Aging and the Nervous System: Nursing

Aging and the Nervous System

• Aging can lead to decreased blood flow to the brain.
• Aging results in the deposition of aging pigment lipofuscin in nerve cells and amyloid in blood vessels
• Acetylcholine decreases and there is a progressive loss of dendrites.
• Dopamine and norepinephrine levels decrease.
• Consequences of aging include increased syncope, decreased mental function, impaired cognition, altered sleep patterns, and increased accidents/falls.
• Decreased postural stability is also an effect of aging.
• Short term memory and motor function can be impaired

Nursing for Neurological conditions

• Licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) must provide care that meets the needs of adult clients aged 65 and older.
• It's important to use precautions to prevent injury and/or complications associated with procedures or diagnoses.
• Nurses should perform focused data collection based on the client's condition, such as neurological and circulatory checks.

Basic Neurological Assessment

• Key components of a neurological assessment include the level of consciousness, vital signs, pupil response to light, extremity strength and movement, and sensation.

Gathering Patient History

• When taking a patient history, consider assessing for symptoms, medication use, surgical history, family history, lifestyle factors, and general well-being.

Subjective Data Collection

• Relevant data includes mental status, intellectual function, thought content, perception, language ability, memory, and pain level.

Physical Assessment

• Includes assessing level of consciousness, mental state, pupillary response, muscle function, and cranial nerve function.

Cranial Nerves

• The 12 cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal.

Pupil Assessment

• Pupil assessment should evaluate equality, roundness, and reactivity to light and accommodation.

Glasgow Coma Scale

• Assesses eye-opening, verbal response, and motor response, including posturing.

Abnormal Posturing

• Decorticate posturing involves wrists and fingers flexed, feet plantar flexed, legs internally rotated, elbows flexed, and arms adducted.
• Decerebrate posturing involves feet plantar flexed, wrists and fingers flexed, arms adducted, forearms pronated, and elbows extended.

FOUR Score Coma Scale

-Eye response is scored from 4 (eyelids open or opened, tracking, or blinking to command) to 0 (eyelids remain closed with pain)

• Motor response is scored from 4 (thumbs-up, fist, or peace sign) to 0 (no response to pain or generalized myoclonus status)
• Brainstem reflexes are scored from 4 (pupil and corneal reflexes present) to 0 (absent pupil, corneal, and cough reflexes)
• Respiration is scored from 4 (not intubated, regular breathing pattern) to 0 (breathes at ventilator rate or apnea)

Stroke Symptoms using BE FAST

• BE FAST acronym is used to recognise signs of stroke
• B= Balance: Loss of balance or coordination.
• E= Eyes: Vision trouble.
• F= Face drooping.
• A= Arms: Weakness or numbness on one side.
• S= Speech: Slurred or garbled speech.
• T= Time: Note when symptoms began and seek immediate intervention.

Diagnostic Laboratory Tests

• The lab tests include thyroid, Vitamin B12, complete blood count, creatine kinase, erythrocyte sedimentation rate, electrolytes, hormone levels, Venereal Disease Research Laboratory, liver function, and renal function tests.

Computed Tomography (CT) Scan:

• Pre-procedure, administer contrast dye if ordered after checking for allergies.
• Sedation may be needed, so request an order if indicated.
• Post-procedure, encourage fluids if contrast dye was used.
• During the procedure, warn that contrast dye may cause a feeling of warmth.
• Teach patients to report any signs and symptoms of an allergic reaction.

Magnetic Resonance Imaging (MRI)

• Pre-procedure, ensure the patient has no pacemaker or metal on their body.
• Administer analgesic or sedative as ordered and teach relaxation techniques.
• Post-procedure, no special care is needed.

Angiogram:

• Pre-procedure, verify informed consent, give a clear liquid diet if ordered, insert an IV catheter, and administer sedation as ordered.
• Post-procedure, keep the patient flat in bed for 4 to 6 hours.
• Keep pressure, possibly with a sandbag, on the insertion site for 3 to 6 hours.
• Monitor vital signs, the catheter insertion site, and pulses.
• Encourage fluids.

Electroencephalogram

• Pre-procedure, ensure the hair is clean and dry and check medication orders.
• Post-procedure, wash the patient's hair.

Lumbar Puncture

• Pre-procedure, verify informed consent and assist with positioning.
• Post-procedure, maintain flat bedrest for 6 to 8 hours as ordered.
• Encourage fluids and monitor the puncture site, movement, sensation, and presence of headache.

Myelogram

• Pre-procedure, check for allergies to contrast and shellfish, assess the history of seizures, and verify informed consent.
• Post-procedure care is similar to that of a lumbar puncture, with encouraged fluids and the head of the bed elevated 30 degrees.

Therapeutic Measures

• Key aspects include moving and positioning patients to maintain functional positions, avoid injury, prevent contracture, and mobilize as soon as possible.
• Encourage independence based on functional level, maintain routines, and provide assistance as needed.

Communication Strategies

• Problems like dysarthria, expressive aphasia and receptive aphasia can make clear communication difficult
• Care interventions include using care with yes/no questions, correcting substituted words, anticipating needs, using gestures, and being patient.

Improving Nutrition

• If any neurological damage has occurred, it is important to assess and evaluate swallowing.
• Key interventions for impaired swallowing include thickening liquids, positioning the patient upright for eating, monitoring meals, and providing enteral tube feedings if necessary.

Structure of Neurons

• Sensory (afferent) neurons detect stimuli and transmit the information to the CNS.
• Interneurons, found only in the CNS, connect sensory and motor pathways and process/store information. Motor (efferent) neurons relay messages from the brain to muscles or glands.

Multipolar Neuron

• The cell body, or soma, contains the nucleus.
• Dendrites receive signals and conduct information to the cell body.
• The axon carries nerve signals away from the cell body.
• Many axons are insulated by a myelin sheath, formed by Schwann cells in the peripheral nervous system and oligodendrocytes in the CNS.
• Gaps in the myelin sheath are called neurofibral nodes (nodes of Ranvier).
• Synaptic knobs at the end of axon terminals contain vesicles with neurotransmitters.

Brain Anatomy

• The cerebrum is the largest part of the brain, marked by gyri (ridges) and sulci (grooves); deep sulci are called fissures.
• The diencephalon sits between the cerebrum and midbrain.
• The cerebellum is the second largest region of the brain.
• The brainstem includes the midbrain, pons, and medulla oblongata.

Cerebral Lobes

• The frontal lobe, separated from the parietal lobe by the central sulcus, contains motor areas for voluntary movement.
• Each motor area controls movement on the opposite side of the body.
• The frontal lobe hosts Broca's motor speech area and influences personality aspects like initiative, emotion, judgment, reasoning, and conscience.
• The temporal lobe, separated from the parietal lobe by the lateral sulcus, contains sensory areas for hearing and olfaction and is involved in visual recognition.
• Wernicke's area, typically on the left side, is involved in the comprehension of speech.
• The occipital lobe contains visual areas for receiving and interpreting sight.

Spinal Cord

• The spinal cord extends from the base of the brain to about the first lumbar vertebra, consisting of nerve fibers.
• A bundle of nerve roots at the end of the spinal cord is called the cauda equina.
• Nerves from the cervical region of the spinal cord serve the chest, head, neck, shoulders, arms, hands, and diaphragm.
• Nerves from the thoracic region extend to the intercostalmuscles of the ribcage, abdominal muscles, and back muscles.
• Lumbar spinal nerves innervate the lower abdominal wall and parts of the thighs and legs.
• Sacral region nerves extend to the thighs, buttocks, skin of the legs and feet, and anal/genital regions.

Spinal Cord Anatomy

• White matter, abundant in myelin, appears white and contains tracts for carrying impulses.
• Gray matter, lacking myelin, contains cell bodies of motor neurons and interneurons, forming posterior (dorsal) and ventral (anterior) horns.
• The central canal carries cerebrospinal fluid.
• The epidural space between the spinal cord covering and vertebrae contains fat and blood vessels.

Parasympathetic Nervous System

• Fibers leave the brainstem via cranial nerves: oculomotor (III), facial (VII), glossopharyngeal (IX), and vagus (X).
• Vagus nerve (X) carries about 90% of all parasympathetic preganglionic fibers to thoracic and abdominal organs.
• Fibers leave the sacral region via pelvic nerves.
• Ganglia reside in or near the target organ, resulting in long preganglionic and short postganglionic fibers.

Sympathetic Nervous System

• Preganglionic neurons start within the spinal cord.
• Myelinated fibers reach sympathetic ganglia in chains along both sides of the spinal cord.
• Ganglia lie close to the spinal cord, so preganglionic neurons are short; the postganglionic fibers are long.
• Unmyelinated postganglionic fibers extend to the target organs

Reflex Arc

The reflex arc involves:

• Somatic receptors detecting a sensation.
• Afferent (sensory) nerve fibers sending a signal to the spinal cord.
• An impulse immediately passing to a motor neuron.
• The motor neuron initiating an impulse back to the muscle, causing it to contract.