MEDICAL-SURGICAL NUR MEDICAL-SURGICAL NURSING NERVOUS SYSTEM Overview of structures and functions: Central Nervous System Brain Spinal

Cord Peripheral Nervous System Cranial Nerves Spinal Nerves Autonomic Nervous System Sympathetic nervous system

Parasympathetic nervous system Sympathetic Nervous System(ADRENERGIC)Parasympathetic Nervous System(CHOLINERGIC, VAGAL, SYMPATHOLYTIC)Involved in fight or aggression response.- Release of Norepinephrine (cathecolamines)from adrenal glands and causes vasoconstriction. - Increase all bodily activity except GIT EFFECTS OF SNS - Dilation of pupils(

mydriasis ) in order to be aware.- Dry mouth (thickened saliva).- Increase BP and Heart Rate.Bronchodilation, Increase RR- Constipation.- Urinary Retention.- Increase blood supply to brain , heart and skeletalmuscles .- SNS I. Adrenergic Agents - Give Epinephrine.Signs and Symptoms: - SNS Contraindication: - Contraindicated to patients suffering from COPD(Broncholitis, Bronchoectasis, Emphysema, Asthma). II. Beta-adrenergic Blocking Agents - Also called Beta-blockers .- All ending with lol Propranolol , Atenelol , Metoprolol . Effects of Beta-blockers B roncho spasm

E licits a decrease in myocardial contraction. T reats hypertension. A V conduction slows down. Should be given to patients with Angina Pectoris , Myocardial Infarction , Hypertension . ANTI- HYPERTENSIVE AGENTS 1. Beta-blockers lol2. Ace Inhibitors Angiotensin, pril (Captopril,Enalapril)3. Calcium Antagonist Nifedipine (Calcibloc) In chronic cases of arrhythmia give Lidocaine ( Xylocaine ) Involved in fight or withdrawal response.- Release of Acetylcholine.- Decreases all bodily activities except GIT. EFFECTS OF PNS - Constriction of pupils ( meiosis ).- Increase salivation.- Decrease BP and Heart Rate.- Bronchoconstriction, Decrease RR.Diarrhea- Urinary frequency. I. Cholinergic Agents Mestinon , Neostigmine . Side Effects - PNS II. Anti-cholinergic AgentsTo counter cholinergic agents.- Atropine Sulfate Side Effects - SNS

CENTRAL NERVOUS SYSTEM Brain and Spinal Cord. I. CELLSA. NEURONS Basic cells for nerve impulse and conduction. PROPERTIESExcitability ability of neuron to be affected by changes in external environment. Conductivity ability of neuron to transmit a wave of excitation from one cell to another. Permanent Cell once destroyed not capable of regeneration. TYPES OF CELLS BASED ON REGENERATIVE CAPACITY1. Labile Capable of regeneration. Epidermal cells, GIT cells, GUT cells, cells of lungs. 2. Stable Capable of regeneration with limited time, survival period. Kidney cells, Liver cells, Salivary cells, pancreas. 3. Permanent Not capable of regeneration. Myocardial cells, Neurons, Bone cells, Osteocytes, Retinal Cells. B. NEUROGLIA Support and protection of neurons. TYPES1. Astrocytes maintains blood brain barrier semi-permeable. Majority of brain tumors (90%) arises from called astrocytoma . 2. Oligodendria3. Microglia4. EpindymalSUBSTANCES THAT CAN PASS THE BLOOD-BRAIN BARRIER1. Ammonia Cerebral toxin Hepatic Encephalopathy (Liver Cirrhosis) Ascites Esophageal Varices Early Signs of Hepatic Encephalopathy asterixis (flapping hand tremors). Late Signs of Hepatic Encephalopathy

Headache Dizziness Confusion Fetor hepaticus (ammonia like breath) Decrease LOC

PATHOGNOMONIC SIGNS 1. PTB low-grade afternoon fever. 2. PNEUMONIA rusty sputum. 3. ASTHMA wheezing on expiration. 4. EMPHYSEMA barrel chest. 5. KAWASAKI SYNDROME strawberry tongue. 6. PERNICIOUS ANEMIA red beefy tongue. 7. DOWN SYNDROME protruding tongue. 8. CHOLERA rice watery stool. 9. MALARIA stepladder like fever with chills. 10. TYPHOID rose spots in abdomen. 11. DIPTHERIA pseudo membrane formation 12. MEASLES kopliks spots. 13. SLE butterfly rashes. 14. LIVER CIRRHOSIS spider like varices. 15. LEPROSY lioning face. 16. BULIMIA chipmunk face. 17. APPENDICITIS rebound tenderness. 18. DENGUE petechiae or (+) Hermans sign.

19. MENINGITIS Kernigs sign (leg pain), Brudzinski sign (neck pain). 20. TETANY HYPOCALCEMIA (+) Trousseaus sign/carpopedal spasm; Chvostek sign (facial spasm). 21. TETANUS risus sardonicus. 22. PANCREATITIS Cullens sign (ecchymosis of umbilicus); (+) Grey turners spots . 23. PYLORIC STENOSIS olive like mass. 24. PDA machine like murmur. 25. ADDISONS DISEASE bronze like skin pigmentation. 26. CUSHINGS SYNDROME moon face appearance and buffalo hump. 27. HYPERTHYROIDISM/GRAVES DISEASE exopthalmus. 28. INTUSSUSCEPTION -sausage shaped mass

2. Carbon Monoxide and Lead Poisoning Can lead to Parkinsons Disease. Epilepsy Treat with ANTIDOTE : Calcium EDTA.3. Type 1 DM (IDDM) Causes diabetic ketoacidosis. And increases breakdown of fats. And free fatty acids Resulting to cholesterol and (+) to Ketones (CNS depressant).

Resulting to acetone breath odor/fruity odor. KUSSMAULS respiration, a rapid shallow respiration. Which may lead to diabetic coma. 4. Hepatitis Signs of jaundice (icteric sclerae). Caused by bilirubin (yellow pigment) 5. Bilirubin Increase bilirubin in brain ( Kernicterus ). Causing irreversible brain damage. Astrocites Maintains integrity of blood brain barrier. Oligodendria

Produces myelin sheath in CNS Act as insulator and facilitates rapid nerve impulse transmission.