Perception and Coordination
Perception and Coordination
II. Diencephalon
• Embedded in the brain superior to brain stem
• Thalamus-process sensory impulses before it
reaches cerebral cortex
• Hypothalamus-regulates endocrine and
autonomic function, temperature, water
metabolism, appetite, emotion, sleep-wake cycle
and thirst
• Epithalamus-includes pineal gland (secretes
melatonin and inhibits LH), part of endocrine
system, affects growth and development.
V. Spinal cord
• Sympathetic Nervous System
• Extends from medulla up to first lumbar
originates from lateral horns of first
vertebra
thoracic through the first lumbar of
• Gives rise to 31 pairs of spiral nerves (C1-
spinal cord (thoracolumbar)
C8, T1-T12, L1-L5, S1-S5, coccygeal nerve) helps the body cope with events in the
• Center for conducting messages to and from external environment
the brain; a reflex center Functions mainly during stress,
triggering the fight or flight response
Divisions: Increases heart rate and respiratory
rate, pupil dilation, cold, and sweaty
Ascending (Spinocerebellar) palms
• Carry a specific sensory information to
higher levels of CNS
• Parasympathetic Nervous System
• Spinocerebellar tracts-muscle tension and
Consist of the vagus nerves originating
body position
in the medulla of the brain stem and
• Spinothalamic-pain and temperature
spinal nerves originating from the
sensation
sacral region of the spinal cord
(craniosacral)
Descending (Corticospinal)
Activates GI system
• Pyramidal tracts-from the cortex to cranial
Supports restorative, resting body
and peripheral nerves; inhibits muscle tone
function through such actions as
• Extrapyramidal tracts-from brain stem,
replenishing fluids and electrolytes
basal ganglia, and cerebellum; maintains
muscle tone and gross body movements
Effect organ Sympathetic Parasympathetic
• Upper motor neurons-from cerebral cortex
Heart Increased rate Decreased rate
to anterior gray column of SC; spasticity
and contractility and contractility
and hyperactive reflexes
Lungs Relaxation Contraction
• Lower motor neurons-“final common
GIT
pathways” from anterior gray column up to
• Motility Decreased Increased
muscles; flaccidity and loss of reflexes
• Tone Contraction Relaxation
VI. Reflex arc sphincter
s
• Reflexes-automatic action; spinal cord
Urinary bladder
mediates most reflexes
• Bladder Relaxation Contraction
• Automatic or perceptible, inhibited or
muscle
conditioned
• Sphincter Contraction Relaxation
• Hyperreflexia-disease or injury of Liver Glycogenolysis None
certain descending motor tracts
• Hyporeflexia-damage or
degeneration of the sensory or
Sensory System (General and special)
motor neurons
Type of receptors:
1. Exteroreceptors
Peripheral Nervous system 2. Interoreceptors
• Cranial nerves-innervate head and neck 3. Proprioceptors-specific receptors to detect balance,
region, except the vagus nerve sense of position
• Spinal nerves 4. Mechanoceptors-detect pressure, touch (any
• Plexuses-complex cluster of nerve stimulus that is physical in nature)
fibers (cervical, brachial, lumbar 5. Thermoreceptors-any changes in temperature
and sacral region) 6. Photoreceptors-light stimulus
7. Chemoreceptors-taste, olfactory, pancreatic enzymes
8. Nociceptors-severe stimulus
9. Cutaneous receptors-touch
• Loudness- Neurologic or psychologic
Special senses: interpretation of intensity; the greater
• Sense of Sight intensity of the sound waves stimulating
the organ of Corti, the greater will be
• Collect light waves and transmit them as the size of nerve impulses
impulses to the brain, which translate
them into images Decibels(dB)-unit of measure of intensity of sound
• Normally form of a clear retinal image of Normal conversation= 65 dB
an object at 20 ft. away Amplified rock music= 120 dB
• Binocular vision—ability to judge relative, Nearby jetplane= about 140 dB
distances of objects
Pitch
Anatomical features of the Eyeball •Corresponds to frequency; the higher the
Outer: frequency the higher the pitch of the sound
1. Cornea-thin, tough, transparent layer supplied •Humans can potentially hear sounds whose
with sensory nerve (touch and pain), no blood frequency range from 16 to 2000 Hz
supply, oxygen and glucose through diffusion •Upper range decreases slight with increasing age
2. Sclera •Speech falls in the range of 85-1050 Hz
Inner:
3. Movement of the malleus to the incus
1. Retina-neural tissue, phagocytic, stores Vit. A, 4. As the incus moves, it moves the stapes against the
contains rods and cones oval window, it starts a ripple on the perilymph
2. Fovea-responsible for highly colored vision 5. Movement of the perilymph is transmitted to the
endolymph muscle inside the cochlear duct and
Refraction stimulates the organ of Corti
• bending of light when it meets surfaces of 6. Cochlear nerve conduct impulses from the organ of
different medium Corti to the brain; hearing occurs when impulses
reaches auditory area in the temporal lobe of
cerebral cortex
Refractory media of the Eye
1. Cornea-performs most of the refraction because of
its convex form
2. Aqueous humor-fluid at the anterior and posterior
Mental Status Examination
chamber of the anterior cavity • An indication of how patient is functioning as a whole
3. Crystalline lens-greatest refractive power and how the patient is adapting to the environment
4. Vitrous humor- thick, gelatinous fluid found at 1. General appearance
posterior chamber, give spherical shape to the eye 2. State of consciousness
• Arousal component
Physiology of Vision • Content component
Formation of an image on the retina accomplished by the 3. Mood and effect-changes in the nervous system
following: 4. Thought content
1. Refraction 5. Intellectual capacity
2. Accomodation
3. Constriction of pupils NEUROLOGIC ASSESSMENT
4. Convergence of eyeballs I. Comprehensive History Taking
• Demographic Data
Stimulation of retina • Current health
•Dim light causes breakdown of the chemical • Past health history
rhodopsin present in rods
• Medication history
•Cones-responsible for daylight and color vision
•Perception of color is dependent on the cones • Growth and development
•Most cones concentrated on fovea centralis • Family health history
•Condition to central area in occipital lobe • Psychosocial history
II. V/S
• Sense of Hearing III. Mental Status Assessment
Parts of the ear • LOC
1. Outer-collects sound • Orientation
2. Inner-conducts sound • Memory
•Eustachian tube • Mood/affect
• joins the middle ear and nasopharynx • Intellectual performance
• transmit sound waves and maintain • Judgment/Insight
equilibrium • Language/communication
Interpretation of sound
IV. Motor System assessment-muscle strength,
tone, coordination, gait and station movement
• Cranial nerve III, IV, VI (Oculomotor, Trochlear,
V. Sensory Function-superficial sensation, Abducens)-motor nerves that arise from the brainstem
touch/pain, temperature, proprioception, 1. Nystagmus –- involuntary eye movement;
discrimination strokes of anterior, inferior, superior,
VI. Reflex activity cerebellar arteries
VII. Cranial nerve testing 2. Constricted pupils: may signify impaired
blood flow to vertebralbasilar arteries.
3. Ptosis (eyelid falldown); dropping of the
MENTAL STATUS ASSESSMENT WITH ABNORMAL upper eyelid over the globe—strokes of
FINDINGS posterior inferior cerebellar artery;
myasthenia gravis, palsy of CN III
Brain Death
GLASGOW RESPONSE
1. Cessation and irreversibility of all brain functions
Eye opening responses
4 Opens eyes spontaneously 2. General criteria:
3 Opens eyes in a. Absent motor and reflex movements
response to voice 2 Opens eye in b. Apnea
response to painful stimuli 1 Does not c. Fixed and dilated pupils
open eyes d. No ocular responses to head turning and caloric
Best verbal response stimulation
5 Oriented e. Flat EEG
4 Confused
3 Utters inappropriate words NURSING DIAGNOSIS
2 Incomprehensible words • Ineffective airway clearance: limit
1 None suctioning to <10-15 seconds,
hyperoxygenate
• Risk for aspiration
• Risk for impaired skin integrity: preventive
measures, continual inspection
• Impaired physical mobility: maintain
B functionality of joints, physical therapy
est • Risk for Imbalanced Nutrition: Less than
motor response body requirements
6 Obeys command • Anxiety (of family)
5 Localizes pain
4 Withdraws with painful stimuli
3 Flexion (Decorticate posturing) ICP
2 Extension (Decerebrate posturing Increased blood volume, increased brain volume,
1 None increased CSF volume
Total 3-15 Normal pressure: 5-15 mmHg, with pressure
14 – no impairment tranducer with head elevated 30˚; 60-180 cmH20,
3 – compatible with brain death water manometer with client lateral recumbent
7 – state of coma Sustained increases associated with:
a. Cerebral edema
MOTOR FUNCTION ASSESSMENT b. Head trauma
a. Client follows verbal commands c. Tumors
b. Pushes away purposely from noxious stimuli d. Abscesses
e. Stroke
c. Movements are more generalized and less purposeful
f. Inflammation
(withdrawal, grimacing) g. Hemorrhage
d. Reflexive motor responses
e. Flaccid with little or no motor response
Factors that Increases ICP
• Hypercapnea, hypoxemia
COMA • Cerebral vasodilating agents
• Valsalva maneuver; coughing or sneezing
Irreversible coma - vegetative state • Body positioning (prone, neck flexion,
• Permanent condition of complete unawareness extreme hip flexion)
of self and environment, death of cerebral • Isometric muscle contraction
hemispheres with continued function of brain • Emotional upset; noxious stimuli
stem and cerebellum • Arousal from sleep
• Client does not respond meaningfully to • Clustering of activities
environment but has sleep-wake cycles and • Pain and agitation
retains ability to chew, swallow and cough
ICP 2. Risk for infection: open head wounds and intracranial
monitor device requires meticulous aseptic technique
Cranial insult Tissue edema Increased ICP 3. Anxiety (family)
• Severe hypertension
• Headache
Parkinson’s Disease
(fourth common
• Flushed skin
neurodegenerative disease)
• Diaphoresis • Degeneration of dopamine-providing cells in the
substantia nigra, which leads to degeneration of
• Nasal Congestion neurons in the basal ganglia; usually develops after
60 age
Management
• Associated with decreased levels of dopamine due to
1. Place in high-Fowler’s position
destruction of pigmented neuronal cells in the
2. Ensure patency of urinary drainage and assess substantia nigra in the basal ganglia of the brain
(Smelzer & Bare, 2004, p. 1979)
for infection.
4. Constipation r/t the injury, inadequate fluid 2. Rigidity-resistance to passive limb movement
intake, diet low in roughage and immobility
3. Bradykinesia-most common features; patients
5. Urinary retention take longer to complete most activities and have
difficulty initiating movement
6. Impaired physical mobility
8. Altered nutrition less than body requirements r/t • Mild, diffuse muscular pain
increased metabolic demand
• Hand tremor at rest (pill rolling)
9. Sexual dysfunction r/t inability to achieve
erection or perceive pelvic sensations
• Akinesia
Physical therapy
Medical Management
• Levodopa-Carbidopa T-synthetic precursor of • Believed to be due to reduced acetylcholine
dopamine for basal ganglia (Sinemet) receptors due to destruction and blockage attributed
to autoimmune process
• Anticholinergic-to control symptoms (Cogentin,
Artane, Symmetrel); anticholinergics drugs act • An autoimmune disorder, characterized by varying
at central sites to inhibit cerebral motor
degrees of weakness of the voluntary muscles
impulses that cause rigidity of themusculature
(Smeltzer & Bare, 2004, p. 1956)
• MAOI-Bomcriptine; inhibit breakdown of
dopamine • Highest in young adult females.
• Assist client in setting achievable goals to X-ray or surgical removal of thymus (thymectomy)
improve self-esteem
Paresthesia
Diplopia
Meningitis
• Inflammation of pia matter, arachnoid and
Objective subarachnoid space
Ascending paralysis within the body usually
24-72 hours • Spreads rapidly through CNS because of circulation
of CSF around brain and spinal cord
Respiratory paralysis
• May be bacterial, viral, fungal, parasitic in origin
Hypertension, tachycardia and low grade
fever • Infection enters CNS though invasive procedure or
through bloodstream, secondary to another infection
Incontinence in body
Viral Meningitis
• Less severe, benign course with short duration,
intense headache with malaise, nausea, vomiting,
Skeletal muscle
lethargy, signs of meningeal irritation
• Attach to the skeleton
Encephalitis • Permits voluntary movements
1. Acute inflammation of parenchyma of brain or spinal
cord
• Maintain posture
2. Usually caused by virus
• Generates heat
2. Prophylactic rifampins for persons exposed to 2. Muscles are attached to at least 2 bones; with each
meningococcal meningitis contraction, muscle’s insertion bone moves and the
muscle origin bone remains stationary
3. Mosquito control
3. Bone serve as levers; joint as fulcrums
4. Prompt diagnosis
Classification:
Hydrocephalus Closed-no break in the skin
• Increase in volume of CSF within ventricular system,
which becomes dilated Open-
2. Communicating: CSF is not effectively reabsorbed Incomplete e.g. greenstick, the break
through arachnoid villi occurs through only part of the cross-
section of the bone
3. Normal pressure hydrocephalus: occurs in
persons>60 in which ventricles enlarge causing Displaced
cerebral tissue compression
Comminuted-several bone fragments
Impacted or compression
Complicated-accompanied by infection
Purposes:
Pathologic-systemic, loss of bone density 1. Immobilization
4. Analgesics-Opioid analgesics
Cast care
5. Rehabilitation Keep cast dry; use plastic when bathing
Cast Application
Use of slings/crutches to enhance comfort safety and Principles of Effective Traction
ambulation Traction must be continuous to be effective in
reducing and immobilizing fractures
Reportable conditions:
- Increased swelling
Skeletal traction is never interrupted
4. Pelvic
Nursing Care of Clients with Braces or
5. Buck’s traction (unilateral or bilateral) is skin Splints
traction to the lower leg
1. Check body and equipment alignment
6. Russel’s – one leg is higher than the other
2. Keep equipment in good condition
Care of Client
1. Know the purpose and contraindicated movements
Joints may be unstable; may feel faint or weak Tip of the cane 15 cm (6 inches) lateral to
for a while the base of the fifth toe (Smeltzer & Bare,
2004, p. 174)
4. Ensure proper techniques Disease involving degeneration and or
inflammation of joints and surrounding
Opposite affected extremity structures
Affected extremity cane simultaneously Out of 100 types of with unknown cause
Crutch Osteoarthritis
Nursing care Autosomal recessive trait causing cartilages to
1. Ensure readiness of client wear out or repair less effective; localized; NO
synovial membrane swelling
Strength of upper torso
o Wear and tear of joints
Psychological fitness
o Obesity; joint trauma
2. Ensure proper fit
o Aging: 55 years old and above
Axillary bars 5 cm (2 inches below axilla),
15 cm (6 inches infront and lateral) tripod o Degeneration and atrophy of the
position cartilage and calcification of ligaments
Arthritis
Rheumatoid Arthritis
Systemic with synovial membrane inflammation bone slips over another and eliminates the joint space
with blood, fibrin, and coagulation deposits (Smeltzer & Bare, 2004, p. 1621)
2. Organ meats
3. Meat extracts
Surgical intervention
1. Arthrodesis-surgical fusion of a joint to render a joint
immobile but decreases pain and increases strength
Assistive devices:
1. Eating utensils
2. Braces
3. Walkers
4. Cane-single, quad
Therapies
1. Diversion
3. TENS
Nursing Diagnosis
• Chronic pain related to joint degeneration
• Activity intolerance
• Self-care deficit
• Knowledge deficit