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MEDICAL SURGICAL NOTES

Overview of the Structures & Functions of Nervous System
Central NS:
PNSANS
Brain & spinal cord:
31 spinal & cranial Sympathetic NSParasypathatic NSSomatic NSC- 8T- 12L- 5S- 5C- 1
ANS (or adrenergic of parasympatholitic response)
SNS involved in fight or aggression responseEffects of SNS (
anti-cholinergic/adrenergic)1. Dilate pupil � to aware of surroundingsRelease of
norepinephrine (adrenaline � cathecolamine) - medriasis Adrenal medulla (potent
vasoconstrictor)2. Dry mouthIncreases body activities
VS = Increase
3. BP & HR= increasedExcept GIT � decrease GITmotility bronchioles dilated to take
more oxygen4. RR increased* Why GIT is not increased = GIT is not important!5.
Constipation & urinary retentionIncrease blood flow to skeletal muscles, brain &
heart.I. Adrenergic Agents �
Epinephrine (adrenaline)
SE: SNS effectII. PNS: Beta adrenergic blocking agents (opposite of adrenergic
agents) (all end in
��lol�
)
-
Blocks release of norepinephrine.
-
Decrease body activities except GIT (diarrhea)Ex.
Propanolol, Metopranolol
SE:
B
� ronchospasm (bronchoconstriction)
E
� licits a decrease in myocardial contraction
T
� reats HPN
A
� V conduction slows downGiven to angina & MI � beta-blockers to rest heart.
Anti HPN agents:
1.Beta blockers
(-lol)
2.Ace inhibitors
(-pril)
e.g. ENALAPRIL, CAPTOPRIL3.Calcium antagonist e.g. CALCIBLOC or NEFEDIPINE
Peripheral nervous system: cholinergic/ vagal or sympatholitic responseEffect of
PNS: (
cholinergic)
-
Involved in fly or withdrawal response1. Meiosis � contraction of pupils
-
Release of acetylcholine (ACTH)2. Increase salivation
-
Decrease all bodily activities except GIT (diarrhea)3. BP & HR decreased4. RR
decrease � broncho constrictionI. Cholinergic agents5. Diarrhea � increased GI
motilitye.g.
Mestinon
6. Urinary frequency Antidote � anti cholinergic agents
Atropine Sulfate
� S/E � SNS
S/E- of anti-HPN drugs:
1.orthostatic hpn2.transient headache & dizziness.-Mngt: Rise slowly. Assist in
ambulation.
CNS (brain & spinal cord):I. Cells � A. neurons
Properties and characteristics:a.Excitability � ability of neuron to be affected in
external environment.b.Conductivity � ability of neuron to transmit a wave of
excitation from one cell to another.c.Permanent cells � once destroyed, can�t
regenerate (ex. Heart, retina, brain, osteocytes).
1
Regenerative capacity A. Labile � once destroyed can�t regeneratee.g. Epidermal

cells, GIT cells, resp (lung cells). GUTB. Stable � capable of regeneration BUT
limited time onlye.g. salivary gland, pancreas cells cell of liver, kidney cells.C.
Permanent cells � retina, brain, heart, and osteocytes can�t regenerate.
Neuroglia
� attached to neurons. Support neurons. Where brain tumors are
found.Types:1.Astrocyte2.Oligodendria Astrocytoma � 90 � 95% brain tumor from
astrocyte. Most brain tumors are found at astrocyte. Astrocyte � maintains
integrity of blood brain barrier (BBB).BBB � semi permeable / selective-Toxic
substance that destroys astrocyte & destroy BBB.Toxins that can pass in
BBB:1.Ammonia-liver cirrhosis.2.2. Carbon Monoxide � seizure & parkinsons.3.3.
Bilirubin- jaundice, hepatitis, kernicterus/hyperbilirubenia.4.4. Ketones �DM.
OLIGODENDRIA
� Produces myelin sheath � wraps around a neuron � acts as insulator facilitates
rapid nerveimpulse transmission.No myelin sheath � degenerates neurons
Damage to myelin sheath ? demyelenating disordersDEMYELENATING DISEASE:
1.)
ALZHEIMER�S DISEASE
� atrophy of brain tissue due to a deficiency of acetylcholine.S&Sx:
A � amnesia
� loss of memory
A � apraxia
� unable to determine function & purpose of object
A � agnosia
� unable to recognize familiar object
A � aphasia
:-
Expressive � Brocca�s aphasia
� unable to speak-
Receptive � Wernicke�s aphasia
� unable to understand spoken wordsGlobal Aphasia- bothCommon to Alzheimer:
receptive aphasiaDrug of choice:
ARICEPT (taken at bedtime) & COGNEX
.Mgt: Supportive & palliative.
Microglia
� stationary cells, engulfs bacteria, engulfs cellular debris.
II. Compositions of Cord & Spinal cord
80% - brain mass10% - CSF10% - bloodMONROE KELLY HYPOTHESIS: The skull is a closed
vault. Any increase in one component will increase ICP.Normal ICP: 0-15mmHg
Brain mass:
1.
Cerebrum
� largest part of the brain.Corpus collusum- connects R & L cerebral
hemisphereRight cerebral hemisphere, Left cerebral hemisphere:
Function:
1.Sensory2.Motor 3.Integrative
Lobes:
1.) Frontala. Controls motor activityb. Controls personality developmentc. Where
primitive reflexes are inhibitedd. Site of development of sense of umor e. Brocca�s
area � speech center
2
Damage - expressive aphasia2.) Temporal �a. Hearingb. Short term memoryc. Wernickes
area � generates interpretative or knowing diagnostic areaDamage � receptive
aphasia3.) Parietal lobe � appreciation & discrimation of sensory imp- Pain, touch,
pressure, heat & cold4.) Occipital - vision5.) Insula/island of reil/ Central lobe-
controls visceral functionFunction: - activities of internal organ6.)
Rhinencephalon/ Limbic- Smell, libido, long-term memory
Basal Ganglia
� areas of gray matter located deep within a cerebral hemisphere.
?
Extra pyramidal tract
?
Releases dopamine-
?
Controls gross voluntary unitDecrease dopamine: (Parkinson�s) pill rolling of
extremities & Huntington�s Dse.Decrease acetylcholine:Myasthenia Gravis &
Alzheimer�sIncreased neurotransmitter = psychiatric disorders: Increase dopamine �
schizoIncrease acetylcholine � bipolar
MID BRAIN
� relay station for sight & hearingControls size & reaction of pupil 2 � 3
mmControls hearing acuityControls CN 3 & 4
Isocoria
� normal size (equal)
Anisocoria
� uneven size � damage to mid brain
PERRLA
(Pupils Equally Rounded and Reactive to Light and Accomodation) � normal reaction
DIENCEPHALON-
between brain.Thalamus � acts as a relay station for sensationHypothalamus �
thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety
center,emotional responses, controls pituitary function.BRAIN STEM
: a.
Pons
� or pneumotaxic center � controls respiration.Controls the: Cranial 5 � 8 CNS
MEDULLA OBLONGATA
- controls heart rate, respiratory rate, swallowing, vomiting, hiccups/
singutusVasomotor center, spinaldecuissation termination.Controls CN 9, 10, 11, 12
CEREBELLUM
� lesser brain.- Controls posture, gait, balance, equilibriumCerebellar Tests:a.)
R � Romberg�s test- needs 2 RNs to assist- Normal anatomical position 5 � 10 min(+)
Romberg�s test � (+) ataxia or unsteady gait or drunken like movement with loss of
balance.b.) Finger to nose test �(+) To FTNT �
dymentria
� inability to stop a movement at a desired point.c.) Alternate pronation &
supinationPalm up & down. (+) To alternate pronation & supination or damage to
cerebellum �
dymentrium
Composition of brain - based on Monroe Kellie Hypothesis
o
Skull is a closed container. Any alteration in 1 of 3 intracranial components =
increase in ICPNormal ICP � 0 � 15 mmHgForamen MagnumC1 � atlasC2 � axis(+)
Projectile vomiting = increase ICPObserve for 24 - 48 hrsCSF � cushions the brain,
shock absorber Obstruction of flow of CSF = increase ICPHydrocephalus � posteriorly
due to closure of posterior fontanelCVA � partial/ total obstruction of blood
supply
INCREASED ICP
� increase ICP is due to increase in 1 of the Intra Cranial components.
3
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gangguan lesi perifer bawaan

MEDICAL SURGICAL NOTES

Regenerative capacity A. Labile � once destroyed can�t regeneratee.g. Epidermal

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