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26.1 Structure and Function

The structures of the neurological system include the CNS and PNS. The CNS includes the brain and spinal cord and is responsible for receiving, processing, and responding to sensory information. The brain is the organ responsible for sensation, movement, emotions, responses, thought processing, communication, and memory. The spinal cord sends motor commands from the brain to the peripheral body and also relays sensory information from sensory organs to the brain. The PNS includes the cranial nerves, spinal nerves, and autonomic nervous system. The primary function of the PNS is to connect the CNS to the limbs and organs. Peripheral nerves are categorized as either sensory or motor nerves, or a combination of the two. Sensory nerves transmit impulses from the body to the brain for processing. Motor nerves conduct motor signals from the brain to the muscles to initiate movement. Physical effects of an impaired nervous system include dizziness, loss of balance or gait issues, dysphagia, muscle weakness, paralysis, loss of senses, headaches, and inability to perform ADLs. Psychological effects of an impaired neurological system include, but are not limited to, depression, changes in cognition, fear of losing control, and anxiety.

26.2 Physical Assessment

The comprehensive neurological assessment requires the nurse to collect both subjective and objective data through an interview as well as a detailed physical exam. The nurse will collect a complete health history, using effective communication to identify any issues or potential concerns, because some issues may only identified through precise questioning during the interview. The nurse will also collect objective data to assess the patient’s mental status, appearance, motor and sensory functions, cranial nerve function, and deep tendon reflexes. Tests that may be used include, but are not limited to, the GCS, NIH Stroke Scale, MMSE, various cranial nerve assessments, heel-to-shin test, and finger-to-nose test. The nurse should be able to identify expected versus abnormal findings. For example, as part of assessing the patient’s orientation, the nurse should recognize a potential alteration if the patient provides an incorrect date. The nurse should also validate and document their findings. The documentation should be comprehensive to provide baseline information for future comparisons.

26.3 Recognizing Common Neurological Disorders

Cognitive disorders are those that affect the cognitive function of an individual, such as how the brain processes and stores information. Cognitive disorders affect behavior, memory, communication, learning, perception, problem-solving, and the ability to reason; and include headaches and facial pain; degenerative disorders such as dementia, Alzheimer, Parkinson, and Huntington diseases, and MS; seizure disorders such as epilepsy; cerebrovascular accidents; and neurological infections. Spinal cord injuries include any injury to the vertebral column, supporting soft tissue, intervertebral discs, or the spinal cord itself. These injuries may be due to lacerations, concussion, tissue compression, or complete severing of the spinal cord. Types of spinal cord injuries include Brown-Séquard syndrome, central cord syndrome, anterior cord syndrome, and posterior cord syndrome. Developmental disorders vary but include conditions that result in impairment in learning, language, behavior, and movement. These conditions may develop at or during conception or shortly after birth. Types of developmental disorders include cerebral palsy, intellectual disability, and prenatal injuries.

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