Neuro 1 with SLM

chemical messengers of the nervous system

• Acetylcholine (ACh)
• Norepinephrine (NE)

• ACh-excitatory NTS
• NE-excitatory and inhibitory

nerves that transmit impulses through the release of ACh

Excitatory or Inhibitory

nerves that transmit impulses through the release of NE

viscera, skeletal muscle cells and adrenal medulla

• heart
• lungs
• kidney
• blood vessels

*all target organs stimulated by the Sympathetic except for the heart

Alpha and Beta

they bind to alpha receptors to stimulate arterial vasoconstriction

• binding  to beta receptors inhibits 2 types of responses...
• Beta 1-receptors in heart to regulate rate and force of contraction
• Beta 2-receptor cells of the lungs, arteries, liver and uterus

Left controls language

Rt controls nonverbal perceptual functions

sorting, processing and relaying station of the brain

• regulation of temp
• water metabolism
• appetite
• emotional expression
• sleep wake cycle
• thirst

center for auditory and visual revlexes

controls respiration

controls heart rate, blood pressure, respiration and swallowing

• coordinates skeletal muscle activity
• maintenance of balance
• controls fine motor movements

• lipids
• glucose
• some amino acids
• water
• carbon dioxide
• oxygen

• urea
• creatinine
• some toxins
• proteins
• most antibiotics

Limbic system

relaying sensory input from all body systems to the brain

alert and responsiveness

• pain
• temperature
• crude touch

• sensations of fine touch, position and vibration
• purposeful movements
• stimulate/inhibit muscle actions
• muscle tone
• gross body movements

skeletal muscle contractions

activate cardiac and smooth muscle and glands

• the bodies environment...
• visceral motor system:
• cardiac muscle
• smooth muscle
• glands

Reticular formation in the brain stem

• ACh-parasympathetic
• NE-sympathetic

fight or flight

• dilated pupils
• increased mental alertness
• inhibits secretions (dry mouth) and diaphoresis
• decreased urine output
• Increased blood clotting

Causes dilation of arteries and increases the rate and force of the contraction....arteries vasoconstrict

Bronchioles dilate

• increases the release of glucose by the liver
• increasing the metabolic rate

vasoconstriction

• constriction of pupils
• stimulation of glandular secretions
• constriction of bronchioles
• increased peristalsis and secretion of GI fluid

**Basically runs our body during non stressful times

it's a degenerative disorder of the CNS characterized by the demyelinization of nerve fibers of the brain and spinal cord myelin sheath.

the motor and sensory conduction pathways of the CNS

• person becomes uncoordinated (trips)
• and has a muttled brain

• have a susceptible gene
• infection by a slow virus
• immune problem

A European American woman 20-50 years old

• Infections-URI or UTI
• Trauma
• Immunization
• Delivery after pregnancy
• Stress
• Change in climate

impulses don't move from nerve to nerve

• weakness/paralysis
• diplopia
• scanning speech
• muscle spasms
• numbness/tingly
• constipation
• spastic/hypotonic bladder
• fatigue
• depression
• problems with airway clearance
• problems with chewing/swallowing

Can be severely fatigued

Changes are mainly seen in short term memory, attention, processing information, word finding and visual perception.

NO CHANGE IN INTELLIGENCE

• Corticosteroids
• ACTH
• Methylprednisolone
• Prednisone

• Edema
• Euphoria
• weight gain

• Restrict fluid intake
• Don't stop abruptly
• Know drug interactions

• Betaseron
• Copaxone
• Novantrone

• Flu like symptoms
• local skin rash
• depression

• CBC
• Blood chemistries
• LFT

*every 3 months**

• Skin reactions
• chest pain
• weak

• NVD
• Hepatotoxicity
• cardiovascular disease
• Myelosuppression

there is a lifetime dose limit because of cardiotoxicity

Monitor CBC and LFT every month

How to perform self infection and report side effects

• Need regular monitoring and follow up
• Talk with HCP prior to getting immunizations
• Maintain adequate fluid intake
• **Urine may turn blue-green**

Urecholine and Prostigmin

• Hypotension and cardiac dysfunction
• Diarrhea
• Diaphoresis
• Peptic Ulcers
• Allergies/Asthma

Consult HCP before using any other meds....including OTC

• Probathine
• Ditropan

• Anticholinergic-cant see, pee, spit, poop
• HTN
• Urinary retention....if take too much

Consult HCP prior to taking any other meds..

**If you take sleeping aids or anithistamines could possibly have a potentiated effect

• Hx of glaucoma
• cardiac dysfunction
• Intestinal obstruction

• Valium
• Baclofen
• Dantrium
• Zanaflex

SE-drowsiness, ataxia

PT. Teaching-avoid driving, no CNS depressants and don't drink

person with glaucoma

• can be addictive
• avoid long term use

• barbituates
• MAOI
• antidepressants

person with history of hypersensitivity and renal damage

*don't take if you have a seizure disorder

with food or milk

have hallucinations

anybody with a history of respiratory or cardiac dysfunction

hepatotoxicity

photosensitivity

get a baseline LFT

• persons with liver or renal disease
• hypotension
• bradycardia

with small meals to help with nausea

change positions slowly cuz of orthos

Monoclonal antibodies

• blocks access for lymphocytes to the CNS...
• KILLS T CELLS

• ROM exercises to prevent contractures
• gait training
• aids for ambulating
• assistive devices
• techniques to maintain indep.  with ADL
• braces and adaptive equipment

increase coordination and train patient to substitute unaffected muscles for impaired ones.

*lots of exercises done in water

• antispasmodic drugs
• surgery (neurectomy, rhizotomy, cordotomy)
• dorsal-column electric stimulation

if unmanageable with drugs...treat with thallamotomy or deep brain stimulation

• they will  probably be on bedrest and be immobile...
• so to prevent complications reposition/skin care
• TCDB
• toileting/peri care

• mega vitamins (cobalamin and vitamin c
• low fat
• gluten free
• roughage/taw vegetables

patch an eye

increase cuz need more due to spasticity

coding yes or no with eyes....allow time for responses

becomes inadequate so suctioning may be required and IS used to help with respiratory muscles

an autoimmune disease of the neuromuscular junction that is characterized by fluctuating weakness of certain skeletal muscle groups

Antibodies to ACh attack the receptors causing a decrease in the number of ACh receptor sites at the neuromuscular junction....prevents ACh molecules from attaching and stimulating muscle contraction

10-65...peak age for women is 20-30

Thymic abnormalities or hyperplasia (increased cell production)

• Neostigmine
• Pyridostigmine

they at at the neuromuscular junction and allow ACh to concentrate at the receptor site promoting muscle contractions

• Thymectomy
• Plasmaphoresis

• focus on preventing complications and controlling pain
• at risk for pneumothorax

can be several years

• it is used for patients with respiratory problems
• need a CVC or AV fistula or graft to do

*removes anti acetycholine antibodies to improve sever muscle weakness, fatigue and other symptoms

• cuz poor cough mechanisms
• decreased cage expansion
• diminished diaphragm movement
• decreased expiratory effort

• encourage hydration; percussion postural drainage and suction
• TCDB q 2h
• Semi Fowlers
• check lung sounds, rate and character
• Pulse ox as needed

weakness of the laryngeal and pharyngeal muscles involved with swallowing.

*Need to make changes with foods cuz at risk for aspiration

• prevention/recognition of crisis situation
• understanding the disorder and coping with the physical, psychosocial problems and impaired self care abilities

• speak....get louder
• supra orbital pressure
• trapezius squeeze
• sternal rub

LOC....

start acting confused or disoriented

RAS....and it's connection to the thalamus and cerebral cortex

This is the lowest level of consciousness and observation is centered around the patients ability to respond to verbal/noxious stimuli appropriately

Cerebral Cortex

It is a higher functioning test which deals with orientation to person, place time and pupose

Mentation, memory and attention span

state of drowsiness or inaction, patient needs increased stimulus to be awakened

confusion with disordered perceptions and decreased attention span.

marked anxiety with motor and sensory excitement

a duller difference to external stimuli exists and response is minimally maintained

can be aroused only by vigorous and continuous external stimuli

• eye opening
• verbal response
• motor response

It is a practice means of monitoring changes in LOC

3-15 score

• 4-Spontaneously
• 3-To speech
• 2-To pain
• 1-No response

**record "C" if eyes closed by swelling

• 6-Obeys verbal commands
• 5-localizes pain
• 4-Flexion withdrawl
• 3-Flexion abnormal
• 2-Extension abnormal
• 1-No response

*Record best upper limb response

• 5-oriented x 3
• 4-conversation confused
• 3-speech inappropriate
• 2-sounds incomprehensible
• 1-no response

**Record "E" for ET tube and "T" for Tracheostomy

in the brain stem

• first time all should be assessed....
• after that 2-6, 9 and 10

Cuz they regulate pupil response, eye movement and protective mechanisms

Oh, oh, oh, to touch and feel a guys veiny slimy hotdog

• olfactory
• optic
• oculomotor
• trochlea
• trigeminal
• abducens
• facial
• auditory
• glossopharyngeal
• vagus
• spinal accessory
• hypoglossal

smell

• Vision
• tested with Snellen and Rosenbaum charts

• raise eyelids
• constrict pupils
• change eye lens shape

Oculomotor....III

downward and inward eye movements

Facial Movement and Sensation

*inspect face for muscle atrophy and tremors

lateral eye movement

• facial expression
• taste
• secretion of saliva and tears

hearing and equillibrium

Weber and Rhine test

Speech, Swallowing and Gag Reflex

**Test to ID sour and bitter tastes and test gag reflex for ability to swallow

Speech, Swallowing and Gag Reflex

• turn head
• shoulder shrug

**Problems here after radical neck surgery

tongue movement for speech and swallowing

**test tongue strength with index finger when tongue is pressed against the cheek

**Evaluate quality of linqual speech sounds (l,t,d,n)

• Glossopharyngeal IX
• Vagus X

• III Oculomotor
• IV Trochlear
• VI Abducens

IX Glossopharhngeal

push and pull against the resistance of your arm as it opposes flexion and extension of the patient's muscle...

Done at shoulder, elbow, wrist, hips, knees and ankles

**Note any weakness or asymmetry of strength between the same muscle groups of the right and left side

by passively moving the limbs through their ROM, there should be slight resistance to these movements

• flaccidity
• spasticity

involuntary spasm of muscles....tics/tremors

slow, writhing, involuntary movements of extremities

involuntary purposeless rapid motions

impairment of muscle tone

• Just look at their posture while standing and their gait
• Note the pace and rhythm of the gait and the arm swing

• Thumb-Finger
• Index Finger-Index Finger
• Finger-Nose
• Heel-Shin

5/5....normal movement against gravity and resistance

full ROM against moderate resistance and gravity

full ROM against gravity only, NOT against resistance

Can hold hand up, but cant hold it up against resistance

extremity can move...but not against gravity

**can roll but cant lift

muscle contracts but extremity cant move

**spinal cord injury

No visible or palpable muscle contraction or movement of the extremity

• Romberg
• when you push a patient they should sway mildly, but not have a loss of balance.

done with eyes open and closed

2

• 0 is no response
• 4 is hyperactive

Used to assess for a brain or nervous disorder

• Pt. lays supine
• Stroke lateral-plantar aspect of the bottom of the foot with your thumbnail

After the age of 2 it is abnormal to have a positive result with dorsiflexion of the big toe and fanning of other toes

• PMH
• Cerebral Spinal Fluid
• MRI

• Precipitating factors?
• Febrile?
• Neurologic Assessment
• Seizure description:onset, duration, frequency and postictal state

• CBC
• Urinalysis
• Lytes
• CSG
• CT, MRI, PET
• EEG

high incidence with elderly

Phenytoin...cuz is hard on liver and is metabolized in liver causing (antiseizure med)

Phenobarbitol and Primidone affect cognition

• achieve a good balance of exercise and rest
• eat nutritiously
• avoid the hazards of immobility(contractures/pressure ulcers)
• avoid exposure to infections
• know your meds for side effects, interactions and OTC reactions

cuz the thymus increases production of ACh antibodies which attack the ACh receptors not allowing ACh to bind to receptor sites.

30 minutes prior to meal time

• Fatigue
• Ineffective Airway Clearance
• Impaired Swallowing

this occurs from under medication or the body not responding to the medication. 

Adjust or change meds...Tenselon?

this occurs from over medication and allowing too much ACh to be present so muscles stop responding to ACh

• Worsening of Myasthenia symptoms
• Flaccid Paralysis
• Respiratory Failure
• Increased sweating and salivation

Give them Atropine

• increased weakness or paralysis...especially of the diaphragm and chest muscles......
• respiratory failure
• severe ocular or bulbular symptoms

change meds... or go on Tenselon?

coma

they hypothalamus has probably been damaged

The SBP is increasing, but the DBP isn't.

Increased ICP....

Bradycardia

Some say marry money but my brother say big brains matter more

• ALS
• Brain Tumor/injury
• Meningitis
• MS
• Spinal Cord Injury, defect or tumor
• Stroke