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Mike Chavez
NERVOUS SYSTEM
CENTRAL – center of control the body (brain); all organs will not work if the brain shuts
Down
MUSCLES
Somatic (brain and consciousness)
• Voluntary (consciously controlled), made up of Straited muscles like the musculoskeletal
• Ex. walking
Autonomic
• involuntary (reflexes); muscles directly controlled by the brain, made out of smooth muscles which are found in the visceral parts of the
body (internal organs)
• Vital signs (Para and Sympa)
• Ex. Digestion, Release of Insulin by Pancreas
CEREBRUM – consciousness (combination of the functions of the lobes of the brains) = collective function
a. Frontal – thinking and reasoning (analysis and speech or expression); motor
o [APHASIA] Expressive / BROCA’S – alternative communication (Ex. paper and pen for response)
o Behavior and Personality → In cases of CVA – changes in behavior / personality (if frontal lobe was affected)
*Cerebrum as a whole is voluntary (controlled)
b. Temporal – hearing and memory; responsible for comprehension (to understand is to listen)
o [APHASIA] Receptive / Wernicke’s – use simple sentences and speak slowly
c. Occipital – seeing (the future); visualization (brain produces a lot of hormones to achieve the visual); induces “motivation of energy”
d. Parietal – tactile sensation (sense of touch); send messages to brain upon the touch → ascending
o The parietal lobe feels the pain
o If parietal lobe is damaged, check the temperature of everything (avoid giving warm compress, etc.)
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NEURO | Mr. Mike Chavez
o Paresthesia
Which is more important? Brain stem or Cerebrum → BRAIN STEM (vital functions > thinking)
After a seizure attack, what is your priority? Turn your patient to side or reorient: SIDE → airway
FORAMEN MAGNUM
Skull covers the brain; foramen magnum is beneath the skull (Brain injuries are more fatal than spinal cord injuries)
Lumbar—catheter is yes, oxygen is no, patient can speak, patient wil have no coma, pt is
not confused, pt needs wheelchair
Cervical—catheter is yes, oxygen yes, pt can’t walk, pt can still speak
Brain—coma, no orientation
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NEURO | Mr. Mike Chavez
Manifestations in most Diseases → Diagnosis through checking for a pt’s ICP
Possible causes of Increased ICP
(1) Tumor – abnormal tissue → compression
(2) Encephalitis – inflammation of brain
(3) Meningitis – inflammation of CSF
▪ Meninges – fluid portion; for the skull and brain to prevent friction rub
o Sub-arachnoid Spaces
▪ Within the ventricles
• CSF → high in glucose (50-75 mg/dL)
o To nourish the brain and spinal
cord
• Arterial and Venous Blood
▪ Lumbar Puncture
*Basilar Skull Fracture → nabasag yung base ng skull; nasal discharge is checked if there is glucose present within the fluid discharge
MD order: prophylactic, antibiotic
Break – bacterial growth → through the meninges = infection
*Rhinorrhea → may have a mix of CSF; blood has glucose in nature that is why it is not tested for presence of glucose
HALO – secretion → 4x4 sterile gauze –dry—if the blood remained red when dried = normal
If the blood has a yellowish ring when dried = presence of CSF = MENINGITIS = Refer
MD: antibiotic
*Na are small molecules that can penetrate through the skin = maalat ang body fluids secreted like sweat or tears
Choroid plexus in the brain produces glucose everyday (500 mL) → fed to the brain – circulated through the heart – excreted through the urine
Malformation of the brain → blockage of the ventricles (few CSF can pass); abnormal accumulation of CSF
o Hydrocephalus NON-COMMUNICATING
▪ VP Shunt → redirect CSF flow to peritoneal cavity
2 Types of Stroke
Ischemic – decreased perfusion (oxygen and blood supply)
Thrombo-embolic – stationary clot is thrombus | travelling clot is embolus
o Brain infarction – death of brain
o If the clot travelled to the brain and obstructed the right brain → paralysis is on the left
o Tetraplegia – all four extremities
o Hemiplegia – everything on the certain side is paralyzed
Mgmt: let the pt exercise/walk
It is possible that a clot may block both the right and left side
How to determine if the injury is cervical or brain: Assess LOC (If pt answered: cervical only)
Speech = cerebrum = consciousness (brain)
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NEURO | Mr. Mike Chavez
IMPACT and HEMATOMA – hematoma is bleeding outside the blood vessels; pooling of blood under the skin
❖ Subdural H. – Veins
❖ Epidural H. – Arteries
• Fatal
• Cannot tourniquet
Increased ICP – from hematoma – naiipit ang brain stem = Cushing’s Triad
Observe progress of disease; cannot be put in MRI for 24hrs
Cushing’s Triad – Systolic Hypertension (There is widening of pulse pressure because systolic BP Is higher)
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NEURO | Mr. Mike Chavez
Compress pons → Cheyne Stroke Respiration
• hyperventilation – hypoventilation -- with periods of apnea
Compressed Med Ob → severe cerebral compression (lalabas ang brain stem sa skull to the foramen magnum)
• projectile vomiting (3 to 4 ft) = death
• why not HR? → not easily measurable by mere observation