Nervous System Divisions and Aging

Divisions of the Nervous System

• The nervous system is divided into the Central Nervous System (CNS) and the Peripheral Nervous System (PNS).
• The CNS includes the brain and spinal cord, processing sensory information and coordinating motor responses.
• The PNS consists of nerves outside the CNS, transmitting sensory and motor signals.
• The PNS has two parts, Somatic Nervous System and Autonomic Nervous System.
• The Somatic Nervous System controls voluntary skeletal muscle movements.
• The Autonomic Nervous System (ANS) regulates involuntary functions like heart rate and digestion.
• The ANS has two branches, the Sympathetic and Parasympathetic Nervous Systems.
• The Sympathetic Nervous System initiates the "fight or flight" response, increasing heart rate, blood pressure, and causing bronchodilation.
• The Parasympathetic Nervous System evokes the "rest and digest" response, decreasing heart rate and promoting digestion.

Aging and the Nervous System

• Aging affects the nervous system, causing neuronal loss and atrophy, leading to slower cognitive processing.
• Decreased neurotransmitter levels due to aging results in memory loss and slowed reflexes.
• The brain shrinks and has reduced blood flow, increasing the risk of stroke.
• Peripheral nerve degeneration leads to decreased sensation and delayed reaction time.
• Decreased autonomic function causes orthostatic hypotension and thermoregulation issues.

Manifestations of Neurological Dysfunction

• Altered mental status includes confusion, memory loss, and agitation.
• Motor deficits appear as weakness, tremors, and paralysis.
• Sensory changes manifest as numbness, tingling, and vision or hearing loss.
• Seizures, headaches, dizziness, and syncope are common signs.
• Speech and language impairments include aphasia and dysarthria.

Diagnostic Tests for Neurological Dysfunction

• CT/MRI is used for brain and spinal cord imaging in cases of stroke, tumors, and trauma.
• EEG is used to evaluate brain activity for seizures and epilepsy.
• Lumbar puncture assesses CSF for meningitis and encephalitis.
• EMG/Nerve conduction studies diagnose neuromuscular disorders.
• Angiography evaluates blood flow in the brain for stroke and aneurysms.

Assessing Motor Skills in Infants and Young Children

• Motor skill assessment includes reflex testing (Moro, grasp, Babinski, rooting reflexes).
• Assess gross motor milestones (rolling, sitting, walking).
• Fine motor skills like grasping, pinching, and drawing are evaluated.
• Coordination and muscle tone are assessed.

Neurologic Assessment Findings in Relation to Developmental Stage

• Newborns have presence of primitive reflexes (Moro, rooting).
• Infants/Toddlers demonstrate progression of motor and speech skills.
• Abnormal findings include delayed milestones, hypertonia/hypotonia, and persistent primitive reflexes.

Migraine vs Cluster Headaches

• Migraine pain is unilateral and throbbing, lasting 4-72 hours, and is associated with nausea, photophobia, phonophobia, and aura, and can be triggered by stress, food, and hormones.
• Cluster headache pain is unilateral, sharp, and excruciating, lasting 15-180 minutes and is associated with tearing, rhinorrhea, ptosis, and restlessness, and can be triggered by alcohol, smoking, and sleep cycle changes.

Migraine Treatment Plan

• Acute treatments include NSAIDs, triptans, and antiemetics.
• Preventive therapies include beta-blockers, anticonvulsants (topiramate), and CGRP inhibitors.
• Lifestyle modifications involve avoiding triggers and managing stress.

Seizures: Types, Manifestations, and Management

• Focal (partial) seizures have localized symptoms; the patient may be aware or have impaired awareness.
• Generalized tonic-clonic seizures involve loss of consciousness and convulsions.
• Absence seizures manifest as brief staring spells.
• Focal seizures are treated with antiepileptics like carbamazepine and lamotrigine.
• Generalized tonic-clonic seizures are managed with benzodiazepines (acute) and long-term AEDs (valproate, levetiracetam).
• Absence seizures are treated with ethosuximide.

Care for Patients with Seizures

• Maintain airway patency.
• Protect from injury by using padded rails and keeping the bed in a low position.
• Monitor postictal state.
• Ensure medication adherence.

Priorities of Care for Patients with Meningitis

• Administer immediate antibiotics for bacterial meningitis.
• Use dexamethasone to reduce inflammation.
• Institute seizure precautions.
• Monitor for increased ICP.

Pathophysiology of Parkinson Disease (PD)

• Parkinson's involves the degeneration of dopaminergic neurons in the substantia nigra, leading to decreased dopamine levels.
• This degeneration results in bradykinesia, tremors, rigidity, and postural instability.

Treatment Plan for Alzheimer Disease (AD)

• Use cholinesterase inhibitors (donepezil, rivastigmine).
• Administer NMDA receptor antagonists (memantine).
• Provide behavioral therapy and caregiver support.

Huntington Disease: Counseling and Education

• Genetic counseling is needed because it is an autosomal dominant inheritance.
• Manage symptoms (chorea, cognitive decline).
• Provide mental health support.

Seizure Disorders in Children: Management

• Types include febrile, absence, and generalized tonic-clonic seizures.
• Management involves seizure precautions, medication adherence, and parental education.

Hydrocephalus: Pre/Postoperative Care

• Pre-op: Monitor for signs of increased ICP.
• Post-op: Provide VP shunt care and prevent infection.

Neuromuscular Disorders in Children

• Examples include Duchenne muscular dystrophy and spinal muscular atrophy.
• Management includes physical therapy and respiratory support.

Back Pain: Risk Factors & Prevention

• Risk factors: Poor posture, obesity, and a sedentary lifestyle.
• Prevention: Ergonomic adjustments and core strengthening.

Spine Surgery: Plan of Care

• Pre-op: Education and pain management.
• Post-op: Neurovascular checks and mobility precautions.

Spinal Cord Injury (SCI): Care & Outcomes

• Priorities are Airway, hemodynamic stability, and pressure ulcer prevention.
• Outcomes encompass mobility adaptations and rehabilitation.

Stroke, TBI, ICP Management

• Stroke treatment includes fibrinolytics (ischemic) and BP control.
• ICP management involves head elevation and mannitol administration.

Sensory Perception & Ear/Eye Disorders

• Focus on preventative education, like ear protection and routine eye exams.
• Use medications like glaucoma medications and antibiotics for infections.