Nervous System | Picmonic Nursing Webinar

okay we're going to talk quickly now about the nervous system uh and we're going to go over all of its different parts so we can get everything covered here today my name is Kendall Wyatt if you haven't seen me these before um I am started out as paramedic became an RN now I'm finishing up medical school and I am the content director here at Pig Manik making sure everything works good for you what speak Manik everyone always asks well we take fun characters everything you need to know medical school and nursing school and turn it into fun characters that then help you keep everything straight in your brain keep the highs and the lows the ups and the downs and all the side effects of drugs and things straight so if you need to remember warfarin the drug warfarin becomes a warfare II here in big Manik I mean just a contrast warfarin everything you need to know for it we have the contrasting if the Heron that crazy bird then have is for heparin to help you remember with all the side effects and everything and how one's contraindicated in pregnancy one's safe for pregnancy and whatnot today though we're going to talk about nervous system disorders we're going to talk through two different parts for nervous system disorders our first part we're going to talk about Parkinson's disease we're going to talk about myasthenia gravis we're gonna talk about multiple sclerosis ribs are by Gillian Bray I'm ripped open Huntington's disease in a minor traffic lateral sclerosis or Lou Gehrig's disease everything you see here today includes pieces just parts of our Pig monic learning system and so you can always go to pick monochrome and learn all of the details that go along with this and truly do anything that you see in that's characterized here today so if you don't understand how it works like Parkinson's disease becomes a park in son garage so you can associate that with the pigmented character as well so for part two we're going to talk about intracranial pressure intracranial pressure and the associations there we are going to quickly touch on head injuries and then we're going to talk about meningitis more men in tights and then we're going to talk about strokes types of strokes as well as left and right hemisphere stroke assessment knowing those one from the other and that's really really important making sure you know the differences so let's go get started part one so just so really really quick to put together I love to teach everything as a system and I love to imagine that everything in the human body is this is all goes together and works and you obviously as you know you need to know all those compensation pieces but we like to see I like to teach it as this big giant fish tank I'm imagine that the human body's one big giant fish tank you've got your tank which is your body you've got some pipes which are the veins and arteries moving everything around or in a fish tank you know the pipes moving the water around recirculating the water you've got to have a good pump to move the water or the blood around in your fish tank and you go is got to have a good aerator to keep things alive and that's exactly what the lungs do in the human body they're constantly pumping oxygen into that that fluid or blood we have to have the fluid pump everything in - of course that's our blood or the water of a good fish tank and to keep that water nice and clean we have to have good filters that's where the kidneys come in here's our kidney filters just like you have to have a filter a fish tank now nothing can live inside your fish tank list has sustenance and we like to have show fish food as the GI system so you put in the food it gets digested and then it gets turned into energy that energy can't be correlated without the nervous system itself which is what we're going to talk about today and that's kind of like the batteries of the electricity to keep everything firing and keep it all working in in conjunction together so here's just an example of how all these systems go together it's so important that you know how one system then compensates for the other or how they all work together in this beautiful system that we like to call a wonderful fish tank with your beautiful fish or the human body so let's get started on the actual nervous system first we're going to talk about Parkinson's disease Parkinson's disease or a park in some garages probably the most important nervous system disorder that I would say you have to just really have everything down for one it's a little complicated but you just you're just really likely to get a lot of questions on Parkinson's because it is very common so what's the cost for each one of these disorders you kind of need to know what the cause is what actually made the what caused the problem to happen which neurotransmitter is responsible or linked to the disease and knowing the signs and symptoms and what's different you know just like I teach with every other disorder you really need what is different about this one versus all of the others so if they all have nausea and vomiting or they all have confusion probably not something that you need to make sure you really focus in on you need to know it yes and I believe it's important but you need to focus in on the little details that are specific for each one and Parkinson's just has to have a lot of them so this is one err one subject that I see so many students always telling me to get select all that apply questions on and they always end up missing them so let's talk about Parkinson's disease so what's the actual main cause what's going wrong well it's a decrease of dopamine and slightly decrease in serotonin but the main offender here is dopamine and I always right away we have this decreased Doberman which we represent for dopamine inside a pig morning but where it's important that you remember the substantial substantial as well as the basal ganglia true but most importantly decrease dopamine and substantial that's really most likely what you're going to get what's important is you have to be able to identify this patient this particular how they how they present and they present very classically and I'm just going to explain a lot of the signs and symptoms here really quick the first thing is cogwheel rigidity cogwheel well you can see right here we've got this little cog drawn in this arm and what does this really mean well if you imagine that a cog goes to a manufacturing plant and since giant thing that moves things um you know third gears they go together and those are very commonly called cogs and they then work together to do a systematic movement and you know moving things together they raise things or move things or turn things so what happens is they usually have to go they have to fit perfectly together and they kind of this have to align right and then usually they're usually not really smooth in their motions yes newer ones are of course but we're talking let's imagine like the most basic cogs if you were going to make one yourself so if I were to take someone's arm like this and I had cogwheel rigidity if I'm pushing me on that way pulling it down I'm gonna you know they're gonna have they're gonna be very rigid it's going to be very much like you are moving their arm like it's a you know it's a wheel-like imagine that their elbow is a cogwheel and it's going to constantly just kind of pull down are hard to move or straighten and it's more of a you know a rigid muscle type problem and this all stems back to that decrease of dopamine so what's next so cogwheel rigidity muscles you know muscle stiffness is right what's really important is this shuffling gait and we show it here just as a shuffling gait but what you need to know is that these patients they you know they have a shuffling gait what does that mean what am i doing here well if I'm actually walking and imagine these two beautiful hands are two feet the way they walk is they actually move their feet like this they don't actually pick up and walk they just shuffle shuffle shuffle shuffle shuffle shuffle shuffle shuffle shuffle it's a little bit of a shuffling gait so you're going to see them very often going very slow and very often the term is brady kinesia you know they're very slow to get things moving especially in the beginning we're slow to get started you know kinetic is movement and kinetic injuries moving in energy is movement and you know you would brady kinesia is a slow movement so that's where you see that as well especially when they get started so here's brady kinesia or this snail kite brady can use your slow getting started but even once they get started I mean they're like ah shuffle shuffle shuffle it's not going to be a fast they don't go anywhere very fast usually especially in later stages of the disease another classic sign symptom is this tremor at rest so what does that really mean well that means they're not moving at all right now and then they end up with a tremor and that tremor is very classically defined as a pill rolling term so it's like the hand if you imagine you put a pill between your two fingers or your three fingers and you kind of rolled it like this you roll that pill that's a pill rolling trimmer and they may be just at rest have this little pill rolling trimmer that they're going to have it's very classically like them it's basically it's important remember that it's at rest because what kind of patient's going to have oh it's a term for a tremor that occurs when you move when you move well I mean one example is is in tension trimmer so this is somebody who goes to start to grab something in though okay so they're fine like this and then they reach out to go grab something and then they you know they they then start shaking as they try to grab something that's more of an intention trim that's something we see in alcoholics very often is some you know along with with other problems with live severe liver failure of latest in stage liver failure we see a lot of these these other types of trimmers and there's also some other ones we'll get to this but this is a trimmer at rest and it's really important to remember that and the last thing is this mask like faces masks like faces so what does that really mean I mean does that mean they're wearing a mask right our image here no it means that they are having trouble they're the muscle the little tiny muscles of their face also don't they don't get started very easy right they're slow and they're not very reactive they don't have this amazing flexibility to be able to move around so what happens is they have trouble chewing trouble swallowing trouble speaking and the interpreters mask like straights well why does it look why is it a mask like face why do they have this you know mask like face well they don't really don't really show a lot of expression so it looks like they're wearing a mask you know and you see a very classic picture in most of textbooks but they don't you know very unlike my expressive face they're going to be very very stoic they're not going to have a lot of expression in their face and then it's why we call that mask like faces it's a little different in a flat effect but still along the same lines it's they're not actually able to show any show any expression but it's because the muscles don't but I like to compare it to somebody who just had a whole face full of Botox they don't move nothing moves so I guess technically it could be a blessing in disguise but I really doubt it in case you've seen any of our other series here I like to drink for my pic monic cup I get in a wonderful 35 cents every time I drink from this thing my mouth get turns into sandpaper pretty quick so I like to take a lot of drinks for my cup mainly because I like all of those 35 cents I just really wish they'd stop paying me and nickels here at big Manik but I think they really just enjoy doing that as well so let's talk about treatments for Parkinson's disease this is important too especially the first one and the big one this is how we can just kind of associate the whole idea if you memorize one thing for Parkinson's disease and you say this Parkinson's garage Parkinson's disease what's the problem with the main problem is a decrease in dopamine where in the brain so this is decreed opah mean but we're in the substantia ok so then what's a treatment for what's the first-line treatment or a main treatment for Parkinson's disease the answer is levodopa carbidopa and we show it here is this levitating Doberman in this carpet government so levodopa carbidopa is one of the treatments for our concerns very important to remember that now why is this a combined drug do you know do you know why levodopa is combined with carbon OPA why would we give two dopest or just dhoka dhoka dhoka and all over the place ever you're right I mean no well the answer is levodopa crosses the blood-brain barrier and turns into the active form of dopamine well what happens is with with carbidopa is carbidopa not cause cross the blood-brain barrier so carbidopa stays in the bloodstream doesn't cross into the blood but what it actually does is it keeps dopamine from being Trent it keeps the levodopa or any of the dopamine for being converted into the active form of dopamine because you should know dopamine as doing one what what important thing you know dopamine is indicated for alone as a drug you can you remember the answer is dopamine is a very powerful catecholamine so it's a catecholamine that basal constricts and it increases blood pressure it's one medication that we can give dopamine but it's very important that we don't overload we only want to give patients Parkinson's patients dopamine in their brain so we have to keep any kind of peripheral conversion of dopamine from happening and that's why this drug is combined with levodopa and carbidopa combined in the same drug that's really important um there's a controversial treat you know thing about taking a drug holiday from levodopa carbidopa every now and then because you build up tolerance and that's just something that most textbooks have removed and not something we're about really today so there are lots of other different drugs in the treatment of Parkinson's disease there's into Capone and it what it what does it do it breaks down this enzyme comt and inhibits comt from breaking down dopamine so if you think about you know there are lots of ways to get a replacement neurotransmitter right we can either give the neurotransmitter direct which is not very common we give a precursor that converts into the active form which is common and then the other one is to either stop what's there from being destroyed or to stop the body from be the from reabsorbing so either keep it from breaking down on its own or keep the body from basically breaking it down or you know really up reabsorbing it so i this and that's why we have these two different drugs here so it's comt is something that breaks down dopamine in the brain and also we give the medication saline now cilenti is interesting to know because it's an MAOI and what type of maoi it's a Type B so all the other MO I Mao is or monoamine oxidase inhibitors are Type A this is a Type B so it's different it doesn't have as many effects side effects that you need to know about but it prevents breakdown dopamine I'm just another important little tidbit they're just some other medications to prevent some other side effects there's a man to D which is actually in the antiviral the mechanism of action Y works for the side effects is unknown but it's actually an antiviral drug not really used but just use sometimes in the treatment of Parkinson's as an ancillary treatment the other one is Ben's atropine or Ben's tropi and I always end up saying it wrong it's one of my one of the worst ones I have to ever say correctly that and some monoclonal antibodies which we'll talk about it in immunology but so Ben's a trophy it's an anticholinergic drug yes we give it for the the trimmer' basically because this trimmer you know this constant trimmer can get pretty severe in these patients especially in later stages of the disease so what other scenario do you know give the drug Ben's a trophy or Ben's trophy hmm do you know what the other one what's another indication well you should be thinking immediately psyche right we didn't think about psyche but not necessarily giving to psych patients but we give it to treat what side-effect well we give it to treat EPS symptoms like dystonias and muscle type muscle type of side effects so you can just remember that right there you know it's really important to for dystonias and whatnot to keep those keep those side effects at bay if they're taking antipsychotic medications for those EPS symptoms like Haldol and chlorpromazine so that's keep track there they can come and get it I'm going to get enough to where I can get a check one of these days instead of getting nickels so we talked about lots of drugs we talked about the treatment you must know Parkinson's disease so if you don't have it you need to learn it you can go into Pequannock learning system and go through every single one of these and they're going to tie it all in so you can remember this forever and you must remember it forever it's very very important every time we get any patient that has muscle weakness you should immediately be thinking about safety this is just a this needs be ingrained into that nursing brain years it should be way deep down in there you must always think about safety fall safety aspiration risk safety right so aspiration risks we worry about these people in their diet now speech therapists would essentially decide their diet but we need to be worried and aware of thickening liquids aspiration risk giving them assisted system measures to be aboard so that they can eat and swallow also just a fall risk so a home assessment giving edge proper education all the education for fall precautions very very very important as well so next we're going to talk about Huntington's disease Huntington's disease so Huntington's disease this is actually a demo pick monic that we have from our system just to kind of show you how each one goes together and I'm just going to talk you through it so that you can have it right here in the system so Huntington's disease you can remember it because of this hunter this hunter hunting Huntington's disease it's an autosomal dominant disease shown here as these dominoes and that's just a pattern of inheritance that it follows which means that it's actually a pretty prevalent disease as well now the what's actually wrong and this is really important for you to know what is going wrong in Huntington's disease Huntington's disease is not super high yield but what's what's the fundamental problem the problem is a decrease excuse me a decrease of a gaba GA ba shown here is this gaba goose and what does gaba do then it's also a decrease of a decrease of acetylcholine as well but what does gaba do as gaba really do well gaba is like a controller i like to think about it if you think about all these pathways in the brain and I'm generalizing this for you so you know if you're if you are way up on the the details you can appreciate how this needs to be very simplified just to understand the idea what's going on so what happens is we pretty much have gaba and dopamine that kind of in this constant beautiful balance and they have two different pathways in the brain that work to work through the brain to create this balance of movement so there's always you know dopamine which says move move move muscle and then there is gaba which says don't don't don't you know don't move well what happens is when you need to initiate a movement these two work in balance so that this movement is coordinated and smooth and you're able to just easily quickly grab something to make these nice fluid fluid nice movements right so if I'm making these fluid movements yeah but what happens with when I have a decrease of gaba if I don't have enough gaba my movements are very oversaturated and they're not smooth so this decrease of gaba I can't control or hold back the motion so what happens is you end up with these Coria form movements and that's really important Coria form movements well what's a Coria form movement well it just means that it looks like it's choreographed so it means that it looks like it's like been made to do that they're not doing it on purpose but let's just give an example if I'm going to move up reach over here to grab something similar to reach over to grab my cup for Huntington disease and I want to show you how Coria form movements work so they would it would be very over exaggerated and looked like it's like it's moved and this happens a lot when they walk they all have these court you know very very jerky movements when they go to get things it's very important it's important to know what with Huntington's disease is an interesting one males are usually affected more but so not only that but it also it usually doesn't appear until about age 40 so it is a late a late onset of our appearance of the disease so it it's just because of the the type of genetic abnormality that it is but it appears later in life so they're normal this patients are completely normal until they later on live 40 years old they have start having symptoms of this disease and they do have are affected cognitively that kind of a progresses in stages until they you know they have initial beginning problems and then it kind of goes through these three stages of slow cognitive decline in increasing problems with these loops so what's the treatments for Huntington's disease well we give neuroleptics antipsychotics basically haloperidol and risk our risk for dumb risperidone for as neuroleptics but the only true medication that's actually indicated to treat Huntington's disease is tetra benzene tetra benzene is the only medication so if you have trouble memorizing Huntington's disease you easily go into the pic monic system and view everything in here and all of the important information to remember that it's that down arrow gaba goose again down arrow acetyl choline so you can always remember it and keep it straight next we're going to talk about Gilly and brain Gilliam Bray is an interesting one because it's um it's not one we I believe we know a whole lot about but what we do know is it comes on on after a viral bacterial illness and there's a lot more specific switch what type and type of bacterium we're not going to go in then so beyond the scope of this today but what you need to know the important things are it causes and it shows this a sending paralysis so it's a paralysis that in that begins in the feet and the toes are down low and then ascends up in the body so they get more and more paralyzed as the as it progresses so if I'm thinking about this progressing all the way up at what point what involvement am I worried about with Gillian brain what am I going to be worrying about what is it that's right I'm always worried about respiratory support oh sorry I'm gonna have and I'm worried about that paralysis of the diaphragm and that's what we worry about because if you stop breathing you're not going to stay alive and that's something we can ventilate you and put you on a ventilator and definitely keep you alive Gillian Bray I'm resolved within a couple of months to a year or so and pretty much patients usually don't have any residual deficits most often but it's pretty much supplemental treatment for that um the next one we're going to talk about the next disease we're going to talk about is ALS or amyotrophic lateral sclerosis a Maya trophic lateral sclerosis or ALS now everyone's heard about ALS these days ALS ALS ALS and if I hear one more icebucketchallenge story I think I'm going to puke thank god they're not even out there anymore but do live you find lots of them if you were lived in a rock for the last two years Google ice puck a challenge and that you're just going to be and stuck in it for hours however most people don't actually know what happens with ALS and it's actually a really sad disease so what happens with ALS is that you end up with the systemic muscle wasting so it usually starts in the hands usually patients have this hand weakness on hand weakness it usually starts appears in the hands and then progresses to the systemic muscle weakness of the entire body and it's a very sad disease because these patients have no change in cognitive decline whatsoever they are completely lucid and they know everything that's going on up until the day they die now just as you know the things we talked about before like with Gillian Bray the difference here in ALS is this does not ever resolve there is no cure or treatment for ALS that stops the disease there's only rylos Oh which is a treatment which treats symptoms of the disease and some a weakness the other thing you usually see is fasciculations and spasticity and I just I always like to explain a lot of medical terms just so you know what they are but fasciculations are just like a muscle twitch and I always get this dag on twitch right here in this muscle under my eye every single couple of weeks and it drives me nuts and it pretty much just starts twitching and twitches and it twitches until I just want to kill myself with a stick or something right there just make it stop but that's the fasciculations pretty much just like a muscle twitch but that's what you need to know as far as ALS itself what's important to know about the treatment or what's important to know about these patients is that eventually they're just going to become progressively and progressively weak until what happens well what's going to happen is they need respiratory support so you can see these lungs being supported by these scaffolding you think about respiratory support you've got remember that and it's really sad because these patients don't recover once they go on the ventilator I mean they never really they never come off I mean they have to UM always be ventilated them because their muscles are too weak to essentially to to breathe normally so they've never really reverses as well so it's just a really sad disease because the people patients are aware the entire time what's going on so often they they know as this disease progresses over several years and they set up things you know end-of-life treatments and things like that as well it's going to take a little drinkie rule here so the next thing myasthenia gravis myasthenia gravis is another really high up disease that you just have to be able to know what it is and what do I need to know what do you mean know what it is well just know it okay just do it just do it I said so stop asking questions just do it right I mean that was simple just do it so what do we really mean of course I'm going to tell you but we're stringing along just for a minute what actually happens in - Nene revs what's the underlying cost the underlying cause is myasthenia gravis is autoimmune disease what does it mean by autoimmune and I always use the same example but it's pretty much imagining that the body is somehow attacking itself that's not very nice I mean hello body why are you attacking yourself you stupid idiot that's not very nice but there's tons of autoimmune diseases and what happens is I just assume one part of the body gets ticked off the other part and it just goes at it um and I just wish that these parts of the body would be a lot nicer to one another personally but just doesn't happen that way so let's imagine that my left hand here gets mad at my right hand and they get into a fight well when they get into a fight they just go at it until either they get broken up and they they get a treatment or they just keep going at and something that happens somebody gets beat up and somebody gets their feelings hurt that's not very nice right hand gets gets a lot of anyway we'll just leave him alone he's he's uh he's sore loser let's put it that way so myasthenia gravis what's important here it's autoimmune it's an autoimmune disease it's it antibodies these antibodies are against them escena choline receptor so what what do we know about acetylcholine well acetylcholine is um important in muscle action right the action of muscles that's really important to know and this is actually you know in the neurons firing I'm not going to go into the details of this as well but maybe I'll go into a little separate in a separate breakout video for you so antibodies against the acetylcholine receptor what you need to know is that let's say there are 100 receptors for this muscle so there are 100 scepters for this muscle and these are all attached on attached to in the process of making one muscle move so if there's 100 receptors - tinea gravis the alchemy of antibodies will attach to let's say 50 of them so they just take those 50 and they're useless there's antibodies bound onto them and they're not going to be activated by acetylcholine well what's interesting is that they're 50 that are left they can get you know there's so much free acetylcholine and they combine to those to get some muscle action so you still have muscle you know use but what's interesting is if you're if you know anything about working out which I do not despise working out I'd rather lay on the couch all night each I can't say that word eat some brand-name foods that are nice I almost got me so but what's important here is over time I mean if you workout you need more and more and more to keep going right I mean you just can't keep running and you just like keep using only half of the muscles the idea of exercising is you end up working the whole muscle and you need more and more and more to keep going and what that is is you need more and more acetylcholine receptors to find acetylcholine so this is how this actually works and this is where over time you end up with weakness with muscle use because half of the receptors are blocked off so what kind of muscle do you think is used all the time in every single day or at least that Kendall uses every single day that might become weak and let me give you a couple of examples right there's one example my mouth never shuts up I talk so much if I had myasthenia gravis I wouldn't be able to get out three words after 15 minutes I talk non-stop it's it's a gift I mean it takes a lot of skill to talk as much but with myasthenia gravis the things that you use the most your lips talking like you know swallowing and one of the really important is pitocin or lid lag so your eyelids just start drooping it's and you know we also call it Setting Sun side which is pretty much the eyelids they just scum tired man just tired tired all the time but they're not actually tired but they had their their their eyelids are tired and they you know they don't know what's going on and this this is a sign that they have myasthenia gravis and that they're having issues dysphasia difficulty swallowing is a biggie and the number one thing we worry about with these particular patients so what do we do for myasthenia gravis patients what's the treatment for an autoimmune disease I don't know probably steroids right probably we're going to talk about that in a sec so the next thing that I find the reason this is so important to talk about myasthenia gravis it's a very difficult concept understand is what tests do we use to diagnose myasthenia gravis this is a very high yield well the answer is the tensilon test that is correct so you remember the tensilon test and I be honest I actually don't know tensilon is actually the trade name of the drug Edra phony which is the drug that's used during the tensilon test so I don't actually know if the inquest would call it the Etra fobian test but I'm assuming they would still use the tensilon test I honestly don't know that I don't know anybody that I could call to actually find the answer but if I do I will update this accordingly so that you know but with the tinsel on test what are we doing what we're going to find out whether is it eventually we're going to essentially we're identifying what's called a myasthenia myasthenic crisis or a cholinergic crisis I get tongue-tied sometimes by the end of this and I just blame it on myasthenia gravis everyone just feel sorry for me they don't know what's going on so what you need to do with these is you need to think of the name of what's going on in the name which piece and that's going to tell you where the problem is so if I have a cholinergic crisis I have the problem is too much cholinergic s-- too much medication if I have a myasthenic crisis or mice with thin eyes as we show here myasthenia is exacerbated I'm having a disease problem the disease is running amok or I don't have enough medication to treat me I mean that's where you need to think about that so cholinergic crisis is a problem with way too much cholinergic so I had way too much cola as we show here too much medication and myasthenic crisis is the problem is myasthenia so the disease is just running amok and that's just I don't have enough medication and you get some medication to get myself in check so what's the treatment we already said the tinsel on tests or Edra phony right so how does it work well we just talked about myasthenia gravis what's going on with those acetylcholine receptors and we talked about cholinergic sand everything but let's talk about really quick just this tinsel on is a draconian Edgar phone IAM is a short-acting it doesn't last very long a co acetylcholinesterase inhibitor now little little secret here I don't know if anybody filled you on this little nugget of information but anytime you see something that ends in ASE what does that mean just give yourself a temporal massage there if you can't if you can't quite remember it if it is an ASE that's right it's probably some type of enzyme which means it breaks down and that's what you need to remember so if I'm giving an acetylcholine esterase inhibitor this is a what that's right it's an enzyme that prevents that breaks down acetylcholine but I'm going to inhibit the enzyme so it's an inhibitor of an enzyme that breaks down acetylcholine does that make sense so you're going to end up with more acetylcholine or less I'm going to end up with more acetylcholine so if I have an ace on the end that means it's going to break down whatever the pre this the original part is the first part of the work so an ace c2 choline esterase is a something that breaks down acetylcholine but if I inhibit that then I'm going to stop breaking down acetylcholine so I'm going to end up with tons of acetylcholine and that's what you need to think about this and you can always kind of use root words and drug into error endings of things to really help you along to just kind of give you a clue in on what's going not so it's an acetylcholine esterase inhibitor so let's talk about them what's happening so I give this a draconian I give I remember I had my hundred receptors my I want a hundred acetylcholine receptors I mean that's all I got right imagine we only have a hundred just for the sake of making this an easy example 50 of them are blocked by these dag on autoimmune antibodies means suckers we're gonna get it I'm gonna get them I just don't know how you so if they're blocked then that means I've got 50 free ones well one of the ways that I could pretty much make all 50 of those get bound to is if I have a whole bunch of acetylcholine and the way to get all a bunch of acetylcholine is to give an acetylcholinesterase inhibitor which stops the breakdown of acetylcholine which immediately makes more acetylcholine free so what happens when I give this test if I give if I give a troponin and these patients start feeling like they got some more muscle use right there they've got muscle use what's going on that's a positive test that means that these patients responded they responded to the increase in acetylcholine so they had an increase in acetylcholine and they were able to move their muscles better an improvement that means that's a myasthenic crisis or they were under medicated or they had myasthenia gravis right that's the diagnostic tool but if I gave a truffaut diem to a patient who and then they didn't have an increase in muscle strength or they have even more spasticity of their muscles that means they have already got too much acetylcholine and now we've got even more so then what happens well that's a cholinergic crisis or too much medication so those people need their medication scaled back so hopefully I was a good example there for you so you could really just understand exactly what's going on next we're going to talk about multiple sclerosis multiple sclerosis is an important disease that you need to know and you really just have to understand what's going on so let's talk about multiple sclerosis what is actually going on well it's destruction of the myelin sheath nerve fiber demyelination and the the myelin sheath the sheath is something that goes over top of its kind of the cover and what is the myelin do in the nerves well it kind of just lets I kind of like to explain it like a freeway I mean it's kind of the thing that just allows the nerve conduction to go even faster all the way down but if you destroy the myelin it's like putting a bunch of potholes in the road nobody likes potholes potholes make me angry like really angry like pineapple I just it's not what I'm going to go there but so just gather my thought here nerve fiber demyelination so if I put a bunch of potholes on the nerves not only are those impulses going to be angry but they're not going to go smoothly across the nerves they're not going to make it at all and the classic thing about multiple sclerosis is what what's a couple what's a classing classic defining feature of multiple sclerosis yes it's common in women and it's common usually in ages 20 to 50 and if you remember that here is this wonderful 50 character with these two two women here what's important is that it has this relapse and remitted um feature so they may end up with this relapse they may be okay for a while and then it just remits the whole thing comes back and then they have these you know exacerbations of multiple sclerosis so I mean you could end up with multiple scores you diagnosed at 25 and you could go years and years and years of multiple sclerosis with multiple motor issues and these people have you know problems motor issues and little spasticity problems and another common thing which someone pointed out to me and I just want to make sure I mentioned it's not as important for the nursing level but an optic neuritis so they end up with this you know optic disc they end up with optic neuritis and inflammation of the nerve in the eye as well just something you can see just kind of a something to memorize we've got the inside of our big monic but it's something that's really commonly not diagnosed that we don't catch it right away because it's uh it's really just someone comes in and they've got these muscle twitches and not usually something we go for right way as far as a diagnosis so with the treatment for this autoimmune are this multiple sclerosis which is a nerve fiber demyelination which is another autoimmune type disease well corticosteroids are a quarter on steroids is a good treatment right yes sir as always yes just going to mention these other treatments we have a whole pic monic to help you remember remember all these these are other treatments in the meat and immunomodulator drugs that will help you remember some other treatments of multiple sclerosis so there's interferon beta we got this beta fish-- here dimethyl fumarate which is another good one single 'mad which is another the finger mob here me toes Antron the mitten xylophone and nettle is you map and remember I was talking about those monoclonal antibodies and how much fun they are nat elizy map say that ten times fast I'm now I'm going to spare you that one today so you can go and remember all these inside of our big money learning system remember all these characters to keep them all together and I highly recommend it because you probably going to get some weird question about Fingal Ahmad and I sure do but I don't know that any of them aside in corticosteroids are particularly the highest to know the most important multiple sclerosis is pretty common disease to get tested on so it's nice to know that kind of these weird new treatments that might be out there okay so now we're going to talk about part two of the nervous system and everything you need to know regarding the nervous system we're going to be wanting more diseases so that we can cover everything for you today so welcome to part 2 of the nervous system if you haven't didn't see part one that's the one that's before the number two here I am educating you every single moment of the hour so let's go and get started first I want to talk about intracranial pressure entering cranial pressure is very very important or ICP this is really important for you to understand and make sure that you have this concept nailed down it's very likely that you're going to get intracranial pressure as a topic on your exams I like to choose that as a topic every single point when I can and what do we actually know about intracranial pressure intracranial pressure is basically an increase in in the cranium I got you there didn't I yeah teaching you good things so what do we look for well the big thing we look for it's called Cushing's triad and first off do you know what a normal intracranial pressure is normal intracranial pressure normal intracranial pressure let's use a ruff-ruff number and we're going to say it's about 10 to 20 that's a good ruff range to know I I know there's different books it definitely measured different different ranges but 10 to 20 is a good range to really remember and it's a good solid range if you get anything really outside of that you should know of course we're worried about increased intracranial pressure anything above 20 22 it's going to be what you're worried about - you know as far as increased so what do we see what do we see with patients with increased intracranial pressure think about it to yourself well I've got it right here on the screen for you of course the big thing is Cushing's triad this Cushing's guy has everything named after him and it gets so confusing so what we want to really remember here I try not to remember Cushing's triad personally because I think it's really difficult to remember with the other things going on that are all named Cushing but Cushing's triad the big one is irregular breathing so this increased intracranial pressure causes us obviously increased pressure and then you end up with this pressure causing an irregular breathing pattern usually most often you know decreased respirations but it's definitely very irregular and sporadic the other thing you're going to find is bradycardia why bradycardia well bradycardia happens because the body is trying to decrease the pressure that's pumping up to the top to the upstairs so it's trying to drop the pressure and the way it drops the pressure is decreasing the number of pumps that's pumping the pressure upstairs and that's really an easy way to think about it on the other thing is widening pulse pressure now do you know what widening or what a pulse pressure is what is a pulse pressure ask yourself you should know this one well what it is just think about it think about it right now pulse pressure so if I take my little hand here and I take motherland and they're working together at the moment and I then measure my own pulse I want you to imagine the pulse pressure is the difference in between no beat and then a beat so it's essentially the pulse pressure it's the amount of pressure to create a pulse which is essence indeed a difference between the systolic blood pressure and the diastolic blood pressure so it's the difference so if you had a blood pressure of 160 over 100 that's pretty high right yes what's the pulse pressure the answer is 60 it's the difference of the two so if you have a pulse pressure of 60 so a widening pulse pressure is essentially an increasing pulse pressure so the heart is beating harder but then relaxing more or you know it's creating a high and increased pulse pressure as well and it's another mechanism to try to decrease the amount of pressure that's being pumped upstairs to the cranium because trying to reduce all this pressure now with sustained hypertension or increasing ICP we see this papal papilledema which is a swelling of the optic disc it can only be seen with an ophthalmoscope actually looking in the eyes but what is the number one classic thing and I have seen way too many times and that's projectile vomiting now I have a story for you and this is one of my favorite stories I love all my stories but this one has a special place right here in my heart I had a patient when I used to work EMS and this patient had fallen off of a roof a little older man fell off a roof landed on his head and he had spinal shock and definitely had it we suspected in a head injury and increased intracranial pressure and this guy raised his head up and vomited and it vomited from the ambulance Cod all the way and hit the back of the ambulance door projectile vomiting I'm not talking just like a little baby blue blue at your stomach I'm talking like projectile vomiting forceful vomiting is a really big indicator that you have an increased intracranial pressure and you know there are other things like different pupil sizes paradox or pupil sizes as well but the big thing is there's projectile vomiting and then Cushing's triad bradycardia wiping pulse pressure and a regular breathing breathing pattern is the big one this breathing ataxia I don't know if you've seen the webinars before but every time I take a drink from my cup I get 35 cents so I'm saving up lots of nickels right now because they pay me here pick Monica nickels and I'm going to buy a new bicycle or something with all of my nickels for sure definitely I think - nice but I'm working on it so here we can see all of our pick monic characters to help you remember this and the other thing I want to mention here is posturing posturing is a important concept but it's another sign of a spinal injury or a neural injury or increased intracranial pressure as well and what are the two types of posturing so what type of posturing do we have displayed right here in this little image here in the bottom what type of posturing is there well that's Dussehra break posturing the cerebrate posturing so it's a way so it's kind of hard to tell on what we've got on our screen today but I'm going to teach you the two types so the first type is decorticate and I want you to remember to court your posturing us towards d'accord towards the court decorticate ah see there I am like blowing your mind right now it's okay it's fine I understand it happens to everyone so towards d'accord so towards the spinal cord is the door to the decor the towards decor the plush drinks towards the court right the cerebrate is away so usually the arms actually go down much like I've got here in this image so they go down and they're away so it's away from the court to cerebrate and usually away from the cerebral cerebellum is another way to remember that but if you remember one the other ones the other one you can easily remember one and then you know the other one is the opposite so if you can remember towards decorticate d'accord towards the gourd then you have two quartic it and you can just easily remember the other one is to cerebrate it's away from the cord and that's just you got to remember now this is a priority a really common priority question what do we do for increased intracranial pressure what do we do do we hang them from their feet from a tree I mean the only time I want to be hanging from a tree is when the zombies come and I get in my sleeping bag the hangs from a tree and no one's gonna get me I'm gonna be up there until Sambi invasion is over and I know it's coming and you think I'm crazy but this this is I'm going to it's going to work and I have a sleeping bag and it hangs from a tree and you're judging me right now but trust me it's you will see just we'll see who gets a laughing matter but anyway so we don't want to hang people with increased intracranial pressure from a tree I mean that's not a good idea we want to elevate the head so if we elevate the head we know if we've brought them up sit a patient up so that helps them breathe right but that's not a priority here the priority here is to decrease the amount of blood that's rushing up to the head so we elevate that that simple thing is what you would always do first any of these types of patients so simple but people always miss the easy stuff and you need to not miss the easy stuff because you're listening to me and that's really good next thing we want to do is we want to do met we may give them a medication there to do the medication that we really want to think about is mannitol and we've got our manatee mannitol character right here mannitol manatee a character inside of a banach but the big thing is you give mannitol now it's an osmotic diuretic and that's really important because it decreases fluid if we decrease it give you a diuretic that decreases free water then relatively we're going to decrease intracranial pressure which is an increase in fluid as well now it's a little bit controversial it's not really indicated any longer but you're still going to see it a lot of textbooks for any kind of neurogenic shock or ICP we give dexamethasone which is a steroid and we've got our Dex moth here to help you remember that but you know it's definitely we used to be a first-line treatment any kind of spinal injuries it's not so much that we give steroids anymore but there's still some schools of thought and expand on it we're not really going to go into the whole debate on whether it's really right or wrong today but just know that that's a possibility the big things you're going to see are elevate the head of the bed right and you know reduce straining that we don't these people straining in any way anything that's going to increase pressure at all inside the body cavity is a no-no so you probably don't want anybody with increased intracranial pressure riding a rollercoaster okay I mean you know all my patients always ride rollercoasters inside the hospital if they're my patient we know they're probably having some kind of rollercoaster but it's usually just putting up with me the next topic I want to talk about is meningitis now this is really important that you know meningitis mainly because I just like the character inside of meningitis for Men in Tights now the good thing about this one is we're going to run you through our actual pic monic much like it is designed in our learning system to show you exactly how you would learn to keep all of these facts together with meningitis now we know meningitis just think about it means meninges inflamed meningitis so meningitis assessment you can always remember because of these men in tights right here inside a pic monocle and you can owe you need to understand that patients with meningitis may have nausea and vomiting shown by this weird vomit here nausea balm and remember projectile vomiting because they also may have a fever here you can remember a fever for fever fever patients the meningitis very often present with fever the other thing is nuchal rigidity we're going to talk about this just a little bit more in a second but nuchal rigidity so you know rigidity in the neck and you can remember that here is these brass knuckles inside a pig monic and of course with meningitis you can remember a severe headache I mean this is the same for increased intracranial pressure and I think that a lot of these things myself are like you know they're Demi's but if I don't mention it then I find students end up coming in I say oh you didn't mention that and you know we did you know and we don't mention everything we hope that you were hoping you tie the concepts in and put the things together in your brain and we're just here to mint that experience the other thing you might find in these patients is purpura so it's a purpura as a skin discoloration that you may find shown by your a purple cat a really common thing we find an increased intracranial pressure or meningitis as well is seizure sone here as Caesar because that's a really common finding another thing with meningitis also because of this headache you're also going to find photophobia and you can remember this afraid of the light character here in adults now when you move to children children or infants you know when we do a newborn assessment we assess the fontanel's right and we assess for a bulging fontanel or a soft fun and we want the font now to be soft and non bulging but also we don't want to be sunken because if it's sunken what does that mean well sunken Fontenot means dehydration a bulging fontanel would mean oh fluid overload or increased intracranial pressure which is no no we want it to be nice and soft but we don't stick our finger in there either because we know that there's no well I mean we want we don't we could do crazy don't don't say Kendall said so newborns or infants they have what's called the opposite in this position and the opposite on this position is really we've got two here shown as this this pistol body but essentially it's it's a raring back it's raring back like this a raring back up the neck and they kind of turn into this this arched back pistol position so we've actually got it shown here for you with this opposite on this baby on top of this little pistol and the other thing that you will never be able to get out of your brain is with a baby with increased intracranial pressure is that they have this high-pitched shrill cry and when I say shrill I've only heard it once but you won't on here you can't unhear that it's definitely something that would just run the tingle down your spine for a really high-pitched thrill shrill cry shrill cry shrill cry can't say a word and the last thing which I already said was a bulging fontanel and because of an increased intracranial pressure or fluid overload which leads to intracranial pressure as well but you see this bulging fontanel this fountain bulging out of the Fond now of this little cute little it's a bit a baby right here inside a PICC Manik so definitely here's how you can easily remember everything inside that you need to know inside of all of the topics and you can always understand where you need to be and what you need to learn that's really important as you go forward there are two signs that you may need to know as part of your assessment and those are Brzezinski sign Bruns and Suki society broods in ski sign what is broods in ski sign do you know think to yourself broods in ski sign well Brezinski sign we were just talking about nuchal rigidity right so Brzezinski sign is when you take someone's head and you push it down and you push purse or hair down so that their chin isn't on their chest right and the other knees flexed you know there's slightly flexed and you push through their chin down to touch their chest what happens is this causes a tug so if I'd like to use my shirt as an example not only because I really like the shirt just because it works as a good example so if I look right here I mean I'm a Giunta shirt is the meninges right actually this shirt it's really tight I need to lose some weight um so I got this shirt so here's the shirt and it's kind of see how it's nice and wrinkly now if I bend my neck down I imagine that this is my meninges and my spinal cord and I poet like this it causes this be really tight right it causes it to be really tight so this is really taut right now and that's exactly what happens with the spinal cord becoming taut and then pulling down its base the base of the meninges of the of the in the brain and that that tension causes severe pain and that causes a positive Brezinski sign the other one is kernig sign kernig sign is when you raise the raise the legs the knees to the chest and then you you will have severe you know pain as well when you bring the knees up to the chest and that's correct sign and that's just you know another really important thing to know so some other pointing things to know I'm doing spinal tap I can't believe I didn't put a slide in here on this but I need to I'm going to add this one in where do you do a spinal tap where do you do a spinal tap no in the spine okay yes fine you do a spinal tap between l3 and l4 and we have a pic monic on that to help you and learn that as well between l3 and l4 and when you're doing any kind of CSF evaluation whether you're looking so you're looking for meningitis you want to make sure you you it's between l3 and l4 the patient needs to lie flat afterwards and when you're taking that CSF fluid you want to make sure you number those tubes that's really important fundamental topic as well next we're gonna move on to cerebral vascular accidents CVAs cerebral cerebral vascular attacks strokes whatever you want to call it today I'm actually I'm not even sure what they're calling it today but you should know each of these see VA cerebrovascular attacks repro vascular incident Cerrito vascular accident stroke um whatever a new term that somebody coins and puts on it next week the idea stroke is a stroke is a stroke now you need to know that there are different types of strokes that's what's important so as we have here in our slide for you we you need to know that there's a hemorrhagic stroke hemorrhagic stroke which is a bleeding and bleeding so anytime we have these vessels in our brain there's lots of vessels inside there and those vessels eventually sometimes can just spring a little leak and when they spring a little leak they leak into the brain and because the brains this nice closed cavity unless you know you have air in there whatever which I know some people I know some people that I really believe just have air in there you spring that leak and that there's nowhere for that pressure to go because so then it causes a lot of damage because of the pressure and then causes you know signs and symptoms now the number one cause of those sporadic leaks of course is hypertension prolonged hypertension can cause an aneurysm bust or can cause stress - hemorrhagic stroke leak that is really the most common cause now the other example are ischemic strokes now ischemia means you know death of tissue right so you got to remember ischemic strokes and ischemic strokes we show here as our I ski mask cute little character so you can remembering now hold onto your pants' for a minute because I'm going to explain this to you so you're never going to miss this really important concept what's the difference between thrombotic and embolic ah every time I used to mess this up all the time and then I figured out a way to remember it and now I'm going to share it with you hmm how do you remember thrombotic well I remember that thrombotic or a thrombus starts with a tea and a thrombus is something that forms right there with a teeth right there so it means it forms in a vessel slowly forms over time and it it's right there in a vessel so if I said it's going to form inside of this vessel I'm going to say well it's right there there it is forming it's a T right there with a T rhombus thrombotic thrombocytopenic and it's going to occlude eventually because it's going to keep building up building up building up and do a blocks off the blood supply formed right there and it just kept getting bigger to a blocked it up now the other type my favorite is an embolic stroke so an embolic stroke how do we remember this one hold onto your pants' mm-hmm an embolic stroke is something starts with e right e I like E now an embolic stroke I want you to remember thrombus forms right there but an embolus it breaks free right breaks free e e it breaks free and breaks free goes through the blood vessel and then land somewhere and causes an occlusion now where it is it brick causing occlusion it causes an occlusion of the bifurcation what's a bifurcation well to split that's where one big artery gets smaller and turns into two smaller arteries kind of like a pipe system you know in a house you get the big giant main the splits off into two tiny ones and splits off even more to go to smaller pipes but remember thrombotic or thrombus forms right there with a T and it forms right there slow over time building and building and building until it just breaks it stops blood flow and what causes that well a Flores chlorosis of course you know you you like eating cheeseburgers which I love cheeseburgers I can't stop eating them ah then if you're going to end up with a flow sclerosis now an embolus and emboli embolic stroke is when something breaks free then it breaks free with all those ease free and embolic embolic or embolus breaks free and it travels through and then it lands somewhere else and and and causes it causes a blood flow broccoli at blood flow I can't even talk causes blood flow to stop moving that's really how you can remember that what's the big cause here is usually atrial fibrillation so you know the heart chambers the top ones just kind of quiver and not really do anything moving and so we have blood stasis and every time we have stasis we form clots and what happens when those clots form right there well then they break free and they'll and go somewhere else usually causing a stroke and that's just not what we don't want that to happen I mean that's never a good thing that's why those patients have to be on anticoagulant therapy very very important so mmm as we move forward the next thing I want you to really understand once you understand this really good concepts really important left versus right hemisphere strokes I used to really have a lot of trouble with this and then you know what happened I just had an epiphany and then I didn't have to study ever again just kidding so with left and right hemisphere strokes it's really important to remember the two different types so we can classify them totally differently so that you can remember them for the long term the important thing here is that you can understand right away that every stroke no matter what whether you have a left-sided stroke or a right-sided stroke the weakness is in the opposite side so if we say that straight away that's all the time then that's the way it is if you have a left-sided stroke weak on the right you have a right-sided stroke you're going to be weak on the left you should just memorize that right away the weakness is on the opposite side then we can theme on the left side is charts versus the right side of strokes and they're very opposite and they're very easy to remember once we characterized them right here in beautiful picnic land I love big monocle and it's such a happy place I just wish they'd paid me more than nickels that would be really nice yeah so think about that could be get paid in nickels left-sided strokes left-sided I wouldn't remember left-sided hemisphere strokes as patients who are slow and cautious they often have depression in the very anxious because they're aware of what's going on and I want you to imagine them that I compare them usually to sloth and yeah I know that's not really fair but that's the example that I like to use I like to really just compare them kind of it to a sloth they're very slow-moving looking around being very careful because they know something is wrong they're aware that the right side of their body is not moving they're aware something's wrong but they're just they get very depressed they're upset they're anxious they're anxious they're just very cautious because of all this and that's really really important because um people who have left-sided hemisphere strokes can't express themselves and that's really that's really what is important they can't express what's going on with them and because of this they may not be able to write they may not be able to speak they may have a gray agraphia an inability to turn my nose itches so they may have a graph y an inability right but they also may have aphasia specifically expressive aphasia where they're unable to speak as well so they're basically they know that something is wrong but they can't tell anyone and they can't write it to express and tell anyone that hey you know something's going on they just you are perceiving it from them having a lot of trouble explaining what's going on and you see this and they're because of this become very cautious of what's going on they get depressed and very anxious and whatnot now let's contrast this with right-sided stroke patients now right-sided stroke patients right-sided stroke patients are not in their right mind that's you've probably heard that before let me explain so I like to explain right-sided stroke patients as they're unable to perceive the environment they're unable to accept things and because they can't really tell what's going on they're like crazy animals they're like wild animals okay they're not in the right mind so these patients may not they're not able to recognize anyone's faces they just can't perceive and they may be completely impulsive and they may have wild personnel Changez every patient is not the same that's really important for you to know well you know it is important to know that they basically may lose their ability to judge they may not know who you are they may not be able to recognize their own family members and because of this they're just they're there they're not in the right mind so they're you know screaming and yelling and flailing and they're completely out of it and of course it's because they can't perceive their environment and they lose the ability to judge so contrast the two left-sided stroke patients left side of hemisphere stroke patients obviously opposite side weakness right-sided weakness left I you know I was going left to right Mixon I did a little hand thing they can do on the camera because I think I read backwards whatever LEM cited stroke patients slow cautious they can't express themselves matching the left-sided stroke patients kind of like a little lazy sloth elf or left-sided stroke elf or lazy sloth and they're slow that's what's important they're not lazy but they're just slow they're very cautious they become very depressed because they can't express themselves poor sloth can express themself can't write can't speak poor sloth many of right-sided stroke patients those patients are not in their right mind at all they can't they can't them perceive anything that's going on in their environment they can't recognize people very often they have tonal hearing loss problems and they just have no judgment and because of this they have personality changes and there may be completely disoriented about what's going on now know where they're at they may think they're the Queen of England so we just touched on a lot of the disorders you have to know in the nervous system very lots more of course we know that as well a lot of fundamental concepts that you have to be able to recognize and understand how to treat and most importantly prioritize what's going on what you need to know is pick monic we have everything covered you can go in check us out view all of the diseases that we have right here view the playlist that we've attached with all the pick monix you need to know relevant to this lecture so that you can remember

Channel: PicmonicVideo

Views: 57,314

Rating: 4.8258166 out of 5

Keywords: Nervous System (Anatomical Structure), nursingstudent, parkinson'sdisease, parkinsons, myasthenia, nursing help, nursing videos, picmonic, visual learning, audiovisual, Nursing School (Organization), Nursing (Field Of Study), nclex, ati, hesi, mnemonics, nursing student, nursing mnemonics, parasympathetic nervous system healing, nursing student morning routines, Picmonic Video, Nervous System, Kendall Wyatt

Id: mUVElc8vIWc

Length: 68min 41sec (4121 seconds)

Published: Wed Feb 24 2016