3. Jane Bordner, Rn, BSN NURSING INSTRUCTOR HACC, Central Pennsylvania’s Community College N100 SPRING 2015

4. To detect changes and feel sensations To initiate appropriate responses to change To organize information for immediate use and store it for future use

5. Works with endocrine system to maintain homeostasis Two principle divisions: Central nervous system Brain Spinal Cord Peripheral nervous system Cranial Nerves Spinal Nerves

6. http://www.youtube.com/watch_popup?v=i- NgGKSNiNw&pop_ads=null http://www.youtube.com/watch_popup?v=i- NgGKSNiNw&pop_ads=null http://www.youtube.com/embed/i- NgGKSNiNw

7. Cell body Axon Dendrite Synapse Neurotransmitter

9. INFO OUT

10. Glial cells Neurons

11. INFO IN INFO OUT

12. http://www.youtube.com/w atch_popup?v=i- NgGKSNiNw&pop_ads=null http://www.youtube.com/w atch_popup?v=i- NgGKSNiNw&pop_ads=null

14. Synapse junction between 2 neurons Communication electrical chemical activity Neurotransmitters chemicals that conduct messages (impulses) across junction

15. http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C

17. http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://www.mind.ilstu.edu/curriculum/neurons_intro /neurons_intro.php http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C http://media.pearsoncmg.com/bc/bc_campbell_biolo gy_7/media/interactivemedia/activities/load.html?48 &C

18. Sensory- Afferent Carry impulses from receptors to the CNS Motor – Efferent Carry impulses from CNS to effectors Confusing because they both sound the Sensory=Afferent SAME Motor=Efferent SAME

19. Brain Spinal cord Myelin Gray Matter White Matter

20. 12 cranial nerves 31 spinal nerves Sensory organs

21. 3 Major Portions Cerebrum Cerebellum Brain Stem

22. http://www.youtube.com/watch?v=snO68aJTOpM

23. 2 hemispheres Corpus callosum: White matter 200 million nerve fibers Bridge sending messages between 2 halves

24. Cerebral cortex: Surface layer of gray matter Covers each hemisphere Folded with fissures and sulci Most of conscious activity

25. Frontal Motor area controlling opposite side of body Left frontal = Broca’s motor speech area Parietal Sensory area Left side = thought that precedes speech Occipital Visual area Temporal Hearing, smell, and taste Left side = thought that precedes speech

27. Basal ganglia Gray matter Deep in cerebral hemispheres Regulates muscle tone Inhibits tremors Subconscious voluntary movements

28. Muscle movement Balance Equilibrium Cerebellum

29. Midbrain Connects pons and cerebellum Pons Connects cerebellum with brain stem, spinal cord and cerebrum Medulla Transmits motor impulses from brain to spinal cord Transmits sensory impulses from peripheral sensory neurons to brain Cross over of motor and sensory pathways Respiration and cardiac centers

30. Midbrain Hypothalamus Pituitary gland

31. Connective tissue Three layers (membranes) Dura mater (outer layer) Arachnoid membrane (middle layer) Pia mater (inner layer )

32. 4 hollow structures Manufacture and absorb Cerebrospinal fluid (CSF) Choroid plexus CSF acts a shock absorber

34. Reflex action Provides motor activity without sending signals to brain Protective

35. http://www.bbc.co.uk/schools/gcsebitesize/science/aq a/human/thenervoussystemrev3.shtml http://www.bbc.co.uk/schools/gcsebitesize/science/aq a/human/thenervoussystemrev3.shtml

37. Pathway for impulses to and from brain Somatic Nervous System = (Voluntary) Conscious control Autonomic Nervous System = (Involuntary) Unconscious control

38. 2 Divisions Work together to maintain homeostasis Sympathetic (fight or flight) Neurotransmitters = epinephrine/norepinephrine Parasympathetic (rest and digest) Neurotransmitter = acetylcholine

39. Cranial nerves 12 pairs Mostly head and neck Sensory, motor, or both Attached in brain and pass through openings in skull

40. V (trigeminal) & VII (facial) = blink reflex IX (glossopharyngeal) & X (vagus) = gag reflex II (optic) & III (oculomotor) = pupil size and response III (oculomotor) & IV (troclear) & VI (abducens) = extraocular eye movements

41. Movements synchronized and smooth without nystagmus

42. Spinal nerves 31 pair 8 cervical 12 thoracic 5 lumbar 5 sacral 1 very small coccygeal

43. Sensory Motor Spinal cord

45. Level consciousness Orientation Coordination Muscle Strength Sensation Movement Speech/Swallowing Body Temperature

46. Describes state of awareness and response to stimuli 5 levels of consciousness

47. Conscious/Alert/Wakeful Lethargic/Drowsy/Obtunded Stuporous Semi-conscious/semi-comatose Comatose/ Unresponsive

48. Determined in 3 spheres Person Place Time Ability to think and reason Terms Disoriented Confused Memory loss (short-term/long-term)

49. Ability to move extremities and body parts voluntarily in a balanced coordinated manner Problem in one body part or all body parts Terms Gait Tremors Ataxia

50. Always assess bilaterally Terms Paresis Hemiparasia Atrophy Contraction Contracture Flaccid

51. Disturbance of sensory perceptions Terms Paresthesia Numbness Pain Neuropathy Radiculopathy

52. Act of changing position of body or its parts Active/Passive movement Terms Paralysis Plegia Hemiplegia Paraplegia Quadriplegia

53. Controlled by cerebral cortex Broca’s speech center Terms Dysphasia Dysarthria Dysphonia Aphasia

54. Types of Aphasia Expressive (Broca’s or Motor) Receptive (Wernicke’s or Sensory) Amnesic Global

55. Process that moves food from mouth through pharynx and esophagus to stomach Complicated act Initiated voluntarily Must be able to move tongue and palate Pharynx must respond appropriately to stimulation Terms Dysphagia

56. Speech Therapy assessment Avoid distraction while eating Small bites Need to stay with client High fowlers position Avoid straws Feed slowly Swallow twice after each bite Use thickening agents as needed

57. Controlled by hypothalamus Balance between heat production/heat loss Heat Production Metabolism Muscle activity Heat loss Sweating Vasodilation

58. Normal range: 97 – 100.4 F Elderly lower Infants higher Lowest in morning Highest in late afternoon

59. LOC and Orientation Cranial nerves Motor Response Pupils Vital Signs

60. Arousal (wakefulness) Alert Lethargic/somnolent/obtunded Stuporous Semi-conscious Unresponsive/comatose Awareness Orientation Attention span Speech (clear/coherent/incoherent/slurred Memory

61. I to XII Mnemonic Cranial Nerves Review

62. http://www.youtube.com/watch?v=-J9QEddbJAU http://www.youtube.com/watch?v=0lbwshg_Kj4

63. Normal motor response Follows verbal commands Abnormal Localizes pain Flexion to pain (decorticate position) Extension to pain (decerebrate position) No response

64. BABINSKI RESPONSE

65. Strength Can only test if they have normal motor response Normal Weak None

66. Equality Anisocoria Grossly unequal is abnormal Size: Always check before shining light in eyes Measure in millimeters (mm) Constricted Normal Dilated

68. Reaction Turn pen light on only when directly in front of pupil Remember blind eyes will not react Record results: Normal = brisk reaction, pupil goes from dilation to constriction rapidly Abnormal = sluggish or no reaction

69. Accommodation Pupils adjust to let in more or less light given distance of object from eye Assess Have patient focus on a distant object Have client look at close object

70. Blood pressure Heart rate Respirations Temperature Late and serious sign Cushing’s Triad Widening pulse pressure SBP DBP Bradycardia Cheyne-Stoke Respirations

71. Glasgow Coma Scale

72. http://www.bt.cdc.gov/masscasualties/pdf/glasgow- coma-scale.pdf

73. CT SCAN PET SCAN MRI OTHERS

79. Normal Myelogram Abnormal Myelogram

82. Result of pressure from contents of skull Amount of brain tissue Intracranial blood volume Intracranial CSF volume Change in any one change in pressure Normal range is small

83. Minor changes cause no difficulty Sustained and continuous increased ICP permanent brain damage death

84. Increased pressure in skull Compresses brain tissue Impairs circulation of blood and CSF Swelling of brain cells (cerebral edema) Eventually death Result from Brain tissue injury (CVA, head trauma) Tumors Aneurysms Surgery to head and face

86. Change in LOC*** Behavior changes; restlessness, irritability*** Headache Nausea and Vomiting (projectile) Changes in speech pattern*** Pupillary changes Cranial nerve dysfunction Ataxia ***Earliest Signs***

87. Seizures Cushing’s Triad Abnormal posturing Chronic elevated ICP Blindness Deafness Paralysis Mental retardation

88. GOAL: quickly lower pressure in skull Drugs to decrease edema in brain Osmotic diuretic (mannitol) Loop diuretic (Lasix) Corticosteroids Restrict fluids Hyperventilation: induce respiratory alkalosis and vasoconstriction

89. HOB elevated at all times Control fever Complete bedrest Decreased environmental stimuli Padded siderails Prevent vomiting, coughing, straining May need surgery to relieve

90. Trauma Accidents Assults

91. Concussion Hemorrhage Epidural hematoma Subdural hematoma

92. Convulsion/Seizure: episode of abnormal motor, sensory, or autonomic activity or any combination, that causes sudden excessive discharge from cerebral neurons Part or all of brain may be involved

93. Idiopathic Genetic Developmental Head Injury Tumors Fever Hypoglycemia Hypoxia

94. Describe circumstances before Time of seizure Type of movement seen? Did patient experience an aura? Incontinence of urine or feces? Confusion afterward and how long it took to clear?

95. Protect airway Prevent injury Provide privacy DO NOT try to restrain NEVER force anything into mouth

96. Vital signs Assess LOC Reorient Pad siderails Offer emotional support Allow sleep and rest Attempt to determine cause Call physician

97. Absence (petite mal) Usually seen in children Loses consciousness momentarily May see twitching of eyes and mouth Brief lapse of attention Blank empty facial expression

98. Simple Partial Seizures (Jacksonian) Seizure activity limited to a certain group of muscles On one side of body No loss of consciousness

99. Complex Partial Seizures (psychomotor) Loss of consciousness Perform repetitive purposeless movements May make unintelligible sounds

100. Generalized seizures (tonic-clonic, Grand mal) Involves both hemispheres of brain Intense rigidity of body with jerking movements

101. Status Epilepticus Seizure activity lasting longer than 30 min Medical Emergency IV Valium or Ativan

102. Treat underlying cause Drug therapy phenytoin (Dilantin) phenobarbitol (Luminal) carbamazepine (Tegretol) valproic acid (Depakote) gabapentin (Neurontin) topiramate (Topamax)

103. DO NOT discontinue drug therapy suddenly Therapeutic blood levels must be reached and maintained to control seizures Major side effect = Sedation

104. Primary vs. Secondary Transient Recurrent

105. Persistent muscle contraction Cerebral vasodilation maybe involved Causes musculoskeletal abnormalities psychosocial stressors

106. Symptoms Pain Pressure Aching Tightness Treatment Symptom management

107. Due to cerebral vasoconstriction followed by vasodilation Tendency is hereditary Triggers

108. Symptoms Aura Neck pain Throbbing Boring Pounding Unilateral Noise and light exacerbate

109. Classic Prodromal phase Common No prodromal phase

110. Prophylactic Dietary restriction Medications that prevent vaso changes NIFEdipine (Procardia) propranolol (Inderal) amitriptyline (Elavil)

111. Direct Vasoconstrictor ergotamine (Cafergot) Serotonin receptors sumatriptan (Imitrex) zolmitriptan (Zomig)

112. H/A occurs in clusters Unilateral throbbing and excruciating Quiet, dark and cold compresses NSAIDS and tricyclic antidepressants

113. History and symptoms MRI CT X-ray Arteriogram EEG Lumbar puncture

114. Assess – WHAT’S UP ID triggers/aggravating factors Stress reduction Relaxation Heat or cold therapy Quiet/dark environment Teach about medications

115. Disruption of nerve tracts Sensory loss Altered activity Autonomic nervous system dysfunction

116. Loss of all reflex activity below the level of the injury Lasts a few weeks Resolution=reflex activity returns

117. Immobilize head and spine Maintain airway Decrease inflammation Skin care ROM Bladder/bowel

118. Reflex response to stimulation of the symapthetic nervous system. Seen in injuries above T-6 Rise in BP Noxious stimuli Over distended bladder,bowel,decubitus,ulcer,chilling

119. Headache Hypertension blurred vision Bradycardia Goose bumps convulsions

120. HOB elevated to decrease ICP Find source of stimuli Monitor BP Administer antihypertensives as ordered

127. C:\Documents and Settings\User\My Documents\Neuroscience For Kids - Explore the nervous system.mht