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Perception And Coordination Revised



Perception And Coordination

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Perception And Coordination

  2. 2. <ul><li>PERCEPTION – it is a mental process by which the brain selects, organizes and interprets these sensations. </li></ul><ul><li>COORDINATION - movement of parts together: the skillful and balanced movement of different parts, especially parts of the body, at the same time </li></ul>
  3. 3. GEOGRAPHY OF THE BRAIN <ul><li>FRONTAL LOBE </li></ul><ul><li>Personality, behavior </li></ul><ul><li>Motor function </li></ul><ul><li>Broca’s area (expressive speech) </li></ul><ul><li>Concentration, abstract thoughts </li></ul><ul><li>PARIETAL LOBE </li></ul><ul><li>Sensation </li></ul><ul><li>Awareness of body parts, orientation in space and spatial relationship </li></ul><ul><li>OCCIPITAL LOBE </li></ul><ul><li>Vision </li></ul>
  4. 4. GEOGRAPHY OF THE BRAIN <ul><li>CEREBELLUM </li></ul><ul><li>Coordination of muscle group </li></ul><ul><li>TEMPORAL LOBE </li></ul><ul><li>Hearing, taste, smell </li></ul><ul><li>Wernicke’s area (receptive speech) </li></ul><ul><li>Interpretive area </li></ul><ul><li>BRAIN STEM ( pons, medulla, midbrain) </li></ul><ul><li>Cardiac, vasomotor, respiratory centers </li></ul><ul><li>THALAMUS </li></ul><ul><li>Interpretation of sensation </li></ul>
  5. 5. GEOGRAPHY OF THE BRAIN <ul><li>HYPOTHALAMUS </li></ul><ul><li>Temperature control </li></ul><ul><li>Water metabolism </li></ul><ul><li>Control of hormonal secretion </li></ul><ul><li>Heart rate </li></ul><ul><li>Peristalsis </li></ul><ul><li>Appetite control </li></ul><ul><li>Thirst center </li></ul><ul><li>Sleep-wake cycle </li></ul>
  6. 6. <ul><li>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. </li></ul>
  7. 7. CRANIAL NERVES <ul><li>I. Olfactory – -smell </li></ul><ul><li>II. Optic – -vision </li></ul><ul><li>III. Oculomotor - -contraction of most eye muscle </li></ul><ul><li>IV. Trochlear - -movement of the eye </li></ul><ul><li>V. Trigeminal – -great sensory nerve of head and face </li></ul><ul><li>VI. Abducens - -supplies one eyeball muscle </li></ul>
  8. 8. CRANIAL NERVES <ul><li>VII. Facial - - motor sensory(muscles) for facial expression </li></ul><ul><li>VIII. Accoustic – - hearing </li></ul><ul><li>IX. Glossopharyngeal – -general sense, impulse from tongue, pharynx, throat </li></ul><ul><li>X. Vagus – - secretory to glands producing digestive and other secretions. </li></ul><ul><li>XI. Accessory - - motor to neck muscles </li></ul><ul><li>XII. Hypoglossal - muscles for tongue </li></ul>
  9. 9. LEVEL OF CONSCIOUSNESS <ul><li>- it is the most sensitive indicator of the changes in neurologic status of the client </li></ul><ul><li>- assess both wakefulness and content of thought. </li></ul><ul><li>LEVEL I </li></ul><ul><li>conscious , cognitive, coherent </li></ul><ul><li>LEVEL II </li></ul><ul><li>confused, drowsy, lethargic, or obtunded, somnolent </li></ul><ul><li>LEVEL III </li></ul><ul><li>stuporous, responds only to noxious, strong intense stimuli </li></ul><ul><li>LEVEL IV </li></ul><ul><li>light coma </li></ul><ul><li>- response is only by grimace or withdrawing limb from pain </li></ul><ul><li>- primitive and disorganized response to painful stimuli </li></ul><ul><li>Deep coma </li></ul><ul><li>- absence of response to even the most painful stimuli </li></ul>
  10. 10. OLDER ADULT CARE FOCUS Assessing Neurological Function in older Adults <ul><li>Signs of Cognitive Impairment </li></ul><ul><li>Significant memory loss ( person, place, and time) </li></ul><ul><li>Person : Does client know who he or she is and can client give you his or her full name? </li></ul><ul><li>Place : Can client identify his or her home address and where he or she right now? </li></ul><ul><li>Time : What was the most recent holiday; what month, time of day, day of the week? </li></ul><ul><li>Does client show a lack pf judgment? </li></ul><ul><li>Is client agitated or/and suspicious? </li></ul>
  11. 11. OLDER ADULT CARE FOCUS Assessing Neurological Function in older Adults <ul><li>A is determined from the clients appearance and family’s response, does client have problem with ADL’s? </li></ul><ul><li>Short term memory: Can the client recall your name, name of the president, or the name of his or her doctor? </li></ul><ul><li>Short term recall: Ask the client to name three or four common objects and ask client to recall them within the next 5 minutes. </li></ul><ul><li>Does the client have sensory deficits ( hearing and vision) of which he or she is not aware? </li></ul>
  12. 12. <ul><li>GLASGOW COMA SCALE (GCS) – is an objective measure to describe LOC </li></ul><ul><li>it is based on the client’s response in 3 areas: </li></ul><ul><li>eye opening ,verbal response, motor response </li></ul>
  13. 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. 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. 15. <ul><li>Decerebrate- extension and adduction of arms, hyperextension of legs </li></ul><ul><li>Decorticate – flexion internal rotation of arms, extension of leg. </li></ul>
  16. 16. NEUROLOGICAL SYSTEM DIAGNOSTICS <ul><li>SKULL AND SPINE X-RAY STUDIES- Simple x-ray films are obtained to determine fractures, calcifications, etc. </li></ul>
  17. 17. <ul><li>ELECTROENCEPHALOGRAPHY-(EEG) </li></ul><ul><li>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. </li></ul>
  18. 18. <ul><li>Nursing Implications: </li></ul><ul><li>Explain to client that procedure is painless and there is no danger of electrical shock. </li></ul><ul><li>Determine from physician if any medication should be withheld before the test, especially tranquilizers and sedatives. </li></ul><ul><li>Frequently, coffee, tea, cola, and other stimulants are prohibited before examination. </li></ul><ul><li>Clients hair should be clean before the examination: after exam, assist client to wash electrode paste out of hair. </li></ul>
  19. 19. <ul><li>MAGNETIC RESONANCE IMAGING </li></ul><ul><li>- 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) </li></ul>
  20. 20. <ul><li>Nursing Implications: </li></ul><ul><li>Procedure will take approximately 1 hour. </li></ul><ul><li>All metal objects should be removed from the client. </li></ul><ul><li>The client will be placed in a long magnetic tunnel for the procedure. </li></ul><ul><li>Poor candidates for MRI include the following: </li></ul><ul><ul><li>Clients with pacemakers </li></ul></ul><ul><ul><li>Clients with implanted insulin pumps </li></ul></ul><ul><ul><li>Pregnant clients </li></ul></ul><ul><ul><li>Obese clients </li></ul></ul><ul><ul><li>Any client who requires life support equipment </li></ul></ul>
  21. 21. <ul><li>COMPUTERIZED AXIAL TOMOGRAPHY SCAN (CAT) - </li></ul><ul><li>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. </li></ul>
  22. 22. <ul><li>Nursing Implications: </li></ul><ul><li>Explain appearance of scanner to client and explain importance of remaining absolutely still during the procedure. </li></ul><ul><li>Remove all objects from client’s hair; clients only receives fluid for 4-6 hours before the test. </li></ul><ul><li>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. </li></ul><ul><li>Contrast dye may discolor urine for about 24 hours. </li></ul>
  23. 23. <ul><li>LUMBAR PUNCTURE- </li></ul><ul><li>A 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. </li></ul>
  24. 24. <ul><li>Nursing Implication: </li></ul><ul><li>Before the test </li></ul><ul><li>have client empty the bladder. </li></ul><ul><li>Explain position (lateral recumbent with knees flexed) </li></ul><ul><li>Advised physician if there is a change in neurological status of the client before the test; increased ICP is a contraindication to lumbar puncture. </li></ul><ul><li>After the test </li></ul><ul><li>Keep the client flat at least 3 hours, and sometimes up to 12 hours, to decrease occurrence of headache. </li></ul><ul><li>Encourage high fluid intake </li></ul><ul><li>Observe for spinal fluid leak fro the puncture site; if leakage occurs, it may precipitate a severe headache. </li></ul>
  25. 25. CRITICAL THINKING <ul><li>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? </li></ul>
  26. 26. CRITICAL THINKING <ul><li>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 don’t open to any stimulus. (verbal and pain). How will you rate the GCS? </li></ul>
  27. 27. CRITICAL THINKING <ul><li>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 doesn’t answer to his mother when talked to. The doctor ordered a restraint and when initiated it open eyes but wasn’t able to recognize his parents and he is trying to free himself from the restraints and kept shouting. GCS? </li></ul>
  28. 28. CRITICAL THINKING <ul><li>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, doesn’t cry to pain, flaccid extremities and has a very high fever. Use the GCS for pediatrics. </li></ul>
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