Lecture Notes: Neurologic System Evaluation

Understanding the Basics

• Nervous System Overview

  • Consists of:
    • Central Nervous System (CNS): Brain and spinal cord
    • Peripheral Nervous System (PNS): Cranial and spinal nerves, autonomic and somatic nervous systems
  • Functions: Controls motor, sensory, autonomic, cognitive, and behavioral activities

• Neuron Anatomy

  • Basic functional unit of the brain
  • Composed of dendrites, cell body, and axon
  • Supported by glial cells
  • Neurotransmitters: Facilitate communication between neurons or target tissues
    • Key neurotransmitters: Acetylcholine, serotonin, dopamine, norepinephrine, GABA, and endorphin

Brain Anatomy and Functions

• Major Areas of the Brain
  • Cerebrum
  • Brain Stem
  • Cerebellum
• Cerebral Circulation
  • Requires constant oxygen supply
  • Blood-brain barrier: Protects CNS, can be altered by trauma, cerebral edema, hypoxia
• Brain Protection
  • Skull, meninges, cerebrospinal fluid
  • Blockage of cerebrospinal fluid can lead to hydrocephaly

Spinal Cord Structure

• Spinal Column Sections
  • Cervical
  • Thoracic
  • Lumbar
  • Sacrum and coccyx

Peripheral Nervous System (PNS)

• Cranial Nerves
  • 12 pairs: 3 sensory, 5 motor, 4 mixed
  • Mnemonic: "Old Operators Occasionally Troubleshoot Trick Tricky Abducted Family Veterans Galloping Valiantly Across History" for memorizing cranial nerve names

Nervous Pathways

• Motor and Sensory Pathways
  • Motor: Upper and lower motor neurons
  • Sensory: Convey heat, cold, pain, etc.
  • Thalamus: Integrates sensory impulses, relays information to the parietal lobe

Nursing Assessment

• Patient Assessment Components
  • Health history, pain assessment, seizure activity, dizziness, visual disturbances, weakness, abnormal sensations
  • Past, family, and social history
• Neurologic Assessment
  • Consciousness and cognition
  • Evaluate cranial nerves
  • Motor function: Muscle size, tone, strength, coordination, balance
  • Sensory system: Tactile sensation, pain, temperature
  • Reflexes: Deep tendon reflexes (graded on a 0-4 scale)

Diagnostic Tests

• Types of Tests

  • CT Scan: Cross-sectional x-ray
  • Cerebral Angiography: X-ray of cerebral circulation with contrast
  • MRI: Detailed imaging
  • PET/SPECT Scan: Nuclear medicine tests
  • Lumbar Puncture: Analysis of cerebrospinal fluid

• Patient Preparation and Aftercare

  • Educate patients about the tests
  • Ensure consent is obtained
  • Monitor for complications post-test

Special Considerations

• Geriatric Considerations
  • Normal aging changes: Decreased strength, agility, slower reaction times, decreased reflexes, changes in hearing, vision, taste, smell
  • Important to assess changes over time and communicate effectively with older patients