Anatomy and Physiology

of the Nervous System

Shintar delos Reyes M.D
! Coordinates and controls all activities of the body
! Divisions:
➢ Central nervous system: Including the brain, and the
Spinal cord.

➢ Peripheral nervous system: Made up of the cranial and

spinal nerves.

➢ Autonomic nervous system: Regulates action of glands

and involuntary smooth muscles in the walls of tubes
and hollow organs and heart
Neurotransmitters
! Communicate messages
from one neuron to
another or from a neuron
to a specific target tissue.

! Signaling chemicals
released when a nerve
impulse reaches a
synapse.
Central nervous system
! Brain- largest and most complex part of the
nervous system. Weighs about 1400g (adult).
! Cerebrum-is composed of two hemispheres the
thalamus and the hypothalamus. Higherst function of the
brain starts here.
! Cerebral cortex- stores knowledge of impulses received
and controls voluntary movement, thought association,
discrimination and judgment
! Frontal lobe- personality, behavior and higher
intellectual functions( consciousness, learning,
abstract, and creative thinking, problem solving,
judgment, memory, volition, and values.
! Parietal lobe- receives sensory impulses from
the opposite side of the body (sight, smell,
hearing, taste ) and sensory area for
interpretation of pain, touch, temperature,
pressure.
! Temporal lobe- contains auditory center and
stores sound memories.
! Occipital lobe- the posterior lobe of the cerebral
hemisphere is responsible for visual
interpretation.
o Brainstem- consist of ascending pathways, reticular
formation, cranial nerves and nuclei, descending autonomic
and motor pathways.
❑Midbrain- conducts impulses between lower
and upper centers.
❑Pons- briges or connects many structures,
midbrain and medulla oblongata, cerebellum
and rest of nervous system. Center of
respiration, swallowing and balance.
❑ Cerebellum- aids in coordination of voluntary muscles
and balance. Maintenance of muscles tone and
posture in space( equilibrium).
❑ Medulla oblongata- joins brain and spinal cord ( opening in
the base of the skull). Contains nerve fibers ( carrying
messages up to and down from brain) group together
forming tracts ( bundles ) to function.
 Peripheral nervous system

! Cranial nerves- conducts special senses

( smell, visual, auditory). Conducts generalized
sense impulses (pain, pressure, touch,
vibration, deep muscle sense).
! Spinal nerves- 31 segments ( 8 cervical, 12
thoracic 5 lumbar, 5 sacral, 1 coccygeal).
Autonomic nervous system

➢ Control of involuntary bodily functions.

! Parasympathetic ( cranioscaral )-
controls normal body functioning.
! Sympathetic ( thoracolumbar )- prepares
body for “fight” and “flight”.
Assessment: The Neurologic
Examination

Health History
! An important aspect of the neurologic
assessment is the history of the present illness.
! The nurse may need to rely on yes or no
answers to questions.
! The health history includes details about the
onset, character, severity, location, duration, and
frequency of symptoms and signs.
Physical Examination
! Neurologic examinationis often limited to a
simple screening.
! The examiner must be able to conduct a
thorough neurologic assessment when the
patient’s history or other physical findings
warrant it.
! The brain and spinal cord cannot be examined
as directly as other systems of the body.
! The neurologic assessment is divided into five
components: cerebral function, cranial nerves,
motor system, sensory system, and reflexes.
DIAGNOSTIC
I. Non-invasive tests EXAMINATION
of structures
! SPINAL & SKULL X- RAY
! films examined for the signs of fracture or
bony defects, calcification, erosion of the
bone, including the size of sella tursica in the
skull.
! Reveals spinal fractures, dislocation,
compression, curvature erosion, narrowed
spinal cord & degenerative processes
! Reveals configuration, density vascular
markings.
Skull X-ray
Nursing Care
- Remove hairpins, hearing aids
- BRAIN SCANNING [ Radionucleide Imaging
Studies]
➢ IV injection of radioactive compound & application of
scintillation scanner in the patient’s brain an increase
uptake of radioactive material at the site of pathology
➢ Used to detect intracranial masses, vascular lesions,
infarcts, hemorrhage
Brain Scanning
 ➢ Nursing Care for Brain Scanning
! Check for allergy to iodine
! Keep NPO 4-6 hours before examination

-MAGNETIC RESONANCE IMAGING [MRI]

•visualization of the distribution of hydrogen
molecules in the body in 3 dimensions
•superior imaging of body soft tissues &
provides more anatomically detailed pictures
than that with CT scan
•does not use harmful ionizing radiation
MRI
! Purposes:
! Differentiates types of tissues in normal &
abnormal states
! Clinical applications: brain, tumors/ vascular
abnormalities, cardiac anomalies, blood
vessels, liver dse.,renal abnormalities,
gallbladder & tumor

-Nursing Care
•Remove all metallic objects andlet patient lie on
platform that will be moved into a table cont’ng
the magnet
 • Nothing will be be felt during scanning, but (+) sound of
the magnetic coils
• Closely monitor pt. w/ potential respiratory or cardiac
collapse

II. Non-invasive tests of structures

! OPHTHALMODYNAMOMETRY
! DOPPLER ULTRASONOGRAPHY
! DOPPLER SCANNING
! QUANTITATIVE SPECIAL PHONOANGIOGRAPHY
III. Invasive test of Structures
a) Lumbar Puncture
➢ introduction of hollow needle with stylet into the lumbar
subarachnoid space of the spinal between L1-L5
➢ withdrawal of CSF fluid for diagnostic & therapeutic purposes

! Purposes:
! Measures CSF pressure [ n opening
P60-150mmH2O]
! Obtain specimen fore laboratory analysis
! Check color of CSF & presence of blood
! Inject air, dye, drugs into spinal canal
-Nursing Care
Pretest
•Have client empty bladder
•Position to lateral with head & neck flexed
on the chest
•Explain the need to remain still

Post- test
•Ensure labeling of CSF specimens in
proper sequence
•Keep client flat for 12-24 as ordered
•Force fluids
! Check puncture sites for bleeding, leakage of CSF
! Assess sensation and movement in lower
extremities
! Monitor vital signs
! Administer analgesics for headache as ordered.
b) MYELOGRAPHY
➢ injection of dye or air into lumbar or spinal subarachnoid space
followed by x-rays of the spinal column.
➢ Used to study the spinal canal & subarachnoid space
➢ Potential complicatins are the same as for lumbar puncture;
cerebral irritation from dye
! Nursing Care:
Pretest
! Keep NPO after liquid breakfast
! Check for iodine allergy
! Confirm signed informed consent
! Pos-test
! Similar with that of lumbar puncture
! If oil-based dye was used [ Pantopaque], keep
pt. flat for 12 hrs.
! If water-based [ Mtrizamide-Amipaque], elevate
head of bed 30-45 degree to prevent upward
displacement of dye meningeal irritation &
seizures
! Institute seizure precautions & don’t administer
any phenothiazines
c) PNEUMOENCEPHALOGRAPHY
! introduction of air or O2 subarachnoid space
by lumbar or cisternal puncture to outline the
ventricular system & intracranial subarachnoid
space for special x-ray studies
! to localize intracranial lesion
d) VENTRICULOGRAPHY
! Introduction of air or O2 directly into lateral
ventricles by ventrular puncture thru
opening made in the frontal, post or
occipital regions for special x-ray studies
Pnuemoencephalogr
Vent
ricul
raph o g
y
 ! To visualize ventricles; localize tumors
! Potential complications: HA,N,V, meningitis,
increase ICP

! Nursing Care
Post-test
! Monitor VS
! Check neurological status
! Elevate head of bed ( 15-20degree)
 e) CISTERNAL PUNCTURE
o introduction of hollow needle with stylet in the median line
below the occipital bone into the cisterna magna
o remove CSF when possible to obtain at lumbar level
o potential complication: Respiratory distress

•Nursing Care

➢Observe for cyanosis, dyspnea & apnea

➢Same as for lumbar puncture
Cis
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f) CEREBRAL ANGIOGRAPHY
➢ injection of radiopaque substance into the cerebral
circulation [carotid/vertebral arteries on the neck] to
visualize by means of x-rays the blood vessels in the head
& neck
➢ used to localize tumors, abscesses, aneurysms,
hematomas & occlusions
➢ Potential complications: anaphylactic rxns to dye, local
vasospasm, adverse intracranial pressure]
! Nursing Care
Pretest
! Keep NPO after midnight or clear liquid
! Check for iodine allergy
! Take baseline assessment\
! Measure neck circumference
! Explain warm flushed feeling and salty taste in mouth may
be felt during the procedure
During & Post-test
! Have emergency equipment available
! Monitor neurological status & vital signs for shock,
LOC, hemiplegia & aphasia
! Monitor swelling of the neck, difficulty of swallowing &
breathing
! Administer ice collar/cap intermittently
! Maintain pressure dressing
! Bed rest until next morning as ordered
 Cerebral
Angiograhy
g) CERBRAL
PERFUSION
STUDIES

➢ injection of 99 mTc to
assess cerebral
perfusion in
suspected brain death
h) ELECTROENCEPHALOGRAM [EEG]
! Consists of graphic record of the electrical activity of brain
by several small electrodes palced on the scalp

Purposes:
! To detect abnormalities indicative of
intracranial pathology or pathological
physiology
! To determine the existence & type of
epilepsy
! Nursing Care
Pretest
! Hair shampoo
! Withhold sedatives, tranquilizers, stimulant [ 2-3 days]
Post test
! Remove electrode paste with acetone & shampoo hair
EEG
• Peripheral Nerve Studies

❑ELECTROMYELOGRAPHY [EMG]
❖measure & records activity of contracting
muscles in response to electrical stimulation
❖helps differentiate muscle disease from
motor neuron dysfunction

•Nursing Care
–Explain procedure; (+) discomfort due to
needle insertion
EMG
• NERVE CONDUCTION
STUDIES
stimulating a
peripheral nerve at
several points
along its course &
recording the
muscle action
potential or the
sensory action
potential
! MUSCLE BIOPSY

! Used to diagnose
neuropathies &
myopathies
! CELLULAR ASSESSMENT
➢Chromosome analysis assists
diagnosis of some abnormal
neurologic conditions
➢Provides basis for genetic
counseling in families w/ evidence of
congenital neurologic
malformations, mental retardation &
seizures.
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