Endo Final review

• system that originates, transmits and causes nerve impulses
• CND & PNS
• somatic- voluntary control of skeletal muscles

• Nerve Cells (neurons)- cell body, dendrites, axons
• Supportive tissue (neuralgia)- supports nerve paths, protects, neutrilze
• Neurotransmitters- chemical substance that conducts an impulse- acetylcholine, epinephrine, norepinephrine, dopamine, sarotonin

• Cell Body
• Dendrites
• Axon types
• afferent- ascending to CNS
• efferent- descending to body (organ)
• association- join A and E pathways
• Neurotransmitters

• 3 Layers
• Dura Mater- fiberous, tough, leathery
• Arachnoid Mater- web like
• Pia Mater- soft, tender, vascular

• Right- Controls left side of body, art, creativity, nonverbal communication, spiritual, perception of physical environment, music
• Left- Controls right side of body, analysis, verbal communication, problem solving, interpretation of hearing, seeing and language, calculations

elevations

Valleys

Behavior, decision making, higher intelligences, concentration

Prefrontal- morals, emotions, judgement

Broca's Area- Speech

Language, sensory information, interpretation of pain, temp and pressure

Hearing, memory, speech perception

Wernicke's Area- speech comprehension

Visual interpretation, vision, reading and understanding

• Produced in Choroid Plexus (500ml daily)
• Reabsorbs in Arachnoid Villa
• Shock absorption, bathes the brain and spinal cord, lubricates

• WBC- 0
• RBC- 0
• Protein- 15-45mg
• Glucose- 60-80mg
• Pressure- 50-175mmH2O (normal)

• 12 Pairs
• Emerge from brain stem and other parts of the brain
• Sensory- sight, hearing, smell, taste, equilibrium
• Motor

• Involuntary control of viscera
• Sympathetic- receptors located in cervical and lumbar levels
• Parasympathetic- receptors located in cranial and sacral levels

• Heart- Vasoconstriction/vasodilation
• BP & P- Increases/back to normal
• Bronchi- Dilate/constrict
• Skin- Sweats/Dry
• Intestine- Slows motility/back to normal
• Bladder- Decrease U. O., less renal blood flow/back to normal
• Pupils- Dilate/back to normal

• Baseline data collection
• History of neuro problems
• Level of consciousness (LOC)
• Cranial Nerves
• Muscle Strength- 0-5 scale, push and pull
• Movement-smooth
• Gait- smooth coordination

• Objective tool to score LOC
• Eye opening- 4
• Verbal response- 5
• Motor response- 6
• Highest- 15, 7 and lower- coma, lowest 3- deep coma

• Right and Left Hemispheres
• Governs sensory and motor activity, thought and learning

• Relays sensory impulses to the cortex
• Provides pain gate
• Part of the reticular activation system

• Regulates autonomic responses
• Regulates stress response, sleep, appetite, body temp, fluid balance, emotions
• Responsible for the production of hormones secreted by the pituitary gland and hypothalamus

• Midbrain
• Pons
• Medulla Oblongata

• Motor Coordination
• Contains visual reflex and auditory relay centers

Contains respiratory centers and regulates breathing

• Contains all afferent and efferent tracts
• Contains cardiac, resp, vomiting and vasomotor centers
• Controls HR, respirations, blood vessel diameter, sneezing, swallowing, vomiting and coughing

Coordinates smooth muscle movement, posture, equilibrium, muscle tone

• LOC- Glasgow Coma Scale
• Orientation
• Mental Status
• Intellectual Functioning
• Emotional Status
• PERRLA
• Communication

• Muscle Size/symmetry
• Muscle Tone/strength
• Coordination
• Romberg Test
• Posturing
• -decorticate- flexion
• -decerebrate- extension

• Tactile
• Pain and Temp
• Vibration
• Proprioception- sense of joint in space
• Stereognosis- ability to recognize a familiar object by touch
• Graphesthesia- identify letters or number drawn on skin
• 2 point discrimination

• Reflexes
• Deep Tendon- nurses don't do
• Superficial- cornial reflex, abd reflex, plantar reflex

• Lumbar Puncture
• EEG (electroencephalogram)
• EMG (electromyogram)
• X-Ray
• CT Scan
• MRI
• Cerebral Angiogram
• Brain Scan
• Myelogram

• Watch for infection
• Clean wound before sutures
• Closed injury- dura mater is intact
• Open injury- damage to dura mater
• Pain, headache, neuro defict,

• Linear- non placed cracks in skull
• Comminuted- broken into fragments
• Depressed- fragment is pressing down into cranial cavity
• Basilar- fracture at base of skull, battle sign, echimosis

• Acceleration- moving object strikes the skull
• Deceleration- head is moving strikes a solid object
• Acceleration-Deceleration
• Rotational- bouncing around
• Coup- impact of the head against the object
• Contracoup- movement of the brain based on the original impact

• Transient neuro deficit caused by shaking the brain
• Loss of conciseness- seconds to hours

headache, dizziness, N, V, amnesia before or after trauma, no skull or dura injury noted, momentary loss of reflexes, agitation, confusion, unsteady gait, visual disturbances, loss of mentation, resp arrest

• Spontaneous improvement
• Post Concussion Syndrome- can last a few weeks to years, lingering headache, emotional ability, insomnia

• Brusing of the brain
• 7-8 GCS
• Prognosis full recovery to death
• Can have permanent brain damage

Unconsciousness, come in and out, skin cool and pale, P, BP and Resp below normal, high risk for ICP, dizziness, doll's eyes

• collection of blood between dura mater adn skull
• arterial bleed, Menigeal Artery
• Medical Emergency
• Data Collection- neuro status decline, headache, paralyzed extraocular movement, seizures, fixed dilated pupils, increased ICP

• Collection of blood between dura and arachnoid
• Vein bleed
• Acute- 24-48hrs Subacute- 2-4 days chronic- 2 weeks to months
• small treated with meds, large surgery to remove
• Data Collection- altered LOC, undilated, paralysis, forgetfulness, lethergy, headache, pupil changes

• Bleeding occurs below arachnoid or in the ventricles
• Surgery to repair, on lots of meds
• In hospital to head injury
• Data Collection- noctual rigidity, all data for others, increased ICP
• Never suction through nose with head injury

• bleeding in the brain tissue
• surgery to repair
• Data collection same as others
• Interventions same as others

• Control ICP
• Airway/lung sounds
• Pain
• Mobility
• Safety

• Anything in the brain that doesn't belong
• Monroe-Kellie Hypothesis
• Causes to much volume, edema, tumor, increased CSF or not being reabsorbed

decreased LOC, confussion, difficulty arousing, restlessness, change in pupil size, responses get slower, vision changes, pulmonary edema, increased temp Systolic BP, decreased P, and resp, hemipalesia, mentation, loss of conciousness, hearing problems, seizures, posturing

Never suction through nose, O2, ABG's, limit activity, HOB 30-40 degrees, shivering, straining, surgery to decompress, resp status

• Corticosteroid, decrease cerebral edema
• PO, IM, IV, Rectal
• SE- depression, euroharia, increased ICP, hypertension, anorexia, N, V, adrenal gland supression, edema, wt gain, decreased wound healing, increase BS
• Interventions- big dose in morning, small in evening, give with food, I&O, daily wt, check BS, wounds that dont heal, report (swelling, tenderness, brusing, wt gain)

• Antiulcer, inhibits action od H2 receptors
• PO, IM, IV
• SE- confusion, dizziness, headache, constipation, drug induced hepitis, N, V
• Interventions- pain status, avoid antacids 30 mins before and after, give with meals, take as prescribed, no smoking, safety, avoid alcohol, irritating foods, report (diarrhea, dizziness, confusion, rash)

• Osmotic diuretic, decrease kidney ability to reabsorb fluids
• IV Only
• SE- confussion, headache, blurried vision, pulmonary edema, N, V, thirst, dehydration, dizziness,
• Interventions- lung sounds, vitals, I&O, daily wt, monitor dehydration, increased ICP, renal function, hypovolemia

• antipyretic, decreases pain and fever
• PO, Rectal
• SE- hepatoxicity, renal failure, rash,
• Interventions- vitals, BS changes, decreased metabolism, decreased cerebral blood flow, decreased ICP, increased O2 to tissue

• Anticonvulsant, slows electrical conduction to stop seizures
• PO, IM, IV
• SE- gingival hyperplasia, N, V, anorexia, constipation, altered sense of taste, redish urine, wt loss, back pain, drowsiness
• Interventions- around the clock as prescribed, seizure data, dental exams, give with meals, safety, avoid alcohol, dont switch between trade and generic, will interfere with birth control, frequent oral care, if on G tube stop feed for 2 hrs, theraputic range 10-20mg

• primarly develop in brain
• can start somewhere else and travel to brain
• tumor grows ICP increases
• find out what blood flow is effected

• CT Scan
• MRI
• EEG
• PET
• Needle biopsy

altered consiousness, decreased mental function, headache, seizures, vomiting, fatigue, inability to preform ADL's, signs of neuro changes (first drowsiness)

Seizures, memory impairment, cognative changes, ataxia, increased ICP

Control symptoms, radiation, meds to control ICP, chriotherapy, prepare for surgery, may be in ICU after surgery

• Opioid agonist
• PO, IM, IV, SubQ
• SE- confussion, sedation, hallucinations, N, V, constipation, dry mouth, urinary retention
• Interventions- vitals, resp delow 10 call dr do not give, bowel function, change position slowly, safety, avoid alcohol, oral hygein, stool softener, sometimes given with amtiemtics

• Self Care
• Reorient
• Pain
• Injury risk, Sensory perceptual alterations

• Sudden attack
• Electrical disturbances
• infection, decreased O2 levels in blood
• Trama during birth, drugs, alcohol, arua, hypoxia, infection, hypoglycemia

• EEG
• CT Scan

• Generalized- tonic clonic, absent, atonic
• Partial- simple, complex

decreased muscle tone, mood changes, perceptation changes

Safety, airway, loosen tight clothes, privacy, never leave alone, don't put anything in mouth, head to side, record length, origin of seizure

• Goal minimize side effects, stop or decrease seizures
• Do not stop taking med abruptly- needs tapered
• Status Epilepticus- emergency condition- acute prolonged seizure last 30 mins or more, can go in and out of consciousness, can have irreversible brain damage

• Anticonvulsants
• Therapeutic levels
• - Dilantin- 10 - 20mg
• - Phenobarbitol- 10 - 40mg
• - Tegretol- 6-12mcg
• - Depakene
• - Mysoline

• Anticonvulsant, Sedative, Hypnotic
• PO, IM, IV
• SE- drowsiness, vertigo, resp depression, bronchiospasm, N, V, photo sensitivity, dependency, diarrhea, constipation
• Interventions- drug levels, toxic, resp rate before admin, document seizure activity, LOC, safety, can crush, deep IM, no alcohol, sunscreen, no driving

• Anticonvulsant, Sedative, Hypnotic
• PO Only
• SE- drowsiness, ataxia, dry mouth, blurred vision, photo sensitivity, urine retention, increase or decrease BP
• Interventions- document seizures, give with food, can not crush, around the clock, safety, sunscreen, frequent fluids, avoid alcohol, messes with birth control

• Anticonvulsant, Sedative, Hypnotic
• PO, IV
• SE- N, V, anorexia, constipation, diarrhea, confusion, dizziness, headache, increased bleeding time
• Interventions- single dose at bedtime, can help sleep, give with meals or right after, sprinkle on food, safety, no alcohol

lower back pain down siatic nerve

• Chronic back pain
• Repetitive lifting
• Trauma
• Twisting
• Falls
• Accidents
• Aging Process
• Sometimes slow progression

• Lumbar- L4-L6 most common 90-95%
• Cervical- C5-C7

Lesegue's sign, Kernig's sign, pain, numbness, tingling, loss of reflex above or below, muscle spasm

• Conservative- provide rest, stress reduction, immobility of spine, pain relief
• Surgical
• Medications- narcotic analgesics, muscle relaxants

• Skeletal muscle relaxer, inhibits reflexes at spinal level
• PO, Intrathecal
• SE- dizziness, drowsiness, fatigue, wt gain
• Interventions- monitor spactisity, give with food, dont stop abruptly, change positions slowly, avoid alcohol

• Injury to the spinal cord
• MVA, violence, falls, sporting accidents
• Cervical and lumbar most common

• Flexion- bends forward
• Hyperextension- bends back
• Rotational- twisting
• Compression- crushed together between vertebrae

• Neurogenic shock
• Hypotensive event
• Loss of motor, sensory, autonomic and reflexes
• Areflexia- absence of reflexes
• Occurs immediatly upon injury
• C5 and above- Resp involvement
• Cervical injury- Quadriplegia
• Thoracic and below- Paraplegia
• Under S1- leg movement
• Under S4- bladder and bowel function

• Hypertensive Crisis
• 1. Elevated systolic BP (260-300)
• 2. Bradycardia
• 3. Throbbing headache
• decreased resp
• diaphoresis
• Data- decreased resp rate, BP, CO, HR
• Loss ability to sweat, poikilothermia
• Tx- notify DR., remove stimuli, elevate HOB

• Immoblize head
• antiembolism stockings
• Diet- high protein, calcium, vita D
• May be on TPN or feeding tube
• Airway kit and suction by bedside
• Skull tong/Halo- pin care, body straight in bed, weights hang free

• Antihypertensive, relaxes venous smooth muscles
• IV Only
• SE- N, V, abd pain, dizziness, headache, bradycardia, flushing, decreased reflexes
• Interventions- vitals, change position slowly, I&O, daily wt, lung sounds

• Resp Status
• Circulation
• Neruo checks
• Gastrointestinal
• Renal Function
• Skin/Oral Care/Positioning
• Safety
• Always assume they can hear you

Incision into the cranium to remove a blood clot, tumor, or anything that doesn't belong

Vitals every 30 mins, head in midline, quiet enviornment, drainage (30-50ml), I&O every hour, fluid restriction 1500ml, electrolyte balance, ROM every 8hrs, monitor for dysrythmias, cold packs for periorbital edema

Decreased LOC, motor weakness, personality changes, vision problems

Increased ICP, swelling, shock, pulmonary edema, Diabetes Insipidus, hemmatoma

causes- infection, trauma, hemmorage, menningitis, tumor

• Facial exercises, use eye drops, food in small pieces, protect eye from injury
• Will eventually come out once cause is treated

problem with taste and swallowing, paralyzed facial movement

• Abnormal response to bodies immune system or viral infection
• Slow peogressive degenerative disease which leads to permanent neuro dysfunction
• No Cure
• Demyelination of the brain and spinal nerve cells and replacement occurs with sclerotic patches, interfering with transmission of nerve impulses
• Onset 20-40 yrs
• Periods of remission and exacerbation
• Women effected 2-3 times more then men

Motor- decreased muscle strength, spasitity of lower extremited, paralysis, incontinence of bowel and bladder

Sensory- Diplopia (double vision), blurred vision, transient blindness, numbness, paresthesia, decreased temp sensation

Other- ataxia, mystagmus, tremors, speech disturbances, vertigo, dysphasia, CSF will have increased protein, IgG, WBC

• Bed rest during exacerbation
• daily exercise, physical therapy, ROM, occupational therapy, change positions frequently, use of assistive devices, safety
• Diet- well balanced, high roughage and fiber, aadiquet fluids, wt reduction
• Meds- Corticosteroids, muscle relaxers, immunosuppressive agents, urinary meds

UTI, pneumonia, pressure ulcers, contractures, depression

• Anti multiple sclerosis agent, slows progression of disease\
• IM, SubQ
• SE- headache, weakness, drowsiness, N, V, diarrhea, dyspnea, UPI, tachycardia, depression, photosensitivity, alopecia, decreased WBC, flu like symptoms
• Interventions- monitor for exacerbation, check for depression, teach correct injection technique, tylonel for relief of flu like symptoms, sunscreen, infection, avoid crowds and ill people

• slow progressive degenerative disease
• caused by viral immune response or genetic
• onset to death 3 years
• men 2-3 times more likely to get
• Body falls apart, mind is intact

drooling, chewing and swallowing difficulties, muscle weakness, atrophy, spasticity of upper extremities, flaccid paralysis, decreased resp status,

• continue activities as long as they can do them, physical therapy, occupational therapy, speech therapy, regular soft foods, may progress to feeding tube
• meds- muscle relaxers
• ask about living wills, POA, and advanced directives before they get bad

• acute inflammatory PNS
• Demyelination of distal nerves, remyelination of the proximal to distal
• immune system overreactsto infectionand destroys the myelin sheath
• Stages acute- 1-3 weeks, plateau- several days to 2 weeks, recovery- up to 2 years
• nonspecific infection, viral, autoimmune

Motor- weakness begins in legs and works up the body, absence of reflexes, resp failure

Sensory- paresthesia, pain

Autonomic- BP regulation, GI mobility, urinary elimination

• Physical therapy, occupational therapy, loc, ABG's, turn frequently, cough and deep breath, skin care, position to prevent contracture, TED hose, Homan's sign, I&O, prune juice, pool therapy, balanced diet to prevent muscle breakdown, vitals
• Meds- steroids, imuran, heparin

• Immunosuppressant, blocks purine metabolism
• PO, IV
• SE- anorexia, N, V, diarrhea, mucositis, leukopenia, chills, fever, pulmonary edema, retinopathy
• Interventions- monitor for infection, life long therapy, avoid crowds and ill people, I&O, daily wt, watch for blood in stool, report tiredness, weakness, cough, hoarseness, fever, chills, lower back or side pain, black tarry stool

• Anticoagulant, prevents conversion of prothrombin to thrombin
• IV, SubQ
• SE- drug enduced hepatitis, alopecia, anemia, injection site pain, fever
• Interventions- monitor for bleeding, teach admin technique, 2 nurses must check, safety, soft toothbrush, electric razor
• antidote- protamine sulfate

• Primary- not caused by an underlying condition
• Tension- most common, steady, occurs frequently
• Migraine- more often in women, irritable, anorexia, N, V, photophobic
• silent migraine- may have aura
• Cluster- severe pain, one side behind the eyes, goes away for years then can come back at any time, alcohol is trigger
• Secondary- result from another condition