1. Anatomy and Physiology

2. Purpose: To understand the workings and
functions of the human nervous system.
To successfully identify disease processes
common to the human nervous system.
To provide proficient care to individuals afflicted
with disease processes or injuries affecting the
human nervous system.

3.  A & P of the Nervous System

4. Neuron- The functional unit (cell) of the nervous
system that conducts electrical impulses to the
brain and to other areas of the body.
Sensory Neurons- Carry information from the
distal parts of the body toward the central
nervous system (CNS)
Motor Neurons- Carry motor information from
the CNS to the periphery.

5. Axon and dendrites branch off of the main body of
the neuron.
Axon- Carry impulses away from the cell body
Dendrites – Carry impulses to the cell body.
Myelin- is a substance that sheaths many axons and
dendrites. It enhances conduction along the nerve
fiber (moves impulse very quickly) and gives the
axons their white appearance.

6. The Central Nervous System (CNS)
Made up of the BRAIN and the SPINAL CORD
The Peripheral Nervous System (PNS)
Made up of all of the peripheral of the body,
including the spinal and cranial nerves

8. The Brain is divided into the Cerebrum,
Cerebellum and the Brain Stem.
Cerebral Spinal Fluid (CSF) is composed of water,
glucose, sodium chloride and protein.
Its FUNCTION is that it acts as a shock absorber
for the brain and spinal cord.

10. The Spinal Cord
Extends from C1 to L2
There are 31 pairs of spinal nerve roots that exit
the spinal cord, each consisting of an afferent root
(posterior sensory)and efferent root (anterior
motor).
These roots, along with the 12 cranial nerves
make up the PERIPHERAL NERVOUS SYSTEM.

11. Autonomic Nervous System
Controls the INVOLUNTARY activities of the
viscera including smooth muscle, cardiac muscle
and glands
Two major subdivisions: The SYMPATHETIC
NERVOUS SYSTEM (SNS) and the
PARASYMPATHETIC NERVOUS SYSTEM
(PNS).

12. Complex functions:
Initiation of movements, recognition of sensory
input, higher-order thinking, regulating
emotional behavior and endocrine and autonomic
functions

13. Divided into two halves: hemispheres
Each hemisphere controls the opposite side of the
body: the right hemisphere controls the left side
of the body, and the left hemisphere controls the
right side of the body
The cortex of each is divided into the parietal,
frontal, temporal, and occipital lobes; each has a
different area of function

15. Brainstem
Includes midbrain, pons, medulla, and part of the
reticular activating system
Controls vital, basic functions, including
respiration, heart rate, and consciousness

16. Uses information received from the cerebrum,
muscles, joints, and inner ear to coordinate
movement, balance, and posture
Unlike the cerebrum, the right side of the
cerebellum controls the right side of the body,
and the left side of the cerebellum controls the left
side of the body

17. Carotid System
Begins as one common artery; later divides into the
external and internal carotid arteries
The external carotid arteries divide to supply blood to
the face
The internal arteries further divide into the middle
cerebral artery and the anterior cerebral artery to
supply blood to the brain

18. Carotid System
Begins as one common artery; later divides into the
external and internal carotid arteries
The external carotid arteries divide to supply blood to
the face
The internal arteries further divide into the middle
cerebral artery and the anterior cerebral artery to
supply blood to the brain

19. Vertebral Arteries
Originate from the subclavian artery, travel up
the anterior neck to merge and form the basilar
artery at the brainstem
Second division forms posterior cerebral artery
Internal carotid and vertebrobasilar arteries unite
to form the circle of Willis

21. TYPES OF DISORDERS
 Genetic/ Developmental
 Trauma
 Infection and Inflammation
 Neoplasms
 Degenerative processes
 Vascular Disorders
 Metabolic and Endocrine Disorders

22. Thought to be caused by:
 Intracranial vasoconstriction followed be
vasodilation.
 TRIGGERED BY:
 Menstruation
 Ovulation
 Alcohol consumption
 Some foods
 STRESS

23. PAIN:
 Usually unilateral
 Often begins in the temple or eye area
 VERY INTENSE
 Tearing and nausea and vomiting may occur
 Hypersensitivity to light and sound

24. TREATMENT MEDICATIONS
 Mild migraines:
 Acetaminophen or aspirin
 Severe migraines:
 Ergotamine (Cafergot)
 Sumatriptan tablet (Imitrex)
 Sumatriptan autoinjector (for self injection)

25. Occur in a series of episodes followed by a long
period with no symptoms.
Intensely painful and seem to be related to stress
or anxiety.
Usually no warning symptoms.

26. TREATMENT MEDICATIONS
 Cold application
 Indomethacin (Indocin)
 Tricyclic antidepressants (Elavil)

27. Results from prolonged muscle contraction from
anxiety, stress, or stimuli from other sources, such
as brain tumor or an abscessed tooth.
Pain location may vary
 May have N/V
 Dizziness
 Tinnitus
 Tearing

28. TREATMENT
 Correction of known causes
 Psychotherapy
 Massage
 Heat application
 Relaxation techniques

29. TREATMENT MEDICATIONS
 Analgesics (usually non-opiod)
 Benzodiazepines to relieve anxiety if severe.

30. Electrical impulses in the brain are conducted in a
highly chaotic pattern that yields abnormal
activity and behavior.
Related to trauma, reduced cerebral perfusion,
infection, electrolyte disturbances, poisoning, or
tumors.

31. MEDICAL DIAGNOSIS
Accurate history of the seizure disorder
Electroencephalogram (EEG)

32. Partial Seizure
Simple
Part of one cerebral hemisphere; consciousness not
impaired
Complex
Consciousness impaired; may exhibit bizarre
behavior

33. Generalized seizures
 Involves the whole brain
 Consciousness lost during the ictal (seizure) period
TYPES
 Tonic-Clonic (Grand Mal)
 Absence (Petit Mal) (Eye Blinking, Lip Smacking,
Daydreaming) generally identified in childhood.
 Myoclonic (brief jerking or stiffening of extremities)
 Atonic (Drop attacks) sudden loss of muscle tone
causes patient to collapse

34. Status Epilepticus
Medical emergency. The continuous seizure or
repeated seizure in rapid succession for 30 minutes
or more.
Aura
Dizziness, numbness, visual or hearing disturbance,
noting an offensive odor, or pain may precede a
seizure

35. MEDICAL TREATMENT
Resolution of the underlying condition
Anticonvulsant therapy
 If good seizure control is not accomplished with one
drug, combinations of drugs may be prescribed.

36. SURGICAL TREATMENT
Removal of seizure foci in the temporal lobe and
pallidotomy or vagal nerve stimulator.

37. Assessment
 Describe the seizure episode, INCLUDING the post-
ictal period, and documenting drug therapy.

38. Risk for Injury:
 Nursing Interventions
 Side rails
 Padded bed .
 Suction machine
 Bed in low position
 Remove objects away from the patient
 DO NOT attempt to restrain the patient

39. Ineffective Coping and Knowledge Deficit
 Nursing Interventions
 Teach family and patient about seizure disorder and
the therapy
 Teaching must be directed toward helping the patient
and family adjust to a chronic condition
 Encourage questions and concerns

40. TYPES
Scalp Injuries
 Lacerations, contusions, abrasions, and hematomas
Concussion
Trauma with no visible injury to the skull or brain
Contusion
Bruising and bleeding in the brain tissue

41. TYPES
Hematoma
Subdural hematoma or epidural hematoma
Intracerebral Hemorrhage
From lesions within the tissue of the brain itself
Penetrating Injuries
Sharp objects penetrate the skull and brain tissue

42. Surgical Treatment
Directed at evacuating hematomas and
debriding damaged tissue

43.  Ineffective Tissue Perfusion
 Ineffective Breathing Pattern
 Risk for Injury
 Risk for Infection
 Impaired Physical Mobility
 Disturbed Body Image
 Ineffective Role Performance

44. Cause and Risk Factors
 Some congenital; others may be related to heredity
 Drug/environmental factors may play a role in
development

45.  Signs and symptoms
 Directly related to area of brain invaded by the
tumor
 Visual disturbances and headache
 New-onset seizure activity
 Difficulties with balance and coordination

46. Medical Treatment
 Surgery often followed by radiation with or without
chemotherapy

47. Acute Pain
Disturbed Thought Processes
Disturbed Sensory Perception
Impaired Physical Mobility
Self-Care Deficit
Ineffective Coping

48. Cause and Risk Factors
Inflammation of the meningeal coverings of the
brain and spinal cord caused by either viruses or
bacteria

49. Signs and Symptoms
 Headache,
 nuchal rigidity (stiffness of the back of the neck)
 irritability
 diminished level of consciousness
 photophobia (sensitivity to light)
 hypersensitivity
 seizure activity
 Positive Kernig sign
 Brudzinski sign

52. Medical Treatment
Bacterial infections usually respond to
antimicrobial therapy, but no specific drugs
effective against most viral infections
Anticonvulsants used to control seizure activity if
necessary

53. Assessment
 Assess vital signs
 Neurologic status frequently to determine
further deterioration or onset of
complications

54. Ineffective Tissue Perfusion
Ineffective Breathing Pattern
Acute Pain
Risk for Injury
Deficient Fluid Volume

55. Cause and Risk Factors
Inflammation of brain tissue caused by virus
Signs and Symptoms
Fever Agitation
Nuchal rigidity (stiff neck) Headache
Confusion Hemiparesis
Restlessness Exhibit aphasia
Delirium Facial weakness
Comatose
Other alterations in motor activity

56. Medical Treatment
Enhance patient comfort and increase strength
Because seizure activity is a potential problem,
take appropriate safety precautions

57. The nursing plan of care parallels that of the
patient with meningitis

58. Cause and Risk Factors
Although specific cause unknown, it is believed to
be an autoimmune response to a viral infection
Patients often report some recent viral infection or
vaccination

59. Initial Phase
Symmetric muscle weakness: begins in lower extremities;
ascends to trunk and upper extremities
Visual and hearing disturbances, difficulty chewing, and lack of
facial expression
Mild paresthesias or anesthesia in feet and hands in a glove or
stocking distribution pattern
Hypertension, orthostatic hypotension, cardiac dysrhythmias,
profuse sweating, paralytic ileus, and urinary retention

60. Plateau Phase
Remains essentially unchanged
No further neurologic deterioration, but no
improvement either
Recovery Phase
Remyelinization; muscle strength returns in a
proximal-to-distal pattern (head to toes)

61. Medical Diagnosis
Characteristic onset and pattern of ascending
motor involvement
Elevated protein level in the CSF
Nerve conduction velocity studies reveal slowed
conduction speed in the involved nerves

62. Medical Treatment
Preserve vital function, particularly respiration
Respiratory status is closely monitored and mechanical
ventilation initiated if vital capacity falls to 15 ml/kg of
body weight
Massive doses of corticosteroids prescribed to suppress
the inflammatory process
Plasmapheresis

63. Assessment
 Health history describes the progression of
symptoms
 Note fears, coping strategies, and sources of
support
 Physical examination focuses on cranial nerve,
motor, respiratory, and cardiovascular function

64. Ineffective Breathing Pattern
Decreased Cardiac Output
Risk for Disuse Syndrome
Imbalanced Nutrition: Less Than Body
Requirements
Anxiety
Deficient Knowledge
Rehabilitation

65. Cause and Risk Factors
 Progressive degenerative disorder of the basal
ganglia: an eventual loss of coordination and
control over involuntary motor movement

66. Signs and Symptoms
Tremor, rigidity, and bradykinesia
Loss of dexterity and power in affected limbs,
aching, monotone voice, handwriting changes,
drooling, lack of facial expression, rhythmic head
nodding, reduced blinking, and slumped posture
Depression common; dementia may develop

68. Medical Diagnosis
From health history and physical examination
MRI to rule out other causes of the symptoms

69. Medical Treatment
Control symptoms: physical therapy and drug
therapy
Massage, heat, exercise, and gait retraining

70. Medications
Dopamine receptor agonists:
Pramipexole (Mirapex)
Ropinirole (Requip);
L-dopa (L-dihydroxyphenylalanine);
Carbidopa/levodopa (Sinemet)
Anticholinergic drugs:
Trihexyphenidyl (Artane)
Benztropine (Cogentin)

71. Assessment
Weakness, fatigue, muscle cramps, sweating,
dysphagia, constipation, difficulty voiding, and
unusual movements
Note lack of facial expression, eyes fixed in one
direction, drooling, slurred speech, tearing,
tremors, muscle stiffness, and poor balance and
coordination

72. Impaired Physical Mobility
Risk for Injury
Imbalanced Nutrition: Less Than Body
Requirements
Ineffective Coping
Deficient Knowledge

73. Cause
Chronic, progressive degenerative disease
Attacks the protective myelin sheath around axons and
disrupts the conduction of impulses through the CNS
Chronic, progressive MS: progresses steadily
Exacerbating-remitting MS: exacerbations and remissions

74. Signs and Symptoms
Fatigue, weakness, and tingling in one or more
extremities; visual disturbances; problems with
coordination; bowel and bladder dysfunction;
spasticity; and depression

75. Relapsing-progressive MS: less stable periods
than exacerbating-remitting
Stable MS: stable; no active disease for a year
Exact cause of MS is unknown; viral infections
and autoimmune processes have been implicated

77. Medical Diagnosis
Based on the physical examination and history of
cyclic remission-exacerbation periods
Magnetic resonance imaging of the brain and
spinal cord may reveal plaques characteristic of
MS

78. Medical Treatment
Corticosteroids
 (ACTH, prednisone, methylprednisolone)
Interferon 1b (Betaseron) and
 interferon 1a (Avonex)
Glatiramer acetate (Copaxone)
Immunosuppressants:
 mitoxantrone (Novantrone)
Amantadine (Symmetrel)

79. Urinary retention treated with cholinergics, such
as bethanechol (Urecholine) or neostigmine
(Prostigmine)

80. Assessment
Onset and progression of symptoms, especially
those that affect mobility, vision, eating, and
elimination
Range of motion and strength, gait abnormalities,
tremors, and muscle spasms

81. Impaired Physical Mobility
Disturbed Sensory Perception
Self-Care Deficit
Functional Urinary Incontinence
Risk for Infection
Ineffective Coping
Deficient Knowledge

82. Cause
Also known as Lou Gehrig’s disease; a
degenerative neurologic disease
Virus suspected, but exact cause unknown

83. Pathophysiology
Degeneration of the anterior horn cells and the
corticospinal tracts, so patient exhibits upper and
lower motor neuron symptoms

84. Signs and Symptoms
Weakness of voluntary muscles of the upper
extremities, particularly the hands
Difficulty swallowing and speaking
Eventually, respirations shallow; difficulty clearing
airway of pulmonary secretions
Death results from aspiration, respiratory infection,
or respiratory failure

85. Medical Diagnosis
History and physical examination findings
Electromyography

86. Medical Treatment
Because no known cure or treatment, therapy is
supportive; focuses on preventing complications
and maintaining maximum function

87. Assessment
Dyspnea, dysphagia, muscle cramps, weakness,
twitching, joint stiffness, muscle atrophy,
abnormal reflexes and gait, and paralysis

88. Ineffective Airway Clearance
Impaired Physical Mobility
Imbalanced Nutrition: Less Than Body
Requirements
Impaired Verbal Communication
Impaired Skin Integrity
Anticipatory Grieving
Situational Low Self-Esteem
Interrupted Family Processes

89. Inherited degenerative neurologic disorder
Usually begins in middle adulthood with abnormal
movements, emotional disturbance, and intellectual
decline
Symptoms progress steadily: increasing disability and
death in 15 to 20 years
Medical and nursing care are supportive only; there is
no cure

90. Cause
May have an autoimmune basis
Pathophysiology
 Insufficient receptor sites at the junction of the
motor nerve with the muscle
 With repeated stimulation, muscle becomes
exhausted; eventually unable to contract at all
 If respiratory muscles involved, death from
respiratory insufficiency or arrest possible

91. Signs and Symptoms
 Weakness of voluntary muscles, particularly those
of chewing, swallowing, and speaking
 Partial improvements of strength with rest
 Dramatic improvement with the use of
anticholinesterase drugs
 Ptosis and diplopia commonly seen

92. Medical Diagnosis
 Administering edrophonium (Tensilon)
 Muscle tone is markedly improved within 1
minute of injection; persists for 4 to 5 minutes

93. Medical Treatment
 Anticholinesterase drugs
 Neostigmine and pyridostigmine (Mestinon)
 Corticosteroids
 Cytotoxic therapies
 Thymectomy
 Plasmapheresis

94. Assessment
Health history describes the onset of symptoms:
muscle weakness, diplopia, dysphagia, slurred
speech, breathing difficulties, and loss of balance

95. Ineffective Breathing Pattern
Impaired Physical Mobility and Self-Care Deficit
Impaired Swallowing
Deficient Knowledge

96. Health History
 Note speech, behavior, coordination, alertness,
comprehension
Chief Complaint and history of present
illness
 Document what prompted the patient to seek
medical attention
 Describe any injuries
 If patient has pain, note the onset, severity,
location, and duration

97. Past Medical History
Head injury, seizures, diabetes mellitus,
hypertension, heart disease, and cancer
Record dates and types of immunizations

98. Family History
Have immediate family members had heart
disease, stroke, diabetes mellitus, cancer, seizure
disorders, muscular dystrophy, or Huntington
disease?

99. Review of Systems
Fatigue or weakness, headache, dizziness, vertigo,
changes in vision/hearing, tinnitus, drainage
from ears or nose, dysphagia, neck pain or
stiffness, vomiting, bladder or bowel function,
sexual dysfunction, fainting, blackouts, tremors,
paralysis, incoordination, numbness or tingling,
memory problems, mood changes

100. Functional Assessment
Document whether present symptoms interfere
with the patient’s usual activities and occupation
Explore sources of stress, usual coping strategies,
and sources of support

101. Physical Examination
Level of consciousness, pupillary evaluation,
neuromuscular response, and vital signs

102. Risk Factors for Stroke
Non-modifiable factors
 Risk factors that cannot be changed
 Age, race, gender, and heredity
Modifiable factors
 Those that can be eliminated or controlled

103. Temporary neurologic deficit caused by
impairment of cerebral blood flow
Blood vessels occluded by spasms, fragments of
plaque, or blood clots
Important warning signs for the individual
experiencing a full stroke

104. Signs and Symptoms
Dizziness, momentary confusion, loss of speech,
loss of balance, tinnitus, visual disturbances,
ptosis, dysarthria, dysphagia, drooping mouth,
weakness, and tingling or numbness on one side
of the body

105. Medical Diagnosis
Health history, physical examination findings,
and results of brain imaging studies
Laboratory studies, electrocardiography (ECG),
duplex ultrasonography, and cerebral
angiography

106. Medical Diagnosis
Health history, physical examination findings,
and results of brain imaging studies
Laboratory studies, electrocardiography (ECG),
duplex ultrasonography, and cerebral
angiography

107. Medical Treatment
Depends on the location of the narrowed vessel and the
degree of narrowing
Acetylsalicylic acid (aspirin)
Ticlopidine hydrochloride (Ticlid)
Extended-release dipyridamole (Aggrenox)
Clopidogrel bisulfate (Plavix) decrease platelet clumping
Warfarin (Coumadin) and heparin
 Carotid endarterectomy and transluminal angioplasty

109. An abrupt impairment of brain function resulting
in a set of neurologic signs and symptoms that are
caused by impaired blood flow to the brain and
last more than 24 hours

110. Pathophysiology
Hemorrhagic stroke
 Blood vessel in brain ruptures; bleeding into the
brain occurs
Ischemic stroke
 Obstruction of blood vessel by atherosclerotic
plaque, blood clot, or a combination of the two, or by
other debris released into vessel that impedes blood
flow to an area of the brain

112. Signs and Symptoms
Different signs and symptoms, depending on the
type, location, and extent of brain injury
Hemorrhagic stroke
 Occurs suddenly; may include severe headache
described as “the worst headache of my life”
 Other symptoms: stiff neck, loss of consciousness,
vomiting, and seizures

113. Signs and Symptoms
Embolic stroke
 Appear without warning
 One or more of the following signs and symptoms:
one-sided weakness, numbness, visual problems,
confusion and memory lapses, headache, dysphagia,
and language problems

114. The number of nerve cells decreases
Brain weight is reduced; ventricles increase in size
Lipofuscin: aging pigment deposited in nerve cells
with amyloid, a type of protein
Increased plaques and tangled fibers in nerve tissue
Eye pupil often smaller; may respond to light more
slowly

115. Reflexes intact except for Achilles tendon jerk,
which is often absent
Reaction time increases, especially complex
reactions
Tremors in the head, face, and hands are common
Some develop dizziness and problems with
balance

117. Signs and Symptoms
Aphasia
 A defect in the use of language; speech, reading,
writing, or word comprehension
Dysarthria
 The inability to speak clearly
Dysphagia
 Swallowing difficulty

118. Signs and Symptoms
Dyspraxia
 The partial inability to initiate
coordinated voluntary motor acts
Hemiplegia
 Defined as paralysis of one side of the
body

120. Signs and Symptoms
Sensory impairment
 Unable to feel touch, pain, or
temperature in affected body parts
Unilateral neglect
 Do not recognize one side of the body
as belonging to them

121. Signs and Symptoms
Homonymous hemianopsia
 Perceptual problem: involves loss of one side of field
of vision
Elimination disturbances
 Neurogenic bladder
 Flaccid bladder
 Bowel incontinence

122. Medical Diagnosis
Blood studies, electrocardiogram (ECG),
computed tomography, magnetic resonance
imaging, carotid ultrasound studies, cerebral and
carotid angiography, electrocardiography,
positron-emission tomography, and
single-photon emission computed tomography

123. Complications
Constipation, dehydration, contractures, urinary tract
infections, thrombophlebitis, decubitus ulcers, and
pneumonia
Sensory losses put patient at risk for traumatic and
thermal injuries
Swallowing difficulties place patient at risk for
pulmonary complications, such as choking and
aspiration pneumonia

124. Prognosis
Prognosis for TIA or stroke increasingly
hopeful
Critical variables for recovery: patient’s
condition before the stroke, time between
stroke and diagnosis, treatment and support
in acute phase (usually the first 48 hours),
severity of patient’s symptoms, and access to
rehabilitative therapy

125. Prognosis
Long-term recovery may depend on the care
received immediately after the stroke
Most recovery takes place in the first 3 to 6
months, but progress often continues long after
that

126. Medical Treatment in the Acute Phase
Begins with the onset of signs and symptoms and
continues until vital signs, particularly blood pressure
and neurologic condition, stabilize
This phase usually lasts 24 to 48 hours
Many medical management interventions are directed
at minimizing complications and deterioration of the
patient’s condition after a stroke

127. Medical Treatment in the Acute Phase
Major focus areas
 Hypertension
 Oxygenation
 Hyperthermia
 Hyperglycemia
Drug therapy
 Tissue plasminogen activator (rt-PA, alteplase,
Activase)
 Given to dissolve clots in acute ischemic strokes

128. Medical Treatment in the Acute Phase
Other Medications
 Mannitol
 Nimodipine (Nimotop)
 Phenytoin (Dilantin) and phenobarbital
 Acetylsalicylic acid (aspirin), ticlopidine
hydrochloride (Ticlid), Aggrenox, and
clopidogrel (Plavix)

129. Medical Treatment in the Acute Phase
Surgical intervention
 An option for some patients with hemorrhagic
strokes
Decisions about surgery are based on patient’s
age, intracranial pressure, and location of the
hemorrhage

130. Medical Treatment in the Acute Phase
Fluids and Nutrition
 Intravenous fluids
 Dietary order based on patient’s
nutritional requirements and ability to eat
 Regular, soft, or pureed
 Total parenteral nutrition may be ordered
for the malnourished patient

131. Medical Treatment in the Acute Phase
Urine Elimination
 Indwelling catheter to manage urinary incontinence
 Intermittent catheterization: controlling incontinence
caused by a flaccid bladder

132. Assessment
Evaluate type and extent of the stroke: time of
onset, symptoms, other details
Cincinnati Pre-hospital Stroke Scale

133. Health History
Chief complaint and history of present illness
Medical history
Family history
Review of systems
Functional assessment

134. Physical Examination
Assess patient’s general appearance,
responsiveness, and behavior
Record restlessness or agitation
Measure vital signs; weight and height if possible

135. Physical Examination
Inspect the face for symmetry; mouth for
moisture and drooling
Evaluate the alert patient’s ability to swallow
Inspect pupils for size, equality, and reaction to
light

136. Physical Examination
Conduct a gross vision assessment
Inspect skin color and palpate for moisture and turgor
Assess extremities for muscle tone and strength, sensation, and
voluntary movement
Record evidence of incontinence or bladder distention
Frequently repeat neurologic checks: evaluating level of
consciousness, pupil appearance and response to light, the patient’s
ability to follow commands, and the movement and sensation of
extremities

137. Ineffective Airway Clearance and Ineffective
Breathing Patterns
Risk for Injury
Deficient Fluid Volume or Excess Fluid Volume
Imbalanced Nutrition
Disturbed Sensory Perception
Ineffective Thermoregulation
Disturbed Thought Processes

138. Impaired Verbal Communication
Impaired Physical Mobility
Total or Functional Urinary Incontinence
Constipation and/or Bowel Incontinence
Ineffective Coping
Interrupted Family Processes

139. Assessment
Reassess patient’s abilities, expectations,
knowledge, motivation, and resources

140. Rehabilitation Phase
Self-Care Deficit
Risk for Injury
Ineffective Coping
Impaired Verbal Communication
Imbalanced Nutrition
Impaired Physical Mobility
Constipation
Total and Functional Urinary Incontinence

144. Patients may be discharged to home or go to
specialized rehabilitation centers for continued
therapy
Outpatient therapy is an option for some patients
When able, patients are transitioned back into the
home setting
Essential to include family, friends, and significant
others in this process

145.  During and after the rehabilitation phase,
patients and families need to be made aware of
resources to help them deal with continuing
disabilities
 In rehabilitation, the patient is respectfully
challenged to return to the highest level of
function possible

146. Anatomy and Physiology
Consists of 33 vertebrae
7 cervical (C1 through C7)
12 thoracic (T1 through T12)
5 lumbar (L1 through L5)
5 sacral (S1 through S5)
4 fused coccygeal

148.  Vertebral Column