I.

ASSESSMENT
A. Nursing Health History This is the case of PJC, a 23 years old woman, single, a Roman Catholic and an Ilocana. She finished her 1st year college as an engineering student at University of Makati and currently lives at San Andres Bukid, Manila. She was admitted for the first time at Ospital ng Maynila Medical Center last May 5, 2011 at around 11 in the morning. She was unconscious and was carried by her relatives. The client was brought to the hospital with chief complaint of lacerated wound due to fall. 2 hours prior to admission the patient fell from the stairs while entering the gate of their house, then a sudden dizziness followed by a seizure attack developed that lead to a head injury. This incident was seen by their neighbor and was just then informed the relatives. They wait until the seizure stop while stretching and massaging the patients extremities and after the seizure attack the patient became unconscious and was then brought to the hospital. The said seizure attack was aggravated whenever she is tired and wearing a high-heeled shoes. Her relatives always massage her hands and stretches her other extremities whenever this attack happens. Her seizure attack started when she was in high school that was her first hospitalization on the year 2003 at Makati Med. But there is no confirmation about her illness because of a need for CT scan. Her second hospitalization was on the year 2008 because of an accident that was brought about by a seizure attack. She was admitted at that time at Makati Med. for 3 days and for observation. May 5, 2011 she was brought at Ospital ng maynila, her head injury was then given an immediate repair. She was prescribed with vitamin B complex and for CT scan. There is no disease or manifestations like her that runs in her family. Her father, 49 years old, was still alive but with high blood pressure. Her mother and her 3 siblings are still well and alive.

Gordons Typology of Health Patterns Health Perception/ Health Management Before hospitalization the client views herself to be healthy especially before when she was not having any seizure attack. The client said that she can do just about anything during those times and very seldom got ill. The client said that she was smoking before during her high school days and drink alcohol occasionally. The client is not taking any self-prescribed medications for her seizure. During her hospitalizations and seizure attacks the client views

herself to be unhealthy because first she was confined in a hospital and second she has been suffering from the injury that was brought by her seizure attack. Nutritional/Metabolic Before hospitalization the client stated that she always eat 3 times a day prior to confinement and preferred to eat almost all delicacies of food. During hospitalization she can still eat three times a day and eats what she wants since her diagnostic test and her illness is still undiagnosed. Elimination Before hospitalization, the client stated that she had a normal defecation pattern of at least once a day and she urinates frequently prior to confinement but wasnt sure about the exact frequency. During hospitalization, the client still has a normal defecation pattern of once a day and urinates frequently. Activity/ Exercise Before hospitalization, the client was not engage in any strenuous or heavy physical activity. She also stated that she stopped her schooling because she easily get tired and this can aggravate his seizure. During hospitalization, the client was just in bed resting and for observation. Sleep/Rest Before hospitalization, the client sleeps at around 11 in the evening and wakes up at around 8 in the morning also she takes a good rest at around 1 in the afternoon. During hospitalization, the client prefers to take a rest especially because of the pain she feels. Cognitive/Perceptual Before hospitalization, the clients mother claimed that her daughter has a normal cognition and perception through things. During hospitalization, the client is oriented with the three spheres of cognition during the track of duty. The client knows the time and reacts appropriately. Self-Perception/Self-Concept Before hospitalization, the client has been aware with her condition. During her hospitalization, she expresses concern about her condition and wants to have a confirmation about her illness.

Role/Relationship Before hospitalization, the client stated that she maintained a good relationship with the people around her, especially to her family. Sexuality/ Reproduction Before and during hospitalization, the client revealed that she is not sexuality active. Coping/ Stress Tolerance Before hospitalization, the client stated that her mechanism to cope stress is through resting, watching television programs, and listening to radio. During hospitalization, resting and talking to her mother and her sibling is her only mechanism to relieve stress. Values/ Beliefs Before hospitalization, the client is a Roman Catholic and stated that she believes in the existence of a Supreme Being. The client stated that she always attend to masses, except if she ill. During hospitalization, the client stated that she still believes in the existence of a Supreme Being. Because of her current condition, the client fails to attend masses.

B.

Physical Assessment

The physical assessment of Ms. PJC was performed May 6, 2011 at around 1:30 in the morning. General appearance The patient was received on bed with her relative. Mrs. C., conscious and coherent, appears and behaves to be as her apparent age has an I.V fluid insertion in her right hand. The patient is clean, dresses well but grooms poorly because of her sick condition. Vital Signs Temp.: 36.2 PR: 72bpm RR: 20 bpm BP: 100/70 mmHg

Skin: During the inspection, the clients skin was characterized of having a dry and brown skin. There are no sign of paleness. Hair and scalp: The clients has a short dry hair and in color black. When it comes to the inspection of her scalp there was no presence of dandruff or lice. Scalp has lesion, a lacerated wound due to fall. Nails: The color of the clients nail bed is pink. She has a short nails. She has normal capillary refill of < 3secs. Neck: After doing inspection to the neck of the client, We found out that the neck has no presence of swelling and soreness. The neck is symmetric. There were no pain felt when she moves her neck. Thorax and Lungs: The respiratory rates of the patient were 20 breaths per minute. There were no masses or scars into the clients chest. Both sides of chest wall were smooth, warm and dry to palpate. Heart: The clients cardiac rate is 72 bpm while her blood pressure is 100/70 mmhg which is normal. The heart beat is regular. Abdomen: The abdomen of the client is flat and in a domed shape. There are no bumps, bulges or masses noted. The umbilicus is located in the middle of the abdomen and it is inverted. The skin of the abdomen of the client is smooth and uniform in color. Borborygmous sound are present, her bowel movements are normal and there is no presence of constipation. Extremities: The clients extremities is symmetric. The length of the left leg is shorter than the right leg, also the right leg has a poor muscle control than the left leg. The skin is smooth and brown in color, the same color with other body parts. Face: The patients skull is smooth and symmetric in contour. There are no lesion or tenderness noted in her face. Facial asymmetry is noted. Eyes: The eyebrows are symmetrical. She has intact eyelids and normally aligned eyeball. There were no signs of inflammation and excessive tearing present but her conjunctiva is pale. Ears: The clients ears are symmetrically aligned. The color of her auricles is brown same as the color of her skin. There are no presence of lesion and discharge. She cant hear clearly. Nose: The color of the clients nose appears to be same color of her face and skin. The nasal septum was positioned in the midline and the nostrils are patent. There are no signs of discharges and flaring in her nose.

Mouth and Oropharynx: The lips of the patient are dry and cracks are visible. Her uvula is in the midline presence of white patches on the tongue noted. There are no signs of lesion, inflammation or nodules apparent. Her gums are pink and her tonsil is normal. The client is able to swallow and her gag reflex is present. Neurological Assessment: The client was conscious and coherent. The client felt a bit dizzy

II. NURSING DIAGNOSIS

 Acute pain related to lacerated wound due to fall as manifested by patients verbalization of pain with a pain scale of 7/10, facial grimace and weak appearance P: Pain, Acute E: related to lacerated wound due to fall S: patients verbalization of pain with a pain scale of 7/10, facial grimace and weak appearance  Activity intolerance related to limited mobility secondary to pain as manifested by verbalization of pain upon moving, facial grimace, slowed movement and weak appearance P: Activity intolerance E: related to limited mobility secondary to pain S: patients verbalization of pain with a pain scale upon moving, facial grimace, slowed movement and weak appearance  Impaired skin integrity related to disrupted skin layers/ lacerated wound due to fall as manifested by disrupted skin layers; wound area is warm to touch. P: Impaired Skin Integrity E: related to disrupted skin layers/ lacerated wound due to fall S: disrupted skin layers; wound area is warm to touch.

III. EXPECTED OUTCOME/PLANNING

After 30 minutes an hour of nursing interventions the client will verbalize or reports that her pain is lessen from a pain scale of 7/10 to 1/10. Also, the client will be able to move or ambulate without assistance from others and that the client will display timely healing of her wound without complication.

IV. INTERVENTION
Independent Nursing Care Plan Assessment Subjective: Masakit ung sugat ko as verbalized by the patient. Diagnosis Inference Planning Intervention  Assess location, characteristic, onset, duration, frequency, quality and severity of pain.  Consider cultural influences on pain response Rationale  To assess the etiology or precipitating factors. Evaluation After 30 minutes an hour of nursing interventions the client verbalized and reported that her pain is lessen from a pain scale of 7/10 to 1/10.

Acute pain Fall After 30 related to minutes an lacerated hour of wound due Lacerated nursing to fall as wound interventions manifested the client by patients will verbalization Disruption verbalize or With pain of pain with of skin reports that scale of a pain scale integrity her pain is 7/10 of 7/10, lessen from facial a pain scale Objective: grimace and Stimulation of 7/10 to With facial weak of sensory 1/10. grimaces appearance nerve Weak endings appearance V/s: Temp.: 36.2 PR: 72bpm RR: 20 bpm BP:100/70 mmHg Pain

 Each person experiences and expresses pain in an individual manner using a variety of sociocultural techniques.  V/s is usually altered in acute pain.

 Monitor V/s  Personal factors can influence pain and pain response  To prevent fatigue

 Reduce or eliminate factors that precipitate pain

experience  Provide quiet environment and encourage adequate rest periods  Encourage use of relaxation technique and diversional activities

 To encourage sense of control and improve coping activities/helps control and alleviate pain.   To maintain acceptable level of pain  Turning and ambulation activities will be enhanced if pain is controllable.

 Provide optional pain relief as prescribed  Medicate before an activity to increase participation but evaluate hazardous sedation  Evaluate the effectiveness of the pain

 For thorough assessment

 To help contol pain.

control measures used  Instruct significant others to help patient divert pain into other things

 Dependent Drug Study

Name of Drug

Classification

Adverse effect

Indication

Contraindication

Nursing Consideration

CV: peripheral vascular thrombosis, heart failure. Vitamin B complex Vitamins GI: transient diarrhea. Respi: pulmonary edema. Skin: itching,

BEFORE: A coenzyme that stimulate metabolic function and is needed for cell replication, hematopoiesis, and nucleoprotein ~ hypersen-sitive to ~ Determine reticulocyte count, hct, vitamin B12 or cobalt. Vit. B12, iron, folate levels before beginning therapy. ~ early Lebers disease ~ Obtain a sensitivity test history before administration ~ Avoid I.V. administration bec. faster systemic elimination will

transitory exanthema, urticaria. Other: anaphylaxis, anaphylactoid reactions with parenteral administration, pain or burning at injection site.

and myelin synthesis.

reduce effectiveness of vitamin. DURING: ~ Dont give large doses of vitamin B12 routinely; drug is lost through excretion. ~ Dont mix parenteral preparation in same syringe with other drugs. AFTER: ~ Protect Vit. B12 from light. Dont refrigerate or freeze. ~ Monitor patient for hypokalemia for first 48 hours, as anemia correct itself. Give potassium supplements, as needed.

Name of Drug

Classification

Adverse effect

Indication

Contraindication

Nursing Consideration

Ascorbic acid

Vitamins

GI: Nausea, vomiting, heartburn, diarrhea. Hematologic: Acute hemolytic anemia (patients with deficiency of G6PD); sickle cell crisis. CNS: Headache (high doses). Urogenital: Urethritis, dysuria, crystalluria (high doses). Other: Mild soreness at injection site;

Assessment & Drug Effects Prophylaxis and treatment of scurvy and as a dietary supplement. Increases protection mechanism of the immune system, thus supporting wound healing. Necessary for wound healing and resistance to infection. Use of sodium ascorbate in patients on sodium restriction; use of calcium ascorbate in patients receiving digitalis. Safety during pregnancy (category C) or lactation is not established.
y

Lab tests: Periodic Hct & Hgb, serum electrolytes. Monitor for S&S of acute hemolytic anemia, sickle cell crisis.

Patient & Family Education Take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time and excretes the rest in urine.
y

Megadoses can interfere with absorption of vitamin B12.

Note: Vitamin C increases the absorption of iron when taken at the same time as iron-rich foods.

dizziness and temporary faintness with rapid IV administration.

Name of Drug

Classification

Adverse effect

Indication

Contraindication

Nursing Consideration

Adverse drug reaction: Lidocaine Anesthetic (local and general)

I o Hypovolemia Heart block or other conduction distrubances Special precaution: o Hepatic or renal impairment o CHF and following cardiac surgery o Bradycardia o Respiratory depression o Elderly or debilitated patients

o Pulseless ventricular o Dizziness, fibrillation or o Paraesthesia, ventricular tachycardia o Drowsiness, o Confusion, o Respiratory depression o Convulsions. o Sympathetic nerve block

o Pregnancy

Potentially fatal: o Hypotension and bradycardia leading to cardiac arrest Anaphylaxis

Drug interactions O Additive cardiac effects with IV phenytoin O Effects antagonized by hypokalaemia caused by acetazolamide, loop diuretics and thiazides. O Dose requirements may be increased with long-term use of phenytoin and other enzymeinducers. Potentially Fatal: O Cimetidine and propranolol increase plasma concentration and toxicity. O Increased risk of myocardial depression with beta blockers and other antiarrhythmics

Collaborative Laboratory  X-ray Definition Purpose Result  Normal  A skull x-ray is a picture of the bones surrounding the brain, including the facial bones, the nose, and the sinuses.  It can take pictures of fractures in bones and diagnose problems such as lung infection etc.  To determine whether there is fracture bone or may  No broken bones are present.  The bones of the skull are normal in size and appearance.  No foreign objects, abnormal growths, or bone abnormalities are present.  No broken bones are present. Normal Values Interpretation/ Analysis

 CBC (Complete Blood Chemistry) Definition Purpose Result Normal Values Interpretation/ Analysis  No infection

 The CBC is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood

 If a patient is having symptoms such as fatigue or weakness or has an infection, inflammation, bruising, or bleeding, then the doctor may order a CBC to help diagnose the cause.

 WBC Count- 8.8  Monocyte- 2.8  Hemoglobin13.6  Hematocrit- 35  Hematocrit- 258

 WBC Count4.8-10.8  Monocyte- 0-7  Hemoglobin- 1216 g/L  Hematocrit- 3747  Hematocrit- 150400

 12 Lead ECG Definition Purpose         Result Ar- 96/ min PR- 0.16 sec. Rhythm- Sinus T-waveUpright Vr- 96/min Qrs- 0.06 St- isoelectric Qt- 0.32 Normal Values  PR Interval: 0.12 0.20 sec  QRS Duration: 0.06 - 0.10 sec  QT Interval (QTc < 0.40 sec)  Rhythm: sinus Interpretation/ Analysis  Normal

 The standard 12lead electrocardiogram is a representation of the heart's electrical activity recorded from electrodes on the body surface.

 the 12-lead ECG provides spatial information about the heart's electrical activity in 3 approximately orthogonal directions: Right <--> Left Superior <---> Inferior Anterior <---> Posterior

V.

EVALUATION

From the admission to the emergency room the patients lacerated wound has been repaired by the physician. She has been given medications to prevent infection and to lessen the pain. After 30 minutes an hour of nursing interventions the client verbalized and repoted that her pain is lessen from a pain scale of 7/10 to 3/10. Also, the client can ambulate with a slight decrease in assistance from others and that the client displays a timely healing of her wound without complication. Goal are partially met because the client still needs to take a rest and her illness is still undiagnosed because of the need for her CT scan.

UNIVERSIDAD DE MANILA (City College of Manila) College of Nursing

In Partial Fulfillment of the Requirements in Emergency Room Related Learning Experience

A Case Analysis
OSPITAL NG MAYNILA MEDICAL CENTER Emergency Room

Submitted by: Linsangan, Nica Rose M. Group 3 Nr-31 Submitted to: Mr. Ben O. De Paz

May 19, 2011

ANATOMY AND PHYSIOLOGY

The nervous system is an organ system that contains a network of specialized cells called neurons. This is the master controlling and communicating system of the body. It coordinates the action of an animal and transmits signals between the different parts of the body. Every thought, movement and emotions reflect the activity of the nervous system. Functions of the NERVOUS SYSTEM 1. To monitor changes that takes place inside and outside the body. The nervous system utilizes the million sensory receptors to carry out this function. Any changes or stimuli occurring are noted by the nervous system and the gathered data is now called a sensory input. 2. Another important function of the nervous system is to process and interpret the sensory input or gathered data. It is the working of this system to make decision about what should be done at each moment. This is the process known as INTEGRATION. 3. As the nervous system has reached a decision of what response and appropriate action to be done in response to the stimuli, it then effects a response by activating muscles or glandsthrough motor output. These functions of the nervous systems works hand in hand. Lets take a look at the situation given above about Maya. While Maya is walking and is about to cross the street she saw the red light for pedestrian crossing just ahead, this is the sensory input. Her nervous system then processes and integrates this information that the red light for pedestrian crossing means stop. The nervous system then sends motor output to Mayas legs and feet and your feet stops walking response. tructural Classification of the Nervous system Structurally, the nervous system is classified into the central nervous system and the peripheral nervous system.  Central nervous system. The CNS consists of the brain and the spinal cord. These organs occupy the dorsal body cavity and act as the INTEGRATING and COMMAND CENTERS of thenervous system. It is the CNS that interprets an incoming sensory information and sends and instruction basing on the past experience and current condition.  Peripheral Nervous System. The PNS is consisting of the nerves that extend from the brainand the spinal cord. It is the part of the nervous system outside the CNS. There are varieties of nerves. The spinal nerves carry impulses to and from the spinal cord. The cranial nerves, on the other hand, carry impulses to and from the brain. These nerves serve as the communication lines of the body.

Functional Classification of the Nervous System The functional classification of the nervous system is only concerned about the structures of the peripheral nervous system (PNS). The PNS in this classification is divided into two principal subdivisions:  Sensory or afferent division. This subdivision is composed of the nerve fibers that convey impulses to the central nervous system (CNS) from the sensory receptors. These sensory receptors are located in the different parts of the body. With the presence of these sensory fibers the CNs is constantly informed of the events going on both inside and outside the body. 1. The fibers responsible for delivering impulses from the skin, skeletal muscles and joints are called the somatic sensory fibers. 2. Fibers that transmit impulses from the visceral organs are called the visceral sensory fibers.  Motor or efferent division. This division is responsible for carrying impulses from the CNS to the effector organs, muscles and glands. In response these impulses, activate muscles andglands and they effect a motor response. The two classification of motor or efferent division are: 1. Somatic nervous system. This subdivision is also referred as the voluntary nervous system.The somatic NS allows a person to consciously or voluntarily control apersons skeletal muscles. 2. Autonomic nervous system (ANS). The ANS regulates the events that are automatic or INVOLUNTARY such as the activity of the smooth and cardiac muscles and glands. The two parts of the ANS are the sympathetic and the parasympathetic systems. Function and Structure of the Nervous System If you think of the brain as a central computer that controls all bodily functions, then the nervous system is like a network that relays messages back and forth from the brain to different parts of the body. It does this via the spinal cord, which runs from the brain down through the back and contains threadlike nerves that branch out to every organ and body part. The nervous system derives its name from nerves, which are cylindrical bundles of fibers that emanate from the brain and central cord, and branch repeatedly to innervate every part of the body. Even though it is complex, nervous tissue is made up of two principal types of cells namely, the supporting cells and the neurons. SUPPORTING CELLS The supporting cells in the CNS are lumped together as NEUROGLIA or GLIAL CELLS. Glial Cells are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin and participate in signal transmission in the nervous system. In the human brain, it is estimated that the total number of glia roughly equals the number of neurons, although the proportions vary in different brain areas. The functions of glial cells are: 1. to support neurons and hold them in place 2. to supply nutrients to neurons 3. to insulate neurons electrically 4. to destroy pathogens and remove dead neurons 5. to provide guidance cues directing the axons of neurons to their targets Characteristics of Glial Cells: 1. Lumped together. 2. Not able to transmit impulses.

3. Never lose their ability to divide. The CNS glia include:  Astrocytes. These are star-shaped cells that account nearly half of the neural tissue. Astrocytes form a living barrier between capillaries and neurons and play a role in makingexchanges between the two. This is to prevent harmful substances in the blood from entering the neurons. Aside from that, astricytes are also important in controlling the chemical environment in the brain. This is done by picking up excess ions and recapturing released neurotransmitters.  Microglia. These are spiderlike phagocytes that dispose debris including dead brain cells and bacteria.  Ependymal cells. These cells line the cavities of the brain and the spinal cord. Aside from lining the cavities of certain organs, these cells are very important in helping the CSF through their cilia to circulate and fill those cavities and form a protective cushion around the CNS.  Oligodendrocytes. These are glial cells that wrap their flat extensions tightly around the nerve fibers, producing fatty insulating coverings called myelin sheaths. NEURONS Anatomy of the Neuron The nervous system is defined by the presence of a special type of cellthe neuron (sometimes called neurone or nerve cell). Neurons can be distinguished from other cells in a number of ways, but their most fundamental property is that they communicate with other cells via SYNAPSES, which are membrane-to-membrane junctions containing molecular machinery that allows rapid transmission of signals, either electrical or chemical. Many types of neuron possess an AXON, a protoplasmic protrusionthat can extend to distant parts of the body and make thousands of synaptic contacts. Axons frequently travel through the body in bundles called nerves. Classification of Neurons Functional Classification of Neurons Even in the nervous system of a single species such as humans, hundreds of different types of neurons exist, with a wide variety of morphologies and functions. These include SENSORY NEURONS that transmute physical stimuli such as light and sound into neural signals, and MOTOR NEURONS that transmute neural signals into activation of muscles or glands; however in many species the great majority of neurons receive all of their input from other neurons and send their output to other neurons. An ITERNEURON is always found completely within the CNS and conveys messages between parts of the system In addition to neurons, nervous tissue contains glial cells such as the Schwann cells covering the neurons with sheath. These cells maintain the tissue by supporting and protecing the neurons. They also provide nutrients to neurons and help to keep the tissue free of debris. The neurons require a great deal of energy for the maintenance of the ionic imbalance between themselves and their surrounding fluids, which is constantly in flux as a result of the opening and closing of channels through the neuronal membranes.

THE CENTRAL NERVOUS SYSTEM The Central Nervous System (CNS) is composed of the brain and spinal cord. The CNS is surrounded by bone-skull and vertebrae. Fluid and tissue also insulate the brain and spinal cord. During embryonic development, the brain first forms as a tube, the anterior end of which enlarges into three hollow swellings that form the brain, and the posterior of which develops into the spinalcord.

Anatomy of the CNS Brain When a message comes into the brain from anywhere in the body, the brain tells the body how to react. For example, if you accidentally touch a hot stove, the nerves in your skin shoot a message of pain to your brain. The brain then sends a message back telling the muscles in your hand to pull away. Luckily, this neurological relay race takes a lot less time than it just took to read about it. Considering everything it does, the human brain is incredibly compact, weighing just 3

pounds. Its many folds and grooves, though, provide it with the additional surface area necessary for storing all of the bodys important information. The four main regions of the brain are:  Cerebral hemispheres  Diencephalon  Brain stem  Cerebellum Cerebral Hemispheres The paired cerebral hemispheres are the most superior part of the brain and are collectively called the cerebrum. 1. Gyri or gyrus (singular) elevated ridges of tissue found on the entire surface of the cerebral hemisphere. 2. Sulci or sulcus (singular) shallow grooves that separates the gyri. 3. Fissures deeper groves which separates the larger regions of the brain. The cerebralhemispheres are separated by a single deep fissure called the LONGITUDINAL FISSURE. The cerebrum, the largest part of the human brain, is divided into left and right hemispheresconnected to each other by the corpus callosum. The hemispheres are covered by a thin layer of gray matter known as the cerebral cortex, the most recently evolved region of the vertebrate brain. The cortex in each hemisphere of the cerebrum is between 1 and 4 mm thick. Folds divide the cortex into four lobes: occipital, frontal, parietal and temporal. No region of the brain functionsalone, although major functions of various parts of the lobes have been determined. The occipital lobe (back of the head) receives and processes visual information. The temporal lobe receives auditory signals, processing language and the meaning of words. The parietal lobe is associated with the sensory cortex and processes information about touch, taste, pressure, pain, and heat and cold. The frontal lobe conducts three functions: 1. motor activity and integration of muscle activity 2. speech 3. thought processes Language comprehension is found in Wernickes area. Speaking ability is in Brocas area. Damage to Brocas area causes speech impairment but not impairment of language comprehension. Lesions in Wernickes area impair ability to comprehend written and spoken words but not speech. The remaining parts of the cortex are associated with higher thought processes, planning, memory, personality and other human activities. Diencephalon The diencephalon or interbrain sits atop the brainstem and is enclosed by the cerebral hemispheres. The major structures of the diencephalon are: 1. Thalamus The thalamus is a relay station for sensory impulses passing upward the sensory cortex. 2. Hypothalamus Plays a role in body temperature regulation, water balance and metabolism. It is also the center for many drives and emotion such as thirst, appetite, sex, pain and pleasure. Aside from that, the hypothalamus regulates the pituitary gland and produces two hormones of its own.

3. Epithalamus The epithalamus contains the pineal body and the choroid plexuses. The choroid plexuses form the cerebrospinal fluid. Brain Stem The brain stem is about the size of a thumb in diameter and is approximately 3 inches long. It provides a pathway for ascending and descending tracts. The structures of the brain stem are: 1. Midbrain The midbrain, located underneath the middle of the forebrain, acts as a master coordinator for all the messages going in and out of the brain to the spinal cord. It is composed primarily of two bulging fiber tracts called the cerebral peduncles, which convey ascending and descending impulses. 2. Pons the pons have an important nuclei in the control of breathing. 3. Medulla oblongata most inferior part of the brain stem. It contains many nuclei that regulate vital visceral activities. The medulla oblongata contains centers that control heart rate, BO, breathing, swallowing, vomiting and others. 4. Reticular Formation the neurons of the reticular formation are involved in the motor control of the visceral organs. A special group of reticular formation neurons, the reticular activating system (RAS) plays a role in consciousness and the awake/sleep cycles. Cerebellum The cerebellum is the third part of the hindbrain, but it is not considered part of the brain stem. Functions of the cerebellum include fine motor coordination and body movement, posture, and balance. This region of the brain is enlarged in birds and controls muscle action needed for flight. Spinal Cord The spinal cord runs along the dorsal side of the body and links the brain to the rest of the body. Vertebrates have their spinal cords encased in a series of (usually) bony vertebrae that comprise the vertebral column. The gray matter of the spinal cord consists mostly of cell bodies and dendrites. The surrounding white matter is made up of bundles of interneuronal axons (tracts). Some tracts are ascending (carrying messages to the brain), others are descending (carrying messages from the brain). The spinal cord is also involved in reflexes that do not immediately involve the brain. Nerves divide many times as they leave the spinal cord so that they may reach all parts of the body. The thickest nerve is 1 inch thick and the thinnest is thinner than a human hair. Each nerve is a bundle of hundreds or thousands of neurons (nerve cells). The spinal cord runs down a tunnel of holes in your backbone or spine. The bones protect it from damage. The cord is a thick bundle of nerves, connecting your brain to the rest of your body. Peripheral Nervous System The Peripheral Nervous System contains only nerves and connects the brain and spinal cord (CNS) to the rest of the body. The axons and dendrites are surrounded by a white myelin sheath. Cell bodies are in the central nervous system (CNS) or ganglia. Ganglia are collections of nerve cell bodies. Cranial nerves in the PNS take impulses to and from the brain (CNS). Spinal nerves take impulses to andaway from the spinal cord. There are two major subdivisions of the PNS motor pathways: the somatic and the autonomic. Two main components of the PNS: 1. sensory (afferent) pathways that provide input from the body into the CNS. 2. motor (efferent) pathways that carry signals to muscles and glands (effectors).

Most sensory input carried in the PNS remains below the level of conscious awareness. Input that does reach the conscious level contributes to perception of our external environment. Autonomic Nervous System The Autonomic Nervous System is that part of PNS consisting of motor neurons that control internal organs. It has two subsystems. The autonomic system controls muscles in the heart, the smooth muscle in internal organs such as the intestine, bladder, and uterus. The Sympathetic Nervous System is involved in the fight or flight response. The Parasympathetic Nervous System is involved in relaxation. Each of these subsystems operates in the reverse of the other (antagonism). Both systems innervate the same organs and act in opposition to maintain homeostasis. For example: when you are scared the sympathetic system causes your heart to beat faster; the parasympathetic system reverses this effect. Motor neurons in this system do not reach their targets directly (as do those in the somatic system) but rather connect to a secondary motor neuron which in turn innervates the target organ. Somatic Nervous System The Somatic Nervous System (SNS) includes all nerves the muscular system and external sensory receptors. External sense organs (including skin) are receptors. Muscle fibers and gland cells are effectors. The reflex arc is an automatic, involuntary reaction to a stimulus. When the doctor taps your knee with the rubber hammer, she/he is testing your reflex (or knee-jerk). The reaction to the stimulus is involuntary, with the CNS being informed but not consciously controlling the response. Examples of reflex arcs include balance, the blinking reflex, and the stretch reflex. Sensory input from the PNS is processed by the CNS and responses are sent by the PNS from the CNS to the organs of the body. Motor neurons of the somatic system are distinct from those of the autonomic system. Inhibitory signals, cannot be sent through the motor neurons of the somatic system.