Transcript

1. PERCEPTION AND COORDINATION BY: MS. SHENELL A. DELFIN,RN

2.
PERCEPTION it is a mental process by which the brain selects, organizes and
interprets these sensations.
COORDINATION - movement of parts together: the skillful and balanced movement
of different parts, especially parts of the body, at the same time
3. GEOGRAPHY OF THE BRAIN
FRONTAL LOBE
Personality, behavior
Motor function
Brocas area (expressive speech)
Concentration, abstract thoughts
PARIETAL LOBE
Sensation
Awareness of body parts, orientation in space and spatial relationship
OCCIPITAL LOBE
Vision
4. GEOGRAPHY OF THE BRAIN
CEREBELLUM
Coordination of muscle group
TEMPORAL LOBE
Hearing, taste, smell
Wernickes area (receptive speech)
Interpretive area
BRAIN STEM ( pons, medulla, midbrain)
Cardiac, vasomotor, respiratory centers

THALAMUS
Interpretation of sensation
5. GEOGRAPHY OF THE BRAIN
HYPOTHALAMUS
Temperature control
Water metabolism
Control of hormonal secretion
Heart rate
Peristalsis
Appetite control
Thirst center
Sleep-wake cycle
6.
CRANIAL NERVES conducts special senses (smell, visual, hearing). It also
generalized sense impulses (pain, pressure, touch, vibration, temperature, deep
muscle sense) voluntary muscle, control or somatic muscle impulses, involuntary
control, or visceral effector messages to glands and involuntary muscles.
7. CRANIAL NERVES
I. Olfactory -smell
II. Optic -vision
III. Oculomotor - -contraction of most eye muscle
IV. Trochlear - -movement of the eye
V. Trigeminal -great sensory nerve of head and face
VI. Abducens - -supplies one eyeball muscle
8. CRANIAL NERVES
VII. Facial - - motor sensory(muscles) for facial expression
VIII. Accoustic - hearing

IX. Glossopharyngeal -general sense, impulse from tongue, pharynx, throat

X. Vagus - secretory to glands producing digestive and other secretions.
XI. Accessory - - motor to neck muscles
XII. Hypoglossal - muscles for tongue
9. LEVEL OF CONSCIOUSNESS
- it is the most sensitive indicator of the changes in neurologic status of the client
- assess both wakefulness and content of thought.
LEVEL I
conscious , cognitive, coherent
LEVEL II
confused, drowsy, lethargic, or obtunded, somnolent
LEVEL III
stuporous, responds only to noxious, strong intense stimuli
LEVEL IV
light coma
- response is only by grimace or withdrawing limb from pain
- primitive and disorganized response to painful stimuli
Deep coma
- absence of response to even the most painful stimuli
10. OLDER ADULT CARE FOCUS Assessing Neurological Function in older Adults
Signs of Cognitive Impairment
Significant memory loss ( person, place, and time)
Person : Does client know who he or she is and can client give you his or her full
name?
Place : Can client identify his or her home address and where he or she right now?
Time : What was the most recent holiday; what month, time of day, day of the
week?

Does client show a lack pf judgment?

Is client agitated or/and suspicious?
11. OLDER ADULT CARE FOCUS Assessing Neurological Function in older Adults
A is determined from the clients appearance and familys response, does client have
problem with ADLs?
Short term memory: Can the client recall your name, name of the president, or the
name of his or her doctor?
Short term recall: Ask the client to name three or four common objects and ask
client to recall them within the next 5 minutes.
Does the client have sensory deficits ( hearing and vision) of which he or she is not
aware?
12.
GLASGOW COMA SCALE (GCS) is an objective measure to describe LOC
it is based on the clients response in 3 areas:
eye opening ,verbal response, motor response
13. GLASGOW COMA SCALE Score 15 = patient is awake and oriented 7 or below
coma Lowest score 3 deep coma 4 3 2 1 5 4 3 2 1 6 5 4 3 2 1 Spontaneous To
voice To pain None Oriented Confused conversation Inappropriate words
Incomprehensible sounds None Obeys command Localize to pain Flex or withdrawal
Abdominal flexion Extension Flaccid Best eye opening Best verbal response Best
motor response
14. MODIFIED GLASGOW COMA SCALE FOR PEDIATRICS 4 3 2 1 5 4 3 2 1 6 5 4 3 2 1
Spontaneous To speech To pain No response Coos, babbles Irritable cry Cries in
response to pain Moans in response to pain No response Normal spontaneous
movement Withdraws from touch Withdraws from pain Abdominal flexion Abnormal
Extension No response Best eye opening Best verbal response Best motor response
15.
Decerebrate- extension and adduction of arms, hyperextension of legs
Decorticate flexion internal rotation of arms, extension of leg.
16. NEUROLOGICAL SYSTEM DIAGNOSTICS
SKULL AND SPINE X-RAY STUDIES- Simple x-ray films are obtained to determine
fractures, calcifications, etc.

17.
ELECTROENCEPHALOGRAPHY-(EEG)
a recording of the electrical activity of the brain to physiologically assess cerebral
activity; useful for diagnosing seizure disorders; used as screening procedure for
coma; also serve as an indicator for brain death. May also be used to assess sleep
disorders, metabolic disorders and encephalitis.
18.
Nursing Implications:
Explain to client that procedure is painless and there is no danger of electrical
shock.
Determine from physician if any medication should be withheld before the test,
especially tranquilizers and sedatives.
Frequently, coffee, tea, cola, and other stimulants are prohibited before
examination.
Clients hair should be clean before the examination: after exam, assist client to
wash electrode paste out of hair.
19.
MAGNETIC RESONANCE IMAGING
- Cell nuclei have magnetic properties; the MRI machine records the signals from the
cells in a manner that provides information to evaluate soft tissue structures
(tumors, blood vessels)
20.
Nursing Implications:
Procedure will take approximately 1 hour.
All metal objects should be removed from the client.
The client will be placed in a long magnetic tunnel for the procedure.
Poor candidates for MRI include the following:
Clients with pacemakers
Clients with implanted insulin pumps
Pregnant clients

Obese clients
Any client who requires life support equipment
21.
COMPUTERIZED AXIAL TOMOGRAPHY SCAN (CAT) Computer-assisted x-ray examination of thin cross-sections of the brain to identify
hemorrhage, tumor, edema, infarctions, and hydrocephalus. Machine is large donut
shaped tube with table through the middle.
22.
Nursing Implications:
Explain appearance of scanner to client and explain importance of remaining
absolutely still during the procedure.
Remove all objects from clients hair; clients only receives fluid for 4-6 hours before
the test.
Dye will be injected via venipuncture; assess for iodine allergy and advise the client
that he/she may experience a flushing or warm sensation when the dye is injected.
Contrast dye may discolor urine for about 24 hours.
23.
LUMBAR PUNCTUREA needle is inserted into the lumbar area at the L4-L5 level; spinal fluid is
withdrawn, and spinal fluid pressure is measured; contraindicated in presence of
increased ICP. Normal spinal fluid values; opening pressure, 60-150 mm water;
specific gravity 1.007; pH 7.35; clear fluid; protein concentration,15-45 mg/dl;
glucose concentration 45-75 mg/dl; no microorganism present.
24.
Nursing Implication:
Before the test
have client empty the bladder.
Explain position (lateral recumbent with knees flexed)
Advised physician if there is a change in neurological status of the client before the
test; increased ICP is a contraindication to lumbar puncture.

After the test

Keep the client flat at least 3 hours, and sometimes up to 12 hours, to decrease
occurrence of headache.
Encourage high fluid intake
Observe for spinal fluid leak fro the puncture site; if leakage occurs, it may
precipitate a severe headache.
25. CRITICAL THINKING
The nurse is caring for a client who had a right-sided cerebrovascular accident
(CVA). The nurse assessed the GCS and she observed that the patient is drowsy,
conversant but disoriented when talked to. Can obey verbal commands but eyes
only open when talked to. What is your GCS?
26. CRITICAL THINKING
A 55 y.o. factory worker brought to ER because of head injury at the factory where
he work. He is restless but moaning when stimulated, flexion of arms noted as if
making a fist, eyes dont open to any stimulus. (verbal and pain). How will you rate
the GCS?
27. CRITICAL THINKING
A preschool boy was admitted to PICU and on guarded condition because of
sustained multiple skull fractures from a vehicular accident 2 hours ago. Restless
and uncooperative, shouts and cries but doesnt answer to his mother when talked
to. The doctor ordered a restraint and when initiated it open eyes but wasnt able to
recognize his parents and he is trying to free himself from the restraints and kept
shouting. GCS?
28. CRITICAL THINKING
A 9 month old baby girl has been diagnosed with meningitis and on close
monitoring by the nurse. A few minutes later the baby is unarousable even on
pressure on proximal nail bed, doesnt cry to pain, flaccid extremities and has a very
high fever. Use the GCS for pediatrics.
29. WAKE UP!!! THANK YOU FOR LISTENING AND THANK YOU FOR SLEEPING..