MEDICAL- SURGICAL NURSING
MEDICAL- SURGICAL NURSING Nursing 424
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This 4 page Class Notes was uploaded by Robert Garrity on Friday February 5, 2016. The Class Notes belongs to Nursing 424 at University of South Carolina taught by in Winter 2016. Since its upload, it has received 44 views. For similar materials see Med surg 3 in Nursing and Health Sciences at University of South Carolina.
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Date Created: 02/05/16
MEDICAL SURGICAL Overview of the Structures & Functions of Nervous System Central NS PNS ANS Brain & spinal cord 31 spinal & cranial sympathetic NS Parasypathatic NS Somatic NS C 8 T 12 L 5 S 5 C 1 ANS (or adrenergic of parasympatholitic response) SNS involved in fight or aggression response Effects of SNS (anticholinergic/adrenergic) 1. Dilate pupil – to aware of surroundings Release of norepinephrine (adrenaline – cathecolamine) medriasis Adrenal medulla (potent vasoconstrictor) 2. Dry mouth Increases body activities VS = Increase 3. BP & HR= increased Except GIT – decrease GITmotility bronchioles dilated to take more oxygen 4. RR increased * Why GIT is not increased = GIT is not important! 5. Constipation & urinary retention Increase blood flow to skeletal muscles, brain & heart. I. Adrenergic Agents – Epinephrine (adrenaline) SE: SNS effect II. PNS: Beta adrenergic blocking agents (opposite of adrenergic agents) (all end in –‘lol’) Blocks release of norepinephrine. Decrease body activities except GIT (diarrhea) Ex. Propanolol, Metopanolol SE: B – broncho spasm (bronchoconstriction) E – elicits a decrease in myocardial contraction T – treats HPN A – AV conduction slows down Given to angina & MI – betablockers to rest heart Anti HPN agents: 1. Beta blockers (lol) 2. Ace inhibitors (pril) ex ENALAPRIL, CAPTOPRIL 3. Calcium antagonist ex CALCIBLOC or NEFEDIPINE Peripheral nervous system: cholinergic/ vagal or sympatholitic response Effect of PNS: (cholinergic) Involved in fly or withdrawal response 1. Meiosis – contraction of pupils Release of acetylcholine (ACTH) 2. Increase salivation Decrease all bodily activities except GIT (diarrhea) 3. BP & HR decreased 4. RR decrease – broncho constriction I Cholinergic agents 5. Diarrhea – increased GI motility ex 1. Mestinon 6. Urinary frequency Antidote – anti cholinergic agents Atropine Sulfate – S/E – SNS S/E of antihpn drugs: 1. orthostatic hpn 2. transient headache & dizziness. Mgt. Rise slowly. Assist in ambulation. CNS (brain & spinal cord) I. Cells – A. neurons Properties and characteristics a. Excitability – ability of neuron to be affected in external environment. b. Conductivity – ability of neuron to transmit a wave of excitation from one cell to another c. Permanent cells – once destroyed, cant regenerate (ex. heart, retina, brain, osteocytes) Regenerative capacity A. Labile – once destroyed cant regenerate Epidermal cells, GIT cells, resp (lung cells). GUT B. Stable – capable of regeneration BUT limited time only ex salivary gland, pancreas cells cell of liver, kidney cells C. Permanent cells – retina, brain, heart, osteocytes can’t regenerate. 3.) Neuroglia – attached to neurons. Supports neurons. Where brain tumors are found. Types: 1. Astrocyte 2. Oligodendria Astrocytoma – 90 – 95% brain tumor from astrocyte. Most brain tumors are found at astrocyte. Astrocyte – maintains integrity of blood brain barrier (BBB). BBB – semi permeable / selective Toxic substance that destroys astrocyte & destroy BBB. Toxins that can pass in BBB: 1. Ammonialiver cirrhosis. 2. 2. Carbon Monoxide – seizure & parkinsons. 3. 3. Bilirubin jaundice, hepatitis, kernicterus/hyperbilirubenia. 4. 4. Ketones –DM. OLIGODENDRIA – Produces myelin sheath – wraps around a neuron – acts as insulator facilitates rapid nerve impulse transmission. No myelin sheath – degenerates neurons Damage to myelin sheath – demyellenating disorders DEMYELLENATING DSE 1.)ALZHEIMER’S DISEASE – atrophy of brain tissue due to a deficiency of acetylcholine. S&Sx: A – amnesia – loss of memory A – apraxia – unable to determine function & purpose of object A – agnosia – unable to recognize familiar object A – aphasia – Expressive – brocca’s aphasia – unable to speak Receptive – wernickes aphasia – unable to understand spoken words Common to Alzheimer – receptive aphasia Drug of choice – ARICEPT (taken at bedtime) & COGNEX. Mgt: Supportive & palliative. Microglia – stationary cells, engulfs bacteria, engulfs cellular debris. II. Compositions of Cord & Spinal cord 80% brain mass 10% CSF 10% blood MONROE KELLY HYPOTHESIS: The skull is a closed vault. Any increase in one component will increase ICP. Normal ICP: 015mmHg Brain mass 1. Cerebrum – largest Connects R & L cerebral hemisphere Corpus collusum Rt cerebral hemisphere, Lt cerebral hemisphere Function: 1. Sensory 2. Motor 3. Integrative Lobes 1.) Frontal a. Controls motor activity b. Controls personality development c. Where primitive reflexes are inhibited d. Site of development of sense of umor e. Brocca’s area – speech center Damage expressive aphasia 2.) Temporal – a. Hearing b. Short term memory c. Wernickes area – gen interpretative or knowing Gnostic area Damage – receptive aphasia 3.) Parietal lobe – appreciation & discrimation of sensory imp Pain, touch, pressure, heat & cold 4.) Occipital vision 5.) Insula/island of reil/ Central lobe controls visceral fx Function: activities of internal organ 6.) Rhinencephalon/ Limbec Smell, libido, longterm memory Basal Ganglia – areas of gray matte located deep within a cerebral hemisphere Extra pyramidal tract Releases dopamine Controls gross voluntary unit Decrease dopamine – (Parkinson’s) pin rolling of extremities & Huntington’s Dse. Decrease acetylcholine – Myasthenia Gravis & Alzheimer’s Increased neurotransmitter = psychiatric disorder Increase dopamine – schizo Increase acetylcholine – bipolar MID BRAIN – relay station for sight & hearing Controls size & reaction of pupil 2 – 3 mm Controls hearing acuity CN 3 – 4 Isocoria – normal size (equal) Anisocoria – uneven size – damage to mid brain PERRLA – normal reaction DIENCEPHALON between brain Thalamus – acts as a relay station for sensation Hypothalamus – (thermoregulating center of temp, sleep & wakefulness, thirst, appetite/ satiety center, emotional responses, controls pituitary function. BRAIN STEM a. Pons – or pneumotaxic center – controls respiration Cranial 5 – 8 CNS MEDULLA OBLONGATA controls heart rate, respiratory rate, swallowing, vomiting, hiccups/ singutus Vasomotor center, spinal decuissation termination , CN 9, 10, 11, 12 CEREBELLUM – lesser brain Controls posture, gait, balance, equilibrium Cerebellar Tests: a.) R – Romberg’s test needs 2 RNs to assist Normal anatomical position 5 – 10 min (+) Romberg’s test – (+) ataxia or unsteady gait or drunken like movement with loss of balance. b.) Finger to nose test – (+) To FTNT – dymetria – inability to stop a movement at a desired point c.) Alternate pronation & supination Palm up & down . (+) To alternate pronation & supination or damage to cerebellum – dymentrium Composition of brain based on Monroe Kellie Hypothesis Skull is a closed container. Any alteration in 1 of 3 intracranial components = increase in ICP Normal ICP – 0 – 15 mmHg Foramen Magnum C1 – atlas C2 – axis (+) Projectile vomiting = increase ICP Observe for 24 48 hrs CSF – cushions the brain, shock absorber Obstruction of flow of CSF = increase ICP Hydrocephalus – posteriorly due to closure of posterior fontanel CVA – partial/ total obstruction of blood supply
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