CausesCauses•• Trauma, lesions, cerebral edemaTrauma, lesions, cerebral edema

•• Signs and SymptomsSigns and Symptoms•• Double visionDouble vision•• HeadacheHeadache•• Decreased level of consciousnessDecreased level of consciousness•• PupillaryPupillary signs (blown pupil)signs (blown pupil)•• BradycardiaBradycardia•• Respiratory problemsRespiratory problems•• Seizures Seizures •• PosturingPosturing•• VomitingVomiting


PosturingPosturing

DecorticateDecorticate

DecerebrateDecerebrate

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Other Disorders of the Other Disorders of the Neurological SystemNeurological System

Epilepsy or seizuresEpilepsy or seizures PathophysiologyPathophysiology

•• Sudden, violent, involuntary Sudden, violent, involuntary contraction of a group of musclescontraction of a group of muscles

•• Types: grand mal; petit mal; psychomotor; Types: grand mal; petit mal; psychomotor; JacksonianJacksonian--focal; focal; myoclonicmyoclonic; ; akineticakinetic

•• Status Status epilepticusepilepticus


Epilepsy or seizuresEpilepsy or seizures

Medical management/nursing interventionsMedical management/nursing interventions•• During seizureDuring seizure: : Monitor ABCMonitor ABC’’ss•• Anticonvulsant medicationsAnticonvulsant medications

Nursing interventions Nursing interventions •• Medical alert tagMedical alert tag•• Adequate restAdequate rest•• Good nutritionGood nutrition•• Avoid alcoholAvoid alcohol•• Avoid driving, operating machinery, and swimming Avoid driving, operating machinery, and swimming

until seizures are controlleduntil seizures are controlled


Degenerative DiseasesDegenerative Diseases

Multiple sclerosisMultiple sclerosisDegenerative neurological disorder with Degenerative neurological disorder with

demyelinationdemyelination of the brain stem, spinal cord, of the brain stem, spinal cord, optic nerves, and cerebrumoptic nerves, and cerebrum

•• Autoimmune diseaseAutoimmune disease•• TT-- cells attack the myelin sheathcells attack the myelin sheath

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In addition to nerve damage, another part In addition to nerve damage, another part of MS is inflammation. Inflammation of MS is inflammation. Inflammation occurs when the body's own immune cells occurs when the body's own immune cells attack the nervous system. The attack the nervous system. The inflammation destroys the myelin, leaving inflammation destroys the myelin, leaving multiple areas of scar tissue (sclerosis). It multiple areas of scar tissue (sclerosis). It also causes nerve impulses to slow down also causes nerve impulses to slow down or become blocked, leading to the or become blocked, leading to the symptoms of MS. Repeated episodes, or symptoms of MS. Repeated episodes, or flare ups, of inflammation can occur along flare ups, of inflammation can occur along any area of the brain and spinal cord.any area of the brain and spinal cord.




Multiple sclerosis Multiple sclerosis Clinical signs and symptoms Clinical signs and symptoms

•• Visual problemsVisual problems•• Urinary incontinenceUrinary incontinence

•• FatigueFatigue•• WeaknessWeakness•• IncoordinationIncoordination•• Sexual problemsSexual problems

•• Swallowing difficultiesSwallowing difficulties

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Multiple sclerosis Multiple sclerosis Medical management/nursing Medical management/nursing

interventionsinterventions•• No specific treatment or cureNo specific treatment or cure•• AntiAnti--inflammatory drugsinflammatory drugs



ParkinsonParkinson’’s diseases disease Deficiency of dopamineDeficiency of dopamine Clinical manifestations/assessmentClinical manifestations/assessment

•• Muscular tremorsMuscular tremors•• Rigidity; propulsive gaitRigidity; propulsive gait•• Mask like face Mask like face

•• ““PillPill--rollingrolling”” motions of fingersmotions of fingers•• Slowed speechSlowed speech


IntroductionIntroduction Parkinson's disease is a disorder that Parkinson's disease is a disorder that

affects nerve cells in the part of the brain affects nerve cells in the part of the brain controlling muscle movement.controlling muscle movement.

People with Parkinson's disease often People with Parkinson's disease often experience trembling, muscle rigidity, experience trembling, muscle rigidity, difficulty walking, problems with balance difficulty walking, problems with balance and slowed movements. These symptoms and slowed movements. These symptoms usually develop after age 60, although usually develop after age 60, although some people affected by Parkinson's some people affected by Parkinson's disease are younger than age 50.disease are younger than age 50.

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pillpill--rollingrolling n.n. A circular movement or A circular movement or tremor of the tips of the thumb and tremor of the tips of the thumb and the index finger when brought the index finger when brought together, seen in Parkinson's together, seen in Parkinson's disease.disease.



ParkinsonParkinson’’s disease s disease Medical management/nursing interventionsMedical management/nursing interventions

•• MedicationsMedications LevodopaLevodopa SinemetSinemet ArtaneArtane CogentinCogentin


In 2007, the FDA approved the first skin In 2007, the FDA approved the first skin patch drug for treatment of patch drug for treatment of ParkinsonsParkinsonsdisease. disease. TransdermalTransdermal rotigotinerotigotine((NeuproNeupro) is a dopamine agonist drug ) is a dopamine agonist drug that may help improve symptoms of that may help improve symptoms of earlyearly--stage stage ParkinsonsParkinsons disease. The disease. The patch is applied daily.patch is applied daily.

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AlzheimerAlzheimer’’s diseases disease Etiology/Etiology/pathophysiologypathophysiology

•• Impaired intellectual functioning Impaired intellectual functioning •• Degeneration of the cells of the brainDegeneration of the cells of the brain



AlzheimerAlzheimer’’s diseases disease Clinical manifestations/assessmentClinical manifestations/assessment

•• Early stageEarly stage Mild memory lapses; decreased attention spanMild memory lapses; decreased attention span

•• Second stageSecond stage Obvious memory lapsesObvious memory lapses

•• Third stageThird stage Total disorientation to person, place, and Total disorientation to person, place, and

timetime wanderingwandering

•• Terminal stageTerminal stage Severe mental and physical deteriorationSevere mental and physical deterioration

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AlzheimerAlzheimer’’s disease s disease Medical management/nursing interventionsMedical management/nursing interventions

•• MedicationsMedications

Agitation: Agitation: lorazepamlorazepam; ; HaldolHaldol Dementia: Dementia: CognexCognex; Aricept; Aricept

•• NutritionNutrition•• SafetySafety

DoubleDouble--lock all doors and windowslock all doors and windows Constant supervisionConstant supervision



Myasthenia gravisMyasthenia gravisPathophysiologyPathophysiology

•• Neuromuscular disorder; nerve Neuromuscular disorder; nerve impulses fail to pass at the impulses fail to pass at the myoneuralmyoneural junction; junction; causes causes muscular weaknessmuscular weakness


MGMG) is a ) is a neuromuscular diseaseneuromuscular disease leading leading to fluctuating muscle weakness and to fluctuating muscle weakness and fatiguabilityfatiguability. It is an . It is an autoimmune disorderautoimmune disorder, , in which weakness is caused by circulating in which weakness is caused by circulating antibodiesantibodies that block that block acetylcholine acetylcholine receptorsreceptors at the postat the post--synaptic synaptic neuromuscular junctionneuromuscular junction..

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MSMS

Clinical signs and symptomsClinical signs and symptoms•• PtosisPtosis (eyelid drooping) (eyelid drooping) •• Skeletal weakness may progress Skeletal weakness may progress to respiratory distress to respiratory distress

•• DysphagiaDysphagia•• Bowel and bladder incontinenceBowel and bladder incontinence



Myasthenia gravis Myasthenia gravis Medical management/nursing interventionsMedical management/nursing interventions

•• AnticholinesteraseAnticholinesterase drugsdrugs ProstigminProstigmin MestinonMestinon

•• CorticosteroidsCorticosteroids



Amyotrophic lateral sclerosis (ALS)Amyotrophic lateral sclerosis (ALS) PathophysiologyPathophysiology

•• Motor neuronsMotor neurons in the brain stem and spinal in the brain stem and spinal cord gradually degenerate and diecord gradually degenerate and die

•• Electrical and chemical messages originating in Electrical and chemical messages originating in the brain do not reach the muscles to activate the brain do not reach the muscles to activate themthem

•• Lou GehrigLou Gehrig’’s diseases disease•• Leads to death in 2Leads to death in 2--6 years6 years•• Do not loose cognitive powerDo not loose cognitive power

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AA--myomyo--trophictrophic comes from the Greek comes from the Greek language. "A" means no or negative. language. "A" means no or negative. ""MyoMyo" refers to muscle, and "" refers to muscle, and "TrophicTrophic" " means nourishmentmeans nourishment------"No muscle "No muscle nourishment." When a muscle has no nourishment." When a muscle has no nourishment, it "atrophies" or wastes nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a away. "Lateral" identifies the areas in a person's spinal cord where portions of the person's spinal cord where portions of the nerve cells that signal and control the nerve cells that signal and control the muscles are located. As this area muscles are located. As this area degenerates it leads to scarring or degenerates it leads to scarring or hardening ("sclerosis") in the region.hardening ("sclerosis") in the region.


How is ALS treated?

No cure has yet been found for ALS. However, the Food and Drug Administration (FDA) has approved the first drug treatment for the disease—riluzole (Rilutek).

Riluzole is believed to reduce damage to motor neurons by decreasing the release of glutamate.

Clinical trials with ALS patients showed that riluzoleprolongs survival by several months, mainly in those with difficulty swallowing. The drug also extends the

time before a patient needs ventilation support. Riluzoledoes not reverse the damage already done to motor

neurons, and patients taking the drug must be monitored for liver damage and other possible side effects. However, this first disease-specific therapy

offers hope that the progression of ALS may one day be slowed by new medications or combinations of

drugs.


Amyotrophic lateral sclerosis (ALS) Amyotrophic lateral sclerosis (ALS)

Clinical Signs and Symptoms Clinical Signs and Symptoms •• DysphagiaDysphagia•• Muscle wastingMuscle wasting•• Compromised respiratory functionCompromised respiratory function

Medical management/nursing interventionsMedical management/nursing interventions•• No cureNo cure•• RilutecRilutec ((RiluzoleRiluzole))

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HuntingtonHuntington’’s diseases disease PathophysiologyPathophysiology

•• OveractivityOveractivity of the dopamine pathwaysof the dopamine pathways

•• Genetically transmittedGenetically transmitted Clinical manifestations/assessmentClinical manifestations/assessment

•• Abnormal and excessive involuntary Abnormal and excessive involuntary movements (chorea)movements (chorea)

•• Ataxia to immobilityAtaxia to immobility


HuntingtonHuntington’’s disease s disease

Medical management/nursing interventionsMedical management/nursing interventions•• No cure; palliative treatmentNo cure; palliative treatment•• AntidepressantsAntidepressants•• Safe environmentSafe environment•• Emotional supportEmotional support•• HighHigh--calorie dietcalorie diet


Vascular ProblemsVascular Problems

Stroke (Brain Attack)Stroke (Brain Attack) PathophysiologyPathophysiology

•• Thrombosis or hemorrhage of blood vessel or Thrombosis or hemorrhage of blood vessel or blood vessels blood vessels

•• Results in death of the brain tissueResults in death of the brain tissue•• 700,000 people will suffer a stroke700,000 people will suffer a stroke•• 160,000 will die160,000 will die

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Three types of stroke.

(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)


Vascular ProblemsVascular Problems

Stroke Stroke Medical management/nursing Medical management/nursing

interventionsinterventions•• Thrombosis or embolismThrombosis or embolism

ThrombolyticsThrombolytics Heparin and CoumadinHeparin and Coumadin

•• Neurological checksNeurological checks•• Feeding tubeFeeding tube•• Physical, occupational, and/or speech therapyPhysical, occupational, and/or speech therapy


TraumaTrauma

•• Spinal cord traumaSpinal cord trauma Etiology/Etiology/pathophysiologypathophysiology

•• Automobile, motorcycle, diving, surfing, other Automobile, motorcycle, diving, surfing, other athletic accidents, and gunshot woundsathletic accidents, and gunshot wounds

•• Fracture of vertebraFracture of vertebra•• Complete cord injuryComplete cord injury

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Mechanisms of spinal injury.

(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)


TraumaTrauma

Spinal cord trauma Spinal cord trauma Signs and Symptoms Signs and Symptoms

•• Loss of muscle function depends on level of injuryLoss of muscle function depends on level of injury•• Spinal shockSpinal shock


Autonomic Autonomic DysreflexiaDysreflexia

Abnormal response of the cardiovascular Abnormal response of the cardiovascular system to stimulation from bladder system to stimulation from bladder stimulation or fecal impactionstimulation or fecal impaction

Severe Severe bradycardiabradycardia Severe hypertension, up to 300 mm Hg Severe hypertension, up to 300 mm Hg oorr ffeeccaall iimmppaaccttiioonn

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TraumaTrauma

Spinal cord trauma Spinal cord trauma Medical management/nursing Medical management/nursing

interventionsinterventions•• Urinary function: Foley catheter; bladder trainingUrinary function: Foley catheter; bladder training

Intermittent catheterizationIntermittent catheterization

•• Bowel programBowel program


Any one have a headache?Any one have a headache?

Overview of Anatomy and Physiology Disorders.pdfOverview of Anatomy and Physiology Structural...

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