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INTRACRANIAL REGULATION, Can be separated into two parts: central nervous…
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Neuron: basic cell of the nervous system that are highly specialized and send impulses through the body
Central nervous system
- consists of the brain and the spinal cord
- brain regulates homeostasis within the body and controls basic functions
- protected by protective membranes known as meninges
- cerebrospinal fluid cushions the brain and spinal cord; CSF is closely regulated by the brain
- blood brain barrier protects the CNS by preventing neurotoxins from passing through the bloodstream to the brain; becomes permeable during inflammation and can lead to infections
- brain has 4 parts: cerebrum, cerebellum, diencephalon, and brainstem
- cerebrum: largest part; contains the 4 regions known as lobes (frontal, parietal, occipital, and temporal)
- folds in the brain help to maximize surface area
- cerebellum: controls muscle movement and balance
- diencephalon: contains thalamus and hypothalamus
- brainstem: controls reflexes and influences basic life functions (breathing, blood pressure, and heart rate)
- spinal cord: extension of brain stem
Peripheral System
- 12 pairs of cranial nerves and 31 pairs of spinal nerves
- Cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, hypoglossal
- all spinal nerves produce both motor and sensory activities
- each nerve is responsible for a different segments of the body, called a dermatome
- reflexes: involuntary, instantaneous motor responses to a stimulus
- follows the reflex arc (neural pathways)
- somatic reflex: skeletal muscle contraction
- autonomic reflex: smooth muscle contraction
Acid-base balance
- breathing is controlled by nerves and can impact CO2 levels; impacting acid-base
Cognition
- altered intracranial regulation can lead to impaired cognitive function (confusion, no LOC, etc.)
Mobility
- depending on alterations to intracranial regulation and nerves, certain movements may be affected
- causes complications with mobility
Oxygenation
- complications with regulation can lead to complications with respirations
Safety
- decreased intracranial regulation could lead to confusion, which could cause safety risks
- seizures can put a patient at risk
Stress and coping
- can be very scary complications, can cause stress in the progress of navigating them and their effects
Can be done during a health screening or a part of a total health assessment; should be completed as early as possible during assessment process
Glasgow Coma Scale for assessment
- eye opening
- verbal response
- motor response
Observation and patient interview
- lots can be told by careful observation of the patient
- how they are dressed and appear
- how they walk
- facial movements and speech patterns
- alertness and general comprehension
- cannot draw conclusions, but can be helpful
- patient interview should ask the specific questions, important to not leave anything out
Physical examination
- some parts can be done by general observation and not formal process
- assessment of cranial nerves, mental status, reflexes, muscle strength and coordination, and gait
- note symmetry between sides of the body
- full neuro assessment is not usually performed on otherwise healthy patients
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- CT scan
- MRI
- X-ray
- EEG
- Ultrasonography of the brain
- brain echography
- cerebral angiography
- positron emission
- PET Scan
- nerve conduction studies
- myelography
- CSF assessment
- serum glucose testing
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Primary interventions
- maintaining patent airway
- initiating protocols to treat neurologic issues
- prepare for surgical interventions
Along with vital signs...
- assess LOC and neuro status
- monitor fluid IO's
- reduce environmental stimuli
- raising head of bed to 30 degrees
- taking precautions for seizures
- deep vein thrombosis prophylaxis
- administering IV fluids as needed
Collaborative interventions
- management of IV fluids
- aware of possible surgeries and when they would apply
- pharmacologic therapies for seizures
- nutrition management
Infants
- assessing head circumference
- testing reflexes is the best way to identify neurological complications early
- looking for IICP; could be due to shaken baby syndrome (child abuse)
Children
- causes of IICP are similar to other age groups
- trauma, infection, tumors, certain meds, or endocrine problems
- look for changes in behavior, difficulty waking, nausea, vomiting, stiff neck, or uncoordinated movements
Pregnant woman
- require close monitoring by their obstetrician and neonatologist
- may require special ethical assistance
Older Adults
- often go unnoticed in older adults
- confused with normal changes; memory loss, loss of coordination, slower reflexes
- careful assessment is necessary
- sometimes marks end of independence, may be a source of depression
- allow extra times for responses in interviews
- most common cause is falls