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MEDICAL-SURGICAL NURSINGBy: Anthony T. Villegas R.N.Overview of structures and functions:NERVOUS SYSTEM
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The functional unit of the nervous system is the nerve cellsor neurons
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The nervous system is composed of the ff:Central Nervous System
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Brain
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Spinal Cord– serves as a connecting link between the brain& the periphery.Peripheral Nervous System
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Cranial Nerves–12 pairs; carry impulses to & from the brain.
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Spinal Nerves– 31 pairs; carry impulses to & from spinalcord.Autonomic Nervous Systemsubdivision of the PNS that automatically controls bodyfunction such as breathing & heart beat.Special senses of vision and hearing are also covered in thissection
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Sympathetic nervous system– generally accelerate somebody functions in response to stress.
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Parasympathetic nervous system– controls normal bodyfunctioning.
CELLS
A.NEURONS
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Primary component of nervous system
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Composed of cell body(gray matter), axon, and dendrites
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Basic cells for nerve impulse and conduction.Axon
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Elongated process or fiber extending from the cell body
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Transmits impulses(messages)away from the cell body todendrites or directly to the cell bodies of other neurons
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Neurons usually has only one axonDendrites
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Short, blanching fibers that receives impulses and conductsthem toward the nerve cell body.
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Neurons may have many dendrites.Synapse
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Junction between neurons where an impulse is transmittedNeurotransmitter
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Chemical agent(ex. Acetylcholine, norepinephrine)involvedin the transmission of impulse across synapse.Myelin Sheath
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A wrapping of myelin(whitish, fatty material)that protectsand insulates nerve fibers and enhances the speed of impulse conduction.
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Both axons and dendrites may or may not have amyelin sheath(myelinated/unmyelinated)
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Most axons leaving the CNS are heavily myelinatedbyschwann cellsFunctional Classification1.Afferent (sensory) neurons
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Transmit impulses from peripheral receptors to the CNS2.Efferent (motor) neurons
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Conduct impulses from CNS to muscle and glands3.Internuncial neurons (interneurons)
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Connecting links between afferent and efferent neuronsProperties
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Excitability– ability of neuron to be affected by changes inexternal environment.
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Conductility– ability of neuron to transmit a wave of excitetation from one cell to another.
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Permanent Cell– once destroyed not capable of regeneration. TYPES OF CELLS BASED ON REGENERATIVE CAPACITY1.Labile
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Capable of regeneration.
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Epidermal cells, GIT cells, GUT cells, cells of lungs.2.Stable
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Capable of regeneration with limited time, survivalperiod.
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Kidney cells, Liver cells, Salivary cells, pancreas.3.Permanent
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Not capable of regeneration.
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Myocardial cells, Neurons, Bone cells, Osteocytes,Retinal Cells.B.NEUROGLIA
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Support and protection of neurons. TYPES1.Astrocytes
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maintains blood brain barrier semi-permiable.
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majority of brain tumors (90%) arises from calledastrocytoma.
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integrity of blood brain barrier.2.Oligodendria
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producesmyelin sheathin CNS.
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act as insulator and facilitates rapid nerve impulsetransmission.3.Microglia
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stationary cells that carry on phagocytosis(engulfing of bacteria or cellular debris, eating), pinocytosis(celldrinking).4.Epindymal
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secretes a glue calledchemo attractantsthatconcentrate the bacteria.MACROPHAGEORGANMicrogliaMonocytesKupffersHistiocytesAlveolar MacrophageBrainBloodKidneySkinLung
Central Nervous System
Composition Of Brain
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80% brain mass
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10% blood
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10% CSFBrain MassParts Of The Brain1.Cerebrum
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largest part of the brain
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outermost area(cerebral cortex)is gray matter
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deeper area is composed of white matter
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function of cerebrum:integration, sensory, motor
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composed of two hemispherethe Right CerebralHemisphere and Left Cerebral Hemisphere enclosed intheCorpus Callosum.
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Each hemisphere divided into four lobes; many of thefunctional areas of the cerebrum have been located inthese lobes:Lobes of Cerebrum1.Frontal Lobe
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controls personality, behavior
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higher cortical thinking, intellectual functioning
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precentral gyrus: controls motor function
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Broca’s Area: specializedmotorspeech area -when
damaged results to garbled speech.2.Temporal Lobe
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hearing, taste, smell
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short term memory
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Wernicke’s area: sensoryspeech area
(understanding/formulation of language)3.Pareital Lobe
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for appreciation
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integrates sensory information
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discrimination of sensory impulses to pain, touch,pressure, heat, cold, numbness.
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Postcentral gyrus:registered general sensation(ex. Touch, pressure)4.Occipital Lobe
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for visionInsula(Island of Reil)
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visceral function activities of internal organ like gastricmotility.Limbic System(Rhinencephalon)
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controls smell -if damaged results to anosmia
(absenceof smell).
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controls libido
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controls long term memoryCorpus Callosum
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large fiber tract thatconnectsthetwo cerebral
hemisphereBasal Ganglia
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island of gray matter within white matter of cerebrum
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regulate & integrate motor activity originating in thecerebral cortex
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part of extrapyramidal system
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area of gray matter located deep within each cerebralhemisphere.
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release dopamine (controls gross voluntary movement).2.Diencephalon/interbrain
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Connecting part of the brain, between the cerebrum &the brain stem
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Contains several small structures:the thalamus &hypothalamus are most important Thalamus
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acts as relay station for discrimination of sensory signals(ex. Pain, temperature, touch)
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controls primitive emotional responses(ex. Rage, fear)Hypothalamus
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found immediately beneath the thalamus
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plays a major role in regulation/controls of vital function:blood pressure, thirst, appetite, sleep & wakefulness,temperature(thermoregulatory center)
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acts as controls center for pituitary gland and affectsboth divisions of the autonomic nervous system.
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controls some emotional responses like fear, anxietyand excitement.
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androgenic hormones
promotes secondary sexcharacteristics.
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early sign for males are testicular and penileenlargement
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late sign is deepening of voice.
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early sign for females telarch and late sign is menarch.3.Mesencephalon/Midbrain
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acts as relay station for sight and hearing.
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size of pupil is2 – 3 mm.
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equal size of pupil isisocoria.
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unequal size of pupil isanisocoria.
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hearing acuity is30 – 40 dB.
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positive PERRLA4.Brain Stem
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located at lowest part of brain.
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contains midbrain, pons, medulla oblongata.
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extends from the cerebral hemispheres to the foramenmagnum at the base of the skull.
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contains nuclei of the cranial nerves and the longascending and descending tracts connecting thecerebrum and the spinal cord.
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contains vital center of respiratory, vasomotor, andcardiac functions.Pons
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pneumotaxic center controls the rate, rhythm and depthof respiration.Medulla Oblongata
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controls respiration, heart rate, swallowing, vomiting,hiccup, vasomotor center (dilation and constriction of bronchioles).5.Cerebellum
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smallest part of the brain, lesser brain.
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coordinates muscle tone and movements and maintainsposition in space (equilibrium)
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controls balance, equilibrium, posture and gait.Spinal Cord
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serves as a connecting link between the brain andperiphery
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extends from foramen magnum to second lumbarvertebra
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H-shapedgray matterin the center(cell bodies)
surrounded bywhite matter (nerve tract and fibers)
Gray Matter1.Anterior Horns
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Contains cell bodies giving rise to efferent(motor)fibers2.Posterior Horns
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Contains cell bodies connecting with afferent(sensory)fibers from dorsal root ganglion3.Lateral Horns
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In thoracic region, contain cells giving rise toautonomic fibers of sympathetic nervous systemWhite Matter
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Ascending Tracts(sensory pathways)a.Posterior Column
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Carry impulses concerned with touch,pressure, vibration, & position senseb.Spinocerebellar
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Carry impulses concerned with muscletension & position sense to cerebellumc.Lateral Spinothalamic
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Carry impulses resulting in pain &temperature sensationsd.Anterior Spinothlamic
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Carry impulses concerned with crudetouch & pressure
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Descending Tracts(motor pathways)
a.
Corticospinal(pyramidal, upper motor neurons)
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Conduct motor impulses from motorcortex to anterior horn cells (cross inthe medulla)b.Extrapyramidal
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Help to maintain muscle tone & tocontrol body movement, especiallygross automatic movements such aswalkingReflex Arc
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Reflex consists of an involuntary response to a stimulusoccurring over a neural pathway called areflex arc.
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Not relayed to & from brain: take place at cord levelsComponentsa.Sensory Receptors
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Receives/reacts to stimulusb.Afferent Pathways
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Transmits impulses to spinal cordc.Interneurons
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Synapses with a motor neuron(anterior horn cell)d.Efferent Pathways
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Transmits impulses from motor neuron to effectore.Effectors
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Muscle or organ that responds to stimulusSupporting Structures1.Skull
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Rigid; numerous bones fused together
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Protects & support the brain2.Spinal Column
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Consists of 7 cervical, 12 thoracic, & 5 lumbar vertebraeas well as sacrum & coccyx
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Supports the head & protect the spinal cord3.Meninges
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Membranes between the skull & brain & the vertebralcolumn & spinal cord
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3 fold membrane that covers brain and spinal cord.
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For support and protection; for nourishment; bloodsupply
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Area between arachnoid & pia mater is calledsubarachnoid space:CSF aspiration is done
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Subdural spacebetween the dura and arachnoid
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Layers:Dura Mater
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outermost layer, tough, leatheryArachnoid Mater
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middle layer, weblikePia Mater
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innermost layer, delicate, clings to surface of brain4.Ventricles
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Four fluid-filled cavities connecting with oneanother & spinal canal
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Produce & circulate cerebrospinal fluid
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Cerebrospinal Fluid (CSF)
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Surrounds brain & spinal cord
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Offer protection by functioning as ashock absorber
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Allows fluid shiftsfrom thecranial cavity to the spinalcavity
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Carries nutrient to & waste product away from nervecells
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Component of CSF:CHON, WBC, Glucose6.Vascular Supply
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Two internal carotid arteries anteriorly
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Two vertebral arteries leading to basilar arteryposteriorly
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Thesearteries communicate at the base of the brain
through thecircle of willis
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Anterior, middle, & posterior cerebral arteries are themain arteriesfordistributing blood to each hemisphereof the brain
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Brain stem & cerebellumare supplied by branches of thevertebral & basilar arteries
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Venous blood drainsinto dural sinuses & theninto jugular veins
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Blood-Brain-Barrier(BBB)
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Protective barrier preventing harmful agents fromentering the capillaries of the CNS; protect brain &spinal cordSubstance That Can Pass Blood-Brain Barrier1.Amonia
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Cerebral toxin
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Hepatic Encephalopathy(Liver Cirrhosis)
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Ascites
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Esophageal VaricesEarly Signs of Hepatic Encephalopathy
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Asterexis
(flapping hand tremors).Late Signs of Hepatic Encephalopathy
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Headache
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Dizziness
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Confusion
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Fetor hepaticus
(amonia like breath)
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decrease LOC2.Carbon Monoxide and Lead Poisoning
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Can lead toParkinson’s Disease
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Epilepsy
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Treated withcalcium EDTA
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3.Type 1 DM (IDDM)
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Causes diabetic ketoacidosis.
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And increases breakdown of fats.
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And free fatty acids
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Resulting tocholesterol
and positive to
ketones (CNSdepressant).
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Resulting to acetone breath odor/fruity odor.
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Andkusshmauls respirationa rapid shallow respiration.
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Which may lead to diabetic coma.4.Hepatitis
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Signs of jaundice(icteric sclerae).
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Caused by bilirubin (yellow pigment)5.Bilirubin
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Increase bilirubin in brain(kernicterus).
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Causing irreversible brain damage.
Peripheral Nervous System
Spinal Nerves31 pairs: carry impulses to & from spinal cordEach segment of the spinal cord contains a pair of spinalnerves(one of each side of the body)Each nerve is attached to the spinal bytwo roots:
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Dorsal(posterior)roots
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contains afferent(sensory)nerve whose cellbody is in the dorsal roots ganglion
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Ventral(anterior)roots
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Contains efferent(motor)nerve whose nervefibers originate in the anterior horn cell of thespinal cord(lower motor neuron)Cranial Nerves12 pairs: carry impulses to & from the brain.May havesensory,motor, ormixedfunctions.
Name & Number FunctionOlfactory:CN ISensory: carries impulses for
sense of smell.Optic:CN IISensory: carries impulses for vision.
Oculomotor:CN IIIMotor: muscles for papillary
constriction,elevation of upper eyelid;4 out of 6 extraocularmovement. Trochlear:CN IVMotor: muscles for downward,
inward,movement of the eye Trigeminal:CN VMixed: impulses from face,surface
of eyes(corneal reflex);muscle
Controlling mastication.Abducens:CN VIMotor: muscles for lateral deviation
of eyeFacial:CN VIIMixed: impulses for taste from
anterior tongue;muscles for facial Movement.Acoustic:CN VIIISensory: impulses for
hearing(cochlear division)&balance(vestibular
Division).Glossopharyngeal:CN IXMixed: impulses for
sensation to posterior tongue & pharynx;muscle For movement of pharynx(elevation)& swallowing.Vagus:CN XMixed: impulses for sensation to
lower pharynx & larynx;muscle for Movement of soft palate,pharynx, & larynx.Spinal Accessory:CN XIMotor: movement of
sternomastoid muscles & upper part of trapeziusMuscles.Hypoglossal:CN XIIMotor: movement of tongue.
Autonomic Nervous System
Part of the peripheral nervous systemInclude those peripheral nerves(both cranial & spinal)thatregulates smooth muscles, cardiac muscles, & glands.Component:1.Sympathetic Nervous SystemGenerally accelerates some body function inresponse to stress.2.Parasympathetic Nervous System
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