NCLEX Review & Nursing School

Understand that the Nervous system includes the Central Nervous System (CNS), the Peripheral Nervous Sytem (PNS) and the Autonomic Nervous System or the (ANS).

When we say the Central Nervous System, We are basically just talking about the Brain and the Spinal Cord.

The Peripheral Nervous System on the other hand, contains the cranial nerves and the spinal nerves.

• When we talk about the Autonomic Nervous Sytem, we are basically talking about the “Sympathetic” (Fight or Flight) System or the “Parasympathetic” System.
• .The basic component of the nervous system is the nerve cell or neuron

Neuron

– is the primary component of the nervous system.  Composed of cell body (gray matter), axon and dendrites.

Brain (Central Nervous System: Brain and Spinal Cord).

Cerebrum– Outermost area (cerebral cortex) is gray matter, deeper area is composed of white matter

• Two Hemispheres: Left and right and each hemisphere is divided into two lobes.

Frontal Lobe

• Personality, behavior
• Higher intellectual functioning
• Broca’s Area: Specialized Motor Speech Area

Parietal Lobe

• Postcentral gyrus: registers sensation (touch, pressure)
• Integrates sensory information

Temporal Lobe

• Hearing, taste, smell
• Wernicke’s Area: Sensory Speech Area
• (Understanding, formation of language)

Occipital Lobe

• vision

Peripheral Nervous System- composed of Spinal Nerves (31)

Autonomic Nervous System- part of the Peripheral Nervous System

• Regulates functions occurring automatically in the body.
• ANS regulates smooth muscle, cardiac muscle and glands.

Things to know for the NCLEX:

Glascow Coma Scale

• The scale is method of assessing a client’s neurological condition
• The scoring system is based on a scale of one to fifteen (1-15) pts.
• A score of lower than eight indicates that a coma is present.

Neuro Diagnostic Tests

• Computed Tomography (CT) scan
• Cerebral angiography
• Magnetic resonance imaging (MRI)
• Lumbar puncture
• Electroencephalography (EEG)
• Myelography

Increased Intracranial Pressure

Aneurysm

Cerebral Aneurysm is a dilation of the walls of a cerebral artery, resulting in a sac like outpouching of vessel

Seizures

– abnormal activity in the brain that can cause a chaotic electrical discharge within the neuron system of the brain.

Types of Seizures:

• Generalized Seizures (Tonic Clonic, Absent Seizures)
• Partial Seizures (Simple, Complex)

Meningitis

Brudzinski’s Sign

• Involuntary flexion of the hip and knee when the neck is passively flexed, indicating meningeal irritation.

Kernig’s Sign

• Loss of the ability of a supine client to straighten the leg completely when it is fully flexed at the knee and hip, indicating meningeal irritation.

Stroke

• Cerebrovascular Accident (CVA) can be a reduction in cerebral blood flow and oxygen or a bleeding or hemorrhaging of a blood vessel.

Diagnosis:

• Diagnosis can be determined by a CT Scan, cerebral arteriography, electroencephalography, and MRI.
• Carotid Endarterectomy
• A surgical intervention used in a stroke management and can be used as a stroke prevention.

Important Assessments:

• Headache, Nausea, Vomiting
• Facial Drooping
• Aphasia, Speech Changes
• Nuchal Rigidity

Encephalitis

Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.

Assessment:

• Fever
• headache
• Low appetite
• Low energy

Multiple Sclerosis

– a chronic degenerative disease of the CNS that is characterized by the demineralization of the neurons.

Assessment for patients with MS

• Fatigue and Weakness
• Bladder and bowel disturbances (later stage)
• Respiratory paralysis and failure (later stage)
• * Positive Babinski Reflex.

Myasthenia Gravis

– a neuromuscular disease that is characterized by weakness and fatigue of the voluntary muscles.

Assessment

• Weakness and Fatigue
• Difficulty Chewing
• Dysphagia, Ptosis
• Difficulty Breathing (respiratory)

Brain Tumors

– a brain tumor in the brain.  There are different types of brain tumors:

General Assessment:

• Seizures
• Visual Changes
• Symptoms of ICP

Surgical Procedures:

• Craniotomy
• Gamma Knife Surgery

ALS/ Lou Gehrig’s

Headaches

Parkinsons Disease

– degenerative disease caused by the decrease and lack of dopamine in the brain.

Assessment:

• Tremors in hands and fingers (pill rolling)
• Akinesia
• Bradykinesia
• Blank facial expression
• Shuffling steps and gait
• Restlessness

Nursing Interventions for the patient with Parkinson’s disease:

give antiparkinson medication.

give anticholinergic medication.

Spinal Cord Injury

– a trauma in the spinal cord (partial or complete) that traumatize and disrupt the nerve tracts and neurons within our system.  A spinal cord injury can be classified as either complete or incomplete

Patient with Spinal Cord Injury Assessment:

• Acute respiratory failure
• Compromised respiratory function
• Sensory and Motor paralysis within or below level of injury.

Spinal Shock

– is also called a neurogenic shock.

Assessment includes:

• Decrease or loss of reflex activity, flaccid paralysis, bradycardia.
• usually occurs within several hours right after injury.

Autonomic Dysreflexia

Asessment includes:

• Hypertension (Severe)
• Headache (throbbing)

– also known as autonomic hyperrefelexia.

Head Fractures

Side Note:  Remember for the NCLEX

– Guillain–Barré syndrome: Patient will have an increase in protien but a normal cell count.

– Guillain–Barré patient: usually has a previous virus illness.

– With Meningitis: There is an increase in WBC. And with bacterial meningitis, there is an increased protien  & decreased glucose.

– For pt. with a stroke and has a fever:  Tylenol can be givin.  Not Aspirin or Advil.

– Patients w/ Multiple Sclerosis: give Biological Response Modifiers, Steroids, Immunosupressants and Muscle Relaxers

• Biological Response Modifiers: Avonex, Betaseron, Copaxone.

– Earliest indication of Increased Intracranial Pressure: Restlessness.

Medications for Neurological Diseases

– Antiparkinsonian Medications:

• Restores the production of dopamine and suppression of acetylcholine.

♣ Dopaminergic Medications:

• Carbidopa (Sinemet)
• Bromocriptine (Parlodel)
• (Mirapex), (Carbex)

¥ Anticholinergic Medications:

• Benztropine Mesylate (Cogentin)
• Trihexyphenidyl Hydrochloride

♣ Anticonvulsants

♦Osmotic Diuretics

♥ Cholinesterase Inhibitor

♣ Skeletal Muscle Relaxants

♦ Antigout Medications