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Chapter 7:6 Study Guide NERVOUS SYSTEM P179-187 Nervous System-complex, highly organized system that coordinates all the activities of the body. *The basic structural unit of the nervous system is the neuron, or nerve cell. It consists of a cell body containing:  Nucleus  Nerve fibers called dendrites (carry impulses toward the cell body)  Single nerve fiber called axon (carry impulses away from the cell body) Many axons have a lipid covering called a myelin sheath, which increases the rate of impulse transmission and insulates and maintains the axon. The axon of one neuron lies close to the dendrites of many other neurons. The spaces between them are known as synapses. Special chemicals, called neurotransmitters, located at the end of each axon allow the nerve impulses to pass from one neuron to another. Nerves are a combination of many nerve fibers located outside the brain and spinal cord. Meninges are membranes or protective lining that covers the brain and spinal cord. Afferent, or sensory, nerves carry messages from all parts of the body to the brain and spinal cord. Efferent, or motor, nerves carry messages from the brain and spinal cord to the muscles and glands. Associative, or internuncial, nerves carry both sensory and motor messages. There are two main divisions to the nervous system: 1. 2. Central nervous system: consists of the brain and spinal cord Peripheral nervous system: consists of the nerves. A separate division of the peripheral nervous system is the autonomic nervous system. This system controls involuntary body functions. *Brain-mass of nerve tissue well protected by membranes and the cranium, or skull. The main sections include:  Cerebrum-the largest and highest section of the brain. Responsible for: reasoning, thought, memory, speech, sensation, sight, smell, hearing, and voluntary body movement.  Cerebellum-section below the back of the cerebrum. Responsible for: muscle coordination, balance and posture, muscle tone.  Diencephalon-section between the cerebrum and midbrain. o Thalamus-acts as a relay center and directs sensory impulses to the cerebrum. o Hypothalamus-regulates and controls the autonomic nervous system, temperature, appetite, water balance sleep and blood vessel constriction and dilation. Also involved in emotions such as anger, fear, pleasure, pain and affection.  Midbrain-the section located below the cerebrum at the top of the brain stem. Responsible for conducting impulses between brain parts and for certain eye and auditory reflexes.  Pons-located below the midbrain and in the brain stem. Responsible for conducting messages to other parts of the brain; for certain reflex actions including chewing, tasting, and saliva production; and for assisting with respiration.  Medulla oblongata-the lowest part of the brain stem. Connects with the spinal cord and is responsible for regulating heartbeat, respiration, swallowing, coughing, and blood pressure. The spinal cord continues down from the medulla oblongata and ends at the first or second lumbar vertebrae. *The meninges are three membranes that cover and protect the brain and spinal cord. 1. 2. 3. Dura mater-thick, tough, outer layer Arachnoid membrane-delicate and web like Pia mater-closely attached to the brain and spinal cord and contains blood vessels that nourish the nerve tissue. The brain has four ventricles, hollow spaces that connect with each other and with the space under the arachnoid membrane. The ventricles are filled with a fluid called cerebrospinal fluid. This fluid circulates continually between the ventricles and through the subarachnoid space. It serves as a shock absorber to protect the brain and spinal cord. It also carries nutrients to some parts of the brain and spinal cord and helps remove metabolic products and wastes. After circulating, it is absorbed into the blood vessels of the dura mater and returned to the bloodstream through special structures called the arachnoid villi. The peripheral nervous system consists of the somatic and autonomic nervous systems. The somatic nervous system consists of 12 pairs of cranial nerves and their branches and 31 pairs of spinal nerves and their branches. Some of the cranial nerves are responsible for special senses such as sight, hearing, taste, and smell. The Autonomic nervous system is an important part of the peripheral nervous system. It helps maintain a balance in the involuntary functions of the body and allows the body to react in times of emergency. *There are two divisions to the autonomic nervous system: Sympathetic nervous system: prepares the body in times of emergencies. Prepares the body to act by increasing heart rate, respiration, and blood pressure and slowing activity in the digestive tract. This is known as the fight or flight response. Parasympathetic nervous system: After the emergency, this slows down the heart rate, decreases respirations, lowers blood pressure and increases activity in the digestive tract. Cerebral Palsy is a disturbance in voluntary muscle action and is caused by brain damage. Lack of oxygen to the brain, birth injuries, prenatal rubella, and infections can all cause cerebral palsy. Cerebrovascular Accident or CVA (stroke) occurs when the blood flow to the brain is impaired, resulting in a lack of oxygen and a destruction of brain tissue. CVA includes loss of consciousness; weakness or 1. 2. paralysis on one side of the body (hemiplegia); dizziness; dysphagia (difficulty swallowing); visual disturbances; mental confusion; aphasia (speech and language impairment); and incontinence. When a CVA occurs, immediate care within the first three hours can help prevent brain damage. Treatment with thrombolytic or “clot-busting” drugs such as TPA (tissue plasminogen activator) can dissolve the blood clot and restore blood flow to the brain. Aphasia is a speech or language impairment. There are different types. ALS is amyotrophic lateral sclerosis. Also called Lou Gehrig’s disease. This is a chronic degenerative neuromuscular disease. The cause is unknown. Carpal tunnel syndrome is a progressive, painful condition of the wrist and hand. It occurs when the median nurse is pinched or compressed. Concussions are traumatic brain injuries, usually from a blow to the head by an accident, injury or fall. The brain slides back/forward and forcefully hits against the skull. Think of it like a bruise on the brain. Encephalitis is an inflammation of the brain and is caused by a virus, bacterium, or chemical agent. Epilepsy or seizure syndrome is a brain disorder associated with abnormal electrical impulses in the neurons of the brain. Hydrocephalus is an excessive accumulation of cerebrospinal fluid in the ventricles and, in some cases, the subarachnoid space of the brain. It is usually cause by a congenital (at birth) defect, infection, or tumor that obstructs the flow of cerebrospinal fluid out of the brain. The condition is treated by the surgical implantation of a shunt (tube) between the ventricles and the veins, heart, or abdominal peritoneal cavity to provide for drainage of the excess fluid. Meningitis is an inflammation of the meninges of the brain and/or spinal cord and is caused by a bacterium, virus, fungus, or toxins such as lead and arsenic. Multiple Sclerosis (MS) is a chronic, progressive, disabling condition resulting from a degeneration of the myelin sheath in the central nervous system. Neuralgia is nerve pain. Inflammation, pressure, toxins, and other disease cause it. Paralysis usually results from a brain or spinal cord injury that destroys neurons and results in a loss of function and sensation below the level of injury. Hemiplegia is paralysis on side of the body and is caused by a tumor, injury, or CVA. Paraplegia is paralysis in the lower extremities or lower part of the body and is caused by a spinal cord injury. Quadriplegia is paralysis of t harems, legs, and body below the spinal cord injury. Parkinson’s disease is a chronic, progressive condition involving degeneration of brain cells, usually in persons over 50 years of age
Updated 38d ago
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Updated 186d ago
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1. Hyperemesis Gravidarum/ Pernicious Vomiting Definition: Excessive nausea and vomiting during pregnancy, extending beyond week 12 or causing dehydration, ketonuria, and significant weight loss within the first 12 weeks. Incidence: 1 in 200-300 women Cause: Unknown, but may be associated with increased thyroid function and Helicobacter pylori infection. Signs and Symptoms: • Decreased urine output • Weight loss • Ketonuria • Dry mucous membranes • Poor skin turgor • Elevated hematocrit • Decreased sodium, potassium, and chloride levels • Polyneuritis (in some cases) Assessment: • Hemoglobin: Elevated hematocrit concentration (hemoconcentration) due to inability to retain fluids. • Electrolytes: Decreased sodium, potassium, and chloride levels due to low intake. • Acid-base Balance: Hypokalemic alkalosis (severe vomiting, prolonged period). • Neurological Examination: Polyneuritis due to B vitamin deficiency. Effects (if left untreated): • Intrauterine Growth Restriction (IUGR): Dehydration and inability to provide nutrients for fetal growth. • Preterm birth: Due to complications caused by the condition. • Prolonged hospitalization/home care: Resulting in social isolation. Therapeutic Management: • Fluid and Electrolyte Management: Monitor input and output, blood chemistry to prevent dehydration. • Nutritional Support: Withhold oral food and fluids (usually) and administer total parenteral nutrition (TPN). • Intravenous Fluid Replacement: 3000 ml Ringer's lactate with added vitamin B to increase hydration. • Antiemetic Medication: Metoclopramide (Reglan) to control vomiting. 2. Ectopic Pregnancy Definition: Implantation of a fertilized egg outside the uterine cavity (ovary, cervix, fallopian tube - most common). Incidence: Second most frequent cause of bleeding during the first trimester. Causes: • Obstruction of the fallopian tube: ◦ Adhesions (from previous infection like chronic salpingitis or pelvic inflammatory disease). ◦ Congenital malformations. ◦ Scars from tubal surgery. ◦ Uterine tumor pressing on the proximal end of the tube. ◦ Current use of an intrauterine device (IUD). Signs and Symptoms: • Missed period/amenorrhea. • Positive hCG test. • Sharp, stabbing pain in the lower abdominal quadrants and pelvic pain (at time of rupture). • Scant vaginal spotting/bleeding. • Rigid abdomen (from peritoneal irritation). • Leukocytosis (increased WBC count due to trauma). • Decreased blood pressure and increased pulse rate (signs of shock). • Cullen's sign (bluish tinge around the umbilicus). • Tender mass palpable in the cul-de-sac of Douglas (vaginal exam). • Falling hCG or serum progesterone level (suggesting the pregnancy has ended). • No gestational sac on ultrasound. Therapeutic Management: • Non-ruptured Ectopic Pregnancy: Oral administration of methotrexate followed by leucovorin. • Ruptured Ectopic Pregnancy (emergency): Laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube. 3. Hydatidiform Mole (H-mole)/ Gestational Trophoblastic Disease/ Molar Pregnancy Definition: A gestational anomaly of the placenta consisting of a bunch of clear vesicles resembling grapes. This neoplasm is formed from the swelling of the chorionic villi, resulting from a fertilized egg whose nucleus is lost, and the sperm nucleus duplicates, producing a diploid number 46XX. Incidence: Approximately 1 in every 1500 pregnancies. Risk Factors: • Low socioeconomic group (decreased protein intake). • Women under 18 or over 35 years old. • Women of Asian heritage. • Receiving clomiphene citrate (Clomid) for induced ovulation. Types of Molar Growth: • Complete/Classic H-mole: All trophoblastic villi swell and become cystic. No embryonic or fetal tissue present. High risk for malignancy. • Partial/Incomplete H-mole: Some of the villi form normally. Presence of fetal or embryonic tissue. Low risk for malignancy. Signs and Symptoms: • Uterus expands faster than normal. • No fetal heart sounds heard. • Serum or urine test for hCG strongly positive. • Early signs of preeclampsia. • Vaginal bleeding (dark-brown spotting or profuse fresh flow). • Discharge of fluid-filled vesicles. Diagnosis: • Ultrasound. • Chest x-ray (lung metastasis). • Amniocentesis (no fluid). • Hysteroscopy (via cervix). Management: • Evacuation of the mole: Dilation and curettage (D&C). • Blood transfusion. • Hysterectomy (in some cases). • Monitoring hCG levels: Every 2 weeks until normal. • Contraception: Reliable method for 12 months to prevent confusion with a new pregnancy. 4. Premature Cervical Dilatation/ Incompetent Cervix Definition: Premature dilation of the cervix, usually occurring around week 20, when the fetus is too immature to survive. Incidence: About 1% of pregnancies. Causes: • Increased maternal age. • Congenital structural defects. • Trauma to the cervix (cone biopsy, repeated D&C). Signs and Symptoms: • Painless dilation of the cervix. • Pink-stained vaginal discharge. • Increased pelvic pressure. • Rupture of membranes and discharge of amniotic fluid. Therapeutic Management: • Cervical cerclage: Surgical procedure to prevent loss of the child due to premature dilation. • Bed rest: After cerclage surgery, to decrease pressure on the sutures. 5. Abortion Definition: Termination of pregnancy before the fetus is viable (400-500 grams or 20-24 weeks gestation). Types of Abortion: • Spontaneous Abortion: Pregnancy interruption due to natural causes. ◦ Threatened: Mild cramping, vaginal spotting. ◦ Inevitable/Imminent: Profuse bleeding, uterine contractions, cervical dilation. ◦ Complete: All products of conception expelled spontaneously. ◦ Incomplete: Part of the conceptus expelled, some retained in the uterus. ◦ Missed: Fetus dies in utero but is not expelled. ◦ Habitual: 3 or more consecutive spontaneous abortions. • Induced Abortion: Deliberate termination of pregnancy in a controlled setting. Complications of Abortion: • Hemorrhage. • Infection (endometritis, parametritis, peritonitis, thrombophlebitis, septicemia). Management: • Bed rest. • Emotional support. • Sedation. • D&C: Surgical removal of retained products of conception. • Antibiotics. • Blood transfusion. 6. Placenta Previa Definition: The placenta is implanted in the lower uterine segment, covering the cervical os, obstructing the birth canal. Incidence: 5 per 1000 pregnancies. Signs and Symptoms: • Abrupt, painless vaginal bleeding (bright red). • Bleeding may stop or slow after the initial hemorrhage, but continue as spotting. Types: • Total: Placenta completely obstructs the cervical os. • Partial: Placenta partially obstructs the cervical os. • Marginal: Placenta edge approaches the cervical os. • Low-lying: Placenta implanted in the lower rather than the upper portion of the uterus. Therapeutic Management: • Immediate Care: Bed rest in a side-lying position. • Assessment: Monitor vital signs, bleeding, and fetal heart sounds. • Intravenous Therapy: Fluid replacement with large gauge catheter. • Delivery: Vaginal birth (safe for infant if previa is less than 30%). Cesarean section (safest for both mother and infant if previa is over 30%). 7. Abruptio Placenta/ Premature Separation of Placenta/ Accidental Hemorrhage/ Placental Abruption Definition: Separation of a normally implanted placenta after the 20th week of pregnancy, before birth of the fetus. Incidence: Most frequent cause of perinatal death. Causes: • Unknown. • Predisposing Factors: ◦ High parity. ◦ Advanced maternal age. ◦ Short umbilical cord. ◦ Chronic hypertensive disease. ◦ PIH. ◦ Trauma (automobile accident, intimate partner abuse). ◦ Cocaine or cigarette use. ◦ Thrombophilitic conditions (autoimmune antibodies). Classification: • Total/Complete: Concealed hemorrhage. • Partial: Concealed or apparent hemorrhage. Signs and Symptoms: • Sharp, stabbing pain in the uterine fundus. • Contractions accompanied by pain. • Uterine tenderness on palpation. • Heavy vaginal bleeding (may be concealed). • Signs of shock. • Tense, rigid uterus. • Disseminated Intravascular Coagulation (DIC). Therapeutic Management: • Fluid Replacement: IV fluids. • Oxygen: Limit fetal hypoxia. • Fetal Monitoring: External fetal heart rate monitoring. • Fibrinogen Determination: IV fibrinogen or cryoprecipitate. • Lateral Position: Prevent pressure on the vena cava. • Delivery: CS is the method of choice if birth is not imminent. 8. Premature Rupture of Membranes Definition: Rupture of the fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks. Incidence: 5%-10% of pregnancies. Causes: • Unknown. • Associated with: Infection of the membranes (chorioamnionitis), vaginal infections (gonorrhea, streptococcus B, Chlamydia). Signs and Symptoms: • Sudden gush of clear fluid from the vagina with continued minimal leakage. • Nitrazine paper test: Amniotic fluid turns the paper blue (alkaline), urine remains yellow (acidic). • Microscopic examination: Amniotic fluid shows ferning, urine does not. • Ultrasound: Assess amniotic fluid index. • Signs of infection (increased WBC count, C-reactive protein, temperature, tenderness, odorous vaginal discharge). Therapeutic Management: • Bed Rest: To prevent further leakage and risk of infection. • Corticosteroids: To hasten fetal lung maturity. • Prophylactic Antibiotics: To reduce risk of infection. • Intravenous Penicillin/Ampicillin: If (+) for streptococcus B. • Induction of Labor: If fetus is mature and labor does not begin within 24 hours. 9. Pregnancy-Induced Hypertension (PIH)/ Toxemia Definition: Vasospasm occurring in both small and large arteries during pregnancy, causing elevated blood pressure, proteinuria, and edema. Incidence: Rarely occurs before 20 weeks of pregnancy. Risk Factors: • Multiple pregnancy. • Primiparas younger than 20 or older than 40. • Low socioeconomic background. • Five or more pregnancies. • Hydramnios. • Underlying diseases (heart disease, diabetes). • Rh incompatibility. • History of H-mole. Categories: • Gestational Hypertension: Blood pressure 140/90 or greater, without proteinuria or edema. • Preeclampsia: Blood pressure 140/90 or greater, with proteinuria and edema. • Eclampsia: Seizures or coma accompanied by preeclampsia. Therapeutic Management: • Preeclampsia: Bed rest, balanced diet, left lateral position. • Severe Preeclampsia: Hospitalization, diazepam, hydralazine, magnesium sulfate. • Eclampsia: Magnesium sulfate, diazepam, oxygen therapy, left lateral position
Updated 264d ago
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