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Medical Surgical Nursing (Review)

Medical Surgical Nursing (Review)

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Published by naithan

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Published by: naithan on Dec 02, 2009
Copyright:Attribution Non-commercial


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Overview of the Structures & Functions of Nervous System
Central NS
Brain & spinal cord
31 spinal & cranial
sympathetic NS
Parasypathatic NS

Somatic NS
C- 8
T- 12
L- 5
S- 5
C- 1

ANS (or adrenergic of parasympatholitic response)
SNS involved in fight or aggression response
Effects of SNS (anti-cholinergic/adrenergic)
1. Dilate pupil \u2013 to aware of surroundings
Release of norepinephrine (adrenaline \u2013 cathecolamine)
- medriasis
Adrenal medulla (potent vasoconstrictor)
2. Dry mouth
Increases body activities
VS = Increase
3. BP & HR= increased
Except GIT \u2013 decrease GITmotility
bronchioles dilated to take more oxygen
4. RR increased
* Why GIT is not increased = GIT is not important!
5. Constipation & urinary retention
Increase blood flow to skeletal muscles, brain & heart.
I. Adrenergic Agents \u2013 Epinephrine (adrenaline)
SE: SNS effect
II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in \u2013\u2018lol\u2019)
Blocks release of norepinephrine.
Decrease body activities except GIT (diarrhea)
Ex. Propanolol, Metopanolol

B \u2013 broncho spasm (bronchoconstriction)
E \u2013 elicits a decrease in myocardial contraction
T \u2013 treats HPN
A \u2013 AV conduction slows down

Given to angina & MI \u2013 beta-blockers to rest heart
Anti HPN agents:
Beta blockers (-lol)
Ace inhibitors (-pril) ex ENALAPRIL, CAPTOPRIL
Calcium antagonist
Peripheral nervous system: cholinergic/ vagal or sympatholitic response
Effect of PNS: (cholinergic)
Involved in fly or withdrawal response
1. Meiosis \u2013 contraction of pupils
Release of acetylcholine (ACTH)
2. Increase salivation
Decrease all bodily activities except GIT (diarrhea)
3. BP & HR decreased
4. RR decrease \u2013 broncho constriction
I Cholinergic agents
5. Diarrhea \u2013 increased GI motility
ex 1. Mestinon
6. Urinary frequency
Antidote \u2013 anti cholinergic agents Atropine Sulfate \u2013 S/E \u2013 SNS
S/E- of anti-hpn drugs:
1. orthostatic hpn
2. transient headache & dizziness.
-Mgt. Rise slowly. Assist in ambulation.
CNS (brain & spinal cord)
I. Cells \u2013 A. neurons

Properties and characteristics
a. Excitability \u2013 ability of neuron to be affected in external environment.
b. Conductivity \u2013 ability of neuron to transmit a wave of excitation from one cell to another
c. Permanent cells \u2013 once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes)

Regenerative capacity
A. Labile \u2013 once destroyed cant regenerate

- Epidermal cells, GIT cells, resp (lung cells). GUT
B. Stable \u2013 capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cells
C. Permanent cells \u2013 retina, brain, heart, osteocytes can\u2019t regenerate.

3.) Neuroglia \u2013 attached to neurons. Supports neurons. Where brain tumors are found.
1. Astrocyte
2. Oligodendria

Astrocytoma \u2013 90 \u2013 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte.
Astrocyte \u2013 maintains integrity of blood brain barrier (BBB).
BBB \u2013 semi permeable / selective
-Toxic substance that destroys astrocyte & destroy BBB.
Toxins that can pass in BBB:

1. Ammonia-liver cirrhosis.

2. 2. Carbon Monoxide \u2013 seizure & parkinsons.
3. 3. Bilirubin- jaundice, hepatitis, kernicterus/hyperbilirubenia.
4. 4. Ketones \u2013DM.

OLIGODENDRIA \u2013 Produces myelin sheath \u2013 wraps around a neuron \u2013 acts as insulator facilitates rapid nerve impulse transmission.
No myelin sheath \u2013 degenerates neurons
Damage to myelin sheath \u2013 demyellenating disorders
1.)ALZHEIMER\u2019S DISEASE\u2013 atrophy of brain tissue due to a deficiency of acetylcholine.

A \u2013 amnesia \u2013 loss of memory
A \u2013 apraxia \u2013 unable to determine function & purpose of object
A \u2013 agnosia \u2013 unable to recognize familiar object
A \u2013 aphasia \u2013- Expressive \u2013 brocca\u2019s aphasia \u2013 unable to speak

- Receptive \u2013 wernickes aphasia \u2013 unable to understand spoken words
Common to Alzheimer \u2013 receptive aphasia
Drug of choice \u2013 ARICEPT (taken at bedtime) & COGNEX.
Mgt: Supportive & palliative.

Microglia \u2013 stationary cells, engulfs bacteria, engulfs cellular debris.

II. Compositions of Cord & Spinal cord
80% - brain mass
10% - CSF
10% - blood

MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP.
Normal ICP: 0-15mmHg
Brain mass

1. Cerebrum \u2013 largest -
Connects R & L cerebral hemisphere
- Corpus collusum
Rt cerebral hemisphere, Lt cerebral hemisphere

1. Sensory
2. Motor
3. Integrative


1.) Frontal
a. Controls motor activity
b. Controls personality development
c. Where primitive reflexes are inhibited
d. Site of development of sense of umor
e. Brocca\u2019s area \u2013 speech center

Damage - expressive aphasia

2.) Temporal \u2013
a. Hearing
b. Short term memory
c. Wernickes area \u2013 gen interpretative or knowing Gnostic area

Damage \u2013 receptive aphasia
3.) Parietal lobe \u2013 appreciation & discrimation of sensory imp

- Pain, touch, pressure, heat & cold
4.) Occipital - vision
5.) Insula/island of reil/ Central lobe- controls visceral fx

Function: - activities of internal organ
6.) Rhinencephalon/ Limbec
- Smell, libido, long-term memory
Basal Ganglia \u2013 areas of gray matte located deep within a cerebral hemisphere
Extra pyramidal tract
Releases dopamine-
Controls gross voluntary unit

Decrease dopamine \u2013 (Parkinson\u2019s) pin rolling of extremities & Huntington\u2019s Dse.
Decrease acetylcholine \u2013 Myasthenia Gravis & Alzheimer\u2019s
Increased neurotransmitter = psychiatric disorder

Increase dopamine \u2013 schizo
Increase acetylcholine \u2013 bipolar

MID BRAIN \u2013 relay station for sight & hearing
Controls size & reaction of pupil 2 \u2013 3 mm
Controls hearing acuity
CN 3 \u2013 4
Isocoria \u2013 normal size (equal)
Anisocoria \u2013 uneven size \u2013 damage to mid brain
PERRLA \u2013 normal reaction

DIENCEPHALON- between brain
Thalamus \u2013 acts as a relay station for sensation
Hypothalamus \u2013 (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center, emotional responses,
controls pituitary function.

BRAIN STEM- a. Pons \u2013 or pneumotaxic center \u2013 controls respiration
Cranial 5 \u2013 8 CNS
MEDULLA OBLONGATA- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus
Vasomotor center, spinal decuissation termination, CN 9, 10, 11, 12
CEREBELLUM \u2013 lesser brain
- Controls posture, gait, balance, equilibrium

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