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N450 - Neurologic System (3).
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N450 - Neurologic System (3).
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N450 - Neurologic SystemIntroduction - ANS-- Our neurological system defines who we are - it controls consciousness,
ethics, cognition, judgement, decision making and behavior
- When brain function ceases, life itself is determined to have ceased.
- The neurological system consists of two systems: Central
and Peripheral
- The functional health of older adults is dependent on a healthy, functioning neurological
system.
- The functions of all other bodily systems rely on the intact function of the neurological system
- Older adults have greater fear of losing mind or memories than body functions
Central Nervous System - ANS-- Neurotransmitters influence memory and cognition, mood, and
motor function and are very important
- Neurotransmitters also control the hypothalamic-pituitary-adrenal axis (HPA), which integrates
the endocrine, immune, and nervous systems.
- The brain decreases in size and weight with aging.
- The function and survival of neurons depends on key biological processes and with aging
there is neuronal death and changes in the synapse between neurons
- These changes are especially pronounced in neurodegenerative diseases such as Alzheimer's
disease or Parkinson's disease
- The three d's can occur individually or together - know the baseline behavior or cognition
Acetylcholine - ANS-important in memory formation as well as movement
Dopamine - ANS-important in mood and movement
- the balance of the dopamine and acetylcholine causes smooth movement
Norepinephrine and Serotonin - ANS-are involved in mood
Glutamate - ANS-excitatory
GABA - ANS-inhibitory
Normal Changes of Aging - ANS-The challenge of caring for older adults is not to treat normal
aging changes as disease
- What is normal and what is related to disease - hard to distinguish
- Cognition - characterized by memory, attention span, and by executive function (ability to plan
& think abstractly)
Normal changes of Aging in the Neurologic System. - ANS-- Decrease in size and weight of
brain
, - Decrease in number of neurons
- Decrease in arterial perfusion secondary to arterial sclerosis
- Decrease in neurotransmitters as well as receptors
- Mean increase in glucocorticoids which can lead the body to be in a chronic stress state - pt is
more likely to develop diabetes, depression
- Change in sleep cycles - insomnia or frequent awakening which interferes with REM sleep
(restores us, forms memories and organizes thoughts) - don't get restoration
- Increase in reaction time - slower to respond - issue w/driving and problem w/falling
- Decrease in DTR, vibration and light touch as well as **propriception** (position sense of body
parts)
- Change in all of the senses - decrease in smell, hearing, vision
- Change in autonomic nervous system - baro receptors - when change position it takes a long
time for BP to come up (orthostatic hypotension)
- Change in thermoregulation - can't regulate temperature as well - higher risk for heat stroke
Peripheral Nervous System - ANS-- The spinal cord is not spared in aging --> degeneration of
the spine can lead to pain, immobility and disability
- Arthritis of the spine - lumbar/sacral or other spines
- Cells of the spinal cord decline in number, and narrowing of the interior of vertebral bodies puts
pressure on the spinal cord.
- From the perspective of directing nursing care, the neurologic conditions of the central nervous
system fall into the categories of memory, movement, seizure disorders, and stroke.
- The conditions of the peripheral nervous system fall into the categories of motor, sensory, and
autonomic disorders
- Motor sensory problems and autonomic disorders
Conditions of the CNS - ANS-- Mental status includes more than just cognitive ability; level of
consciousness, appearance and behavior, speech and language, mood and affect, perception
and thought content, and insight and judgment all are factors in mental health status
- When older persons have difficulties with their memory or changes in their behavior, they need
to be carefully assessed to determine whether there is a treatable cause.
- Looking at LOC, cognitive ability, speech, language and appearance, behavior, perception &
thought content
**This becomes a safety issue - maybe interpreting environment differently**
**Huge burden on care givers to protect them**
Typical Cognitive Function vs. Cognitive Disorder in the Older Adult - ANS-- Forgetfulness
should not be confused with true cognitive impairment
- If allowed more time, older adults experience no more memory loss than younger persons
- A decline in cognitive function is an effect of disease not the normal aging process
- Cognitive Disorders of the Older Adult: Depression, Delirium and Dementia; Cranial Tumors;
Subdural Hematomas; Normal Pressure Hydrocephalus
***Most of the time we need to rule these things out and then diagnose depression, delilrium or
dementia***
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