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1. NURSING OF ADULTS 111 Introduction to Neurological Nursing

6. FUNCIONAL AREAS OF THE CEREBRAL CORTEX Frontal Lobe Parietal Lobe Temporal Lobe Brain Stem Occipital Lobe Cerebellum Written speech Motor speech Auditory receiving area Auditory interpretation area Motor cortex Sensory area (pain, touch, etc.) Visual interpretation area Visual receiving area

14. Brainstem - The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brainstem include those necessary for survival (breathing, digestion, heart rate, blood pressure) and for arousal (being awake and alert). Most of the cranial nerves come from the brainstem . The brainstem is the pathway for all fiber tracts passing up and down from peripheral nerves and spinal cord to the highest parts of the brain.

15. Anatomy of the Autonomic Nervous System (Brunner 2000, p. 1618) What impact on body re SC injury?

32. AROUSAL The mediator of arousal and sensory stimulation is the RETICULAR ACTIVATING SYSTEM (RAS). The RAS is located in the Brain Stem and contains projections between the Thalamus and the Cortex. A network of neurons in the RAS monitors ascending and descending stimuli. Nerve cells run through the medulla, pons, midbrain, thalamus, and hypothalamus. RAS maintains muscle tone, keeps the higher brain in a state of alert wakefulness, and filters incoming messages .

44. The Glasgow Coma Scale (GCS) Universally used Measures eye, verbal, and motor response Excellent scale to measure Arousal . Know the difference b/t content & arousal

45. GLASGOW COMA SCALE SCORE (GCS) Eyes 1 Closed at all times 2 Opens to pain 3 Opens to voice command 4 Open spontaneously Motor 1 No response 2 Extension (decerebrate rigidity) 3 Flexion posturing 4 Flexion withdrawal 5 Localizes painful stimulus 6 Obeys commands Verbal 1 No response 2 Incomprehensible sounds 3 Inappropriate words 4 Disoriented and converses 5 Oriented and converses 15 (top score) A score of 10 or less indicates a need for emergency attention A score less than 7 is interpreted as coma

48. Any process that results in ↑ ICP will produce impairment of content and arousal . *** Remember restless and other changes in behavior frequently precede changes in vital signs, However, changes in LOC will occur first.