Functions all motor sensory autonomic cognitive behavioral activities

Cells of the nervous system:

Neuron

Neurotransmitters

- Communicate messages from one neuron to another or from one neuron to a

specific target tissue

- Can potentiate, terminate, or modulate a specific action

- Can excite or inhibit the activity of a target cell

- Many neurologic disorders are due to imbalance of neurotransmitters

Example: Alcoholic syndrome (GABA), decreased acetylcholine, decreased

dopamine level (Parkinson’s)

Nervous System

1. CNS – Brain, spinal cord

2. PNS – cranial nerves, spinal nerves – autonomic nervous system (sympathetic

and parasympathetic), somatic nervous system

CENTRAL NERVOUS SYSTEM

Anatomy of the Brain

A. Cerebrum

- 2 hemispheres – connected by corpus callosum

- Thalamus

- Hypothalamus

- Basal ganglia

- Connections for CN 1 and 3

- Cerebral hemispheres

a. Frontal

1. Largest lobe

2. Concentration, abstract thought, information storage or

memory and motor function

3. Broca’s area: motor control of speech

4. Affect, judgment, personality and inhibitions

b. Parietal

1. Sensory lobe

2. Awareness of the body in space, orientation in space and

spatial relations

c. Temporal

1. Auditory receptive areas

d. Occipital

1. Visual interpretation

2. Balance and movement

- Thalamus

a. Either side of the third ventricle

b. Relay station for all sensation except smell

c. It permits the passage of all sensation and pain impulses

- Hypothalamus

a. Optic chiasm

b. Mamillary bodies: Olfaction

c. Endocrine function: Metabolism, reproduction, stress

response and urine production

d. ADH and GH – posterior

 e. Maintain fluid balance, temperature regulation

f. Hunger center: appetite control

g. Regulate the sleep-wake cycle, blood pressure,

aggressive and sexual behavior, and emotional response

B. Brain Stem

- Midbrain

a. Connects the pons and the cerebellum with the cerebral

hemisphere

b. Contains sensory and motor pathways

c. Center for auditory and visual reflexes

d. Origin of CN 3 and 4

- Pons

a. Bridge between the 2 halves of the cerebellum and

between the medulla and cerebellum

b. Connects CN 5-8

c. Contains motor and sensory pathways

d. Portions control the heart, respiration and blood pressure

- Medulla

a. Contains motor fibers from the brain to the spinal cord

b. Contains sensory fibers from the spinal cord to the brain

c. Connects CN 9-12

C. Cerebellum

- Tentorium cerebella

- Has both excitatory and inhibitory action

- Coordination of movement

- Controls fine movement, balance, position (postural) sense or

proprioception and integration of sensory input

STRUCTURES PROTECTING THE BRAIN

Major bones of the skull:

 1. Frontal

2. Temporal

3. Parietal

4. Occipital

Meninges and Related Structures

1. Dura Mater

2. Aracnoid

3. Pia Mater

Cerebrospinal Fluid

1. Clear and colorless fluid

2. Specific gravity of 1.007

3. Choroid plexus

Cerebral Circulation

Blood Brain Barrier

PNS

Cranial Nerves

1. Table 60-2

2. Chart 60-1

Spinal Nerves

1. Sermatome distribution

AUTONOMIC NERVOUS SYSTEM

A. Sympathetic Nervous System

a. Fight or Flight

B. Parasympathetic Nervous System

Health history

1. History of present illness

2. Overall appearance, mental status, posture, movement and affect

Clinical Manifestations

1. Pain

2. Seizures

3. Dizziness and Vertigo

4. Visual disturbances

5. Weakness

6. Abnormal sensation

Physical Exampination

1. Assessing Cerebral Function

a. Mental status

b. Intellectual function

c. Thought content

d. Emotional status

e. Perception: Agnosia

f. Motor ability

g. Language ability

h. Impact on lifestyle

2. Examining the Motor System

a. Muscle strength (size and tone): spasticity, rigidity, flaccidity

b. Balance and Coordination: Ataxia, Romberg test

c. Five-point scale p 2146 (p.1846)

3. Examining sensory system

a. Tactile sensation

b. Pain and temperature

 c. Vibration and Proprioception

4. Reflexes

a. Grading reflexes p 2148 (p. 1848)

b. Biceps

c. Triceps

d. Brachioradialis

e. Patellar

f. Ankle reflex

g. Clonus: sustained

h. Superficial reflexes

i. Babinski response

ASSIGNMENT
- all the diagnostic tests found on chapter 16.

Give definition and the procedure to perform and nursing interventions

1. Computed Tomography Scanning

2. Positron Emission Tomography

3. Magnetic Resonance Imaging

Chapter 61

*Increased Intracranial pressure

Rigid Cranial Vault

A. Brain tissue (1400 G)

B. Blood (75 ml)

C. CSF (75 ml)

-State of Equilibrium

-Intracranial Pressure (ICP)

-Lateral Ventricles

-ICP: 10-20 mmHg

Monro-Kellie Hypothesis
 1. Because of limited space for expansion within the skull

2. An increase in any one of the components causes a change in the colume of

others

1. Displacing or shifting CSF

2. Increasing the absorption or diminishing the production of CSF

3. Decreasing cerebral blood volume

Pathophysio

• Decreased cerebral blood flow

• Cerebral edema

• Cerebral response to increased intracranial pressure

Clinical Manifestations

• Clinical changes in LOC

• Abnormal respiratory responses

• Abnormal vasomotor responsescanning

• MRI

• Cerebral angiography

• PET scan

• Transcranial Doppler

• Lumbar puncture

Complications

• Brain stem herniation

• Diabetes Insipidus

• SIADH