[2.1] NEURO Part I (Nervous System and Neurologic Dysfunction)

From Ms. Lorelie Pomentil's lecture on July 17, 2025

Nervous System

This controls the motor, sensory, autonomic, cognitive, and behavioral activities

Nervous System

This is the command center of the body

Central Nervous System and Peripheral Nervous System

What are the two branches of the nervous system?

Brain and Spinal Cord

What consists of the Central Nervous System?

Brain

CNS: Processing Center

Spinal Cord

CNS: Pathway to and from the brain

Motor neurons and Sensory neurons

What are the two branches of the Peripheral Nervous System?

Motor

PNS: CNS to Body

Sensory Neurons

PNS: Body to CNS

Somatic Nervous System and Autonomic Nervous System

What are the two branches of the Motor Neurons?

Somatic Nervous System

MN: Voluntary Muscles

Autonomic Nervous System

MN: Involuntary Muscles

Sympathetic nervous system and Parasympathetic nervous system

What are the two branches of the Autonomic Nervous System?

Sympathetic Nervous System

PNS: Fight or flight

Parasympathetic NS

PNS: Rest and digest

1. Cerebrum

2. Cerebellum

3. Brainstem

What are the three major parts of the brain?

Cerebrum

Brain: Largest part

Cerebrum

Brain: Divided into the left and right hemispheres

4

Brain: How many lobes does the Cerebrum have?

MPM

1. Midbrain

2. Pons

3. Medulla Oblongata

Brain: What are the parts of the Brainstem?

1. Frontal Lobe

2. Parietal Lobe

3. Temporal Lobe

4. Occipital Lobe

What are the lobes of the cerebrum?

Frontal Lobe

Cerebrum: Responsible for executive functions

Executive Functions

Cerebrum: This makes you a unique person and in charge for the thought processes

1. Concentration

2. Cognition

3. Memory

4. Judgment

5. Affect

//What are the types of thought processes the frontal lobe is responsible for?

Outward expression of feelings

Executive Function = Thought processes

Affect = ___________________

Frontal Lobe

Cerebrum: Responsible for personality and inhibition

Broca’s Area

• Left hemisphere of the frontal lobe

Cerebrum: Responsible for the motor control of speech. Where is it exactly located?

Expressive Aphasia

• Expression = Lacking

• Comprehension = Intact

Cerebrum: When the Broca’s Area is damaged, what does the patient develop? What happens to their expression and comprehension?

Parietal Lobe

Cerebrum: Responsible for sensory and motor functions (but predominantly sensory)

Parietal Lobe

Cerebrum: Responsible for spatial awareness or awareness where objects are

Parietal Lobe

Cerebrum: Responsible for left-right orientation

Temporal Lobe

Cerebrum: Auditory and receptive area

Temporal Lobe

Cerebrum: Responsible for memory of sound

Wernicke’s Area

• Left hemisphere of the Temporal Lobe

Cerebrum: Responsible for the understanding of language. Where is it exactly located?

Receptive Aphasia

• Expression = Intact

• Comprehension = Lacking/Difficult

Cerebrum: When the Wernicke’s Area is damaged, what does the patient develop? What happens to their expression and comprehension?

Occipital Lobe

Cerebrum: Visual center of the brain

Midbrain

Brainstem: Motor relay system

Pons

Brainstem: Vice president of respiration

Medulla oblongata

Brainstem: Cardiac and respiratory center

a. Pons

Deepness/Shallowness of breathing

a. Pons
b. Medulla Oblongata

b. Medulla Oblongata

Respiratory rate and heart rate

a. Pons
b. Medulla Oblongata

Medulla Oblongata

• It is the cardiac and respiratory center

Which is more important, Pons or Medulla Oblongata? Why?

Cerebellum

Brain: Controls fine motor movement

b. Cerebellum

Balance and proprioception

a. Parietal Lobe of the Cerebrum
b. Cerebellum

Proprioception

Awareness of positioning of extremities without looking

12

How many cranial nerves are there?

Oh Oh Oh To Touch And Feel Very Good Velvet Ah Heaven

1. Olfactory

2. Optic

3. Oculomotor

4. Trochlear

5. Trigeminal

6. Abducens

7. Facial

8. Vestibulocochlear

9. Glossopharyngeal

10. Vagus

11. Accessory

12. Hypoglossal

Enumerate the cranial nerves

s3nsory

1. Olfactory = Smell (1 Nose)

2. Optic = Vision (2 Eyes)

8. Vestibulocochlear = Hearing (Left and Right ears form number 8)

What are the Cranial Nerves with Sensory Functions? Give their corresponding functions as well

MOTOR = 5 Letters; 5 CNs

3. Oculomotor = Eye Movement: UP

   1. Pupil cons3ction

4. Trochlear = Eye Movement: DOWN

6. Abducens = Eye Movement: LATERAL

   1. Parang abduction joint movement: Away left/right

11. Accessory = Sternocleidomastoid & Trapezius Muscle

12. Hypoglossal = Tongue Movement

What are the Cranial Nerves with Motor Functions? Give their corresponding functions as well

BOTH = 4 Letters; 4 CNs

5. Trigeminal = Facial Sensation and Mastication (triCHEWinal)

7. Facial = Facial Expression and Taste

9. Glossopharyngeal = Swallowing and Taste

10. Vagus = Muscle Movement of Pharynx and Larynx + Sensation in Ear

What are the Cranial Nerves with both Sensory and Motor Functions? Give their corresponding functions as well

Glasgow Coma Scale

Neurological Assessment: What tool is commonly used?

Level of Consciousness

Neurological Assessment: Most sensitive indicator of neurologic function

1. Eye opening Response

2. Verbal Response

3. Motor Response

What are the components of GCS?

4 = Spontaneous

3 = To speech

2 = To pain

1 = No response

GCS: Give all the possible scores for Eye opening Response

1. Supraorbital Pressure

2. Trapezius Speech

3. Nailbed Pressure (peripheral)

Neurological Assessment: What types of pain stimulation can be done to elicit response?

5 = Oriented to time, place, and person (commonly used is place)

4 = Confused (understood but wrong answer)

3 = Inappropriate words

2 = Incomprehensible sounds

1 = No response

GCS: Give all the possible scores for Verbal Response

6 = Obeys Command

5 = Moves to localized pain

4 = Flex to withdraw from pain

3 = Abnormal Flexion (Decorticate)

2 = Abnormal Extension (Decerebrate)

1 = No Response

GCS: Give all the possible scores for Motor Response

3 to 8 = Severe TBi

9 to 12 = Moderate TBI

13 to 15 = Mild TBI

What are the classifications of GCS Score?

8

• intub8

What GCS score is an indicator for intubation?

Intracranial pressure (ICP)

Neurologic Dysfunction: This is produced by the equilibrium between the 3 components inside the cranial vault

1. Brain Tissue

2. Blood

3. CSF

What are the three components of the cranial vault?

0-15 mmHg

What is the normal ICP range?

10-21 mmHg

What is the normal IOP range?

Sitting

High Back Rest

What are other terms for High Fowler’s Position?

Alteration in the equilibrium of the components of the cranial vault

Neurologic Dysfunction: What is the cause of Increased ICP?

Monroe-Kellie Hypothesis

Neurologic Dysfunction: This says that the cranium is inexpansible and increase in any of the cranial vault components will lead to an increase in ICP, given that none of them decreases to compensate

Pupillary Changes

Projectile Vomiting

Neurologic Dysfunction: What are the manifestations of Increased ICP aside from its earliest and latest signs?

Changes in Level of Consciousness (LOC)

Neurologic Dysfunction: What is the Earliest sign of increased ICP?

Changes in Vital signs → “Cushing’s Triad”

Neurologic Dysfunction: What is the Late sign of increased ICP?

HyperBradyBrady w/ Wide Pulse Pressure

1. Hypertension

2. Bradycardia

3. Bradypnea

Neurologic Dysfunction: What are the components of Cushing’s Triad?

30 - 40 mmHg

What is the normal range of pulse pressure?

Anisocoria (Unequal pupil size)

• Compression of CN 3 Oculomotor (Cons3ction)

Neurologic Dysfunction: Describe the pupillary change brought by increased ICP. What is its exact cause?

Compression of the CTZ (Chemoreceptor Trigger Zone)

Neurologic Dysfunction: What is the cause of projective vomiting in increased ICP?

Chemoreceptor Trigger Zone (Still at the Medulla Oblongata)

Cardiac and Respiratory Center = Medulla Oblongata

Vomiting Center = ____________________

Restlessness

Neurologic Dysfunction: Describe the change in LOC in increased LOC?

CDLOSCo

1. Confusion

2. Disorientation

3. Lethargy

4. Obtunded/Obtundation

5. Stuporous

6. Coma

Neurologic Dysfunction: What are the other terms that can be used to describe changes in LOC aside from restlessness?

Stuporous

Changes in LOC: Super antok

Obtunded/Obtundation

Changes in LOC: Decreased response to stimuli

1. CT Scan

2. MRI

Neurologic Dysfunction: What are the diagnostics for Increased ICP?

CT Scan

Neurologic Dysfunction (Diagnostic): Quick; 15 minutes to be done; More affordable

CT Scan

Preferably done first

a. CT Scan
b. MRI

a. CT Scan

For neuro emergencies

a. CT Scan
b. MRI

MRI

Neurologic Dysfunction (Diagnostic): Identify cerebral abnormality earlier and more clearly; takes 1 hour or longer

Lumbar Puncture

• Increased Risk for Brain Herniation

Neurologic Dysfunction (Diagnostic): Contraindicated for increased ICP. What is its consequence?

Foramen Magnum

• Respiratory Arrest

Neurologic Dysfunction: Where do cranial vault components go / pass through during lumbar puncture? What happens if there is sudden release of pressure?

Avoid increase in intra-abdominal, intrathoracic, and intrajugular pressure

Neurologic Dysfunction: What is the general concept of the nursing management?

Neutral (Midline) Alignment

• No neck rotation

• No neck flexion (increases intrajugular pressure)

Neurologic Dysfunction (Nursing Management): How do you position the patient?

30 to 45 degrees

• Semi fowler’s or Low fowler’s

Neurologic Dysfunction (Nursing Management): How much should the head of bed be raised?

Promote venous return from the brain to the heart

• Decrease ICP by gravity

Neurologic Dysfunction (Nursing Management): Why should the bed be raised?

1. Extreme hip flexion = Increased intra-abdominal pressure

2. Coughing = Increased intra-thoracic pressure

3. Laughing = Increased intra-abdominal pressure

4. Vomiting = Increased intra-abdominal pressure

5. Valsalva Maneuver: Straining in stool and moving in bed

   • Increased Fiber Diet

   • Stool softeners

   • Exhale when getting up

Neurologic Dysfunction (Nursing Management): What should be avoided? What should be done in relation to that?

FALSE

• Do not increase OFI as it also increases CSF. Fluid restriction is usually prescribed to these patients

TRUE or FALSE: To avoid straining when defecating, the OFI should be increased