Neurological Function: Mark Ebony Sumalinog

NEUROLOGICAL
FUNCTION
Mark Ebony Sumalinog
Effects of Aging on the Nervous System
• loss of nerve cell mass- brain atrophy
• brain weight decreases
• no. of nerve cells declines
• each nerve cells has fewer dendrites
• demylenization of nerve cells occurs
• plaques and tangles occur
• free radicals accumulate with age and may have toxic
effect
• cerebral blood flow dec. by 20% due to fatty deposits
• further decrease in cerebral blood flow due to diabetes
and hypertension - increased risk of stroke
• intellectual performance tends to be maintained until at
least age 80
• delay in the time required to perform task
• verbal skills are well maintained until age 70, after which
is a gradual decrease in vocabulary
• difficulty learning and forgetfulness
• the no. of sensory receptors, dermatomes and neurons
decrease leading to decreased tactile sensation
• decline in the function of the cranial nerves mediating

taste and smell
• increased levels of taste, sound, scents, touch, and

lighting are required for perception of older persons
• It does not affect all individuals similarly
• genetic makeup, diet, lifestyle, and other factors influence

the health and function of the neurologic system
NEUROLOGIC HEALTH PROMOTION
• Risk factors to neurovascular disease: cigarette smoking,
obesity, ineffective stress management, elevated
cholesterol and hypertension
• risk of injury to the head and spinal column: failure to use
seatbelts, incompetent driving skills, alcohol and drug
use, and falls
• infection of the ear or sinuses and STI can lead to
neurologic dysfunction
• Nurses: educate persons of all ages in preventive
measures
NEUROLOGIC HEALTH PROMOTION
• Detect new or subtle symptoms of neurologic disease:
– new headaches that occur in the early morning or interrupt
sleep
– change in vision (sudden decreased acuity, double vision, and
blindness in portion of visual field)
– sudden deafness, ringing in the ears
– mood, personality changes
– altered cognition or LOC
– clumsiness or unsteady gait
– numbness, tingling of extremity
– unusual sensation or pain over nerve
ASSESSMENT GUIDE
GENERAL OBSERVATIONS and INTERVIEW

• observe for assymetry, deformity, weakness, paralysis,
tremors and other abnormalities
• observe for pain, tingling sensations, numbness,
blackouts, headaches, twitching, seizures, sleep
disturbances, dizziness, distortion of reality, weakness
and change in mental status
• if present, inquire for origin, length of time present, and
resulting limitations or problems
ASSESSMENT GUIDE
SPEECH ASSESSMENT
• for speech problems, it is important to differentiate
problems with articulation (dysarthria) and symbols
(dysphasias)
ASSESSMENT GUIDE
DYSARTHRIA
• speech may be slurred due to poor motor control
• ask the patient to do the following:
– me, me, me (to test the lips)
– la, la, la (to test the tongue)
– ga, ga, ga (to test the pharynx)
ASSESSMENT GUIDE
DYSPHASIA
• Receptive aphasia- ask the patient to follow a command
– ex. pick up a pencil: the patient's inability to understand what
these means will prevent the command from being followed
• Expressive aphasia- the patient is able to follow a

command but not able to put symbols together into an
intelligent speech form
– ex. point to several objects and ask the patient to name them
– paraphasia (mild): substitutes a close word for the right one
ASSESSMENT GUIDE
• Evaluate for ability to understand and express oneself
through the written word
– ask the patient to write a short sentence that you dictate and to
read a sentence from a newspaper
– make sure the patient has the educational and visual abilities to
fullfill these commands
ASSESSMENT GUIDE
PHYSICAL EXAMINATION
• Sensation- ask the patient to close eyes and describe the
sensation felt
– touch various parts of the body with fingers or cotton; do in both
sides
– if intact, test ability to identify two simultaneous stimuli (ex. right
cheek and left forearm)
– cortical sensation (steriognosis)- closed eyes and identify
various objects placed in each hand; inability (asteriognosis)
ASSESSMENT GUIDE
• Coordination and Cerebellar Function
– point to point testing: your finger and his nose (note for
jerking movement and inability to touch your finger or his nose)
– coordination in the lower extremity: patient lies down and
have the heel of one foot run against the shin of the other leg
– test rapid alternating movements: have the patient tap his or
her index finger on the thigh or a table surface
– tandem walking: patient walks heal to toe
ASSESSMENT GUIDE
• Reflexes
– Corneal Reflex: gently touch the cornea with cotton wisp; the
eyes should blink
– Babinski: stroke the patient's foot; the toes should flex;
abnormal response- fanning of the toes
ASSESSMENT GUIDE
• Additional tests
– CRANIAL NERVE TESTING
– lumbar puncture, cerebral angiography,
pneumoencephalography and CT scan to evaluate neurologic
problems
– MMSE
NURSING DIAGNOSIS
NURSING DIAGNOSIS
NURSING DIAGNOSIS
SELECTED NEUROLOGIC CONDITIONS
PARKINSON’S DISEASE
• inability to control body movements
• neurons that produce dopamine in the substantia
nigra die or become impaired
• dopamine is important to control smooth motor
movement; it also has a role in emotions
• more common in men, more frequent in the 5th decade
(50 years old)
PARKINSONS DISEASE
• incidence increases with age (diagnosed in the 7th
decade)
• associated with history of exposure to toxins, encephalitis,
and cerebrovascular disease, esp. arteriosclerosis)
• presence of Lewy body in the brain
PARKINSONS DISEASE
• Faint tremor in the hands or feet that progresses
overtime
• Tremor is reduced when the patient attempts a
purposeful movement
• Muscle rigidity and weakness develop evidenced by
drooling, difficulty swallowing, slow speech and a
monotone voice
• Mask-like appearance and the skin is moist
• bradykinesia (slow movement) and poor balance occurs
• Appetite frequently increases
• emotional instability
• Characteristic sign: shuffling gait (rate of movement
increases as the patient walks)
• as disease progress, may be unable to ambulate
• secondary symptoms: depression, sleep disturbance,
dementia, forced eyelid closure, drooling, dysphagia,
constipation, SOB, urinary hesitancy, urgency and
reduced interest in sex
• Anticholinergics (monitor for glaucoma and anuria)
• While in levodopa, avoid food high in vitamin B6 such as
avocado, lentils, poultry, eggs, beans and peas
• dietary instructions are not necessary if the patient is
taking Carbidopa-levodopa (Sinemet)
• Pulse generators (block tremor-causing brain signals)
• Active and passive ROM exercises for joint mobility
• Warm bath and massage relieve muscle spasm caused
by rigidity
• PT and OT to involve in exercise programs; devices that
may be proven useful and increase self-care abilities
• Offer psychological support and minimize emotional
upsets (Parkinson's can be frustrating)
• Educate the family about the disease progress and the
necessary therapy to minimize disability
• Do not assume that people with Parkinson’s are
cognitively impaired (degrading); underestimating them
may lead to depression and irritability
• Communication and mental stimulation should be
encouraged
• As disease progresses, level of assistance increases
• nurse should assess for caregiver burnout
TRANSIENT ISCHEMIC ATTACK
• temporary or intermittent neurological events that results

from any situation that reduces cerebral circulation
• hyperextension and flexion of the head when falling
asleep on a chair, reduced blood pressure (due to anemia
and certain drugs like diuretics and anti-hypertensives)
and smoking
• sudden standing from a prone position
TRANSIET ISCHEMIC ATTACK
• manifestations: hemiparesis, hemianesthesia, aphasia,

unilateral loss of vision, diplopia, vertigo, nausea and
vomiting, and dysphagia
• manifestation depends on the location of ischemia
• signs can last from minutes to hours; complete recovery
is within the day
TRANSIET ISCHEMIC ATTACK
• ttt: anti-coagulants or vascular reconstruction

CEREBROVASCULAR ACCIDENTS
• HIGH RISK; older persons with: HPN, severe
arteriosclerosis, diabetes, gout, anemia, hyperthyroidism,
silent MI, TIAs, and dehydration
• Ischemic: thrombus or embolus that lodged

• Hemorrhagic: ruptured blood vessel
• Ischemic, caused by partial or complete cerebral
thrombosis, is the most common in older adults
• warning signs: light headedness, dizziness, headache,
drop attack, memory and behavioral changes
• Drop Attack- feeling of being strongly and suddenly
pulled to the ground; caused by a complete muscular
flaccidity in the legs but with no alterations in the
consciousness
• Major signs: hemiplegia, aphasia, and hemianopia

• Older adults have higher mortality rate than younger ones
but those who survive have a good chance of recovery
Good nursing care can increase chance of survival and

minimize limitations that impair a full recovery)
• Acute phase:
– maintain a patent airway
– provide adequate nutrition and hydration
– monitor neurologic and vital signs
– prevent complications associated with mobility
• Unconscious patients:
– Good skin care and frequent turning
– If urinary catheter is not used, check for distended bladder
– Eyes open for a long time: irrigation of saline solution to the
eyes can prevent corneal damage followed by the use of sterile
mineral oil eye drops
– Eye pads may help keep the eyelids closed
– Mouth care and ROM exercises
• When patient regains consciousness:
– rehabilitation can be difficult for patients to understand and
participate because of speech, behavior, and memory problems
– attention span is reduced- avoid long and complicated
directions
– recent events or explanations can be forgotten
– difficulty transferring information from one situation to another
– confusion, restlessness, and irritability
– emotional lability (rapid change in mood, temper)
• Nursing Interventions-
– talk to the patient during routine activities
– explain the basics of what has occurred, the procedure being
performed and activities to expect
– do not shout, speak distinctly
– devise an easy means of communication; picture charts
– minimize environmental noise, traffic and clutter
– aim for consistency of those providing care and care activities
(avoid frequent change of caregivers)
– Use objects familiar to patient
– Keep a calendar and clock inside the room
– Supply sensory stimulation (radio, TV, wall decorations, etc)
– Provide frequent positive feedback (a minor task can be a
major achievement); encouragement
– Expect and accept errors and failures
• manage hypertension
• smoking cessation
NURSING CARE PLAN: CVA
Nursing Dx:
1. Self care Deficits r/t sensory or motor impairment,
visual deficits, aphasia
2. Activity Intolerance r/t depression, poor motivation ,
prolonged immobility and fatigue
Goal:
The patient progressively increases independence in ADLs
Nursing Dx:
2. Impaired Physical Mobility r/t altered sensory and
motor function
Goal:
The patient is free from complications r/t immobiltiy;
progresively increases independent mobility
Nursing Dx:
3. Ineffective Role Performance r/t loss of body
function, physical changes
4. Interrupted Family Process r/t changes in function,
dependency of family for caregiving, ineffective coping
Goal:
The patient expresses acceptance of altered lifestyle and
functions; develops or maintains satisfying interactions with
family
PREVENTING INJURY
• the nurse should scrutinize the environment for potential
source of mishaps
– loose carpeting, poorly lit stairs, clutter, ill-functioning
appliances
– lack of fire warning systems, fire escapes, tub rails, nonslip tub
surfaces, or other safeguards
– avoid contractures, pressure ulcers and other risks to health
and well-being
NEUROLOGICAL
FUNCTION
Mark Ebony Sumalinog
EXERCISE 6
1. Differentiate delirium from dementia (cause, onset,

mental status, LOC, behavior and recovery)
2. Enumerate the different types of dementia and give a
brief description of each (cause, characteristics, etc)
3. Enumerate the stages of alzheimer's disease and its
corresponding manifestation
4. Explain. What is sundowner syndrome and how do you
manage it?
5. Enumerate at least 8 measures to promote safety in older
adults with dementia
6. Provide at least 2 nursing diagnosis for older adults with
dementia. Give at least 10 interventions for each diagnosis.
7. Enumerate 10 risk factors for Alzheimer's and how it
causes the disease.
8. Enumerate 10 measures to promote Mental Health in
older adults

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NEUROLOGICAL

• decline in the function of the cranial nerves mediating

• increased levels of taste, sound, scents, touch, and

• genetic makeup, diet, lifestyle, and other factors influence

GENERAL OBSERVATIONS and INTERVIEW

• Expressive aphasia- the patient is able to follow a

TRANSIENT ISCHEMIC ATTACK

• temporary or intermittent neurological events that results

TRANSIET ISCHEMIC ATTACK

• manifestations: hemiparesis, hemianesthesia, aphasia,

TRANSIET ISCHEMIC ATTACK

• ttt: anti-coagulants or vascular reconstruction

• Ischemic: thrombus or embolus that lodged

• Major signs: hemiplegia, aphasia, and hemianopia

Good nursing care can increase chance of survival and

1. Differentiate delirium from dementia (cause, onset,

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