Quick review point for Nervous System

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•        1.Hypothalamus regulate (SAH-FEAST)
• Ø  S – Stress response
• Ø  A – autonomic response  include sympathetic & parasympathetic
• Ø  H – Hormone production
• Ø  F – Fluid balance
• Ø  E – Emotion
• Ø  A – Appetite
• Ø  S – SLEEP
• Ø  T – Temperature regulation
• ·       is a relay station of sensory impulse, provide pain gate , and is part of reticular activation  system(provide sense  about familiar things)
• ·       Pons contain respiratory center and regulate breathing (AD-PR – means   apneustic for depth, inspiration and pneumocystis for the rate )
• ·       Medulla oblongata contain all afferent and efferent tract of cardiac , respiratory , vomiting and vasomotor reflex center (sneezing coughing)
• ·       Cerebellum coordinate muscle movement   posture  , equilibrium , muscle tone.
• ·       Spinal cord contain horns (inner column of gray matter contain two anterior and two posterior horns. Posterior horns connect with afferent (sensory) nerve fibers, and anterior horns connect with efferent( motor) nerve fiber. (anterior part for MTP-means m- motor, T- temperature, P – pain & posterior part for PVT means – P- pressure, V – vibration, T – Touch sense)
• ·        Frontal lobe contain broca’s area for speech, and other is moral ,emotional reasoning, judgement,concentration.
• ·       Parietal lobe responsible for interpretation of test, pain, touch, temperature and pressure.
• ·       Temporal lobe for auditory, wernic’s area for sensory and speech.
• ·       Occipital for the vision area.
• ·       Limbic systiem for emotional patterns and visceral patterns of survival.
• ·       Cerebrospinal fluid normal volume is 120- 150 ml and pressure about 50 to 175mmh2o
• ·       Neurotransmitter (PASAND)
• Ø  P- POLYPEPTIDE
• Ø  A – ACETYLCHOLIN
• Ø  S – SEROTONIN
• Ø  A – AMINO ACID
• Ø  N – NPREPINEPHRIN
• Ø  D- DOPAMINE
• ·       Sypathetic( adrenergic ) fiber dilate the pupil,increase the heart rate and rhythm, contractblood vessels ,  and relax smooth muscle of bronchi.
• ·       Parasympathetic (cholinergic ) fiber produce opposite effect of sympathetic system.
• ·       Always check with the client about the possibility of pregnancy before any radiological procedure are done.
• ·       Asses the need to withhold metformin if iodinated contrast dye is used for a diagnostic procedure because of the risk for metformin induce lactic acidosis.
• ·       An MRI contraindicated in a pregnant women because the increase in amniotic fluid temperature that occurs during the procedure maybe harmful to the fetus .
• ·       Insertion of a spinal needle through the L3-L4 interspace  into lumber subarachnoid space to obtain CSF  ,puncture is contraindicate in increase intracranial pressure , sample taken in fetal attitude position   , c-shape lateral recumbent position, after  procedure flat position should be given.
• ·       Caloric testing ( oculovestibular reflex) it provide the information about the function of vestibular portion of 8^th cranial nerve and it aid the diagnosis of cerebellar and brain stem lesion, in which provide supine position to  patient and head elevated and inject hot or cold water in ear and heck for nystagmus( involuntary eye movement) remember TRIC  is  COWS ( Means  C- COLD WATER –OPPOSITE EYE NYSTAGMUS AND WARM WATER SAME EYE NYSTAGMUS),If test is positive nystagmus means no lesion.
• ·       Level of consciousness is the   most sensitive indicator of neurological status, it check by GLASSGO COMA SCALE.
• ·       Rhythmic, with period of apnea is called  Cheyne –stokes it indicate metabolic dysfunction in the cerebral hemisphere or basal ganglia
• ·       Regular rapid and deep sustained respiration is called neurogenic hyperventilatation . indicate a dysfunction in the low midbrain and middle pons.
• ·       Irregular respiration, with pauses at the end of inspiration and expiration is called apneustic ,indicate dysfunction in the meddle and caudal pons.
• ·       Cluster of breath with irregular spaced pauses called cluster respiration , indicate dysfunction in the medulla and pons
• ·       One dilated pupil indicate compressed cranial nerve 3^rd .
• ·       Bilateral dilated ,fixed pupils called ominus sign,indicate midbrain injury.
• ·       Pinpoint pupil indicate pons damage(pontine damage) and organophosphate poisoning.
• ·       Flexor( decorticate posturing) in which client flexes one or both arms on the chest and may extend the legs stiffly. It indicate nonfunctioning cortex.
• ·       Extensor ( decerebrate posturing ) client stiffly extended one or both arm and possible the legs. It indicate brainstem lesion.
• ·       Flaccid posturing – client display no motor response in any extremity.
• ·       Babinski reflex means dorsi flexion of the big toe and fanning of the other toe ,elicited by firmly stroking the lateral aspect of the sole of the foot.(is a pathological or abnormal reflex in anyone older than 2 year and represent the presence of central nervous system disease.
• ·       Blink reflex –involuntary closure of the eyelids in response to stimulation of the cornea ,it indicate dysfunction of cranial nerve –V
• ·       Gag reflex (contraction of pharyngeal muscle , elicited by touching the back of the throat ) loss of gag reflex indicate dysfunction of cranial nerve ix and x.
• ·       Involuntary flexion of the hip and knee when the neck is passively flexed indicate meningeal irritation  is called brudzinski sign.
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•  Kernig’s sing Loss of the ability of a supine client to straighten the knee and hip; indicate meningeal irritation.
• ·        In GCS score is based on a scale of 1-15 point a score lower than 8 indicate that coma is present
• ·       A score lower than 8 indicate that coma is present.
• ·       In GCS lowest possible score is 3 point means deep coma or death and highest possible score is 15 point means fully conscious and in GCS scale EVM is checked E – MEANS eye opening point  response maximum is 4,V – Verbal response  max. point is 5, M – MEANS  Motar  response max. point  is  6.
• ·       Altered level of consciousness, which is the most sensitive and earliest indication of increase ICP. Other widened pulse pressure , slow pulse , vomiting(fist sign in new born).
• ·       Late sings  of increase ICP include increase systolic blood pressure ,widening pulse pressure and slow heart.
• ·       Maintaining respiratory status( increase rate )  and prevent hypoxia ,maintain mechanical ventilation as prescribe maintain the PaCO2 at 30 to  35 mm hg will result in vasoconstriction of the cerebral blood vessels , decease blood flow ,and then decrease in IVP.
• ·       For the client with increase ICP elevate the head of the bed 30-40 degree , avoid the trendelenburg  position ,and prevent flexion of the neck and hip.
• ·       VP shunt use for the surgical intervention for ICP, and in which divert CSF  from the ventricles into the  peritoneum. After  procedure provide supine position and turn from the back to the non-operating side.
• ·       CONCUSSION – is a jarring of the brain with in the skull ,with no loss of consciousness.
• ·       CINTUSSION-  it is a bruishing type of injury to the brain tissue and it occur with other  neurological injury .sub dural and epidural hemotoma.
• ·       EPIDURAL HEMOTOMA – it form rapidly , result from arterial rupture.(meningeal artery) between dura and skull.it is a surgical emergency condition ,temporary loss of consciousness.
• ·       SUBDURAL HEMOTOMA  slow and result from venous blood.it occure under the dura.
• ·       CSF can be distinguished from other fluid by the presence of  concentric  ring (bloody fluid surrounding by yellowish stain , halo ring) when the fluid is place on a white sterile backgroung ,such as a gauze pad. CSF  also test positive for glucose when tested using a strip test.
• ·       In hematoma condition maintain patent airway because increase co2 level increase cerebral edema .give morphine sulphate if prescribe to decrease agitation and control restlessness caused by pain but it administer with caution because it cause respiratory depression.
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