223-4

Hypothalamus

◦Main regulator for the Autonomic Nervous System (metabolism/growth/stress response

CNS

◦Brain

◦Spinal cord

PNS

◦Cranial nerves

◦Spinal nerves

ANS

◦Sympathetic: “fight or flight”

◦Parasympathetic: calming/relax “rest/digest”

Neuroglial cells

the “glue” that support and protect the neurons

Neurons

the communication cells of the brain and spinal cord

Afferent neurons

sensory

Efferent neurons

motor

Interneurons

decision-makers

Excitatory neurotransmitters

◦Acetylcholine

◦Glutamate

◦Norepinephrine

Inhibitory neurons

◦Serotonin

◦Dopamine

Parts of the brain

◦Cerebrum

◦Brainstem

◦Cerebellum

Frontal lobe

◦Broca’s expressive speech center/motor movement/personality

Parietal lobe

◦Sensation and perception

Temporal lobe

◦Wernicke’s receptive speech center/long-term memory/auditory sensation & perception

Occipital lobe

◦Process visual info/perception of color & shapes

Thalamus

◦Relay center for sensory impulses to cerebral cortex (pain/taste/smell/hearing/touch/balance)

Basal ganglia

◦Regulates movement (problems = movement disorders like Parkinson’s)

Limbic system

◦Primary role in memory and emotions (pleasure/reward/grief/dread)

Brainstem

◦mediates overall LOC; maintain balance and posture; controls resp. and cardiac function; pain modulation;

Cerebellum

◦Responsible for coordination of muscle activities, fine motor, balance, gait

Blood flow to the brain

◦Arterial circulation of the brain: right and left carotid arteries

◦-Circle of Willis

◦Venous blood flow

◦-Occurs through the dura sinuses found between the dura mater and the brain: jugular veins

Spinal cord

◦Pathway carries information to and from the brain and the body

◦Located within vertebral column

◦Begins at brainstem and extends to lumbar region

Spinal nerves

◦pain sensation, temperature, pressure, proprioception, fine touch, vibration

◦Conscious movement of skeletal muscles and subconscious movement and control of balance, tone, reflexes

CNS protective mechanisms

◦**Cranium/skull**

◦**Vertebrae**

◦**Meninges**

◦**CSF**

◦**Blood-brain barrier**

Spinal nerves

transmit to and from spinal cord and receptors throughout the body

◦Each nerve connects to cord at 2 points

◦Ventral root transmits motor impulses to muscle

◦Dorsal root carries sensory info to the cord

Cranial nerves

◦Originate in the brain except for the olfactory and optic nerves

◦Transmit signals to receptors in the body

◦Identified by roman numerals

◦Names in order according to where they arise in the brain

Cranial nerve I

olfactory (smell)

Cranial nerve II

Optic (vision)

Cranial nerve III

Oculomotor (eye movement and pupil constriction)

Cranial nerve IV

Trochlear (medial eye movement)

Cranial nerve V

Trigeminal (sensation from upper and lower face, chewing)

Cranial nerve VI

Abducens (lateral eye movement)

Cranial nerve VII

Facial (facial expressions, taste)

Cranial nerve VIII

Vestibulocochlear (hearing and balance)

Cranial nerve IX

Glossopharyngeal (taste, sensations from tongue and outer ear, salivation, swallow and gag)

Cranial nerve X

Vagus (sensations of hunger, fullness, GI discomfort, bronchoconstriction, GI secretion and motility)

Cranial nerve XI

Accessory (swallow, movement of head, neck, and shoulders)

Cranial nerve XII

Hypoglossal (tongue movement, and swallowing)

Sympathetic nervous system

◦Neurotransmitter is norepinephrine

◦Receptor - adrenergic

Parasympathetic nervous system

◦Neurotransmitter is acetylcholine

◦Receptor - cholinergic

Neurological assessment hx

◦Routine medical care

◦Medical history

◦Family history

◦Allergies

◦Medications

◦Social history

◦Chief complaint

Physical assessment of the neurological system

◦Level of consciousness – Glascow Coma Scale

◦-Conscious

◦-Lethargic

◦-Stupor

◦-Coma

◦Cognitive function – Mini Mental Exam

Motor assessment

◦Pronator drift

Sensory assessment

◦Dermatome chart

◦-Cortical sensory interpretation

◦--Sterognosis (pt able to identify object by shape)

◦--Graphestesia (identify letters/numbers when drawn on skin)

◦--Two-point discrimination (can distinguish 2 points separately)

Cerebellar assessment

◦Romberg test

Babinski assessment

(toes flare upward \[positive\]) (toes curl \[negative\])

Neurological vital sign assessment

◦Regulated in the brain and brainstem

◦-Heart rate

◦-Blood pressure

◦-Respirations

ICP

◦Normal 7-15mmHg

◦Monroe-Kellie hypothesis (volume of the brain is constant)

◦Cushing's Triad (late sign of ICP, elevated BP, bradycardia, irregular R)

Assessments of a mini-mental exam

Orientation

Registration

Attention and calculation

Recall

Language

Diagnostic studies of the neurological system

◦Radiographic procedures

◦Computed tomography

◦Positron emission tomography (PET)

◦Magnetic resonance imaging (MRI)

◦Cerebral angiography

◦Computed tomography angiography (CTA)

◦Electroencephalography (EEG)

◦Evoked potential

◦Lumbar puncture

◦Myelography/myelogram

◦Brain biopsies

Which scan uses radioactive tracers to help identify cancer?

PET

What medication should we avoid giving 48 hours prior to and after performing a scan with contrast dye?

Metformin

How can we as nurses help a patient avoid a post lumbar headache following a lumbar puncture?

Encourage fluids

Psychological considerations of the neurological system

◦Age, general health, social status, history of chronic illness, previous life experience, job, and home responsibilities

Altered social roles and body image issues

Age related changes for the neurological system

◦Motor and sensory changes

◦Alteration in thermoregulation

Bones

•Skeleton consists of 206 bones

•Collagen

•Osteoblasts

•Osteoclasts 

•Bones are classified by structure or shape

•Classification by bone shape

•Long bones, short bones, flat bones, irregular bones, and sesamoid bones

•Different shaped bones contain different portions of osseous tissue

•compact and spongy bone

Long bones

•Femur

•Tibia

•Fibula

•Humerus

•Radius

•Ulna

Short bones

•Carpals

•Tarsals

Flat bones

•Sternum

•Cranium

•Ribs

irregular bones

•Vertebrae

•Mandible

sesamoid bones

Patella

Bone marrow

• Red and yellow marrow

• Red marrow consists mainly of hematopoietic tissue

Estrogen

induces chemical in osteoclasts to self destruct- slows bone destruction

Calcitonin and TSH

Inhibit activity of osteoclasts

Parathyroid hormones

promotes activity and number of osteoblasts

growth hormone

helps the bones grow

Muscles

•Muscles contract and help produce movement

•40-50% of the body’s weight

•3 types of muscle

Skeletal muscle

•Flexion & Extension

•Abduction & Adduction

•Pronation & Supination

•Circumduction

•Inversion & Eversion

•Rotation

•Protraction & Retraction

•Elevation & Depression

Smooth muscle

•Stomach

•Esophagus

•Blood Vessels

•Bronchi

Cardiac muscle

•Can increase or decrease contraction rate

•Highly resistant to fatigue

•Continuous aerobic metabolism

Joints

•Place of union between 2 or more bones

•Permit mobility

•Provide mechanical support

•Essential part of the musculoskeletal system

•Non-synovial or synovial

•Cartilage

•Bursa

Synarthrosis

•provides little mobility

Amphiarthrosis

provides slight mobility

Diarthrosis

•provides mobility

Ligaments

•bone to bone connection (provides stability of joints)

•Viscoelastic (stretch under tension)

Tendons

•(connects muscle to bone)- facilitate movement

Fascia

(layer of interconnective fiber) – stabilize muscles and internal organs

Muscular skeletal system hx

•Must collect history of the present illness to gain a clearer description of the current problem so that proper treatment can be initiated.

•Location, swelling, stiffness, deformity, weakness, instability, function, color, sensation, family history, response

Location questions for muscular skeletal hx

•Is the pain sharp, stabbing, dull throbbing, or continuous?

•When did the pain start?

•Is there anything that makes it better or worse?

Swelling questions for muscular skeletal hx

•When did you first notice the swelling?

•Has there been any increase or decrease in swelling?

Stiffness questions for muscular skeletal hx

•Note location, duration, and degree and stiffness

Deformity question for muscular skeletal hx

•Are there any obvious changes?

Weakness questions for muscular skeletal hx

•Is there weakness present?

•Has the weakness increased or decreased?

Instability questions for muscular skeletal hx

•Is there any instability present?

•Note the degree of instability

Function question for muscular skeletal hx

•Does the affected area function differently than before?

Color change questions for muscular skeletal hx

Are there changes in color to temp

Sensation questions for muscular skeletal hx

•Are you having numbness or tingling

Symptom questions for muscular skeletal hx

•Is there any past medical hx that could impact the injury?

•Any family hx related to this type of injury

Response questions for muscular skeletal hx

•What have you tried for the pain ect?

•How have your symptoms responded to what you have tried

Physical assessment of muscular skeletal posture

•Maintains body alignment

•Poor posture affects other joints

•Curvature of spine should be noted

Physical assessment of muscular skeletal gait

•Must observe the patient walking

•Smooth, even, and well-balanced

Physical assessment of muscular skeletal joint motbility

•Deliberate, accurate, smooth, and coordinated

•No pain or discomfort

•Goniometer

Physical assessment of muscular skeletal sensation

•Assess for parastesia

•Indicates sensory nerve damage or impingement

•Pinprick test

Physical assessment of muscular skeletal pulse

•Adequate blood flow

•Rate, rhythm, depth, symmetry

Physical assessment of muscular skeletal tone and strength

•Normal degree of tension

•Passive ROM

•Resist force

•0=no contraction

•5=normal ROM

Lab studies for the musculoskeletal system

•Bones are the major source of calcium in the body

•Low blood calcium= risk fracture risk

•Calcium and phosphorus have inverse relationship

•Vitamin D

Imaging studies for the musculoskeletal system

•X-ray

•CT

•MRI

•Arthrogram

•Bone Mineral Density Studies

•Bones Scan

X-ray

•Assist in assessing full extent of injury

Patient preparation for Xray

•Remove clothes or jewelry from the site

•Proper shielding of patient- lead aprons