1. Introduction to neurological System By Dr. Hanan Said Ali

2. Objectives  Describe the anatomy of nervous system.  Explain the diagnostic studies of the nervous system.  Mention the nursing responsibilities for each diagnostic measures.  Enumerate the Clinical Manifestations of nervous system alteration.

3. Overview about nervous system The nervous system is divided into two anatomical divisions The central nervous system and the peripheral nervous syst. 1.central nervous system (CNS) The (CNS) consists of the brain and spinal cord, The brain divided into three parts, the cerebrum, cerebellum, brain stem. The brain stem consists of the midbrain, Pons and medulla oblongata.

4. Overview about nervous system 2. The peripheral nervous system It consists of all nerves outside the CNS. The cranial nerves, which are 12 pairs. The spinal nerves, which are 31 pairs : 8 cervical, 12 thoracic, 5 lumber, 5 sacral, and 1 coccygeal.

5. The Autonomic Nervous System It consists of the sympathetic nervous system and parasympathetic nervous system. 1. sympathetic nervous system is regulates the expenditure of energy. The neurotransmitters of it known as catecholamine, are epinephrine, norepinephrine, and dopamine. 2. The Parasympathetic Nervous System It works to conserve body energy and is partly responsible for slowing the heart rate, digesting food, and eliminating body wastes. Acetylcholine is a neurotransmitter

6. Diagnostic Studies of the Nervous System 1.Cerebrospinal Fluid (CSF) analysis. Is a clear fluid that is formed in the third, fourth, and lateral ventricles of the brain. (lumber puncture), the normal: ItemsNormal Specific gravity1.007 PH7.35 AppearanceClear, Colourless RBCsNone WBCs0-8/ ul (0.0.oo8/L) ItemsNormal Opening pressure with LP 60- 150 mmH2o Pressure75 to 180 mmH2o Protein Lumber Cisternal Ventricular 15-45 mg/dl 15-25 mg/dl 5-15 mg/dl Glucose45-75 mg/dl. MicroorganismsNone

7. Nursing responsibility while obtaining CSF Assist client to assume and maintain lateral recumbent position with knee flexed. Ensure maintenance of strict aseptic technique. Ensure labelling of CSF specimen in proper sequence. Keep client flat for at least a few hours. Encourage fluids. Monitor neurologic and vital signs. Administer analgesia as needed.

8. Radiological Tests 1.Skull and spine X- rays. To detect fractures, bone erosion, calcification and abnormal vascularity. 2. Cerebral angiography. Involves the injection of contrasts medium into the cerebral arterial circulation from femoral artery for determining aetiology of strokes, seizures, headache, and motor weakness.

9. Cerebral angiography.

10. Radiological Tests Cont. Cerebral angiography Cont. Nursing Responsibility  Inform the client that the procedure takes 1 to 2 hours.  Keep the client fasting for 6 to 10 hours prior to procedure.  Explain that client will have hot flush of head when take dye.  Administer premedication as ordered.  Explain need to be absolutely still during procedure.  Monitor neurologic and vital signs every 15-30 minutes for first H.  Maintain pressure dressing and ice to injection site.  Maintain bed rest until client is alert and vital signs are stable.

11. Radiological Tests Cont. 3. Computed tomography (CT) Scan It is computer assisted X- ray of several levels of thin cross sections of body parts to detect problems such as haemorrhage, tumours, cyst, oedema, infarction. Nursing Responsibility  Explain that the procedure is non-invasive(if no dye is used)  Observe for allergic reactions and note puncture site (dye)  Explain appearance of scanner.  Instruct the client to remain the head absolutely still during pro.

12. Computed tomography (CT) Scan

13. Radiological Tests Cont. 4. Myelography It refers to X-ray of spinal cord and vertebral Column after injection of dye into subarachnoid space to detect spinal lesions (ruptured disk, tumour). Nursing Responsibility  Administer pre-procedure sedation.  Instruct client to empty bladder.  Inform client that test is performed with client on till in table that is moved during test.  Encourage fluids and monitor neurologic and vital signs..

14. Radiological Tests Cont. 5. MRI In MRI internal body parts are visualized by means of magnetic energy. No invasive procedures are required unless contrast material is used. Nursing Responsibility  Screen client for metal parts and pace maker in the body.  Instruct client to be knee to lie very still for up to 1 hour.  Sedation may be necessary if the client is claustrophobic.

15. MRI

16. Radiological Tests Cont. Positron Emission Tomography (PET) Measures metabolic activity of brain regions to assess cell death or damage by using radioactive compounds. Nursing Responsibility  Explain procedure to client.  Explain that two IV line will be inserted.  Instruct client not to take sedatives or tranquilizers.  Empty bladder before procedure.  May be asked to perform different activities during test.

17. Positron Emission Tomography (PET)

18. Electrographic Studies 1.Electroencephalography (EEG) Electrical activity of brain is recorded by scalp electrodes to evaluate cerebral disease, CNS effects of systemic diseases and brain death. Nursing Responsibility  Inform client that procedure is painless and without danger of electric shock.  Withhold stimulants  Inform that client may be asked to perform activities as hyperventilation during test.  Withheld some medication and resume it after test

19. Electrographic Studies 2. Electromyography Nerve Conduction Is an electrical activity associated with nerve and skeletal muscle is recorded by insertion of needle electrode to detect muscle and peripheral nerve disease. 3. Evoked potentials  Refer to electrical activity associated with nerve conduction along sensory pathways is recorded by electrodes placed on skin and scalp. Stimulus generates the impulse.  To diagnose diseases, locate nerve damage and monitor function intraoperatively.

20. Electrographic Studies 4. Visual evoked potentials Refer to electrical activity in visual pathway is recorded with rapidly reverting checkerboard pattern on television screen. One eye is tested at time 5. Brainstem auditory evoked potentials. Refer to electrical activity in auditory pathway is recorded with earphones that produce clicking sounds. One ear is tested at time.

21. Electrographic Studies 6. Somatosensory evoked potentials  Refer to electrical activity in certain nerve pathway is recorded with mild electrical pulse (several per second)  This procedure needs to inform client that stimulus may cause mild discomfort or muscle switch.

22. Ultrasound 1.Carotid duplex studies In which sound waves determine blood flow velocity, which indicates presence of occlusive vascular disease. 2. Transcranial Doppler  Same technology as carotid duplex, but evaluates intracranial vessels.  In these procedures, the nurse needs to explain the procedure to the client.

23. Basic Neurological Assessment  Assess level of consciousness (patient’s response to verbal or tactile stimulation) and orientation.  2. Obtain vital signs (specifically blood pressure, pulse, and respirations).  3. Check papillary response to light.  4. Assess strength and equality of hand grip and movement of extremities.  5. Determine ability to sense touch or pain in extremities.

24. Clinical Manifestations  Pain May be acute or chronic. In general, acute pain lasts for a relatively short period of time.Is associated with spinal disk disease. Chronic pain extends for long periods of time, it occurs with chronic neurological condition.  Seizures Result of abnormal paroxysmal discharges in the cerebral cortex. It occurs when brain affected or by high fever, alcohol or drug withdrawal, or hypoglycaemia.

25. Clinical Manifestations Cont.  Dizziness and Vertigo Dizziness is abnormal sensation of imbalance or movement, it can causes by viral syndromes, hot weather, middle ear infections. Vertigo is an illusion of movement, usually rotation, it can so sever as to result in light- headache, loss of equilibrium, and nausea and vomiting.

26. Clinical Manifestations Cont.  Visual Disturbance It can ranged from the decreased visual acuity associated with aging to sudden blindness caused by glaucoma.  Weakness Specifically muscle weakness, it can be sudden and permanent, as in stroke, or progressive,as in sclerosis.

27. Clinical Manifestations Cont.  Abnormal Sensation  Numbness, abnormal sensation, or loss of sensation is a neurologic manifestation of both central and peripheral nervous system disease.  It is frequently associated with weakness or pain.  Both numbness and weakness can significantly affect balance and coordination.

28. Thank You