A lecture by: Mr.

Kim Derek Ramsey Octaviano

The Nervous System

Consists of two divisions
The Central Nervous System composed of the Brain and the Spinal Cord The Peripheral Nervous System made up of the cranial and spinal nerves

The Nervous System

The function of the nervous system is to control all motor, sensory, autonomic, cognitive and behavioral activities. The peripheral nervous system can be further divided into the somatic or voluntary and the autonomic or the involuntary nervous system.

Anatomy of the nervous system

The basic functional unit of the brain is the neuron The neuron is composed of cell body, a dendrite and an axon. The dendrite is a branch-type structure with synapses for receiving electrochemical charges The axon is a long projection that carries impulses away from the cell body

Neurotransmitters
Neurotransmitters communicate messages form one neuron to another or from a neuron to a specific target tissue The action of a neurotransmitter is to potentiate, terminate, or modulate a specific action and can either excite or inhibit a cells activity.

Anatomy of the Brain

Cerebrum the cerebrum consists of two hemispheres that are incompletely separated by the great longitudinal fissure. The two hemispheres are joined at the lower portion of the fissure by the corpus callosum The outside surface of the hemispheres has a wrinkled appearance that is the result of many folded layers or convolutions called gyri, which increase the surface area of the brain.

Anatomy of the Brain

Brainstem the brainstem consists of the Pons, midbrain and the Medulla Oblongata The midbrain connects the pons and the cerebellum with the cerebral hemispheres. The Medulla Oblongata contains motor fibers from the brain to the spinal cord and sensory fibers from the spinal cord to the brain.

Anatomy of the Brain

Cerebellum the cerebellum is separated from the cerebral hemispheres by a fold of dura mater, the tentorium cerebelli. The cerebellum has both excitatory and inhibitory actions and is largely responsible for coordination of movement. It also controls fine movement, balance, position sense and integration of sensory input.

Lobes of the cerebral hemispheres

The cerebral hemispheres are divided into pairs of frontal, parietal, temporal and occipital lobes

Frontal Lobe
The frontal lobe is the largest lobe. The major functions of this lobe are concentration, abstract thought, information storage or memory and motor function. It also contains the Brocas Area, critical for motor control of speech. The frontal lobe is also responsible in part for an individuals affective judgment, personality and inhibitions

Parietal Lobe
A predominantly sensory lobe. The primary sensory cortex, which analyzes sensory information, and relays the interpretation of this information to the thalamus and other cortical areas, is located in the parietal lobe. It is also essential to an individuals awareness in space as well as orientation in space and spatial relations.

Temporal lobe
Contains the auditory receptive areas. Contains a vital area called the interpretative area (wernickes area) that provides integration of somatization, visual and auditory areas and plays the most dominant role of any cortex in cerebration

Occipital Lobe
The posterior lobe of the cerebral hemisphere is responsible for visual interpretation.

Structures protecting the brain

The brain is contained in the rigid skull, which protects it from injury. The major bones of the skull are the frontal, temporal, parietal and occipital bones.

Structures protecting the brain

The meninges, (fibrous connective tissues that cover the brain and spinal cord) provide protection support and nourishment to the brain and spinal cord. The layers of the meninges are the dura, arachnoid and pia mater.

Meninges
Dura Mater the outermost layer; covers the brain and the spinal cord. It is tough, inelastic, fibrous and gray. Arachnoid Mater the middle membrane; is an extremely intricate membrane that resembles a spider web. Contains the plexus, which produces the CSF Pia Mater the innermost membrane; a thin, transparent layer that hugs the brain closely and extends into every fold of the brains surface

Cranial Nerves
There are 12 pairs of cranial nerves that emerge from the lower surface of the brain and pass through the foramina in the skull Three are entirely sensory (I, II, VIII), five are motor, (III, IV, VI, XI, XII) and four are mixed (V, VII, IX and X)

CN I Olfactory
With eyes closed, the patient identifies familiar odors (coffee, tobacco) Each nostril is tested separately

CN II Optic
Snelle Eye chart, Snellen E Visual Fields Opthalmoscopic Examination

CN III Oculomotor, CN IV Trochlear, CN VI Abducens

Test for ocular rotations, conjugate movements, nystagmus Test for pupillary reflexes and inspect eyelids for ptosis

CN V Trigeminal
Have patient close eyes, touch cotton to forehead, cheeks and jaw. Sensitivity to superficial pain is tested by using the sharp and dull points of a broken tongue blade While the patient looks up, lightly touch a wisp of cotton against the temporal surfaces of the cornea. A blink and tearing response are normal responses. Have the client clench and move the jaw from side to side. Palpate the masseter and temporal muscle, noting strength and equality.

CN VII Facial
Observe for symmetry while the patient performs facial movements; smiles, whistles, elevates eyebrows, frowns, tightly closes eyelids against resistance Observe face for flaccid paralysis Patient extends tongue. Ability to discriminate sugar and salt is tested.

CN VIII Acoustic
Whisper or watch-tick test Test for lateralization Test for air and bone conduction

CN IX Glossopharyngeal

Assess the patients ability to discriminate between sugar and salt on posterior third of the tongue

CN X Vagus
Depress a tongue blade on the posterior tongue, or stimulate posterior pharynx to elicit the gag reflex Note any hoarseness in voice Have patient say Aahhh. Observe for symmetric rise of uvula and soft palate

CN XI Spinal Accessory
Palpate and note the strength of the trapezius muscles while the patient shrugs shoulders against resistance Palpate and assess strength of each sternocleidomastoid muscle as patient turns head against opposing pressure of the examiners hands

CN XII Hypoglossal
While the patient protrudes the tongue, any deviation or tremors are noted. The strength of the tongue is tested by having the patient move the protruded tongue form side to side against a tongue depressor.

Neurologic Disorders

Status Epilepticus
Acute prolonged seizure activity Is a series of generalized seizures that occur without full recovery of consciousness between attacks There is some respiratory arrest at the height of each seizure that produces cumulative effects. Repeated episodes of cerebra anoxia and edema may lead to irreversible and fatal brain damage

Status Epilepticus
Nursing Management
The patient is turned to a side-lying position if possible to assist in draining pharyngeal secretions During seizures, the patient should be protected form injury using seizure precautions and monitored closel Suction equipment must be available for risk of aspiration

Multiple Sclerosis
MS is an immune-mediated progressive myelinating disease of the CNS. Demyelination refers to the structure of Myelin, the fatty and protein material that surrounds certain nerve fibers in the brain

Multiple Sclerosis
Clinical Manifestations
Primary symptoms reported are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, and pain Tremors while moving

Myasthenia Gravis
Myasthenia Gravis is an autoimmune disorder affecting the myoneural junction, is characterized by varying degrees of weakness of the voluntary muscles.

Myasthenia Gravis
Pathophysiology

Myasthenia Gravis
Clinical Manifestations
Voluntary muscle weakness that worsens with activity Diplopia, ptosis, weakness of the facial muscles Laryngeal involvement produces dysphonia,(Voice impairment Tensilon test (Edrophonium Chloride test)
Myasthenic Crisis/ Cholinergic Crisis

Guillain-Barre Syndrome

GBS is an auto-immune attack for the peripheral nerve myelin Segmental demyelination of peripheral nerves and some cranial nerves, An ascending report produces ascending weakness known as paresthesias

Trigeminal Neuralgia (Tic Doloreux)

Trigeminal neuralgia is a condition of the fifth cranial nerve characterized by paroxism of pain in the area innervated by any of the three branches. Pain ends as abruptly as it starts and is described as a unilateral shooting or stabbing pain

Trigeminal Neuralgia (Tic Doloreux)

Associated involuntary contraction of the facial muscles can cause sudden closing of the eye or a twitch of the mouth, hence the name tic doloreux (painful twitch) Paroxysms can occur with any stimulation of the terminal affected nerve branches, such as washing the face, shaving, brushing the teeth, eating and drinking

BellsPalsy

Bells Palsy
Bells Palsy (Facial Paralysis) is due to unilateral inflammation of the seventh cranial nerve which results in weakness or paralysis of the facial muscles on the affected side. The cause is unknown, though possible causes may include vascular ischemia, viral disease, autoimmune disease or a combination of all these factors

Bells Palsy
Corticosteroid therapy ma be prescribed to reduce inflammation and edema Facial pain is controlled with analgesic agents While the paralysis lasts, the involved eye must be protected. Corneal irritation and ulceration may occur if the eye is unprotected.

By: Kim Hotdog Abrenica

Anatomy of the GI Tract

The GI tract is a 23-26 foot-long pathway that extends from the mouth through the esophagus, stomach, intestines and to the anus.

Esophagus
The esophagus is located in the mediastinum in the thoracic cavity. This collapsible tube, which is about 25 cm in length, passes through the diaphragm in an opening called the diaphragmatic hiatus

Stomach
The stomach is situated in the upper portion of the abdomen to the left of the midline. It is a distendable pouch with a capacity of approximately 1500ml

Small Intestine
The small intestine is the longest segment of the GI tract accounting for about two-thirds of the total length providing for about 7000cm of surface area for secretion and absorption. The small intestine can be divided into three anatomic parts: the duodenum, the jejunum and the ileum.

Large intestine (Colon)

The large intestine consists of an ascending segment on the right side of the abdomen, a transverse segment that extends right to left in the upper abdomen, and a descending segment in the left side of the abdomen.

Large Intestine (Colon)

The terminal portion of the intestine consists of two parts: the sigmoid colon and the rectum is continuous with the anus. A network of striated muscles that forms both the internal and external anal sphincters regulates the anal outlet.

Functions of the Digestive System

To break down food particles into the molecular form for digestion To absorb into the bloodstream the small molecules produced by digestion To eliminate undigested and unabsorbed foodstuffs and other waste products from the body.

Gastro-Esophageal Reflux Disease

Excessive reflux may occur because of an incompetent lower esophageal sphincter, pyloric stenosis or a motility disorder. The incidence of reflux seems to increase with aging Symptoms of GERD include pyrosis (burning sensation in the esophagus), dyspepsia (indigestion), odynophagia (painful or difficulty in swallowing) hypersalivation and esophagitis

Gastro-Esophageal Reflux Disease

The patient is instructed to eat a low-fat diet; to avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint and carbonated beverages To avoid eating two hours before bedtime, to maintain an ideal body weight, to avoid tight-fitting clothes and to elevate the head of the bed on 6 to 8inch blocks

Gastrointestinal Intubation

GI intubation is the insertion of a rubber or plastic tube into the stomach, the duodenum, or the intestine. The tube may be inserted through the mouth, nose or the abdominal wall

Gastrointestinal Intubation
GI intubation may be performed for the following reasons
To decompress the stomach and remove gas or fluid To lavage the stomach and remove ingested toxins To diagnose disorders of GI motility and other disorders To administer medications and feeding To treat an obstruction To compress a bleeding site To aspirate gastric contents for analysis

Gastric and Duodenal Ulcers

A peptic ulcer is an