BSN-3C

NCM16 Medical-Surgical Nursing

Self -Directed Activity

Briefly differentiate the following disorders:

Disorders of the Parathyroid gland:

 Hyperparathyroidism and hypoparathyroidism

Hyperparathyroidism: This condition typically occurs due to the overactivity of one or more
of the parathyroid glands, leading to excessive secretion of parathyroid hormone (PTH).
Elevated PTH levels result in increased release of calcium from the bones into the
bloodstream, leading to hypercalcemia. This can cause weakening of the bones
(osteoporosis), kidney stones due to excess calcium in the urine, and other symptoms
associated with high blood calcium levels.
Hypoparathyroidism: Hypoparathyroidism results from decreased or absent secretion of
parathyroid hormone (PTH) due to damage or dysfunction of the parathyroid glands. Without
sufficient PTH, calcium levels in the blood decrease (hypocalcemia), impairing normal nerve
and muscle function. This can lead to symptoms such as muscle cramps, tingling sensations,
seizures, and abnormal heart rhythms.

Disorders of the Adrenal glands

 Cushing’s Syndrome and Addison’s Syndrome

Cushing's Syndrome: Cushing's syndrome is typically caused by prolonged exposure to high

levels of cortisol, either due to overproduction of cortisol by the adrenal glands (adrenal
Cushing's syndrome) or excessive use of corticosteroid medications (iatrogenic Cushing's
syndrome). Elevated cortisol levels disrupt various metabolic processes, leading to symptoms
such as weight gain, particularly in the abdomen and face (moon face), high blood pressure,
insulin resistance, and increased susceptibility to infections.
Addison's Disease: Addison's disease results from damage to the adrenal cortex, leading to
inadequate production of cortisol and often aldosterone as well. This can occur due to
autoimmune destruction of the adrenal glands, infections, or other causes. Insufficient
cortisol levels disrupt the body's ability to respond to stress and regulate blood sugar levels,
while decreased aldosterone levels disrupt electrolyte balance, leading to symptoms such as
fatigue, weight loss, low blood pressure, darkening of the skin, and salt cravings.

Disorders of the Pituitary Gland

 Gigantism and Dwarfism

Gigantism: Gigantism results from excessive secretion of growth hormone (GH) by the
pituitary gland during childhood and adolescence, usually due to a benign tumor (adenoma)
of the pituitary gland. Elevated GH levels stimulate excessive growth of bones and tissues,
resulting in tall stature and other features of gigantism.
Dwarfism: Dwarfism can result from various genetic mutations affecting growth hormone
production or signaling pathways. It can also occur due to pituitary gland abnormalities that
impair GH secretion or response. Depending on the underlying cause, dwarfism may be
characterized by proportionate or disproportionate short stature, often with other associated
skeletal abnormalities.
Unit II ALTERATION IN PERCEPTION AND COORDINATION

I. Identify different terminologies related to neurologic system.

 Neuron: The basic unit of the nervous system, responsible for transmitting nerve
impulses.
 Neuroglia: Supportive cells that nourish, protect, and insulate neurons.
 Myelin sheath: A fatty substance that surrounds nerve fibers and aids in the transmission
of nerve impulses.
 Gray matter: Composed of neuronal cell bodies and is responsible for information
processing.
 White matter: Composed mainly of myelinated nerve fibers and transmits nerve impulses.
 Central Nervous System (CNS): Brain and spinal cord.
 Peripheral Nervous System (PNS): Network of nerves that branch out from the CNS.
 Somatic Nervous System: Controls voluntary movements of skeletal muscles.
 Autonomic Nervous System: Regulates involuntary actions like heart rate, digestion, and
respiration.
 Sympathetic Nervous System: "Fight-or-flight" response during stress.
 Parasympathetic Nervous System: "Rest-and-digest" functions during relaxation.
 Cranial nerves: Twelve nerves originating from the brainstem, controlling various
functions.
 Spinal nerves: Thirty-one nerves that branch out from the spinal cord and connect to
various body parts.
 Sensory reception: Gathering information from the environment.
 Integration: Processing and interpreting sensory information.
 Motor control: Generating nerve impulses for muscle movement and gland activity.
 Homeostasis: Maintaining a stable internal environment.
 Higher-order functions: Learning, memory, reasoning, and emotion.
 Stroke: Damage to brain tissue due to interrupted blood flow.
 Epilepsy: A neurological disorder characterized by recurrent seizures.
 Dementia: Decline in cognitive function that interferes with daily life.
 Parkinson's disease: A neurodegenerative disorder affecting movement.
 Multiple sclerosis: An autoimmune disease that damages the myelin sheath.
 Neuropathy: Damage to nerves that causes weakness, numbness, or pain.
 Meningitis: Inflammation of the meninges, the membranes surrounding the brain and
spinal cord.
 Reflex: An involuntary muscle response to a stimulus.
 Electroencephalogram (EEG): Measures electrical activity in the brain.
 MRI scan: Creates detailed images of the brain and spinal cord.
 CT scan: Provides cross-sectional images of the brain and spinal cord.
 Lumbar puncture: Collects cerebrospinal fluid for analysis.
 Electromyography (EMG): Measures electrical activity in muscles.

II. Illustrate the structure and function of the neurologic system.

Structure of the Nervous System

The nervous system can be broadly divided into two major parts:

 Central Nervous System (CNS): The CNS is the brain and spinal cord. The brain is the
most complex organ in the body, responsible for thought, memory, emotion, and sensory
interpretation. The spinal cord is a long, slender bundle of nerves that connects the brain
to the rest of the body. It transmits signals between the brain and the peripheral nervous
system.
  Peripheral Nervous System (PNS): The PNS is a network of nerves that branches out
from the CNS, carrying messages to and from all parts of the body. The PNS can be
further divided into two subsystems:

 Somatic Nervous System: This controls voluntary movements, such as those of the
skeletal muscles.

 Autonomic Nervous System: This regulates involuntary actions, such as heart rate,
digestion, and respiration. The autonomic nervous system itself has two branches:

 Sympathetic Nervous System: This branch activates the body's "fight-or-flight" response
during stressful situations.

 Parasympathetic Nervous System: This branch promotes the body's "rest-and-digest"

functions that occur during relaxation.

Function of the Nervous System

 The nervous system is responsible for several vital functions:

 Sensory Reception: It gathers information about the internal and external environment
through specialized sensory organs like the eyes, ears, nose, tongue, and skin.

 Integration: It processes and interprets the incoming sensory information.

 Motor Control: It generates nerve impulses that control muscle movement and activity of
glands.

 Homeostasis: It maintains a stable internal environment (homeostasis) by regulating body

temperature, blood pressure, heart rate, and other physiological functions.

 Higher-Order Functions: It is involved in higher-order functions such as learning,

memory, reasoning, and emotion.

III. Neurologic Assessment

a. Health history
This involves collecting information about the patient's past medical conditions, medications,
surgeries, family history, and current symptoms.
You may ask questions about headaches, dizziness, weakness, numbness, memory problems,
or difficulty with balance or coordination.

b. Cerebral function
This part of the assessment evaluates mental status, including:
Alertness and level of consciousness
 Orientation to time, place, and person
 Attention and concentration
 Memory
 Language skills
 Problem-solving abilities
 May use simple bedside tests to assess these functions, such as asking the patient to repeat a
series of numbers or answer questions about the date and location.

c. Cranial nerves
The cranial nerves are twelve nerves that originate from the brainstem and control various
sensory and motor functions, including:
 Vision
 Smell
 Taste
 Hearing
 Balance
 Facial muscle movement
 Swallowing
Evaluate each cranial nerve function using various tests, such as checking pupillary light
reflexes, testing facial muscle symmetry, or assessing gag reflex.

d. Motor system
This part of the assessment evaluates muscle strength, tone, coordination, and movement.
Assess muscle strength by manually moving the limbs against resistance. Muscle tone is the
amount of tension in a muscle at rest. Coordination is tested by asking the patient to perform
tasks such as tapping their finger on their nose or walking heel-to-toe.

e. Sensory system
This part of the assessment evaluates the patient's ability to feel touch, pain, temperature,
vibration, and position sense.
Use various tools to test sensation, such as a cotton swab, a tuning fork, or a pin.

f. Reflexes
Reflexes are involuntary muscle responses to stimuli.
Test reflexes using a reflex hammer to tap on tendons and elicit muscle contractions.

g. Gerontological considerations
When assessing an elderly patient, consider age-related changes in the nervous system, such
as decreased reaction time, balance problems, and cognitive decline.
The assessment may need to be modified to account for these changes.
IV. Visual and auditory assessment
Visual Assessment:

 Visual Acuity: This is the sharpness or clarity of vision, measured using a Snellen chart
or similar tools. The patient is asked to read letters or symbols at a standardized distance
to assess their ability to see details.
 Visual Fields: This test checks a person's peripheral vision. The doctor may use
confrontation testing where they move their finger in different areas of the patient's visual
field while the patient keeps their gaze fixed on a central point.
 Pupillary Light Reflex: A bright light is shone into each pupil to assess how quickly and
symmetrically they constrict (get smaller). This test the function of the optic nerves.
 Color Vision: Tests like Ishihara plates with colored dots forming specific numbers are
used to check for color blindness.
 Ocular Motility: The doctor may ask the patient to follow their finger through various
directions to assess eye movement control.
 Auditory Assessment:

 Otoscopy: The doctor uses an otoscope to examine the external ear canal and eardrum for
any abnormalities like wax buildup, inflammation, or signs of infection.
 Tuning Fork Tests: A tuning fork is used to assess hearing by placing it on the mastoid
bone behind the ear and on the forehead. This helps differentiate between conductive
hearing loss (outer or middle ear issue) and sensorineural hearing loss (inner ear or nerve
issue).
 Audiometry: This is a more advanced test that measures a person's hearing threshold
across different sound frequencies. It's done in a soundproof booth using headphones and
can provide a more detailed picture of hearing ability.

V. Locomotion assessment
Locomotion assessment evaluates a person's ability to move around independently. It helps
identify any weaknesses, limitations, or imbalances that might affect gait, balance, or
coordination.

Observation of Gait: Observe the patient walk, paying attention to:

 Gait pattern (e.g., symmetry, stride length, foot placement)

 Use of assistive devices (cane, walker)
 Gait speed
 Difficulty initiating or stopping gait
Balance Testing:

 Ask the patient to stand with their feet together, eyes open and closed (Romberg test).
This assesses balance and proprioception (body awareness).
 Other tests like the timed up and go (TUG) test measure how long it takes a person to
stand up from a chair, walk a short distance, turn around, walk back, and sit down again.
This assesses agility and balance during transitions.
Muscle Strength and Tone: As discussed in the motor system section, assessing muscle
strength and tone in the legs is crucial for locomotion, as they directly impact movement
ability.
Joint Range of Motion: Limited joint mobility in the ankles, knees, or hips can restrict
movement and affect gait. The doctor may assess the range of motion in these joints.

VI. Identify some diagnostic/laboratory examinations.

a. Neural regulation
 Electroencephalogram (EEG): Measures electrical activity in the brain, helping detect
abnormalities like seizures or epilepsy.
 Evoked Potentials: Records electrical activity in response to specific stimuli (visual,
auditory, etc.), helping assess nerve conduction pathways.
 Blood Tests: Certain blood tests can check for electrolyte imbalances, vitamin
deficiencies, or hormonal abnormalities that might indirectly affect neural regulation.
 Neuroimaging: Techniques like MRI or CT scans can reveal structural abnormalities
in the brain that might impact neural regulation.

b. Visual/auditory
Visual:
  Ophthalmoscopy: Examines the internal structures of the eye using an
ophthalmoscope.
 Visual Field Testing: Measures a person's peripheral vision using automated or
manual techniques.
 Optical Coherence Tomography (OCT): Creates a detailed cross-sectional image of
the retina to detect abnormalities.
Auditory:
 Audiometry: Measures hearing thresholds across different sound frequencies.
 Tympanometry: Assesses the middle ear function by measuring pressure changes
within the eardrum.
 Otoacoustic Emissions (OAE): Measures sound emissions generated by the inner ear
hair cells.
c. Locomotion
 Electromyography (EMG): Records electrical activity in muscles, helping assess
muscle function and nerve conduction.
 Nerve Conduction Studies (NCS): Measures the speed and strength of electrical
signals traveling through nerves, aiding in diagnosing nerve problems.
 Imaging studies: X-rays, CT scans, or MRIs of the spine and joints can reveal
abnormalities like arthritis or bone fractures that might affect gait and balance.
 Gait analysis: Specialized equipment and software can be used to analyze walking
patterns for detailed assessment of gait mechanics.