MEDICAL-SURGICAL NURSING • Not capable of r
STUDY GUIDE NOTES 2023 • Myocardial cells
By: Anthony T. Villegas R.N. Retinal Cells.
Overview of structures and functions: B. NEUROGLIA
NERVOUS SYSTEM • Support and protect
• The functional unit of the nervous system is the nerve cells
or neurons TYPES
• The nervous system is composed of the ff: 1. Astrocytes
Central Nervous System • maintains blood
• Brain • majority of brai
• Spinal Cord – serves as a connecting link between the brain astrocytoma.
& the periphery.
• integrity of bloo
Peripheral Nervous System 2. Oligodendria
• Cranial Nerves – 12 pairs; carry impulses to & from the brain. • produces myeli
• Spinal Nerves – 31 pairs; carry impulses to & from spinal • act as insulator
cord. transmission.
Autonomic Nervous System 3. Microglia
➢ subdivision of the PNS that automatically controls body function such as • stationary cells that
breathing & heart beat. cellular debris, eati
➢ Special senses of vision and hearing are also covered in this 4. Epindymal
section
• secretes a glue
• Sympathetic nervous system – generally accelerate some concentrate the
body functions in response to stress.
• Parasympathetic nervous system – controls normal body MACROPHAGE OR
functioning.
Microglia Bra
Monocytes Blo
CELLS
Kupffers Kid
A. NEURONS
Histiocytes Ski
• Primary component of nervous system
Alveolar Macrophage Lu
• Composed of cell body (gray matter), axon, and dendrites
• Basic cells for nerve impulse and conduction.
Central Nervous System
Axon
• Elongated process or fiber extending from the cell body Composition Of Brain
• Transmits impulses (messages) away from the cell body to • 80% brain mass
dendrites or directly to the cell bodies of other neurons • 10% blood
• Neurons usually has only one axon • 10% CSF
Dendrites Brain Mass
• Short, blanching fibers that receives impulses and conducts Parts Of The Brain
them toward the nerve cell body. 1. Cerebrum
• Neurons may have many dendrites. • largest part of t
Synapse • outermost area
• Junction between neurons where an impulse is transmitted • deeper area is c
Neurotransmitter • function of cere
• Chemical agent (ex. Acetylcholine, norepinephrine) involved • composed of tw
in the transmission of impulse across synapse. Hemisphere and
Myelin Sheath the Corpus Callo
• A wrapping of myelin (whitish, fatty material) that protects • Each hemispher
and insulates nerve fibers and enhances the speed of functional areas
impulse conduction. these lobes:
, • controls libido
• controls long term memory Gray Matter
Corpus Callosum 1. Anterior Horns
• large fiber tract that connects the two cerebral • Contains ce
hemisphere fibers
Basal Ganglia 2. Posterior Horns
• island of gray matter within white matter of cerebrum • Contains ce
• regulate & integrate motor activity originating in the (sensory) fib
cerebral cortex 3. Lateral Horns
• part of extrapyramidal system • In thoracic
• area of gray matter located deep within each cerebral autonomic f
hemisphere.
• release dopamine (controls gross voluntary movement).
White Matter
1. Ascending Tract
2. Diencephalon/interbrain
a. Posterio
• Connecting part of the brain, between the cerebrum &
•
the brain stem
• Contains several small structures: the thalamus &
b. Spinoce
hypothalamus are most important
•
Thalamus
• acts as relay station for discrimination of sensory signals
(ex. Pain, temperature, touch)
c. Lateral
• controls primitive emotional responses (ex. Rage, fear)
•
Hypothalamus
• found immediately beneath the thalamus
d. Anterio
• plays a major role in regulation/controls of vital function:
•
blood pressure, thirst, appetite, sleep & wakefulness,
temperature (thermoregulatory center)
2. Descending Tra
• acts as controls center for pituitary gland and affects
a. Cortico
both divisions of the autonomic nervous system.
•
• controls some emotional responses like fear, anxiety
and excitement.
• androgenic hormones promotes secondary sex
characteristics. b. Extrapy
• early sign for males are testicular and penile •
enlargement
• late sign is deepening of voice.
• early sign for females telarch and late sign is menarch.
3. Mesencephalon/Midbrain Reflex Arc
• acts as relay station for sight and hearing. • Reflex consists
• size of pupil is 2 – 3 mm. occurring over a
• equal size of pupil is isocoria. • Not relayed to &
• unequal size of pupil is anisocoria.
• hearing acuity is 30 – 40 dB. Components
• positive PERRLA a. Sensory Recept
• Receives/re
4. Brain Stem b. Afferent Pathwa
• located at lowest part of brain. • Transmits im
• contains midbrain, pons, medulla oblongata. c. Interneurons
• extends from the cerebral hemispheres to the foramen • Synapses wi
magnum at the base of the skull. d. Efferent Pathwa
, 4. Ventricles • Contain
• Four fluid-filled cavities connecting with one fibers o
another & spinal canal spinal c
• Produce & circulate cerebrospinal fluid
5. Cerebrospinal Fluid (CSF) Cranial Nerves
• Surrounds brain & spinal cord ▪ 12 pairs: carry impu
• Offer protection by functioning as a shock absorber ▪ May have sensory, m
• Allows fluid shifts from the cranial cavity to the spinal
cavity Name & Number
• Carries nutrient to & waste product away from nerve Olfactory : CN
cells sense of smell.
• Component of CSF: CHON, WBC, Glucose Optic : CN II
6. Vascular Supply Oculomotor : CN III
• Two internal carotid arteries anteriorly constriction, elevation of up
• Two vertebral arteries leading to basilar artery
posteriorly
Trochlear : CN IV
• These arteries communicate at the base of the brain
inward, movement of the eye
through the circle of willis
Trigeminal : CN V
• Anterior, middle, & posterior cerebral arteries are the
of eyes (corneal reflex); mu
main arteries for distributing blood to each hemisphere
of the brain
Abducens : CN VI
• Brain stem & cerebellum are supplied by branches of
the vertebral & basilar arteries of eye
• Venous blood drains into dural sinuses & then into Facial : CN VII
jugular veins anterior tongue; mu
7. Blood-Brain-Barrier (BBB)
• Protective barrier preventing harmful agents from Acoustic : CN
entering the capillaries of the CNS; protect brain & hearing (cochlear d
spinal cord
Glossopharyngeal : CN
Substance That Can Pass Blood-Brain Barrier sensation to poster
1. Amonia
• Cerebral toxin (elevation) & swallo
• Hepatic Encephalopathy (Liver Cirrhosis) Vagus : CN X
• Ascites lower pharynx & lar
• Esophageal Varices
Early Signs of Hepatic Encephalopathy pharynx, & larynx.
• Asterexis (flapping hand tremors). Spinal Accessory : CN
Late Signs of Hepatic Encephalopathy
sternomastoid musc
• Headache
• Dizziness
Hypoglossal : CN XII
• Confusion
• Fetor hepaticus (amonia like breath)
Autonomic Nervous System
• decrease LOC
▪ Part of the peripher
2. Carbon Monoxide and Lead Poisoning
▪ Include those perip
• Can lead to Parkinson–s Disease.
regulates smooth m
• Epilepsy
▪ Component:
• Treated with calcium EDTA.
1. Sympathetic Ne
3. Type 1 DM (IDDM)
▪ Generally
• Causes diabetic ketoacidosis.
response to
• And increases breakdown of fats.
2. Parasympathet
, - SNS effect Physical Examination
Contraindication: Comprehensive Neuro Exam
- Contraindicated to patients Neuro Check
suffering from COPD II. Anti-cholinergic Agents 1. Level of Consciousn
(Broncholitis, Bronchoectasis, - To counter cholinergic agents. a. Orientation to t
Emphysema, Asthma). - Atrophine Sulfate b. Speech: clear, g
c. Ability to follow
II. Beta-adrenergic Blocking SE: d. If does not res
Agents - SNS effect stimulus (ex.
- Also called Beta-blockers. trapezius muscl
- all ending with – lol– ➢ Appropriate
- Propranolol, Atenelol, ➢ Inappropria
Metoprolol. e. Abnormal post
Effect of Beta-blockers response to stim
B – broncho spasm ➢ Decorticate
E – elicits a decrease in rotation &
myocardial contraction. wrist, & f
T – treats hypertension. cerebral he
A – AV conduction slows down. ➢ Decerebrate
- Should be given to patients of all four e
with Angina, Myocardial plantar flex
midbrain, o
Infarction, Hypertension
2. Glasgow Coma Scal
ANTI- HYPERTENSIVE AGENTS
➢ Objective meas
1. Beta-blockers – – lol–
quick neuro che
2. Ace Inhibitors – Angiotensin
➢ Objective evalua
– pril– (Captopril, Enalapril)
➢ A standardized
3. Calcium Antagonist –
neurologic impa
Nifedipine (Calcibloc)
- In chronic cases of arrhythmia
Components
give Lidocane, Xylocane.
1. Eye openin
Effectors :Sympathetic (Adrenergic) Effect 2. Verbal resp
Parasympathetic (Cholinergic) Effect 3. Motor respo
Eye dilate pupil (mydriasis) constrict GCS Grading / Scori
pupil (miosis) 1. Conscious
2. Lethargy
Gland of Head 3. Stupor
Lacrimal no effect 4. Coma
stimulate secretions 5. Deep Coma
Salivary scanty thick, viscous secretions copious thin watery
secretions 3. Pupillary Reaction &
Dry mouth a. Observe size, sh
millimeter)
Heart increase rate & force of contraction b. Reaction to ligh
decrease rate c. Corneal reflex:
of cornea
d. Oculocephalic re
Blood Vessel constrict smooth muscles of the skin, no effect unconscious clie
STUDY GUIDE NOTES 2023 • Myocardial cells
By: Anthony T. Villegas R.N. Retinal Cells.
Overview of structures and functions: B. NEUROGLIA
NERVOUS SYSTEM • Support and protect
• The functional unit of the nervous system is the nerve cells
or neurons TYPES
• The nervous system is composed of the ff: 1. Astrocytes
Central Nervous System • maintains blood
• Brain • majority of brai
• Spinal Cord – serves as a connecting link between the brain astrocytoma.
& the periphery.
• integrity of bloo
Peripheral Nervous System 2. Oligodendria
• Cranial Nerves – 12 pairs; carry impulses to & from the brain. • produces myeli
• Spinal Nerves – 31 pairs; carry impulses to & from spinal • act as insulator
cord. transmission.
Autonomic Nervous System 3. Microglia
➢ subdivision of the PNS that automatically controls body function such as • stationary cells that
breathing & heart beat. cellular debris, eati
➢ Special senses of vision and hearing are also covered in this 4. Epindymal
section
• secretes a glue
• Sympathetic nervous system – generally accelerate some concentrate the
body functions in response to stress.
• Parasympathetic nervous system – controls normal body MACROPHAGE OR
functioning.
Microglia Bra
Monocytes Blo
CELLS
Kupffers Kid
A. NEURONS
Histiocytes Ski
• Primary component of nervous system
Alveolar Macrophage Lu
• Composed of cell body (gray matter), axon, and dendrites
• Basic cells for nerve impulse and conduction.
Central Nervous System
Axon
• Elongated process or fiber extending from the cell body Composition Of Brain
• Transmits impulses (messages) away from the cell body to • 80% brain mass
dendrites or directly to the cell bodies of other neurons • 10% blood
• Neurons usually has only one axon • 10% CSF
Dendrites Brain Mass
• Short, blanching fibers that receives impulses and conducts Parts Of The Brain
them toward the nerve cell body. 1. Cerebrum
• Neurons may have many dendrites. • largest part of t
Synapse • outermost area
• Junction between neurons where an impulse is transmitted • deeper area is c
Neurotransmitter • function of cere
• Chemical agent (ex. Acetylcholine, norepinephrine) involved • composed of tw
in the transmission of impulse across synapse. Hemisphere and
Myelin Sheath the Corpus Callo
• A wrapping of myelin (whitish, fatty material) that protects • Each hemispher
and insulates nerve fibers and enhances the speed of functional areas
impulse conduction. these lobes:
, • controls libido
• controls long term memory Gray Matter
Corpus Callosum 1. Anterior Horns
• large fiber tract that connects the two cerebral • Contains ce
hemisphere fibers
Basal Ganglia 2. Posterior Horns
• island of gray matter within white matter of cerebrum • Contains ce
• regulate & integrate motor activity originating in the (sensory) fib
cerebral cortex 3. Lateral Horns
• part of extrapyramidal system • In thoracic
• area of gray matter located deep within each cerebral autonomic f
hemisphere.
• release dopamine (controls gross voluntary movement).
White Matter
1. Ascending Tract
2. Diencephalon/interbrain
a. Posterio
• Connecting part of the brain, between the cerebrum &
•
the brain stem
• Contains several small structures: the thalamus &
b. Spinoce
hypothalamus are most important
•
Thalamus
• acts as relay station for discrimination of sensory signals
(ex. Pain, temperature, touch)
c. Lateral
• controls primitive emotional responses (ex. Rage, fear)
•
Hypothalamus
• found immediately beneath the thalamus
d. Anterio
• plays a major role in regulation/controls of vital function:
•
blood pressure, thirst, appetite, sleep & wakefulness,
temperature (thermoregulatory center)
2. Descending Tra
• acts as controls center for pituitary gland and affects
a. Cortico
both divisions of the autonomic nervous system.
•
• controls some emotional responses like fear, anxiety
and excitement.
• androgenic hormones promotes secondary sex
characteristics. b. Extrapy
• early sign for males are testicular and penile •
enlargement
• late sign is deepening of voice.
• early sign for females telarch and late sign is menarch.
3. Mesencephalon/Midbrain Reflex Arc
• acts as relay station for sight and hearing. • Reflex consists
• size of pupil is 2 – 3 mm. occurring over a
• equal size of pupil is isocoria. • Not relayed to &
• unequal size of pupil is anisocoria.
• hearing acuity is 30 – 40 dB. Components
• positive PERRLA a. Sensory Recept
• Receives/re
4. Brain Stem b. Afferent Pathwa
• located at lowest part of brain. • Transmits im
• contains midbrain, pons, medulla oblongata. c. Interneurons
• extends from the cerebral hemispheres to the foramen • Synapses wi
magnum at the base of the skull. d. Efferent Pathwa
, 4. Ventricles • Contain
• Four fluid-filled cavities connecting with one fibers o
another & spinal canal spinal c
• Produce & circulate cerebrospinal fluid
5. Cerebrospinal Fluid (CSF) Cranial Nerves
• Surrounds brain & spinal cord ▪ 12 pairs: carry impu
• Offer protection by functioning as a shock absorber ▪ May have sensory, m
• Allows fluid shifts from the cranial cavity to the spinal
cavity Name & Number
• Carries nutrient to & waste product away from nerve Olfactory : CN
cells sense of smell.
• Component of CSF: CHON, WBC, Glucose Optic : CN II
6. Vascular Supply Oculomotor : CN III
• Two internal carotid arteries anteriorly constriction, elevation of up
• Two vertebral arteries leading to basilar artery
posteriorly
Trochlear : CN IV
• These arteries communicate at the base of the brain
inward, movement of the eye
through the circle of willis
Trigeminal : CN V
• Anterior, middle, & posterior cerebral arteries are the
of eyes (corneal reflex); mu
main arteries for distributing blood to each hemisphere
of the brain
Abducens : CN VI
• Brain stem & cerebellum are supplied by branches of
the vertebral & basilar arteries of eye
• Venous blood drains into dural sinuses & then into Facial : CN VII
jugular veins anterior tongue; mu
7. Blood-Brain-Barrier (BBB)
• Protective barrier preventing harmful agents from Acoustic : CN
entering the capillaries of the CNS; protect brain & hearing (cochlear d
spinal cord
Glossopharyngeal : CN
Substance That Can Pass Blood-Brain Barrier sensation to poster
1. Amonia
• Cerebral toxin (elevation) & swallo
• Hepatic Encephalopathy (Liver Cirrhosis) Vagus : CN X
• Ascites lower pharynx & lar
• Esophageal Varices
Early Signs of Hepatic Encephalopathy pharynx, & larynx.
• Asterexis (flapping hand tremors). Spinal Accessory : CN
Late Signs of Hepatic Encephalopathy
sternomastoid musc
• Headache
• Dizziness
Hypoglossal : CN XII
• Confusion
• Fetor hepaticus (amonia like breath)
Autonomic Nervous System
• decrease LOC
▪ Part of the peripher
2. Carbon Monoxide and Lead Poisoning
▪ Include those perip
• Can lead to Parkinson–s Disease.
regulates smooth m
• Epilepsy
▪ Component:
• Treated with calcium EDTA.
1. Sympathetic Ne
3. Type 1 DM (IDDM)
▪ Generally
• Causes diabetic ketoacidosis.
response to
• And increases breakdown of fats.
2. Parasympathet
, - SNS effect Physical Examination
Contraindication: Comprehensive Neuro Exam
- Contraindicated to patients Neuro Check
suffering from COPD II. Anti-cholinergic Agents 1. Level of Consciousn
(Broncholitis, Bronchoectasis, - To counter cholinergic agents. a. Orientation to t
Emphysema, Asthma). - Atrophine Sulfate b. Speech: clear, g
c. Ability to follow
II. Beta-adrenergic Blocking SE: d. If does not res
Agents - SNS effect stimulus (ex.
- Also called Beta-blockers. trapezius muscl
- all ending with – lol– ➢ Appropriate
- Propranolol, Atenelol, ➢ Inappropria
Metoprolol. e. Abnormal post
Effect of Beta-blockers response to stim
B – broncho spasm ➢ Decorticate
E – elicits a decrease in rotation &
myocardial contraction. wrist, & f
T – treats hypertension. cerebral he
A – AV conduction slows down. ➢ Decerebrate
- Should be given to patients of all four e
with Angina, Myocardial plantar flex
midbrain, o
Infarction, Hypertension
2. Glasgow Coma Scal
ANTI- HYPERTENSIVE AGENTS
➢ Objective meas
1. Beta-blockers – – lol–
quick neuro che
2. Ace Inhibitors – Angiotensin
➢ Objective evalua
– pril– (Captopril, Enalapril)
➢ A standardized
3. Calcium Antagonist –
neurologic impa
Nifedipine (Calcibloc)
- In chronic cases of arrhythmia
Components
give Lidocane, Xylocane.
1. Eye openin
Effectors :Sympathetic (Adrenergic) Effect 2. Verbal resp
Parasympathetic (Cholinergic) Effect 3. Motor respo
Eye dilate pupil (mydriasis) constrict GCS Grading / Scori
pupil (miosis) 1. Conscious
2. Lethargy
Gland of Head 3. Stupor
Lacrimal no effect 4. Coma
stimulate secretions 5. Deep Coma
Salivary scanty thick, viscous secretions copious thin watery
secretions 3. Pupillary Reaction &
Dry mouth a. Observe size, sh
millimeter)
Heart increase rate & force of contraction b. Reaction to ligh
decrease rate c. Corneal reflex:
of cornea
d. Oculocephalic re
Blood Vessel constrict smooth muscles of the skin, no effect unconscious clie
