medical and surgical nursing lecture

7/28/2019 Medical and Surgical Nursing Lecture

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A lecture by:

Mr. Kim Derek Ramsey Octaviano


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Consists of two divisions

The Central Nervous System composed of the Brain

and the Spinal Cord The Peripheral Nervous System made up of the

cranial and spinal nerves

The Nervous System


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The function of the nervous system is to control allmotor, sensory, autonomic, cognitive and behavioral

activities. The peripheral nervous system can be further

divided into the somatic or voluntary and theautonomic or the involuntary nervous system.

The Nervous System


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The basic functional unit of the brain is the neuron

The neuron is composed of cell body, a dendrite and

an axon.

The dendrite is a branch-type structure withsynapses for receiving electrochemical charges

The axon is a long projection that carries impulses

away from the cell body

Anatomy of the nervous

system


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Neurotransmitters communicate messages form oneneuron to another or from a neuron to a specific

target tissue The action of a neurotransmitter is to potentiate,

terminate, or modulate a specific action and caneither excite or inhibit a cells activity.

Neurotransmitters


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Cerebrum the cerebrum consists of twohemispheres that are incompletely separated by the

great longitudinal fissure. The two hemispheres arejoined at the lower portion of the fissure by thecorpus callosum

The outside surface of the hemispheres has a

wrinkled appearance that is the result of manyfolded layers or convolutions called gyri, whichincrease the surface area of the brain.

Anatomy of the Brain


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Brainstem the brainstem consists of the Pons,midbrain and the Medulla Oblongata

The midbrain connects the pons and the cerebellumwith the cerebral hemispheres.

The Medulla Oblongata contains motor fibers fromthe brain to the spinal cord and sensory fibers from

the spinal cord to the brain.



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Cerebellum the cerebellum is separated from thecerebral hemispheres by a fold of dura mater, the

tentorium cerebelli. The cerebellum has both excitatory and inhibitory

actions and is largely responsible for coordination ofmovement.

It also controls fine movement, balance, positionsense and integration of sensory input.



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The cerebral hemispheres are divided into pairs offrontal, parietal, temporal and occipital lobes

Lobes of the cerebral

hemispheres


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The frontal lobe is the largest lobe.

The major functions of this lobe are concentration,

abstract thought, information storage or memoryand motor function. It also contains the Brocas Area,critical for motor control of speech.

The frontal lobe is also responsible in part for an

individuals affective judgment, personality andinhibitions

Frontal Lobe


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A predominantly sensory lobe.

The primary sensory cortex, which analyzes sensory

information, and relays the interpretation of thisinformation to the thalamus and other cortical areas,is located in the parietal lobe.

It is also essential to an individuals awareness in

space as well as orientation in space and spatialrelations.

Parietal Lobe


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Contains the auditory receptive areas.

Contains a vital area called the interpretative area

(wernickes area) that provides integration ofsomatization, visual and auditory areas and playsthe most dominant role of any cortex in cerebration

Temporal lobe


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The posterior lobe of the cerebral hemisphere isresponsible for visual interpretation.

Occipital Lobe


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The brain is contained in the rigid skull, whichprotects it from injury.

The major bones of the skull are the frontal,temporal, parietal and occipital bones.

Structures protecting the

brain


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The meninges, (fibrous connective tissues that coverthe brain and spinal cord) provide protection

support and nourishment to the brain and spinalcord.

The layers of the meninges are the dura, arachnoidand pia mater.

Structures protecting the

brain


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Dura Mater the outermost layer; covers the brain

and the spinal cord. It is tough, inelastic, fibrous and

gray.Arachnoid Mater the middle membrane; is an

extremely intricate membrane that resembles aspider web. Contains the plexus, which produces theCSF

Pia Mater the innermost membrane; a thin,transparent layer that hugs the brain closely andextends into every fold of the brains surface

Meninges


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There are 12 pairs of cranial nerves that emerge fromthe lower surface of the brain and pass through the

foramina in the skull Three are entirely sensory (I, II, VIII), five are motor,

(III, IV, VI, XI, XII) and four are mixed (V, VII, IX andX)

Cranial Nerves


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With eyes closed, the patient identifies familiar odors(coffee, tobacco)

Each nostril is tested separately

CN I Olfactory


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Snelle Eye chart, Snellen E

Visual Fields

Opthalmoscopic Examination

CN II Optic


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Test for ocular rotations, conjugate movements,nystagmus

Test for pupillary reflexes and inspect eyelids forptosis

CN III Oculomotor, CN IV

Trochlear, CN VI Abducens


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Have patient close eyes, touch cotton to forehead,

cheeks and jaw.

Sensitivity to superficial pain is tested by using thesharp and dull points of a broken tongue blade

While the patient looks up, lightly touch a wisp ofcotton against the temporal surfaces of the cornea. Ablink and tearing response are normal responses.

Have the client clench and move the jaw from side toside. Palpate the masseter and temporal muscle,noting strength and equality.

CN V Trigeminal


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Observe for symmetry while the patient performsfacial movements; smiles, whistles, elevates

eyebrows, frowns, tightly closes eyelids againstresistance

Observe face for flaccid paralysis

Patient extends tongue. Ability to discriminate sugar

and salt is tested.

CN VII Facial


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Whisper or watch-tick test

Test for lateralization

Test for air and bone conduction

CN VIII Acoustic


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Assess the patients ability to discriminate betweensugar and salt on posterior third of the tongue

CN IX Glossopharyngeal


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Depress a tongue blade on the posterior tongue, orstimulate posterior pharynx to elicit the gag reflex

Note any hoarseness in voiceHave patient say Aahhh. Observe for symmetric

rise of uvula and soft palate

CN X Vagus


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Palpate and note the strength of the trapeziusmuscles while the patient shrugs shoulders against

resistance Palpate and assess strength of each

sternocleidomastoid muscle as patient turns headagainst opposing pressure of the examiners hands

CN XI Spinal Accessory


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While the patient protrudes the tongue, anydeviation or tremors are noted.

The strength of the tongue is tested by having thepatient move the protruded tongue form side to sideagainst a tongue depressor.

CN XII Hypoglossal


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Neurologic Disorders


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Acute prolonged seizure activity

Is a series of generalized seizures that occur without

full recovery of consciousness between attacks There is some respiratory arrest at the height of each

seizure that produces cumulative effects.

Repeated episodes of cerebra anoxia and edema may

lead to irreversible and fatal brain damage

Status Epilepticus


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Nursing Management

The patient is turned to a side-lying position if

possible to assist in draining pharyngeal secretions During seizures, the patient should be protected form

injury using seizure precautions and monitored closel

Suction equipment must be available for risk ofaspiration

Status Epilepticus


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MS is an immune-mediated progressive myelinatingdisease of the CNS.

Demyelination refers to the structure of Myelin, thefatty and protein material that surrounds certainnerve fibers in the brain

Multiple Sclerosis


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Clinical Manifestations

Primary symptoms reported are fatigue, depression,

weakness, numbness, difficulty in coordination, loss ofbalance, and pain

Tremors while moving

Multiple Sclerosis


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Myasthenia Gravis is an autoimmune disorderaffecting the myoneural junction, is characterized by

varying degrees of weakness of the voluntarymuscles.

Myasthenia Gravis


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Pathophysiology

Myasthenia Gravis


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Clinical Manifestations

Voluntary muscle weakness that worsens with activity

Diplopia, ptosis, weakness of the facial muscles Laryngeal involvement produces dysphonia,(Voice

impairment

Tensilon test (Edrophonium Chloride test)

Myasthenic Crisis/ Cholinergic Crisis

Myasthenia Gravis


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GBS is an auto-immune attack for the peripheralnerve myelin

Segmental demyelination of peripheral nerves andsome cranial nerves,

An ascending report produces ascending weaknessknown as paresthesias

Guillain-Barre Syndrome


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Trigeminal neuralgia is a condition of the fifthcranial nerve characterized by paroxism of pain in

the area innervated by any of the three branches. Pain ends as abruptly as it starts and is described as

a unilateral shooting or stabbing pain

Trigeminal Neuralgia (Tic

Doloreux)


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Associated involuntary contraction of the facialmuscles can cause sudden closing of the eye or a

twitch of the mouth, hence the name tic doloreux(painful twitch)

Paroxysms can occur with any stimulation of theterminal affected nerve branches, such as washing

the face, shaving, brushing the teeth, eating anddrinking

Trigeminal Neuralgia (Tic

Doloreux)


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BellsPalsy


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Bells Palsy (Facial Paralysis) is due to unilateralinflammation of the seventh cranial nerve which

results in weakness or paralysis of the facial muscleson the affected side.

The cause is unknown, though possible causes mayinclude vascular ischemia, viral disease,

autoimmune disease or a combination of all thesefactors

Bells Palsy


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Corticosteroid therapy ma be prescribed to reduceinflammation and edema

Facial pain is controlled with analgesic agentsWhile the paralysis lasts, the involved eye must be

protected. Corneal irritation and ulceration mayoccur if the eye is unprotected.

Bells Palsy


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By: Kim Hotdog Abrenica


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The GI tract is a 23-26 foot-long pathway thatextends from the mouth through the esophagus,

stomach, intestines and to the anus.

Anatomy of the GI Tract


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Esophagus

The esophagus islocated in the

mediastinum in thethoracic cavity. Thiscollapsible tube, whichis about 25 cm inlength, passes throughthe diaphragm in anopening called thediaphragmatic hiatus


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Stomach

The stomach is situatedin the upper portion of

the abdomen to the leftof the midline. It is adistendable pouch witha capacity ofapproximately 1500ml


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The small intestine is the longest segment of the GItract accounting for about two-thirds of the total

length providing for about 7000cm of surface area forsecretion and absorption.

The small intestine can be divided into threeanatomic parts: the duodenum, the jejunum and the

ileum.

Small Intestine


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Large intestine (Colon)

The large intestineconsists of an ascending

segment on the rightside of the abdomen, atransverse segment thatextends right to left inthe upper abdomen,and a descendingsegment in the left sideof the abdomen.


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The terminal portion of the intestine consists of twoparts: the sigmoid colon and the rectum is

continuous with the anus.A network of striated muscles that forms both the

internal and external anal sphincters regulates theanal outlet.

Large Intestine (Colon)


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To break down food particles into the molecularform for digestion

To absorb into the bloodstream the small moleculesproduced by digestion

To eliminate undigested and unabsorbed foodstuffsand other waste products from the body.

Functions of the Digestive

System


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Excessive reflux may occur because of anincompetent lower esophageal sphincter, pyloric

stenosis or a motility disorder. The incidence ofreflux seems to increase with aging

Symptoms of GERD include pyrosis (burningsensation in the esophagus), dyspepsia (indigestion),

odynophagia (painful or difficulty in swallowing)hypersalivation and esophagitis

Gastro-Esophageal Reflux

Disease

G E h l


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The patient is instructed to eat a low-fat diet; toavoid caffeine, tobacco, beer, milk, foods containing

peppermint or spearmint and carbonated beverages To avoid eating two hours before bedtime, to

maintain an ideal body weight, to avoid tight-fittingclothes and to elevate the head of the bed on 6 to 8-

inch blocks

Gastro-Esophageal

Reflux Disease


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Gastrointestinal Intubation

GI intubation is theinsertion of a rubber or

plastic tube into thestomach, theduodenum, or theintestine. The tube maybe inserted through themouth, nose or theabdominal wall

G i i l


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GI intubation may be performed for the following

reasons

To decompress the stomach and remove gas or fluid To lavage the stomach and remove ingested toxins

To diagnose disorders of GI motility and otherdisorders

To administer medications and feeding

To treat an obstruction To compress a bleeding site

To aspirate gastric contents for analysis

Gastrointestinal

Intubation


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Gastric and Duodenal

UlcersA peptic ulcer is an


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medical and surgical nursing lecture

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