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Nervous system (DAY 1)

Mr. mike chavez

• It is considered as the smallest system in the body is the nervous system.

• Nervous system
o CNS (central nervous system)
§ It is the because the brain is the central control of the body.
§ Brain = spinal cord
§ pathophysiology:
• Acetylcholine (neurotransmi9er and its func;on is memory
processing) produced by the brain à from the brain à goes
directly to the muscle will pass through the cranial nerves, but If
it’s in the spinal cord then it will pass through the spinal nerves à
contrac:on of the muscle
o Memory loss happens if there is less acetylcholine in the
brain or complicaBon such as Alzheimer’s disease.
o Acetylcholine is abundantly produced in the morning.
o If the acetylcholine will not be able to pass through the
muscle and no contracBon of the muscle will occur then it
will result to complicaBon such as Myasthenia Gravis
o Peanuts is the best source of acetylcholine.
o Descending method is used when impulses are from the
brain towards the muscles. (Brain à muscles)
o Ascending method is used when impulses are sent from the
neurotransmiDer below the brain, towards the brain.
(Muscles à brain)
o PNS (peripheral nervous system)
§ Nerves
• Cranial 12 pairs it is divided right and leB.
CN I Olfactory Smell Sensory
CN II OpBc Seeing Sensory
CN III Oculomotor Pupillary response, also supply the
EOM (extraocular movement) or Motor
eye movement
CN IV Trochlear Supplies the extraocular
movement of the eye Motor
CN V Trigeminal Facial motor such as masBcaBon Both
CN VI Abducens Supplies the extraocular
movement of the eye Both
CN VII Facial Facial nerves such as the sense of
taste and movement of the face
Both
CN VIII VesBbulocochlear Hearing Sensory
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CN IX Glossopharyngeal Sensory of taste and muscle of Both

swallowing
CN X Vagus 75% of PNS Both
CN XI Spinal accessory Muscle of shoulders and neck Motor
CN XII Hypoglossal Muscle of tongue Motor
Mnemonics
Oh Oh Oh To Touch And Feel A Girls Vagina ah Seems Heavenly
or
Oh Oh Oh To Take A Family VacaBon Going Vegas and Hawaii

• Spinal 31 pairs
§ Muscles
• Soma:c – voluntary (you can consciously control it means you can
control it or voluntarily you’ve moved the muscle.), straited, MSK
(muscular skeletal system.)
• Autonomic – involuntary (these are reflexes which you cannot
consciously control such as coughing, sneezing, or vomi;ng reflex.),
smooth, and visceral.
o Parasympathe7c system – lower vital signs
o Sympathe7c nervous system – higher vital signs
• Cerebellum
o Balance and coordinaBon
o Or known as the “big brain”
o This has somaBc funcBon, and it helps in the reflexes also to aDain balance or
coordinaBon; example is reciprocal walking (Movement of both the arms and/or both legs at
the same 4me but in opposite direc4ons.)
• Brainstem
o Respiratory reflex
§ Midbrain – auditory and visual reflexes
§ Pons – paDerns of breathing
• Types of breathing:
o Slow
o Rapid
o Deep
o Shallow
o Apnea
§ Rapid and deep breathing is called hyperven7la7on
and oxygen (O2) goes inside the body rapidly. In
Hypoven7la7on Co2 has been increased while
oxygen is decreased, therefore the mngt. Is oxygen
therapy such as brown paper bag, oxygen tank, and
etc.
• Oxygen is alkaline in nature.
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• Carbon dioxide is acid in nature; also,

carbon dioxide helps in s;mula;on in
breathing.
§ Medulla oblongata – it controls the heart rate, respiratory rate, vomiBng,
sneezing, and coughing.
o It also has autonomic funcBon.
• Cerebrum
o Consciousness this is where lobes are located.
§ Frontal – thinking and reasoning or “matalino sa lahat”, it will be the
decision maker for motor, it controls the behavior, and personality.
§ Temporal – feeling and memory, also comprehension.
§ Parietal – response to tacBle sensaBon
§ Occipital – response to the sensaBon
• Usually parietal, and occipital are the ones that process the senses.
• When the pa;ent is unconscious, everything is affected most of the
sensa;on is turned off.
o It has somaBc funcBon.
• Foramen magnum
o Types of injury
§ Brain injury
• From the level going up and down are both bad.
§ Cervical cord injury
• From the level and going down bad
• From the level and going up good.
§ Lumbar cord injury
• From the level and going down bad
• From the level and going up good.
• Spinal cord
o Cervical – 8
o Thoracic – 23
o Lumbar – 5; it carries the body; this is the cri;cal when there is injury
o Sacral – 5
o Coccyx – 1
= 31 pairs
• Increased ICP (intercranial pressure) 0.15 mmHg – Anything that happens inside it affects
the ICP.
o Results to the following when there is increased ICP:
§ Tumor (abnormal it grows faster, and it will create pressure inside by
compressing the brain against the skull.), encephali:s (infec;on of the
brain.), meningi:s (when there is infec;on in the cushion or CSF of the
brain; within the meninges there is subarachnoid space and within that
there is ventricles which is filled with CSF and CSF is clear, mataas sa
glucose 50-75 mg/dl and its main func;on is to feed the brain and spinal
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cord; brain produces 500ml of CSF every day; subdural another space in
the meninges contains veins.)
§ Hydrocephalus (accumula;on of the CSF caused by obstruc;on which is
why the head of the pt. increases in the size.), cerebral edema
(accumula;on of water) / inflamma:on (accumula;on of…)
Increased BP Ischemic – lack of Hemorrhagic – internal
perfusion or lack of blood bleeding
supply because of
occlusion. Types
1. Internal
2. External
Stroke – commonly Thrombo-embolic Ruptured aneurysm
seen in older paBent.

Two types:
1. Ischemic
2. Hemorrhagic
Impact Subdural Epidural
Hematoma – pinalo Veins Arteries
then bleeding occurs.

o Right hemiplegia – in which the paralysis is in the led side.

o Led hemiplegia – paralysis of the right side.
o Paralysis
§ Horizontal – spinal cord is affected.
§ VerBcal – brain is affected.
• Paraplegia – paralysis of the lumbar and 2 extremiBes
• Tetra- or quadriplegia – cervical and brain
o Mngt: assess the level of consciousness.
o Veins bleeding - Slow and less pressure bleeding
• Increased ICP à ALOC (altera;on of the level of consciousness) which is all involved in
the cerebrum.
o Restlessness (earliest signs and it means anxiety or “hindi mapakali”), confusion
(decreased comprehension), and disoriented (loss of sense of direc;on or cannot
process his/her environment; first disorienta;on is ;me à disorienta;on is place
à last disorienta;on of person “nagpa;bok ng puso”.)
o DLOC Lethargy (pa;ent shows signs of drowsiness) à coma (unconscious)
o Seizures (has faster transmission thus valium can be given which is a downer
medica;on) à coma (unconscious)
o Cushing’s triad
§ There is compression in the brainstem (midbrain, pons, and medulla
oblongata)
• AddiBonal
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o If there are seizures sBmulants is not given but can be given

valium
o Crushing triad is more dangerous than coma.
§ Increased BP, decrease HR, decreased RR à widening and pulse pressure.
• Note: If the blood pressure is increased and pulse pressure is
decreased, then it is increased ICP; DOC: mannitol
§ MB: decerebrate
• Plantar
• Flexion
§ Elbows–knees: extended.
§ Arms: adducted
§ Pronated flexed.
§ P: Cheyne stoke respiraBon – it is hyperven;la;on/hypoven;la;on with
periods of apnea.
§ M.Q: projecBle vomiBng (Valsalva maneuver) à brain stem herniaBon
(too much pressure the brain stem already leB the hole and went outside
the skull.)
§ PP: 30 – 40 mmHg
• 190 – 190
• 160 – 110
§ Always focus on the blood pressure not the heart rate.
• Increased ICP management
o Semi-fowlers (to promote venous return and prevent edema; because if high
fowlers there will be foramen magnum), O2, avoiding Valsalvas
o Cerebral edema
§ Mannitol – to prevent edema through IV.
• Osmitrol
• OsmoBc diureBcs
§ Check urine output if there is renal failure do not give mannitol.
o Cerebral inflamma:on
§ Dexamethasone
• Decadron
• “steroids”
• Taken with meals.
o IV Solu:on
§ Hypertonic – malapot
§ Hypotonic – malabnaw
§ Hyperosmolar – malapot which means concentrated.
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Neurologic system (DAY 2)

Mr. mike Chavez
• Seizures – abnormal transmission of impulses and cerebral cortex
o This is a sign not the disease.
o Stages/phases of seizures
§ Pre-ictal phase – aura or no aura
• Aura: warning sensaBon (alam na niya na mag se-seizure na siya) –
T2S2H (Touch, Taste, Sight, Smell, and Hearing) among these senses
is the most sensi;ve is hearing.
• Loss of consciousness
o Protect the head and neck of the paBent and assist the
client on a flat surface, by sliding into your body, with widen
base support.
o Turn to sides à slightly flex the neck to prevent aspira;on
and tongue bi;ng.
o Loosen constricBve clothing at the neck area.
o Clear the area.
§ In the hospital – ensure to remove the pillows; in the
street – slide against the wall.
§
• Priority is the safety of the paBent, next is airway
§ Intra-ictal phase – tonic and clonic phase
• Tonic-clonic – Tonic (s#ffness) and Clonic (jerky movements)
• Convulsion
• Priority: safety of the paBent
• Document observaBon – remember do not touch the pa;ent
because it can cause injury for both the nurse and pa;ent, avoid
restraint, just observe
o Dura:on (in the beginning and end of the a;ack): decreased oxygen
o Origin type: Led or Right
§ ParBal – only part of the brain is affected.
§ Grandmal – or known as the generalized type of
seizure, led and right are affected.
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§ Post-ictal phase – regain consciousness.

• Turn the paBent to the side and re-orient.
• You may allow the paBent to sleep ader the aDack as long as within
the normal duraBon of seizure aDack, unless severe.
• AnBconvulsants:
o Valium – seizure in the hospital; DRUG OF CHOICE!
§ Diazepam – minor tranquilizer
§ Benzodiazepine
§ AnxiolyBc – hypnoBc it is like a sleeping pill
especially for seizure pa;ent, sleep is very important
to lessen the a9ack
§ Muscle relaxant – sedaBve
§ Adverse: cardiopulmonary collapse
§ AnBdote: flumazenil it is also the an;dote of
benzodiazepine.
o Barbiturates – secondary if there is no valium in the
hospital.
o Dilan:n – seizures in the house.
§ Phenytoin – secondary best drug for seizure
§ S/E: gingival hyperplasia (gums swelling)
§ Oral hygiene: Sod bristled toothbrush
§ A/E: agranulocytosis: severe decreased WBC the
pa;ent is risk for infec;on, so, tell the pa;ent do not
go to any crowded places or eat raw foods.
§ Not to abruptly disconBnue à taper and status
epilep:cus
§ Therapeu:c level: 10-20mcg the doctor should
check if the pa;ent was able to reach the
therapeu;c level.
o Depakene – mixed type of seizures
o Tegretol – seizures associated with pain
o MgSO4 – seizures for pregnant paBent
• Epilepsy: chronic recurrent
o It is the disease.
o Usually don’t stay in the hospital and may go home but given with cauBon for
sudden seizures.
o Abacks: once a day, twice a week, it depends on the paBent.
o It can be acquired especially stairs injury.
o the only cure is O2 and valium only
• Status epilep:cus: acute conBnuous it is the most deadly and common cause of death
among pa;ent with neurology problem.
o It is the medical emergency.
o Sudden and conBnuous aDack and doesn’t stop which makes it deadly because the
longer the a9ack the longer less oxygen in the body, thus causes more damage.
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• Brain tolerance to hypoxia (less O2)

o C (cerebrum): 3-5 mins it will only cause 6 minutes to kill a pa;ent from hypoxia;
more than 6 minutes it results to comatose.
o BS (brain stem): 6-8 mins more than 8 minutes it will kill the pa;ent. More than 8
minutes brain stem and cerebrum are dead (both)
• Autoimmune disease
o DefecBve anBbodies
o Not contagious diseases
§ MS (mul7ple sclerosis) - CNS, permanent type and upper neurons are
affected such as the brain and spinal cord.
• Earliest sign: diplopia
§ GDS - PNS, temporarily type and respiratory spasBcity such as Ascending
respiratory paralysis or conBnuous relaxaBon.
• Earliest sign: ataxia
§ MG (myasthenia gravis) – descending respiratory paralysis; conBnuous
relaxaBon.
• Earliest sign: ptosis
o Mul:ple sclerosis (MS) – plaque/scar MRI this means many plaque occurs.
§ DemyelinaBon of CNS (affected is the myelin sheaths which helps fasten in
transmission of the impulses therefore, myelin sheath is destroyed.)
§ Female, 20-40 years old and living in white cold region.
§ Earliest sign: Diplopia – classic sign this is double vision and affects cranial
nerve II. Affects the sensory only.
• Mngt: patch the eyes alternaBvely, only choose patch both eyes
when the quesBon says ader the surgery of eye surgery.
§ Charcot’s triad it affects both sensory and motor.
• Scanning speech
• intenBonal tremors
• nystagmus (involuntarily jerking of the eyeball which is the affected nerve is the Cranial
nerve IV.)
§ P: respiratory spasBcity
§ DOC: Baclofen Lioresal – it is muscle relaxant and has anB-pain effect.
§ If there is Remission/exacerbaBon, follow the management:
• Avoid anything hot
• Avoid any long-term stress
• DayBme naps to lessen the spas;city.
• Stretching
§ DOC: interferons
• Avonex – maintenance
• cepaxone – to lessen relapse.
• IV methylprednisolone
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Summary of autoimmune diseases:

Myasthenia gravis Mul:ple sclerosis Guillain barre syndrome

Neuromuscular juncBon Central Nervous system Peripheral nervous system

Destruc;on of acetylcholine Demyelina;on of the CNS Demyelina;on of the PNS

receptors

E:ology: idiopathic E:ology: idiopathic E:ology: idiopathic

Risk factors: Risk factors:
1. Viral infecBon 1. Viral infecBon:
2. Female cytomegalovirus,
3. Hormonal factors Epstein barr virus,
campylobacter pylori
Decrease impulse transmission DemyelinaBon of the CNS à DemyelinaBon of the PNS
from the nerves to the skeletal decrease impulse transmission nerves
muscles à causes for muscle dysfuncBon.
weakness and paralysis. Earlier sign: ascending
First nerve affected usually is the paralysis, numbness of the
Earlier sign: ptosis op;c nerve. lower extremiBes or ataxia

Earlier sign: blurred vision

disturbances or diplopia
Diagnos:c tests: Diagnos:c tests: Diagnos:c tests
1. Tensilon test 1. CSF analysis 1. CSF analysis
2. CT scan/MRI for MRI 2. MRI
thymoma 3. Electromyography
(EMG)
4. Nerve conducBon test
(NCT)
Management Management Management
More on pallia;ve

1. Support respiratory 1. Provide safe and unhurried 1. Support respiratory

funcBon. environment. funcBon.
2. Prevent aspiraBon. 2. Assist in self-care. 2. Prevent aspiraBon.
3. Prevent complicaBon form 3. Prevent complicaBon. 3. Prevent complicaBons of
immobilizaBon. 4. Drug therapy – relief signs immobilizaBon
4. NutriBonal support and symptoms 4. Plasmapheresis
5. Surgery: thymectomy 5. IV – IG or immunoglobulin
6. Drug therapy: best management
anBcholinesterase drugs
a. NeosBgmine
b. PhysosBgmine
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c. PyridosBgmine
7. Monitor for overdose
(cholinergic crisis)
8. Monitor for underdose
(myasthenic crisis)