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Published by gilbertgarcia

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Published by: gilbertgarcia on Jun 11, 2010
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01/26/2013

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MEDICAL SURGICAL 
Overview of the Structures & Functions of 
Nervous System
Central NSPNSANSBrain & spinal cord 31 spinal & cranial sympathetic NSParasypathatic NSSomatic NSC- 8 T- 12L- 5S- 5C- 1ANS (or adrenergic of parasympatholitic response)SNS involved in fight or aggression response
Effects of SNS (
anti-cholinergic/adrenergic)1. Dilate pupil – to aware of surroundingsRelease of norepinephrine (adrenaline cathecolamine) - medriasisAdrenal medulla (potent vasoconstrictor)2. Dry mouthIncreases body activitiesVS = Increase3. BP & HR= increasedExcept GIT decrease GITmotility bronchioles dilated to take more oxygen4. RR increased* Why GIT is not increased = GIT is not important!5. Constipation & urinary retentionIncrease blood flow to skeletal muscles, brain & heart.I. Adrenergic Agents – Epinephrine (adrenaline)SE: SNS effectII. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’)
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Blocks release of norepinephrine.
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Decrease body activities except GIT (diarrhea)Ex. Propanolol, MetopanololSE:B – broncho spasm (bronchoconstriction)E – elicits a decrease in myocardial contraction T – treats HPNA – AV conduction slows downGiven to angina & MI – beta-blockers to rest heartAnti HPN agents:1.Beta blockers (-lol)2.Ace inhibitors (-pril) ex ENALAPRIL, CAPTOPRIL3.Calcium antagonistex CALCIBLOC or NEFEDIPINEPeripheral nervous system: cholinergic/ vagal or sympatholitic response
Effect of PNS: (
cholinergic)
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Involved in fly or withdrawal response1. Meiosis contraction of pupils
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Release of acetylcholine (ACTH)2. Increase salivation
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Decrease all bodily activities except GIT (diarrhea)3. BP & HR decreased4. RR decrease – broncho constrictionI Cholinergic agents5. Diarrhea increased GI motilityex 1. Mestinon6. Urinary frequencyAntidote – anti cholinergic agents Atropine Sulfate – S/E – SNS S/E- of anti-hpn drugs:1.orthostatic hpn2.transient headache & dizziness.-Mgt. Rise slowly. Assist in ambulation.
CNS (brain & spinal cord)
I. Cells – A. neuronsProperties and characteristicsa.Excitability – ability of neuron to be affected in external environment.b.Conductivity – ability of neuron to transmit a wave of excitation from one cell to anotherc.Permanent cells – once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes)Regenerative capacityA. Labile – once destroyed cant regenerate- Epidermal cells, GIT cells, resp (lung cells). GUTB. Stable – capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cellsC. Permanent cells – retina, brain, heart, osteocytes can’t regenerate.3.) Neuroglia – attached to neurons. Supports neurons. Where brain tumors are found. Types:1.Astrocyte2.OligodendriaAstrocytoma – 90 – 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte.Astrocyte – maintains integrity of blood brain barrier (BBB).BBB – semi permeable / selective-Toxic substance that destroys astrocyte & destroy BBB. Toxins that can pass in BBB:1.Ammonia-liver cirrhosis.2.2. Carbon Monoxide – seizure & parkinsons.3.3. Bilirubin- jaundice, hepatitis, kernicterus/hyperbilirubenia.
1
 
4.4. Ketones –DM.OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulsetransmission.No myelin sheath – degenerates neuronsDamage to myelin sheath – demyellenating disordersDEMYELLENATING DSE1.)
ALZHEIMER’S DISEASE
– atrophy of brain tissue due to a deficiency of acetylcholine.S&Sx:A – amnesia – loss of memoryA – apraxia – unable to determine function & purpose of objectA – agnosia – unable to recognize familiar objectA – aphasia –- Expressive – brocca’s aphasia – unable to speak- Receptive – wernickes aphasia – unable to understand spoken wordsCommon to Alzheimer – receptive aphasiaDrug of choice – ARICEPT (taken at bedtime) & COGNEX.Mgt: Supportive & palliative.Microglia – stationary cells, engulfs bacteria, engulfs cellular debris.II. Compositions of Cord & Spinal cord80% - brain mass10% - CSF10% - bloodMONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP.Normal ICP: 0-15mmHgBrain mass1. Cerebrum largest - Connects R & L cerebral hemisphere- Corpus collusumRt cerebral hemisphere, Lt cerebral hemisphereFunction:1.Sensory2.Motor3.IntegrativeLobes1.) Frontala. Controls motor activityb. Controls personality developmentc. Where primitive reflexes are inhibitedd. Site of development of sense of umore. Brocca’s area – speech centerDamage - expressive aphasia2.) Temporal –a. Hearingb. Short term memoryc. Wernickes area – gen interpretative or knowing Gnostic areaDamage – receptive aphasia3.) Parietal lobe – appreciation & discrimation of sensory imp- Pain, touch, pressure, heat & cold4.) Occipital - vision5.) Insula/island of reil/ Central lobe- controls visceral fxFunction: - activities of internal organ6.) Rhinencephalon/ Limbec- Smell, libido, long-term memoryBasal Ganglia – areas of gray matte located deep within a cerebral hemisphere
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Extra pyramidal tract
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Releases dopamine-
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Controls gross voluntary unitDecrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse.Decrease acetylcholine – Myasthenia Gravis & Alzheimer’sIncreased neurotransmitter = psychiatric disorderIncrease dopamine – schizoIncrease acetylcholine – bipolarMID BRAIN – relay station for sight & hearingControls size & reaction of pupil 2 – 3 mmControls hearing acuityCN 3 – 4Isocoria – normal size (equal)Anisocoria – uneven size – damage to mid brainPERRLA – normal reactionDIENCEPHALON- between brain Thalamus – acts as a relay station for sensationHypothalamus – (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center,emotional responses, controls pituitary function.BRAIN STEM- a. Pons – or pneumotaxic center – controls respiration
2
 
Cranial 5 – 8 CNSMEDULLA OBLONGATA- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutusVasomotor center, spinaldecuissation termination, CN 9, 10, 11, 12CEREBELLUM – lesser brain- Controls posture, gait, balance, equilibriumCerebellar Tests:a.) R – Romberg’s test- needs 2 RNs to assist- Normal anatomical position 5 – 10 min(+) Romberg’s test – (+) ataxia or unsteady gait or drunken like movement with loss of balance.b.) Finger to nose test –(+) To FTNT – dymetria – inability to stop a movement at a desired pointc.) Alternate pronation & supinationPalm up & down . (+) To alternate pronation & supination or damage to cerebellum – dymentriumComposition of brain - based on Monroe Kellie Hypothesis
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Skull is a closed container. Any alteration in 1 of 3 intracranial components = increase in ICPNormal ICP – 0 – 15 mmHgForamen MagnumC1 – atlasC2 – axis(+) Projectile vomiting = increase ICPObserve for 24 - 48 hrsCSF – cushions the brain, shock absorberObstruction of flow of CSF = increase ICPHydrocephalus – posteriorly due to closure of posterior fontanelCVA – partial/ total obstruction of blood supply
INCREASED ICP
– increase ICP is due to increase in 1 of the Intra Cranial components.Predisposing factors:1.)Head injury2.)Tumor3.)Localized abscess4.)Hemorrhage (stroke)5.)Cerebral edema6.)Hydrocephalus7.)Inflammatory conditions - Meningitis, encephalitisB.
S&Sx
change in VS = always late symptomsEarliest Sx:a.)Change or decrease LOCRestlessness to confusion Wide pulse pressure: Increased ICP- Disorientation to lethargyNarrow pp: Cardiac disorder, shock- Stupor to comaLate sign – change in V/S1.BP increase (systolic increase, diastole- same)2.Widening pulse pressureNormal adult BP 120/80 120 – 80 = 40 (normal pulse pressure)Increase ICP = BP 140/80 = 140 – 80= 60 PP (wide)3.RR is decreased (Cheyne-Stokes = bet period of apnea or hyperpnea with periods of apnea)4.Temp increaseIncreased ICP: Increase BPShock – decrease BP Decrease HRIncrease HRCUSHINGS EFFECTDecrease RRIncrease RRIncrease TempDecrease tempb.) HeadacheProjectile vomitingPapilledima (edema of optic disk – outer surface of retina)Decorticate (abnormal flexion) = Damage to cortico spinal tract /Decerebrate (abnormal extension) = Damage to upper brain stem-pons/c.) Uncal herniation – unilateral dilation of pupil. (Bilateral dilation of pupil – tentorial herniation.)d.) Possible seizure.Nursing priority:1.) Maintain patent a/w & adequate ventilationa. Prevention of hypoxia – (decrease tissue oxygenation) & hypercarbia (increase in CO2 retention).Hypoxia – cerebral edema - increase ICPHypoxia – inadequate tissue oxygenationLate symptoms of hypoxia –B– bradycardia E– extreme restlessness D– dyspnea C– cyanosisEarly symptoms –R– restlessness A– agitation  T– tachycardiaIncrease CO2 retention/ hypercarbia – cerebral vasodilatation = increase ICPMost powerful respiratory stimulant increase
in CO2
Hyperventilate decrease CO2 – excrete CO2
3

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