1. Chapter 24 Neurologic Function

2. Introduction
Nervous system and its effect on interactions with the world
Every aspect of activities of daily living (ADLs) depends on a good neurologic status
Dysfunction of the neurologic system has a profound impact on other body systems and general well-being

3. Effects of Aging on the Nervous System
Loss of nerve cell mass
Atrophy of the brain and spinal cord
Brain weight decreases
Number of dendrites declines
Demyelinization
Slower nerve conduction
Response and reaction times are slower
Reflexes become weaker

4. Effects of Aging on the Nervous System (cont.)
Plaques, tangles, atrophy of the brain
Free radicals accumulate
Decrease in cerebral blood flow
Fatty deposits accumulate in blood vessels
Ability to compensate declines with age
Intellectual performance maintained until at least 80 years of age

5. Effects of Aging on the Nervous System (cont.)
Slowing in central processing
Delay in time required to perform tasks
Verbal skills maintained until age 70
Number and sensitivity of sensory receptors, dermatomes, and neurons decrease
Dulling of tactile sensation
Decline in the function of cranial nerves affecting taste and smell

6. Question Is the following statement true or false?
Cerebral blood flow decreases by 50% in older adults.

7. Answer
False
Rationale: Cerebral blood flow decreases about 20% as fatty deposits gradually accumulate in the blood vessels. Decreases are even greater in persons with small-vessel cerebrovascular disease due to diabetes and hypertension; this contributes to an increased risk of strokes.

8. Neurologic Health Promotion
Many neurologic disorders occur for reasons beyond a person’s control
Risk factors
Preventive measures for neurologic health
Nurses can detect new or subtle symptoms of neurologic disorders
Nursing assessment of neurologic function
Nursing diagnoses

9. Subtle Indications of Neurologic Problems
New headaches that occur in the early morning or interrupt sleep
Change in vision (e.g., sudden decreased acuity, double vision, and blindness in portion of visual field)
Sudden deafness, ringing in ears
Mood, personality changes
Altered cognition or level of consciousness
Clumsiness, unsteady gait
Numbness, tingling of extremity
Unusual sensation or pain over nerve

10. Parkinson’s Disease (PD)
Affects ability of the central nervous system (CNS) to control body movements
Role of dopamine
Incidence/prevalence
Exact cause unknown; some theories
Signs and symptoms
Secondary symptoms

11. Parkinson’s Disease (PD) (cont.)
Treatment/management
Anticholinergic medications
Technologies to control symptoms
Nursing interventions
Education
Psychosocial
Physical
Goal: maximum level of independence preserved

12. Tremors and Shuffling Gait Are Characteristic of Parkinson’s Disease.

13. Question Is the following statement true or false?
Secondary symptoms of PD include depression, sleep disturbances, dementia, drooling, and dysphagia.

14. Answer
True
Rationale: Secondary symptoms of PD include depression, sleep disturbances, dementia, forced eyelid closure, drooling, dysphagia, constipation, shortness of breath, urinary hesitancy, urinary urgency, and reduced interest in sex.

15. Transient Ischemic Attacks (TIA)
Temporary or intermittent reduction in cerebral perfusion
Causes
Signs and symptoms
Minutes to hours
Recovery is usually within 1 day
Treatment/management of underlying cause
Increased risk of cerebrovascular accident

16. Question Is the following statement true or false?
Signs and symptoms of a transient ischemic attack can last for several days and complete recovery is usual within 1 week.

17. Answer
False
Rationale: Signs and symptoms of a TIA (hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia) depend on the location of the area of ischemia and can last from minutes to hours and complete recovery is usual within 1 day.

18. Cerebrovascular Accident
Third leading cause of death in older adults
Predisposing factors
Types and cause:
Ischemic
Hemorrhagic
Warning signs
Drop attack

19. Cerebrovascular Accident (cont.)
Prompt medical evaluation
Signs and symptoms
Variable
Depend on the area of brain affected
Nursing care during the acute phase
After patient stabilization, focus is on rehabilitation

20. Cerebrovascular Accident (cont.)
During rehabilitation, problems vary depending on the side of the brain affected
General observations
Nursing interventions
Community resources

21. Question Which of the following best describes a drop attack?
Fall caused by flaccidity in the legs
Fall caused by loss of consciousness
Fall caused by incontinence
Fall caused by mental instability

22. Answer A. Fall caused by flaccidity in the legs
Rationale: A drop attack is a fall caused by a complete muscular flaccidity in the legs, without an alteration in consciousness.

23. Nursing Considerations for Neurologic Conditions
Promoting independence
Assistive devices
Periodic home visits
Regular contact with family and friends
Promoting self-care
Patience, reassurance, and encouragement

24. Nursing Considerations for Neurologic Conditions (cont.)
Promoting independence (cont.)
Personality problems may occur
Depression related to dependence
Loss of former roles and identities
Displaced reactions
Need to educate family members and friends

25. Question Is the following statement true or false?
Persons who have experienced a cerebrovascular accident may experience depression and irritability toward others.

26. Answer
True
Rationale: Personality changes often accompany neurologic problems. Patients may become depressed as they realize their limitations and become frustrated by their need to be dependent on others. Their reactions may be displaced and evidenced by irritability toward others, often their loved ones or immediate caregivers.

27. Nursing Considerations for Neurologic Conditions (cont.)
Preventing injury
High risk of accidents
Avoiding hazards
Safety considerations
Evaluate the environment for danger
Prevention of complications