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Module H Body Systems Student Manual

Module H: Body Systems

Cell Theory and Basic Body Organization

  • Cell Theory: The fundamental principle that cells are the basic unit of all living tissues or organisms, all living organisms are composed of cells, and cellular function is an essential process of living things.
  • Cells:
    • Are the building blocks of the human body.
    • When combined, cells form tissue.
    • Have the same basic structure, though their function, size, and shape may vary.
    • Require food, water, and oxygen to live and function.
    • Are microscopic in size.
    • Are constantly dividing, growing, and dying, thereby renewing tissues and organs.
    • Reproduce in a controlled and orderly manner for tissue growth and repair.
    • Contain functioning structures called organelles that carry on the work of the cell.
  • Tissue: Cells grouped together to carry out a particular activity or function.
    • Types of Tissue:
      • Epithelial Tissue: Covers internal and external body surfaces; lines structures like the nose, mouth, respiratory tract, stomach, and intestines; also includes skin, hair, nails, and glands.
      • Connective Tissue: Anchors, connects, and supports other tissues; found throughout the body, including bones, tendons, ligaments, and cartilage; blood is also a form of connective tissue.
      • Muscle Tissue: Stretches and contracts to enable body movement.
      • Nerve Tissue: Receives and carries impulses to the brain.
    • When grouped together, tissues become organs.
  • Organ: Made of tissue, potentially several different types, that carries on a special function (e.g., heart, stomach, bladder).
    • Some organs are paired (e.g., kidneys, lungs).
    • Organs combine to form a system.
  • System: Made of groups of several organs functioning together for a specific purpose(s).
    • Systems combine to form an organism.
    • Examples of body systems include urinary, musculoskeletal, nervous, respiratory, cardiovascular, digestive, integumentary, endocrine, and reproductive.
  • Organism: Made up of systems functioning together to perform activities of daily living that are needed for continued life.
  • Summary of Body Organization: Cells
    ightarrow Tissue
    ightarrow Organ
    ightarrow System
    ightarrow Organism.

Cells - Normal Findings and Variations

  • Normal Findings: Cells reproduce for tissue growth and repair in a controlled and orderly manner.
  • Variation of Normal (Cancer):
    • Neoplasia (Tumors): Growth of abnormal cells that results from uncontrolled cell division and growth, forming a mass or clump of cells.
      • Benign Tumor: A non-life-threatening, non-cancerous tumor that does not spread to other body parts. May grow large but is not life-threatening. Typically does not grow back when removed.
      • Malignant Tumor (Cancerous): Invades and destroys nearby tissues and can spread to other parts of the body (metastasis) by breaking off and traveling. May be life-threatening and can grow back after removal. Commonly occurs on the skin and in organs such as the lung, colon, breast, prostate, uterus, ovary, bladder, and kidney.
    • Metastasis: The process by which cancer spreads to other parts of the body.

Cancer - Risk Factors

  • Cancer is the second largest cause of death.
  • National Cancer Institute describes risk factors, including:
    • Age: Getting older is the most significant risk factor.
    • Tobacco: Actual use (smoking, chewing, dipping) and second-hand exposure.
    • Radiation: Sunlight, X-rays, and radon gas.
    • Infections: Certain viruses and bacteria.
    • Immuno-suppressive drugs: Lower the body's natural defense against cancer formation (e.g., for organ transplant recipients).
    • Alcohol consumption.
    • Diet: High in fat, protein, and calories, especially red meat (linked to colon and rectal cancer). A diet rich in fruits and vegetables is beneficial.
    • Hormones: Female hormones.
    • Obesity.
    • Environment: Air pollution, second-hand smoke, and asbestos.

Cancer - Seven Warning Signs (CAUTION)

  • Change in bowel or bladder habits.
  • A sore that does not heal.
  • Unusual bleeding or discharge from any body opening.
  • Thickening or lump in the breast or elsewhere.
  • Indigestion or difficulty swallowing.
  • Obvious change in a wart or mole.
  • Nagging cough or hoarseness.

Cancer - Treatment

  • Goals: Cure (remove and kill cancer cells), control (help the resident live longer), and reduce signs and symptoms from the disease and treatment.
  • Early detection is key.
  • Treatment modalities: Surgery, radiation, chemotherapy, others (hormone therapy, stem cell transplants, alternative therapies).
  • Treatment choice depends on the type, site, size, and spread of the cancer. A resident may need one or several types of treatment.
  • Treatments can damage healthy cells and tissues near the cancer.
  • Side effects vary depending on the type and extent of treatment.
Cancer Treatment - Radiation
  • Mechanism: Kills cancer cells using X-ray beams aimed at the tumor or radioactive material implanted at or near the tumor.
  • Side Effects:
    • At the site: Soreness, irritation, redness, and blistering.
    • Head and neck: Dry mouth and sore throat.
    • Tiredness.
    • General discomfort, nausea, vomiting, diarrhea, and loss of appetite.
  • Nurse Aide's Role:
    • Be aware of safety needs for healthcare providers and visitors; strictly follow directives from the care plan and the nurse.
    • Care is directed at minimizing side effects and providing emotional support.
Cancer Treatment - Chemotherapy (Chemo)
  • Mechanism: Affects the whole body, impacting both cancer cells and normal cells.
    • Targeted therapy may be used to distinguish between cancer cells and normal cells.
    • Can be given orally or intravenously, potentially requiring a port (implanted device in a vein for medication, IV fluids, and blood draws).
  • Safety: Be aware of safety needs for healthcare providers and visitors, especially regarding handling body fluids; follow directives from the care plan and the nurse.
  • Side Effects: (depend on specific drugs used)
    • Hair loss (alopecia).
    • Digestive disturbances: Poor appetite, nausea, vomiting, diarrhea, and loss of appetite.
    • Stomatitis: Inflammation of the mouth.
    • Decreased blood cell production, leading to potential for bleeding and infection, weakness, and tiredness.
    • Changes in thinking and memory.
    • Emotional changes.
    • Targeting chemotherapy can also elevate blood pressure.
  • Nurse Aide's Role: Care is directed at minimizing side effects and providing emotional support.

Resident with Cancer - Nurse Aide's Role

  • Resident's Needs: Pain relief/control, rest, exercise, fluids and nutrition, prevention of skin breakdown, prevention of bowel problems, dealing with treatment side effects, psychologic needs, social needs, and spiritual needs.
  • Reporting to the nurse immediately:
    • Increased weakness, fatigue, fainting.
    • Nausea, vomiting, diarrhea.
    • Change in appetite, weight loss.
    • Depression, confusion, change in mental state.
    • Blood in mouth, urine, or bowel movement.
    • Changes in skin, new lumps, sores, rash.
    • Increase in pain or pain not relieved by medication.
  • General approach: Understand that each case is unique; residents may live for months or years, and treatment affects each person differently. Never make assumptions.
  • Social interaction: Residents may or may not want to talk. Listen if they want to share, but never push. Be honest, sensitive, and positive, commenting on improvements (e.g., eating more, seeming stronger).
  • Proper nutrition: Follow the care plan. Encourage varied foods in small portions if appetite is poor. Soups or gelatin may be tolerated for nausea or swallowing issues. Use plastic utensils if a resident is receiving chemo (food may taste better).
  • Pain control: Observe for signs of pain and report to the nurse. Provide comfort measures like repositioning and distraction.
  • Comfort and circulation: Try various positioning devices, assist to a chair as directed, and reposition immobile residents at least every 2 hours.
  • Skin care: Watch for signs of pressure injury, keep skin clean and dry. Never wash off radiation markings. Avoid applying lotion to radiation sites. Follow specific skin care directives.
  • Mouth care: Chemotherapy, nausea, vomiting, and mouth infections can cause pain and bad taste. Use a soft toothbrush, perform mouth care per care plan, avoid alcohol-based mouthwash (increases irritation), and use gentle swabbing with oral swabs dipped in a rinse for mouth sores.
  • Self-image: Assist with grooming and show concern, especially if the resident's appearance has changed (e.g., hair loss).
  • Visitors and family: If visits are positive, do not intrude. Check with the nurse about support groups if requested. Report negative interactions to the nurse.

Integumentary System

Overview

  • The skin, the largest organ and system in the body.
  • Accessory structures include hair and nails.
  • Responsible for providing a natural protective covering of the body.

Structure

  • Three layers:
    • Epidermis: The outer layer, with living and dead cells. Living cells push dead cells up as they divide, and dead cells flake off. Living cells contain pigment for skin color. It lacks blood vessels and has few nerve cells.
    • Dermis: The inner layer, made of connective tissue. Contains blood vessels, nerves, sweat glands, oil glands, and hair roots.
    • Subcutaneous (fatty) tissue: A thick layer of fat and connective tissue.

Function

  • Protects the body from injury and pathogens.
  • Regulates body temperature.
  • Eliminates waste through perspiration.
  • Contains nerve endings for sensations of cold, heat, pain, pressure, and pleasure.
  • Stores fat and vitamins.

Normal Findings

  • Warm, dry skin.
  • Absence of breaks, rash, discoloration, and swelling.

Changes Due to Aging

  • Skin becomes thinner, drier, and more fragile, and loses elasticity.
  • Fatty layer decreases, making the person feel colder.
  • Hair thins and may gray.
  • Folds, lines, wrinkles, and brown spots may appear.
  • Nails harden and become more brittle.
  • Reduced circulation to the skin, leading to dryness and itching.
  • Development of skin tags, warts, and moles.

Variation of Normal

  • Breaks in the skin.
  • Pale, white, or reddened areas.
  • Black and blue areas.
  • Changes in scalp or hair.
  • Rash, itching, or skin discoloration.
  • Abnormal temperature.
  • Ulcers, sores, or lesions.
  • Swelling.
  • Dry or flaking skin.
  • Fluid or bloody drainage.

Common Disorders

  • Dermatitis: Inflammation of the skin.
  • Eczema: Red, itchy areas on the surface of the skin.
Shingles (Herpes Zoster)
  • Cause: A virus, the same one that causes chickenpox. The virus can become active years later, especially in people over 50.
  • Signs: Rash or blisters on one side of the body, burning pain, numbness, and itching. Lasts about 3 to 5 weeks.
  • Infection Control: Infectious until lesions are crusty. The Centers for Disease Control (CDC) recommends that individuals who have never had chickenpox or the immunization, have a weakened immune system, or are pregnant and have not had chickenpox or immunization, should avoid contact with an infected resident.
  • Vaccine: Recommended for people 60 years or older who have had chickenpox.
  • Nurse Aide's Role: Per care plan directive, keep the rash covered until crusty, remind the resident to wash hands frequently, and avoid scratching or touching the rash.
Stasis Dermatitis
  • Description: A skin condition affecting the lower legs and ankles.
  • Cause: Occurs from a buildup of fluid under the skin and problems with circulation, leading to fragile skin.
  • Can lead to open ulcers and wounds.
  • Early Signs: Scaly, red, itchy areas.
  • Later Signs: Swelling of legs, ankles, or other areas; thin skin; darkening skin; leg pain.
  • Nurse Aide's Role: Report signs to the nurse; note and report stockings and shoes that are too tight; follow care plan directives, which may include anti-embolism stockings and elevation of feet.
The Pressure Injury (Pressure Ulcer)
  • Definition (CMS): Any lesion caused by unrelieved pressure that results in damage to underlying tissues. Friction and shear are contributing factors.
  • CMS requires long-term care facilities to identify residents at risk.
  • Many pressure injuries develop within the first 4 weeks of facility admission.
  • Bony Prominences: Areas of the body where bone is close to the skin (e.g., back of head, shoulder blades, elbows, hips, spine, sacrum, knees, ankles, heels, toes).
  • Key Terms:
    • Shear: When layers of skin rub up against each other, or when skin remains in place but underlying tissues move and stretch, damaging capillaries and blood vessels.
    • Friction: Rubbing of one surface against another; skin dragged across a surface.
    • Unavoidable Pressure Injury: Occurs despite proper prevention efforts using best practices.
    • Avoidable Pressure Injury: Develops from improper use of best practices.
  • At-Risk Factors:
    • Pressure is the major cause; shearing and friction are contributing factors, all leading to skin breakdown.
    • Risk Factors: Immobility, breaks in skin, poor circulation, moisture, dry skin, urine and feces irritation.
    • Older and disabled residents are at higher risk due to skin changes with age, chronic disease, and frailty.
  • Residents at Risk (Specifics):
    • Bedfast (confined to bed).
    • Require some or total help moving (e.g., coma, paralysis, hip fracture).
    • Agitated or have involuntary muscle movement.
    • Urinary or fecal incontinence.
    • Exposed to moisture.
    • Poor nutrition; poor fluid balance.
    • Lowered mental awareness.
    • Problems sensing pain or pressure.
    • Have circulatory problems.
    • Are older.
    • Are obese or very thin.
    • Refuse care.
    • Have a history of pressure injuries.
  • Pressure Injury Stages:
    • Stage 1: Intact skin; redness over a bony prominence.
    • Stage 2: Partial-thickness skin loss; may appear as a blister or shallow reddish-pink ulcer; the blister may be intact or open.
    • Stage 3: Full-thickness skin loss; skin is gone; subcutaneous fat may be visible; slough (dead soft tissue, often moist and varying in color—white, yellow, green, or tan—may be present, attached or stringy loose) may be present.
    • Stage 4: Full-thickness skin and tissue loss with muscle, tendon, and bone exposure; slough and eschar (thick, leathery dead tissue, often black or brown, loose or attached to skin) may be present.
    • Unstageable Pressure Injury: Full-thickness tissue loss with the injury covered by slough and/or eschar (dead tissue).
    • Deep Tissue Pressure Injury: Purple or deep red localized area of discolored intact skin or a blood-filled blister; usually due to damage of underlying soft tissue from pressure and/or shear.
  • Pressure Points: Occur over bony areas, with the sacrum being the most common site.
  • Pressure Injury Sites: Can occur from objects (e.g., eyeglasses, oxygen tubing, tubes, casts, braces) or where skin is in contact with skin (e.g., abdominal folds, legs, buttocks, thighs, under breasts).
  • Prevention is Key:
    • Identify residents at risk.
    • Measures focus on handling, moving, and positioning the resident, and providing skin care.
  • Handling, Moving, and Positioning to Prevent Pressure Injuries:
    • Refer to the care plan for directives.
    • Follow the repositioning schedule.
    • Use assistive devices (e.g., pillows, foam wedges).
    • Support feet properly.
    • Do not position on red areas, pressure injuries, or over tubes/medical devices.
    • Prevent bed friction (e.g., avoid powdered sheets that can lead to friction).
    • Prevent shearing (do not raise the head of the bed more than 30^ ext{o}).
    • Keep feet and heels off the bed.
  • The ext{30}^ ext{o} Lateral Position: Bed is not raised more than 30^ ext{o}. Pillows are placed under the head, shoulder, and leg to lift the hip at about a 30^ ext{o} angle, avoiding pressure on the hip. The person does not lie directly on the hip.
  • Providing Skin Care to Prevent Pressure Injury:
    • Inspect skin every time care is provided.
    • Follow the care plan for bathing schedule; avoid hot water; use a cleansing agent (soap can dry and irritate skin).
    • Prevent incontinence.
    • Check for perspiration or wound drainage.
    • Apply moisturizer to dry areas.
    • Give a back rub when repositioning, but do not rub over bony prominences.
    • Keep linen clean, dry, and wrinkle-free.
    • Avoid vigorous scrubbing when bathing or drying.
    • Avoid skin-to-skin contact by using pillows or blankets.
    • Do not apply heat directly to a pressure injury.

Musculoskeletal System

Overview

  • Provides structure and movement for the body.
  • Protects organs and gives the body shape.
  • The body has over 600 muscles composed of elastic tissue.
  • Some muscles are connected to bones by tendons.

Structure

  • Muscles:
    • Involuntary Muscles: Work automatically and cannot be controlled.
      • Cardiac Muscle: Found only in the heart; striated.
      • Smooth Muscle: Controls the action of internal organs like the stomach, intestines, and blood vessels; smooth in appearance.
    • Voluntary Muscles (Skeletal Muscles): Can be controlled; attached to the skeleton (e.g., muscles of the arms and legs); striated.
  • Skeletal (Bones):
    • The skeleton consists of 206 bones, providing the body's framework.
    • Bones have a hard and rigid exterior, covered with periosteum (which contains blood vessels).
    • Bone Marrow: Soft and spongy tissue located inside bones.
    • Bones are connected to other bones by ligaments.
    • Bones are connected to muscles by tendons.
  • Joints:
    • Points where bones meet.
    • Made up of cartilage, a connective tissue that cushions bones and prevents them from rubbing together.
    • Synovial membrane: Lines joints and secretes synovial fluid, which acts as a lubricant for smooth joint movement.
    • May be movable (e.g., ankle), slightly movable (e.g., backbone), or immovable (e.g., skull).
    • Ligaments hold bones together at joints.
    • Types: Ball-and-socket, hinge, and pivot.

Function

  • Muscles:
    • Power movement of the skeleton: Tendons connect muscles to bone and move bones when muscles contract (shorten).
    • Give the body form and posture.
    • Produce most of body heat: When muscles contract, food is burned for energy, producing heat. More muscle activity generates more heat. Rapid muscle contractions (shivering) produce heat when the body is cold.
  • Skeleton (Bones):
    • Provides framework for the body.
    • Protects organs.
    • Allows the body to move.
    • Stores calcium.
    • Makes and stores blood cells in bone marrow.
  • Joints: Allow movement by providing points where bones meet.

Types of Joints - Function

  • Ball-and-socket joint: Allows movement in all directions (e.g., hips and shoulders), formed by the rounded end of one bone fitting into the hollow end of another.
  • Hinge joint: Allows movement in one direction (e.g., elbows and knees).
  • Pivot joint: Allows turning from side to side (e.g., skull connected to the spine).

Normal Findings

  • Ability to perform routine movements and activities of daily living.
  • Ability to perform full range of motion exercises bilaterally without pain.
  • Movements: Abduction, adduction, extension, flexion, pronation, supination, dorsiflexion, plantar flexion, opposition (touching thumb to a finger of the same hand) bilaterally without pain.

Changes Due to Aging

  • Muscles weaken and lose tone.
  • Bones lose density and become brittle.
  • Slower muscle and nerve interaction.
  • Joints stiffen, become less flexible, and painful, leading to decreased range of motion and flexibility.
  • Height decreases by 1 to 2 inches between ages 20 and 70.
  • Slowed recovery from position changes and sudden movement.
  • Pain when moving.
  • Reaction time, movement speed, agility, and endurance decrease.
  • Poorer response to stimuli.

Variation of Normal

  • History of falls.
  • Difficulty holding or lifting objects.
  • Loss of muscle strength and tone.
  • Generalized weakness and tiredness.
  • Bruising.
  • Slow and unsteady body movement.
  • White, shiny, red, or warm areas over a joint.
  • Complaints of pain in joints or muscles or with movement.
  • Swelling, redness, and warmth of joints.
  • Inability to move joints.

Common Disorders

  • Muscle Strain: Damage to the muscle caused by trauma.
  • Sprain: Stretched or torn ligaments or tendons.
Arthritis
  • Inflammation or swelling of the joints, causing stiffness, pain, and decreased mobility.
  • Two common types:
    • Osteoarthritis (Degenerative Joint Disease): Affects the elderly and may occur with aging or joint injury. Usually involves weight-bearing hips and knees, but can also affect fingers, thumbs, and spine. Pain and stiffness typically increase with damp, cold weather.
    • Rheumatoid Arthritis: Can affect any age, starting with smaller joints and progressing to larger ones. Joints become red, swollen, and very painful. Fever, tiredness, and weight loss may occur. Can result in severe and painful deformities with eventual restricted movement. Considered an autoimmune disease where the immune system attacks normal tissue.
  • Nurse Aide's Role:
    • Encourage activity per care plan directives; canes and safety rails are helpful.
    • Encourage independence by assisting with devices for bathing, dressing, and feeding. Offer easy-to-put-on clothing choices. Treat each resident individually.
    • Help maintain self-esteem by encouraging self-care as much as possible; listen.
    • Watch for and report stomach upset and heartburn, which can be side effects of medication.
Osteoporosis
  • Description: Bones lose density, becoming porous and brittle, leading to easy fractures.
  • Causes: Lack of calcium in the diet, lack of regular exercise, decreased mobility, and decrease in female hormones.
  • Signs: Low back pain, stooped posture, becoming shorter, and broken bones.
  • Nurse Aide's Role (Prevention/Slow Progression):
    • Encourage walking and simple exercise per care plan or nurse's directive.
    • Move the resident carefully.
Fracture
  • Description: A break in the bone caused by an accident or osteoporosis.
  • Types:
    • Closed fracture: A broken bone that does not break the skin.
    • Open fracture (Compound fracture): A broken bone that breaks through the skin.
  • Most common in arms, wrists, elbows, legs, and hips.
  • Goal of treatment: Realign the bone for healing. Bone tissue grows and fuses the area, requiring immobilization (e.g., with a cast or brace).
  • Signs: Pain, swelling, bruising, limited mobility.
  • Nurse Aide's Role: Prevention of falls is crucial.
    • Follow fall prevention concepts.
    • If casted or braced, elevate the arm or leg slightly higher than heart level.
    • Observe circulation of fingers or toes (warmth, color, movement).
    • Report swelling, tightness of cast/brace, sores, cool fingers/toes, drainage, or bleeding. Report irritation from cast/brace edges.
    • Keep the cast or brace dry and assist with personal care per care plan/nurse's directive.
    • Monitor and report if the resident inserts objects into the cast or brace.
Hip Fracture
  • Description: A serious condition requiring months of recovery.
  • Older residents heal slowly, and complications like secondary illnesses and disability may occur.
  • Most require surgery and total hip replacement.
  • Focus of care: Healing of the incision, slow strengthening of hip muscles, and increased mobility, gait, and endurance.
  • Nurse Aide's Role: Prevention of falls is crucial.
    • Follow fall prevention concepts.
    • After surgery and during rehabilitation, carefully follow the care plan for weight-bearing limitations.
    • Monitor how much the resident can do and which assistive devices may be used.
    • Follow directives about weight-bearing limitations (non, partial, or full weight-bearing).
    • Do not perform range of motion until directed.
    • Know leg and hip movement limitations; use an abduction pillow (special foam pillow placed between legs to immobilize and position hips and legs with straps) as directed.
    • Report the following to the nurse: Incision redness, drainage, bleeding, increased pain, numbness or tingling of feet/legs, tenderness or swelling in calves, shortening or outward rotation of the affected leg, abnormal vital signs, resident non-compliance with limitations, decreased appetite, or noted improvements.
Total Knee Replacement (TKR)
  • Description: Surgical replacement of the knee with a prosthesis (device that replaces a missing or deformed body part).
  • Performed to relieve pain and restore mobility, often due to arthritis or injury.
  • Post-op care is similar to hip replacement, though residents often have greater ability for self-care.
  • Goals: Prevent blood clots (using special stockings and machines), speed recovery, decrease stiffness, and increase range of motion.
  • Nurse Aide's Role:
    • Follow care plan/nurse's directives regarding mobility.
    • Encourage fluids to reduce urinary infections.
    • Report pain and redness, swelling, heat, or tenderness in calves.
Amputation
  • Description: Surgical removal of a body part (e.g., arm, hand, leg, foot) due to disease or accident.
  • Phantom Sensation and Pain: The person feels the amputated body part is still there and experiences pain in that area. This should not be ignored and possibly results from damaged nerve endings. Report to the nurse.
  • Nurse Aide's Role:
    • Per care plan/nurse's directive, provide assistance with activities of daily living.
    • Provide support if the resident expresses phantom sensations; do not argue.
    • Report to the nurse.
    • Assist with position changes and range of motion exercises per directive.
    • Follow care plan regarding prosthetic care.
Contracture and Muscle Atrophy
  • Contracture: The muscle or tendon shortens, freezes, and becomes inflexible, causing permanent disability.
  • Muscle Atrophy: The muscle wastes away, decreases in size, and becomes weak due to disuse.
  • Prevention: Critical for both conditions.
    • Perform range of motion exercises.
    • Use positioning and supportive devices to maintain the structure and function of extremities.

Nervous System

Overview

  • Controls and coordinates all body functions.
  • Contains reflex centers for heartbeat and respiration.
  • Senses and interprets information from outside the body and responds to necessary changes both internally and externally.

Divisions

  • Central Nervous System (CNS): Includes the brain and spinal cord.
  • Peripheral Nervous System (PNS): Includes nerves that travel throughout the body.

The Neuron (Nerve Cell)

  • The basic unit of the nervous system.
  • Carry messages or impulses through the spinal cord to and from the brain.
  • Neurons are fragile and heal slowly if injured.
  • Some are covered and insulated with a protective fiber called the myelin sheath, which also allows for faster conduction of impulses.

The Brain

  • Protected by the skull.
  • Consists of 3 parts:
    • Cerebrum.
    • Cerebellum.
    • Brainstem.
Brain - The Cerebrum
  • The center of thought and intelligence.
  • Divided into right and left hemispheres.
    • Right hemisphere controls movement and function of the left side of the body.
    • Left hemisphere controls movement and function of the right side of the body.
    • Illness or injury to one hemisphere affects the function of the opposite side.
  • Cerebral Cortex: The outer layer where ideas, thinking, analysis, judgment, emotions, and memory occur. It guides speech, interprets messages from the senses, and controls voluntary muscle movement.
  • Each hemisphere contains four lobes:
    • Frontal Lobe: Important for cognitive functions and control of voluntary movement or activity.
    • Parietal Lobe: Processes information about temperature, taste, touch, and movement.
    • Occipital Lobe: Primarily responsible for vision.
    • Temporal Lobe: Processes memories, integrating them with sensations of taste, sound, sight, and touch.
Brain - Brainstem and Cerebellum
  • Brainstem: The regulatory center.
    • Controls heart rate, breathing, swallowing, and the opening/closing of blood vessels.
  • Cerebellum:
    • Controls balance and regulates voluntary muscles.
    • Produces and coordinates smooth movements.

Spinal Cord and Sensory Organs

  • Spinal Cord:
    • Located within the spine.
    • Connected to the brain.
    • Conducts messages between the brain and the body via pathways.
  • Sensory Organs:
    • Include skin, tongue, nose, eyes, and ears.
    • Receive impulses from the environment and relay them to the brain.

Normal Findings

  • Alert and oriented, with clear short-term/long-term memory.
  • Sensory function intact; ability to sense heat, cold, and pain.
  • Straight gait; coordination of limbs.
  • Reflexes present.

Changes Due to Aging

  • Some hearing loss occurs.
  • Appetite decreases.
  • Less tear production.
  • Vision decreases; problems seeing blue and green.
  • Pupils are less responsive to light.
  • Changes in memory, most likely with short-term memory.
  • Loss of nerve/brain cells.
  • Slowed response and reflex time.
  • Jerking motions or tremors.
  • Reduced sense of touch and sensitivity to pain.
  • Reduced blood flow to the brain.
  • Forgetfulness.
  • Each of the senses decreases in function.
  • Sensitivity to heat and cold decreases.

Variation of Normal

  • Changes in gait or movement.
  • Complaint of loss of feeling or inability to move one side of the body.
  • Paralysis.
  • Seizures.
  • Confusion.
  • Speech, vision, or hearing changes.
  • Complaints of numbness, dizziness, nausea.

Common Disorders

Stroke - Cerebrovascular Accident (CVA)
  • Description: An emergency caused when a blood vessel leaks or breaks in the brain, or when oxygen supply to an area is disrupted, leading to the death of brain cells.
  • Can be mild or severe.
  • Impact: The area and size of the brain affected by injury determine the severity of the stroke, the signs and symptoms exhibited, the extent of disability, and the prognosis.
    • Recall that the right hemisphere controls the left side, and the left hemisphere controls the right side.
  • F.A.S.T. (Signs of Stroke):
    • ext{F} - Facial Drooping
    • ext{A} - Arm weakness
    • ext{S} - Speech Difficulty
    • ext{T} - Time to call the nurse/911
  • Other symptoms: Numbness, confusion, trouble seeing and/or walking, severe headache.
  • After a stroke, the resident may experience:
    • Hemiplegia: Paralysis on one side of the body.
    • Hemiparesis: Weakness on one side of the body.
    • Expressive Aphasia: Trouble communicating thoughts by speech or writing.
    • Receptive Aphasia: Difficulty understanding spoken or written words.
    • Emotional Lability: Inappropriate or uncalled for laughing, crying, or expressions of anger.
    • Loss of sensations (temperature, touch).
    • Loss of bowel/bladder control.
    • Cognitive Impairment: Poor judgment, memory loss, inability to solve problems, confusion.
    • Dysphagia: Difficulty swallowing.
  • Nurse Aide's Role:
    • General assistance: Strengthen muscles and keep joints mobile.
      • Provide range of motion exercises.
      • Maintain correct body alignment and support extremities with pillows.
      • Maintain a positive attitude; never refer to the weak side as the