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Anatomy and Physiology of the Brain and Spinal CordI.Cerebruma.Consists of the right and lefthemispheresb.Each hemisphere receives sensoryinformation from the opposite side of thebody and controls the skeletal musclesof the opposite side.c.The cerebrum governs sensory andmotor activityd.The cerebrum governs thought andlearning.II.Cerebral Cortexa.The cerebral cortex is the outer graylayer.b.The cortex is divided into four lobes.c.The cortex is responsible for theconscious activities of the cerebrumIII.Basal Gangliaa.The basal ganglia are cell bodies inwhite matter.b.The basal ganglia assist the cerebralcortex in producing smooth voluntarymovements.IV.Diencephalona.Thalamusi.The thalamus relays sensoryimpulses to the cortexii.The thalamus provides a paingate.iii.The thalamus is part of thereticular activating system.b.Hypothalamusi.The hypothalamus regulatesautonomic responses of thesympathetic andparasympathetic nervoussystem
ii.
The hypothalamus regulatesstress response, sleep,appetite, body temperature,fluid balance, and emotions.
iii.
The hypothalamus isresponsible for the productionof hormones secreted by thepituitary gland andhypothalamusV.Brainstema.Midbraini.The midbrain is responsible for motor coordination.
ii.
The midbrain contains visualreflex and auditory relaycenters.b.Pons
i.
The pons contains therespiratory centers.
ii.
The pons regulates breathing.c.Medulla oblongatai.The medulla oblongatacontains all afferent andefferent tracts.
ii.
The medulla oblongatacontains cardiac, respiratory,vomiting, and vasomotor centers.iii.The medulla oblongata controlsheart rate, respiration, bloodvessel diameter, sneezing,swallowing, vomiting, andcoughing.VI.Cerebelluma.The cerebellum coordinates smoothmuscle movement.b.The cerebellum coordinates posture,equilibrium, and muscle tone.VII.Spinal Corda.The spinal cord provides neuron andsynapse networks to produceinvoluntary responses to sensorystimulation.b.Allows for control of the number of painimpulses that pass through the spinalcord on their way to the brain.c.The spinal cord carries sensoryinformation to and motor informationfrom the brain.d.The spinal cord extends from the firstcervical to the second lumbar vertebra.
e.
The spinal cord is protected by themeninges, cerebrospinal fluid, andadipose tissue.f.Hornsi.Inner column of gray matter contains two anterior and twoposterior horns.ii.Posterior horns connect withafferent (sensory) nerve fibers.iii.Anterior horns contain efferent(motor) nerve fibers.g.Nerve Tractsi.White matter contains thenerve tract.ii.Ascending tracts (sensorypathway)iii.Descending tract (motor pathway)VIII.Meningesa.Dura mater is the tough and fibrousmembrane.
b.
Arachnoid membrane is the delicatemembrane and contains subarachnoidfluid.
c.
Pia mater is the vascular membrane.
d.
Subarachnoid space is formed by thearachnoid membrane and the pia mater.IX.Cerebrospinal Fluid
a.
Is secreted in the ventricles andcirculates through the ventricles to thesubarachnoid layer of the meninges,where it is reabsorbed.b.Cerebrospinal fluid circulates in thesubarachnoid space.c.Normal pressure is 50 to 175 mm H20.d.Normal volume is 125 to 150ml.e.Cerebrospinal fluid acts as a protectivecushion.f.Cerebrospinal fluid aids in the exchangeof nutrition and wastes.X.Ventriclesa.Four ventriclesb.The ventricles communicate betweenthe subarachnoid spacesc.The ventricles produce and circulatecerebrospinal fluid.XI.Blood Supplya.Right and left internal carotidsb.Right and left vertebral arteries
c.
These arteries supply the brain via ananastamosis at the base of the braincalled the circle of Willis.XII.Neurotransmittersa.Acetylcholineb.Norepinephrinec.Dopamined.Serotonine.Amino acidsf.Polypeptides
 
XIII.Neuronsa.The cell body contains the nucleus.b.The neuron contains the axons anddendritesc.Neurons carrying impulses to the centralnervous systems (CNS) are calledsensory neurons.d.Neurons carrying impulses away fromthe CNS are called motor neurons.e.Synapse is the chemical transmission of impulses from one neuron to another.XIV.Axons and Dendritesa.The axon conducts impulses from thecell body.b.The dendrites receive stimuli from thebody and transmit them to the axon.c.The neurons are protected andinsulated by Schwann cells.
d.
The Schwann cell sheath is called theneurolemma.e.Neurons do not reproduce after theneonatal period.
f.
If an axon or dendrite is damaged, it willdie and be replaced slowly only if theneurolemma is intact and the cell bodyhas not died.XV.Spinal Nervesa.The human being has 31 pairs of spinalnerves.b.Mixed nerve fibers are formed by the joining of the anterior motor andposterior sensory roots.c.Posterior roots contain afferent(sensory) nerve fibers.d. Anterior roots contain efferent (motor)nerve fibers.XVI.Autonomic Nervous Systema.Sympathetic (adrenergic) fibers dilatepupils, increase heart rate and rhythm,contract blood vessels, and relaxsmooth muscles of the bronchi.b.Parasympathetic (cholinergic) fibersproduce the opposite effect.Diagnostic TestI.Skull and Spinal Radiography
a.
Descriptioni.Radiographs of the skull reveal thesize and shape of the skull bones,suture separation, in infants,fractures or bony defects, erosion,or calcification.ii.Spinal radiographs identifyfractures, dislocation, compression,curvature, erosion, narrowed spinalcord, and degenerative processes.b.Procedure interventionsi.Provide nursing support for theconfused, combative, or ventilator-dependent client.ii.Maintain immobilization of the neckif a spinal fracture is suspected.iii.Remove metal items from bodyparts.iv.If the client has thick and heavyhair, this should be documentedbecause it may affect interpretationof the x-ray film.v.Post procedure intervention:maintain immobilization until resultsare known.
II.
Computed tomography scana.Descriptioni.Computed Tomography is a type of brain scanning that may or may notrequire an injection of a dye.
ii.
Computed tomography is used todetect intracranial bleeding, spaceoccupying lesions, cerebral edema,infarctions, hydrocephalus, cerebralatrophy, and shifts of brainstructures.
b.
Preprocedure interventionsi.Obtain an informed consent if a dyeis used.ii.Assess for allergies to iodine,contrast dyes, or shellfish if a dye isused.iii.Instruct the client in the need to liestill and flat during the test.iv.Instruct the client to hold his or her breath when requested.v.Initiate an intravenous line if prescribed.vi.Remove objects from the head,such as wigs, barrettes, earrings,and hairpins.vii.Assess for claustrophobia.viii.Inform the client of possiblemechanical noises as the scanningoccurs.ix.Inform the client that there may bea hot, flushed sensation and ametallic taste in the mouth when thedye is injected.x.Note that some clients may begiven the dye even if they report anallergy and are treated with anantihistamine and corticosteroidsbefore the injection to reduce theseverity of a reaction.
c.
Postprocedure interventions
i.
Provide replacement fluids becausediuresis from the dye is expected.ii.Monitor for allergic reaction to thedye.
iii.
Assess dye injection site for bleeding or hematoma, and monitor extremity for color, warmth, and thepresence of distal pulses.III.Magnetic Resonance Imaginga.Descriptioni.Magnetic resonance imaging is anon-invasive procedure thatidentifies types of tissues, tumors,and vascular abnormalities.ii.Magnetic resonance imaging issimilar to the computed tomographyscan but provides more detailedpictures.
b.
Preprocedure interventionsi.Remove all metal objects from theclientii.Determine whether the client has apacemaker, implanted defibrillator,or metal implants such as a hipprosthesis or vascular clipsbecause these clients cannot havethis test performed.iii.Remove intravenous fluid pumpsduring the test.
iv.
Provide precautions for the clientwho is attached to pulse oximeter because it can cause a burn duringtesting if coiled around the body or a body part.v.Provide an assessment of the clientwith claustrophobia.vi.Administer medication asprescribed for the client withclaustrophobia
 
vii.
Determine whether a contrastagent is to be used, and follow theprescription related to theadministration of food, fluids, andmedications.viii.Instruct the client that he or shewill need to remain still during theprocedure.
c.
Postprocedure interventionsi.Client may resume normal activitiesii.Expect dieresis if a contrast agentwas used.IV.Lumbar Puncturea.Description
i.
Lumbar puncture is insertion of aspinal needle through the L3-L4interspace into the lumbar subarachnoid space to obtaincerebrospinal fluid (CSF), measureCSF or pressure, or instil air, dye,or medications.
ii.
Lumbar puncture is contraindicatedin clients with increased intracranialpressure because the procedurewill cause a rapid decrease inpressure within the CSF around thespinal cord, leading to brainherniation.
b.
Preprocedure interventionsi.Obtain an informed consentii.Have the client empty the bladder c.Interventions during the procedurei.Position the client in a lateralrecumbent position and have theclient draw knees up to theabdomen and chin onto the chestii.Assist with the collection of specimens (label the specimens insequence).iii.Maintain strict asepsis.
d.
Postprocedure interventionsi.Monitor vital signs and neurologicsignsii.Position the client flat as prescribediii.Force fluids.iv.Monitor intake and outputV.Myelograma.Description: injection of dye or air into thesubarachnoid space to detect abnormalitiesof the spinal cord and vertebra
b.
Preprocedure interventionsi.Obtain an informed consentii.Provide hydration for at least 12hours before the test.iii.Assess for allergies to iodine.
iv.
If the client is taking aphenothiazine, hold the medicationbecause this medication lowers theseizure threshold.
v.
Premedicate for sedation asprescribed.
c.
Postprocedure interventionsi.Assess vital signs and neurologicalcondition frequently as prescribed.ii.If a water-based dye is used,elevate the head 15 to 30 degreesfor 6 to 8 hours as prescribed.iii.If an oil-based, keep the client flat 6to 8 hours as prescribed.iv.If air is used, keep the head lower than the trunk for up to 48 hours asprescribed.v.Administer analgesics for headacheor backache as prescribedvi.Encourage fluidsvii.Monitor intake and output
viii.
Assess for bladder distention andvoiding.VI.Cerebral Angiographya.Description: injection of contrast through thefemoral artery into the carotid arteries tovisualize the cerebral arteries and assess for lesions
b.
Preprocedure interventionsi.Obtain an informed consentii.Assess the client for allergies toiodine and shellfishiii.Encourage hydration for 2 daysbefore the testiv.Maintain the client on NPO status 4to 6 hours before the test asprescribed.v.Obtain a baseline neurologicalassessment.vi.Mark the peripheral pulsesvii.Remove metal items from the hair.viii.Administer premedication asprescribed.
c.
Postprocedure interventionsi.Monitor neurological status and vitalsigns frequently until stable.
ii.
Monitor for swelling in the neck andfor difficulty swallowing, and notifythe physician if these symptomsoccur.iii.Maintain bed rest for 12 hours asprescribed.iv.Elevate the head of the bed 15 to30 degrees only if prescribed.v.Keep the bed flat if the femoralartery is used as prescribedvi.Assess peripheral pulsesvii.Apply sandbags and a pressuredressing to the injection site asprescribed.viii.Place ice on the puncture site asprescribed.ix.Encourage fluids.VII.Electroencephalographya.Description: a graphic recording of theelectrical activity of the superficial layers of the cerebral cortex
b.
Preprocedure interventionsi.Wash the client’s hair ii.Inform the client that electrodes areattached to the head and thatelectricity does not enter the headiii.Withhold stimulants,antidepressants, tranquilizers, andanticonvulsants for 24 hours to 48hours before the test as prescribed.iv.Allow the client to have breakfast if prescribed
v.
Premedicate for sedation asprescribed
c.
Postprocedure interventionsi.Wash the client’s hair ii.Maintain side rails and safetyprecautions if the client wassedated
VIII.
Caloric Testing (oculovestibular reflex)a.Description: caloric testing providesinformation about the function of thevestibular portion of the eight cranial nerveand aids in the diagnosis of cerebellum andbrainstem lesions.b.Procedurei.Patency of the external auditorycanal is confirmed.
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