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MEDICAL-SURGICAL NURSING
NERVOUS SYSTEM
Overview of structures and functions:
Central Nervous System
Brain
Spinal Cord
Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Autonomic Nervous System
Sympathetic nervous system
Parasympathetic nervous system
AUTONOMIC NERVOUS SYSTEMSympathetic Nervous System(ADRENERGIC)Parasympathetic Nervous System(CHOLINERGIC, VAGAL, SYMPATHOLYTIC)-
Involved in fight or aggression response.- Release of Norepinephrine (cathecolamines)from
adrenal glands
and causes
vasoconstriction.
- Increase all bodily activity except GIT
EFFECTS OF SNS
- Dilation of pupils(
mydriasis
) in order to be aware.- Dry mouth (thickened saliva).- Increase BP and Heart Rate.- Bronchodilation, Increase RR- Constipation.- Urinary Retention.- Increase blood supply to
brain
,
heart
and
skeletalmuscles
.- SNS
I. Adrenergic Agents
- Give
Epinephrine.Signs and Symptoms:
- SNS
Contraindication:
- Contraindicated to patients suffering from COPD(Broncholitis, Bronchoectasis, Emphysema, Asthma).
II. Beta-adrenergic Blocking Agents
- Also called
Beta-blockers
.- All ending with “
lol
”-
Propranolol
,
Atenelol
,
Metoprolol
.
 
Effects of Beta-blockers
B
 – roncho spasm
E
– licits a decrease in myocardial contraction.
T
– reats hypertension.
A
– V conduction slows down.
Should be given to patients with
Angina Pectoris
,
Myocardial Infarction
,
Hypertension
.
ANTI- HYPERTENSIVE AGENTS
1. Beta-blockers – “lol”2. Ace Inhibitors – Angiotensin, “pril” (Captopril,Enalapril)3. Calcium Antagonist – Nifedipine (Calcibloc)
In chronic cases of arrhythmia give
Lidocaine
(
Xylocaine
)
-
Involved in fight or withdrawal response.- Release of Acetylcholine.- Decreases all bodily activities except GIT.
EFFECTS OF PNS
- Constriction of pupils (
meiosis
).- Increase salivation.- Decrease BP and Heart Rate.- Bronchoconstriction, Decrease RR.- Diarrhea- Urinary frequency.
I. Cholinergic Agents
-
Mestinon
,
Neostigmine
.
Side Effects
- PNS
II. Anti-cholinergic Agents-
To counter cholinergic agents.- Atropine Sulfate
Side Effects
- SNS
 
CENTRAL NERVOUS SYSTEM
Brain and Spinal Cord.
I. CELLSA. NEURONS
Basic cells for nerve impulse and conduction.
PROPERTIESExcitability
– ability of neuron to be affected by changes in external environment.
Conductivity
– ability of neuron to transmit a wave of excitation from one cell to another.
Permanent Cell
– once destroyed not capable of regeneration.
TYPES OF CELLS BASED ON REGENERATIVE CAPACITY1. Labile
Capable of regeneration.
Epidermal cells, GIT cells, GUT cells, cells of lungs.
2. Stable
Capable of regeneration with limited time, survival period.
Kidney cells, Liver cells, Salivary cells, pancreas.
3. Permanent
Not capable of regeneration.
Myocardial cells, Neurons, Bone cells, Osteocytes, Retinal Cells.
B. NEUROGLIA
Support and protection of neurons.
TYPES1. Astrocytes –
maintains blood brain barrier semi-permeable.
Majority of brain tumors (90%) arises from called
astrocytoma
.
2. Oligodendria3. Microglia4. EpindymalSUBSTANCES THAT CAN PASS THE BLOOD-BRAIN BARRIER1. Ammonia
Cerebral toxin
Hepatic Encephalopathy (Liver Cirrhosis)
Ascites
Esophageal Varices
Early Signs of Hepatic Encephalopathy
asterixis
(flapping hand tremors).
Late Signs of Hepatic Encephalopathy
Headache
Dizziness
Confusion
Fetor hepaticus
(ammonia like breath)
Decrease LOC
 
PATHOGNOMONIC SIGNS1. PTB –
low-grade afternoon fever.
2. PNEUMONIA –
rusty sputum.
3. ASTHMA –
wheezing on expiration.
4. EMPHYSEMA
 – barrel chest.
5. KAWASAKI SYNDROME –
strawberry tongue.
6. PERNICIOUS ANEMIA –
red beefy tongue.
7. DOWN SYNDROME –
protruding tongue.
8. CHOLERA –
rice watery stool.
9. MALARIA –
stepladder like fever with chills.
10. TYPHOID –
rose spots in abdomen.
11. DIPTHERIA –
pseudo membrane formation
12. MEASLES –
koplik’s spots.
13. SLE –
butterfly rashes.
14. LIVER CIRRHOSIS –
spider like varices.
15. LEPROSY –
lioning face.
16. BULIMIA –
chipmunk face.
17. APPENDICITIS –
rebound tenderness.
18. DENGUE –
petechiae or (+) Herman’s sign.
19. MENINGITIS –
Kernig’s sign (leg pain), Brudzinski sign (neck pain).
20. TETANY –
HYPOCALCEMIA (+)
Trousseau’s sign/carpopedal spasm; Chvostek sign
(facial spasm).
21. TETANUS –
risus sardonicus.
22. PANCREATITIS –
Cullen’s sign (ecchymosis of umbilicus); (+)
Grey turners spots
.
23. PYLORIC STENOSIS –
olive like mass.
24. PDA –
machine like murmur.
25. ADDISON’S DISEASE –
bronze like skin pigmentation.
26. CUSHING’S SYNDROME –
moon face appearance and buffalo hump.
27. HYPERTHYROIDISM/GRAVE’S DISEASE –
exopthalmus.
28. INTUSSUSCEPTION
 
 –
sausage shaped mass
2. Carbon Monoxide and Lead Poisoning
Can lead to
Parkinson’s Disease.
Epilepsy
Treat with
ANTIDOTE
:
Calcium EDTA.3. Type 1 DM (IDDM)
Causes diabetic ketoacidosis.
And increases breakdown of fats.
And free fatty acids
Resulting to
cholesterol
and (+) to
Ketones
(CNS depressant).
Resulting to acetone breath odor/fruity odor.
KUSSMAUL’S respiration,
a rapid shallow respiration.
Which may lead to diabetic coma.
4. Hepatitis
Signs of jaundice (icteric sclerae).
Caused by bilirubin (yellow pigment)
5. Bilirubin
Increase bilirubin in brain (
Kernicterus
).
Causing irreversible brain damage.
Astrocites
Maintains integrity of blood brain barrier.
Oligodendria
 
Produces
myelin sheath
in CNS
Act as insulator and facilitates rapid nerve impulse transmission.
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