Professional Documents
Culture Documents
Nervous System
Central NS
Brain & spinal cord
C- 8
T- 12
L- 5
S- 5
C- 1
Peripheral NS
31 spinal
Autonomic NS
sympathetic NS
Parasympathatic NS
Somatic NS
ex. Breakfast 8am diaphragm, chest wall muscles, shoulders & arms
ex. Lunch 12nn upper body, GI functions
ex. Dinner 5pm (napaa aga haha) lower body, bladder, bowel
ex. Dinner ulit kasi matakaw
ex. Midnight snack 1am
BRAIN MASS
Nursing priority:
1.) Maintain patent a/w & adequate ventilation
a. Prevention of hypoxia (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention).
o Hypoxia cerebral edema - increase ICP
o Hypoxia inadequate tissue oxygenation
Late symptoms of hypoxia ----------- B bradycardia
E extreme restlessness
D dyspnea
C cyanosis
**Early symptoms --------- R restlessness
A agitation
T tachycardia
N range
0.5 1.5 meq/L
0.6 1.2 meq/L
10 19 mg/100ml
10 -19 mg/100 ml
10 30 mg/100ml
Toxicity
2
2
20
20
200
Classification
cardiac glycosides
antimanic
bronchodilator
anticonvulsant
analgesic
Indication
CHF
bipolar
COPD
seizures
osteoarthritis
Anorexia
b.
c.
d.
e.
f.
nausea/vomiting
Diarrhea
Confusion
Photophobia
Changes in color perception yellow spots
(Ok to give to pts with renal failure. Digoxin is metabolized in liver not in kidney.)
Antimanic agent
S/Sx Anorexia
Diarrhea
Dehydration force fluid, maintain Na intake 4 10g daily
Hypothyroidism
(CRETINISM the only endocrine disorder that can lead to mental retardation)
a.
b.
c.
------------------------------------------------------------------------------------------------------------------------------PARKINSONS (parkinsonism)
chronic, progressive disease of CNS char by degeneration of dopamine producing cells in substancia nigra at mid brain &
basal ganglia
Function of dopamine: controls gross voluntary motors.
Predisposing Factors:
o Poisoning (lead & carbon monoxide). Antidote for lead = Calcium EDTA
o Hypoxia
o Arteriosclerosis
o Encephalitis
o High doses of the ff:
a. Reserpine (serpasil)
anti HPN, Side Effect 1.) depression 2.) breast cancer
b. Methyldopa (aldomet)
c. Haloperidol (Haldol)- anti psychotic
d. Phenothiazide - anti psychotic
**SE of anti psychotic drugs Extra Pyramidal Symptom
Over meds of anti psychotic drugs neuroleptic malignant syndrome char by tremors (severe)
S/Sx: Parkinsonism
1. Pill rolling tremors of extremities early sign
2. Bradykinesia slow movement
3. Over fatigue
4. Rigidity (cogwheel type)
a. Stooped posture
b. Shuffling most common
c. Propulsive gait
5. Mask like facial expression with decrease blinking eyes
6. Monotone speech
7. Difficulty rising from sitting position
8. Mood labilety always depressed suicide
Nsg priority: Promote safety
9. Increase salivation drooling type
10. Autonomic signs:
Increase sweating
Increase lacrimation iyakin!
Seborrhea (increase sebaceous gland) oily!
Constipation
Decrease sexual activity
**Nsg Mgt:
1. Anti parkinsonian agents
Levodopa (L-Dopa) short acting
Carbidopa (Sinemet) long acting
Amantadine Hcl (Symmetrel) eto hindi ko alam haha
Mechanism of action
Increase levels of dopa relieving tremors & bradykinesia
*S/E of anti parkinsonian
o Anorexia
o n/v
*Contraindication:
o Narrow angled closure glaucoma
o
o
Confusion
Orthostatic hypotension
o
o
o
Hallucination
Arrhythmia
a. Weakness
b. Spasiticity tigas
c. Paralysis major problem
5. Impaired cerebellar function
Triad Sx of MS aka (Charcots triad)
I intentional tremors
N nystagmus abnormal rotation of eyes
A Ataxia & Scanning speech
6. Urinary retention or incontinence
7. Constipation
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Dx test
Tensilon test (Edrophonium Hcl) temporarily strengthens muscles for 5 10 mins. Short term- cholinergic. PNS effect.
o Remember ung aso sa video dati, ung biglang lumakas meaning nun (+) sya for MG
Nsg Mgt
1. Maintain patent a/w & adequate vent by:
3. Siderails
*Assist in mechanical vent attach to ventilator
4. Prevent complications of immobility.
*Monitor pulmonary function test.
Adult - every 2 hrs.
//
Elderly - every 1 hr.
= kasi decreased vital lung capacity ung pt.
5. NGT feeding
2. Monitor VS, I&O neuro check, muscle strength or motor
grading scale (4/5, 5/5, etc)
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**Administer meds
Cholinergics or anticholinesterase agents
Mestinon (Pyridostigmine)
Neostignine (prostigmin) Long term
Increase acetylcholine
Corticosteroids to suppress immune response
o Ex. Decadron (dexamethasone)
**Monitor for 2 types of Crisis:
Myastinic Crisis
Cause 1. Under medication
2. Stress
3. Infection
S/S
1. Unable to see Ptosis & diplopia
2. Dysphagia- unable to swallow.
3. Unable to breath
Cholinergic crisis
Cause: 1 over meds
S/Sx - PNS
-----------------------------------------------------------------------------------------------------------------------------------------------GBS Guillain Barre Syndrome aka Acute inflammatory demyelinating polyneuropathy (AIDP)
Disorder of CNS
Bilateral symmetrical polyneuritis
Ascending paralysis
Cause unknown, idiopathic
Auto immune
r/t antecedent viral infection
Immunizations
**S&Sx
Initial :
1.
2.
3.
4.
5.
6.
Clumsiness
Ascending muscle weakness lead to paralysis
Dysphagia
Decrease or diminished DTR (deep tendon reflexes)
Paralysis
Alternate HPN to hypotension lead to arrhythmia - complication
Autonomic changes
increase sweating, increase salivation.
Increase lacrimation
Dx most important: CSF analysis - thru lumbar puncture reveals increase in : IgG & CHON (same with MS)
Nsg Mgt
1. Maintain patent a/w & adequate vent
a. Assist in mechanical vent
b. Monitor pulmonary function test
2. Monitor vs., I&O neuro check, ECG tracing due to arrhythmia
3. Siderails
4. Prevent compl immobility
5. Assist in passive ROM exercises
6. Institute NGT feeding due dysphagia
12
13
4.
Result
1. CSF analysis:
Management:
1. Adm meds
a.) Broad-spectrum antibiotic penicillin
**Side effects:
1. GIT irritation take with food
2. Hepatotoxicity, nephrotoxcicity
3. Allergic reaction
4. Super infection alteration in normal bacterial flora
Normal flora sa throat streptococcus
Normal flora sa intestine e coli
**Sign of superinfection of penicillin = diarrhea
b.) Antipyretic
c.) Mild analgesic
2. Strict respiratory isolation 24h after start of antibiotic therapy
**Side note:
A Cushings synd reverse isolation - due to increased corticosteroid in body.
B Aplastic anemia reverse isolation - due to bone marrow depression.
C Cancer any type reverse isolation immunocompromised.
D Post liver transplant reverse isolation takes steroids lifetime.
E Prolonged use steroids reverse isolation
F Meningitis strict respiratory isolation safe after 24h of antibiotic therapy
G Asthma not to be isolated
3.
4.
5.
6.
7.
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Predisposing factor:
1. Thrombosis clot (attached) [stationary]
2. Embolism dislodged clot pulmo embolism [circulating]
S/Sx: pulmo embolism
Sudden sharp chest pain
Unexplained dyspnea, SOB
Tachycardia, palpitations, diaphoresis & mild restlessness
S/Sx: cerebral embolism
Headache, disorientation, confusion & decrease in LOC
[Femur fracture complications: fat embolism most feared complication w/in 24hrs]
Yellow bone marrow produces fat cells at meduallary cavity of long bone
Red bone marrow provides WBC, platelets, RBC found at epiphisis
3.) Hemorrhage
4.) Compartment syndrome compression of nerves/ arteries
**Risk factors of CVA:
HPN
DM
MI
artherosclerosis
**Lifestyle:
S /S:
1. TIA- [Transient inschemic attack] - warning signs of impending stroke attacks
Headache (initial sx)
dizziness/ vertigo, numbness, tinnitus, visual & speech disturbances, paresis or plegia (monoplegia 1 extreme)
Increase ICP
2. Stroke in evolution progression of S & Sx of stroke
3. Complete stroke resolution of stroke
a.) Headache
b.) Cheyne-Stokes Resp - progressively deeper and sometimes faster breathing, followed by a gradual decrease**
c.) Anorexia, n/v
d.) Dysphagia
e.) Increase BP
f.) (+) Kernigs & Brudzinski sx of hemorrhagic stroke
g.) Focal & neurological deficit
1. Phlegia
2. Dysarthria inability to vocalize, articulate words hirap magsalita! D:
3. Aphasia
4. Agraphia difficulty writing
5. Alesia difficulty reading
6. Homoninous hemianopsia loss of half of field of vision half bulag! ._o
**Ex. Left sided hemianopsia approach Right side of pt the unaffected side - [always approach unaffected side]
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Dx:
1.
2.
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