Rosanna Bucag

ANATOMY AND PHYSIOLOGY

Mental Status

1. Level of Alertness, Cooperation

2. Orientation
3. Memory e.g. recent and remote memory
4. Language
a. Comprehension
b. Naming Nervous System
c. Repetition
Rosanna Bucag
A. CENTRAL NERVOUS SYSTEM (CNS)
- It is the communication and coordination
system of the body.
- The brain is the seat of intellect and reasoning.
NERVOUS TISSUE
a. Neuroglia or Glial Cells
- insulate, support and protect the neurons.
- “nerve glue”
- do not carry nerve impulses.
- Types:
i. Astrocytes – transport nutrients to
neurons and restrict what substances
can enter the brain, forming the blood-
brain barrier.
ii. Microglia – remove cellular debris
iii. Oligodendrocytes – CNS structures that
wrap around the neuronal axons,
forming the myelin sheath.
iv. Schwann cells/ Lemmocytes – PNS
structures that wrap around the
neuronal axons to form the myelin
sheath.
b. Neurons
- Characteristics: irritability and conductivity
- Types:
i. Efferent neurons or motor neurons -
carry messages from the CNS to the
effectors.
ii. Associative neurons or interneurons –
carry impulses from the sensory
neurons to motor neurons.
iii. Afferent neuron or sensory neuron –
receive stimuli from receptor sites in
the sensory organs (skin, eyes, ears,
nose and taste buds)
 carry messages or impulses
toward the CNS.
SYNAPSE
- is where the messages go from one cell to the
next cell.
- Messages go from the axon of one cell to the
dendrite of another; they never touch.
- the space between them is the synaptic cleft.
- the conduction is accomplished through
neurotransmitters.
- Neurotransmitters are chemical substances
that make it possible for messages to cross the
synapse of a neuron to a target receptor.
Did you know? The human brain generates more
electrical impulses in one day than all the world’s
telephone put together.
BRAIN
- an intricate mass of soft nervous tissue.
- weighs about 1400 g (3 lbs) and consists of 100
billion neurons.
- protected by a bony cranial cavity.
- further protection is given by three (3)
membranous coverings called meninges, and
the cerebrospinal fluid.
- contains white and gray matter.
- Cerebral cortex, the gray matter, is the outer
cortex and considered the highest center of
reasoning and intellect.
- White matter- located in the deeper part of
the cerebral cortex, consists of myelinated
nerve tracts.
CLINICAL ALERT! Adequate oxygenated blood supply is
needed by the brain to prevent irreversible brain
Rosanna Bucag
damage. Without oxygen, brain damage will occur
within 1 to 8 minutes.
MEMORY
CEREBROSPINAL FLUID
- process of storing “old” information we have
learned and packaging and storing of new
information by the brain.
- According to scientists, the hippocampus of the
limbic system, acts like a receptionist, deciding
the significance of the event and determining
where in the brain the information should be
stored.
- Memory can be short-term or long-term
depending how much attention we given an
event, how many times we repeat an activity,
and the kinds of memory associations.
2. Subarachnoid space – is between the arachnoid
and pia mater, filled with cerebrospinal fluid,
produced within the ventricles of the brain.
- Acts as a liquid shock absorber and source of
nutrients for the brain.
- A substance formed inside the brain ventricles
from the blood vessels of the choroid plexus.
- Protects the delicate brain and the spinal cord.
- Also removes metabolic waste products from
the brain cells.
- Can be used for detecting selected brain
diseases.

Coverings of the Brain (Meninges)

a. Dura Mater
- Outer brain covering, which lines the inside of
the skull.
- A tough, dense membrane of fibrous connective
tissue containing an abundance of blood
vessels.
b. Arachnoid Mater
- the middle layer, resembling a fine cobweb with
fluid-filled spaces.
c. Pia Mater
- covers the brain surface itself, consisting of
blood vessels held together by fine areolar
connective tissue.

Spaces in between meninges:

1. Subdural space – is between the dura mater

and arachnoid mater.
Rosanna Bucag
Cerebrospinal Fluid (CSF) Circulation
BLOOD BRAIN BARRIER
Clinical Alert! Lumbar puncture/ Spinal tap is the
removal of cerebrospinal fluid for diagnostic purposes.
The needle is inserted into the L3- L4 of the vertebrae.
Clinical Alert! (cont.) Changes in composition of the fluid
withdrawn can be an indication of an injury, infection or
disease. Spinal tap also serves to alleviate the pressure
caused by meningitis, and especially hydrocephalus.
LUMBAR PUNCTURE/ LUMBAR TAP/ SPINAL TAP
- protects the brain by preventing some
substances, drugs and microorganisms from
crossing into the brain.
1) Cerebrum
- largest part of the brain
- covers the whole upper part of the skull
- divided into 2 sections called cerebral
hemispheres- by a deep groove known as
longitudinal fissure
- The cerebral cortex is the outermost layer of
the cerebrum.
- It is composed of gray matter formed into
raised convolutions/ ridges called gyri; the
deeper furrows or grooves are the fissures; the
shallow grooves between the gyri are call sulci.
Rosanna Bucag

a. Frontal Lobe
- Controls the voluntary motor activity
- Expressive (motor) speech- ability to speak
clearly (Broca’s area). Damage to the area
leaves the client unable to speak clearly
(Expressive aphasia), but the client still knows
and understands what to say.

The prefrontal areas control:

1. Concentration (attention over time)

2. Motivation
Left Hemisphere
3. Ability to formulate or select goals
- Language and logical operations
i. Number skills 4. Ability to plan (future planning)
ii. Written language 5. Ability to initiate, maintain and terminate
iii. Reasoning actions.
iv. Spoken language
v. Scientific skills 6. Ability to self-monitor
vi. Right- hand control 7. Ability to use feedback (executive functions)
Right Hemisphere 8. Reasoning, problem-solving activities,
- Emotions, artistic and spatial skills emotional stability
i. Insight 9. Development of personality
ii. Forms
iii. Art awareness b. Parietal Lobe
iv. Imagination - sensory perception (tactile sensations like
v. Music awareness temperature, touch, pain and pressure)
vi. Left- hand control - concept formation and abstraction
- spatial orientation and awareness of size and
Both RIGHT and LEFT hemispheres interpret sensory shapes (stereognosis) and body position
data, store memories, learn and form concepts. (proprioception)- right parietal lobe
- right – left orientation and mathematics – left
LOBES OF THE BRAIN
parietal lobe

c. Temporal Lobe
- auditory receptive area – ability to hear
Rosanna Bucag
- Auditory association areas – ability to store
spoken language memories (left temporal);
sound memories that are not language like
music, various animal sounds, other noises
(right temporal).
- damage to these areas leaves the client unable
to understand spoken or written language or to
recognize music or environmental sounds.
- Wernicke’s area facilitates understanding
speech & language. Damage may result to
receptive or auditory aphasia
d. Occipital Lobe
- visual (receptive) interpretation areas
- visual association areas – storage of visual
memories, contributes to the ability to visually
recognize & understand the environment.
- visual speech center enables a person to read.
Damage to this area leaves the client unable to
read (Alexia).
LIMBIC SYSTEM/LIMBIC LOBE
- located at the center of the brain beneath the
other four lobes.
- center for feelings and control of emotion
(fear, anger, pleasure and sorrow)
- influences unconscious and instinctive
behaviors that relate to survival
- The temporal lobe component of the limbic
system plays essential role in the interpretation
of smell
- Parts:
i. Olfactory bulb - explains why the sense
of smell is associated with emotions
(think of smells that recall happy
memories).
ii. Amygdala - influences behavior
appropriate to meet the body’s needs
and is associated with emotional
reactions especially fear, anxiety and
aggression.
iii. Hippocampus – involves in memory
and learning, recognizes new
information and recalls spatial
relationships.
iv. Parahippocampus – helps monitor
strong emotions like rage and fright
v. Fornix – pathway of nerve fibers from
hippocampus to mamillary body
vi. Mammilary body - nucleus that
transmits messages between the fornix
and the thalamus
vii. Cingulate gyrus – area that comprises
the limbic cortex, and modifies
behavior and emotion.
viii. Septum Pellucidum – connect the
fornix to the corpus callosum.
- The cerebral cortex also controls the conscious
thought, judgment, memory, reasoning and
will power. The high degree of development
makes the human the most intelligent of all the
animals.
2) Diencephalon
- located between the cerebrum and midbrain
- sits on top of the brain stem
- composed of the thalamus and hypothalamus
a. Thalamus
- acts as a relay station for incoming and
outgoing nerve impulses
- Receives and direct nerve impulses from the
various sense organs of the body (except the
olfactory sensations).
- also receive nerve impulses from the cerebral
cortex, cerebellum and other areas of the
brain.
- damage to the thalamus may result in
increased sensitivity to pain or total loss of
consciousness.
b. Hypothalamus
- lies below the thalamus
- a bundle of nerve fibers connects it to the
pituitary gland, thalamus and the midbrain.
- part of the limbic system and considered as
the brain of the brain.
- Functions:
i. Autonomic nervous control- regulated
SNS and PNS of the ANS
ii. Cardiovascular control – controls BP,
regulates vasoconstriction &
Rosanna Bucag
vasodilation of blood vessels and the
heart beat.
iii. Thermoregulation
iv. Appetite control – assist in regulating
the amount of food to ingest.
 the “feeding center” – found
in lateral hypothalamus is
stimulated by hunger “pangs”
which prompt a person to eat.
 the “satiety center” – found
in medial hypothalamus
becomes stimulated when a
person had eaten enough
v. Water balance- “thirst area”
vi. Manufacture of oxytocin
vii. Gastrointestinal control – increases
intestinal peristalsis and secretion from
intestinal glands
viii. Emotional state –
ix. Sleep control – helps keep us awake
when necessary
x. Mind over body experiences – involved
in patients who when diagnosed with
terminal illness, refuse to accept the
diagnosis and experience an
unexplainable cure.
3) Cerebellum
- composed of gray and white matter
- controls balance (equilibrium) and posture.
- controls voluntary (purposeful) motor
activities, muscle movements, and position of
body parts.
4) Brain Stem
- attaches to the spinal cord
- composed of midbrain, pons and medulla
oblongata
- Parts:
i. Pons – contains two (2) respiratory
centers that promote normal rhythm of
breathing.
 Apneustic center – prolongs
inhalation
 Pneumotaxic center –
contributes to exhalation
ii. Medulla Oblongata - a bulb- shaped
structure found between the pons and
the spinal cord containing various
nuclei for vital functions.
 Cardiac centers- regulate heart
rate
 Vasomotor centers- regulate
BP
 Respiratory centers- regulate
breathing
 Reflex centers- for coughing,
sneezing, swallowing and
vomiting.

iii. Midbrain
- integrates visual and auditory reflexes.
 If a person sees a wasp flying toward
him, he ducks or twists away (visual
reflex)
 Turning the head (hear) to a sound
(auditory reflex).
5) Reticular Formation
- assists in the regulation of skeletal motor
movement and spinal reflexes
- Filters incoming sensory information to the
cerebral cortex.
- Reticular- Activating System- controls the
sleep-wake cycle and consciousness
Rosanna Bucag
BLOOD SUPPLY TO THE BRAIN
- The brain receives 750 to 900 ml of blood flow
per minute.
- The vertebral arteries and the internal carotid
arteries provide the arterial supply to the
brain.
- The vertebral arteries join to form the basilar
artery. The basilar artery bifurcates to form 2
posterior cerebral arteries.
- The vertebral arteries supply the brain stem,
the cerebellum, the lower portion of the
diencephalon and the medial and inferior
regions of the temporal and occipital lobes.
- The interior carotid arteries bifurcate into the
anterior and middle cerebral arteries.
DISORDERS OF THE CENTRAL NERVOUS SYSTEM
Multiple Sclerosis
- autoimmune disorder that results to
destruction of myelin sheath of nerve fibers in
the brain and spinal cord
- characterized by remissions and exacerbations
- MRI of the brain and spinal cord shows MS
plaques
- Schwann cells of the myelin sheath are
destroyed resulting to distortion of nerve
impulses.
- Clinical manifestations:
 Eye manifestations- vision loss
 Paresthesia- due to cerebrum and
spinal cord involvement
 Ataxic gait due to cerebellar
involvement
 Bowel and bladder dysfunction- spinal
cord involvement
 Muscle fatigue- due to muscle
spasticity
 Charcot’s triad (Scanning speech,
Intentional tremors, Nystagmus)
FOCUS: The focus of treatment is on retaining
optimum functioning and limiting disability.
- Exacerbations may be aggravated by fatigue,
chilling and emotional stress.
- Collaborative management:
 Patch the eye alternately – for diplopia
 Provide well-balanced diet, fiber rich
food.
 Physical therapy- to improve muscle
strength and prevent contracture
 Avoid hot baths.
 Force fluids.
 Speech therapy
Rosanna Bucag
 Plasmapheresis. To inhibit autoimmune
response
- Pharmacotherapy:
 Glucocorticoids
Prednisone
Decadron (dexamethasone)
Corticotropin
 Muscle relaxants. To relieve muscle
spasm
Lioresal (baclofen)
Betaseron (reduces spasticity)
 Immunosuppresants. To reduce the 1. Confabulation- filling in memory gaps to
relapse of MS maintain self-esteem
Imuran (azathioprine) 2. Sundown syndrome- increase disorientation
Cytoxan (cyclophosphamide) and confusion in the late afternoon or early
evening
Alzheimer’s Disease 3. Perseveration phenomenon- repetitive
- a degenerative disorder of the cerebral cortex behaviors including pacing and echoing other
resulting from microscopic plaques words.
- characterized by impaired intellect and INTERVENTION:
progressive loss of ability to perform ADL
- loss of recent memory occurs first. Remote APHASIA- deterioration of language function
memory may remain intact for a long period of Observe for gestures, tone, and facial
time. expression
- Unknown cause but associated with Keep it short and simple
autoimmune disorders and heredity Symbols, signs and pictures are used
- Risk Factors:
 Age 65y/o and above APRAXIA- impaired motor function
 Gender- female
Simplify talk
 Brain injury
Step-by-step instructions
 Low level of education
AGNOSIA and ANOMIA- inability to recognize and
name objects

Name objects and demonstrate use

No to ingestible hazard

AMNESIA- inability to recall

Operate in the HERE and NOW

Orient – person, time and place

COLLABORATIVE MANAGEMENT:

1. Protect client from injury. The client has

tendency to wander around

 Provide close supervision

 Close and secure doors
 Use ID bracelets and electronic surveillance
SYMPTOMPS:
Rosanna Bucag
 Remove throw rugs, toxic substances and - These factors escalate behavioral dysfunction
dangerous electrical appliances
Take note:
 Reduce hot water heater temperature
 Orient client to the environment. STRUCTURE, SIMPLICITY, SUPPORT, SAFETY, SOCIAL
INTERACTION
2. Promote activity
Golden Rule:
 Provide exercise such as walking with an escort.
 Provide activities that distract and occupy time - Promote maximum functioning
such as listening to music, coloring and - Patience
watching television
 Provide mental stimulation with simple games Increased Intracranial Pressure
or activities. - Bulk of the brain consists of: brain tissues,
 Promote activities of daily living. blood supply and CSF
3. Promote sleep - ANY INCREASE IN THE BULK OF THE BRAIN may
result to increased ICP.
 Allow client to wander in a safe place until
he/she becomes tired.
 Prevent shadows in the room.
 Avoid the use of hypnotics- it causes confusion
and aggravate sundown effect.

4. Avoid agitation and violence

 Assess and remove the cause of agitation.

 Avoid scolding, embarrassing, arguing or
reasoning with the client.
 Approach the client slowly and calmly.
 Remove the client from a stressful
environment.

5. Minimize confusion and disorientation

 Call the client by name.

 Orient the client frequently.
 Ask one question at a time and give one
direction at time.
 Use familiar objects in the room.
 Place a calendar and a clock in a visible place.
 Provide structured activities (routine schedule)
 Reminiscence therapy (photos, videos, diary
and letters)
 Provide simple environment that requires less
decision making
 Allow time for the client to complete a task

6. Prevent fatigues by avoiding the ff:

 Change of routine
 Excessive demands
 Physical stressors
 Overwhelming situation
Rosanna Bucag

 Disorders that increase the bulk of the brain

COLLABORATIVE MANAGEMENT:
tissues are called space-occupying lesions:
cerebral tumor, abscess, edema (due to 1. Position: Semi-fowler’s, lateral position
infection or trauma). (15-30 degrees, maximum of 45 degrees.
 Factors that may increase the blood supply to To promote CSF drainage.
the brain are: cerebral hemorrhage, 2. Adequate oxygenation. Mechanical
thrombosis, embolism, aneurysm and ventilation promotes acid-base balance.
arteriovenous malformation 3. Safety. Prevent falls that may result to
 The factors that increase the bulk of CSF are altered LOC.
obstruction to the CSF flow caused by brain 4. Promote rest.
tumor or ventricular system defects 5. Avoid factors that may increase ICP.
(hydrocephalus), overproduction of CSF caused  Nausea and vomiting
by tumor in the choroid plexus.  Valsalva maneuver
 Increase ICP causes cerebral hypoxia.  Oversuctioning
 Restraints application
Note: Increase ICP is a medical emergency. The cerebral
 Rectal examination
cortex can tolerate hypoxia for 4-6 minutes. The
 Enema
medulla oblongata can tolerate hypoxia for 10-15
 Bending or stooping
minutes.
6. If coughing and sneezing cannot be avoided,
follow through with open mouth.
7. Control hypertension. Reduces cerebral
tissue perfusion.
8. Limit fluid intake to 1200 to 1500 mls/day
to reduce CSF production.
9. Pharmacotherapy
Mannitol- osmotic diuretic; reduces
cerebral edema by increasing urine
output
Check hourly urine output
(N= 30-60ml/hr)
Monitor for potential
hypotension.
Lasix (Furosemide)- diuretic;
reduces cerebral edema by
increasing urine output
Rosanna Bucag
Decadron (dexamethasone)- - Regain of consciousness is as rapid as it was
corticosteroids. The only lost; last for 10-20 seconds, occurs during
corticosteroids that can pass thru childhood or adolescence.
the BBB.
Anticonvulsants: valium (diazepam),
dilantin (phenytoin Na),
phenobarbital (Na luminal), tegretol
(carbamazepine)
Antacids. To prevent G.I. irritation.
H-2 receptor antagonists. To
prevent stress ulcer.
zantac (ranitidine)
Anticoagulants. To prevent
thromboembolism.

Seizures (convulsion)
Jacksonian seizures (focal seizures)
- sudden, excessive, disorderly electrical
- common among clients with organic brain
discharges of the neurons.
lesion like frontal lobe tumor. Aura is present
- the most common type of generalized seizure
like numbness, tingling, crawling feeling.
is the Grand Mal Seizure.
- characterized by tonic-clonic movements of
- Grand mal seizures are characterized by aura.
groups of muscles e.g. hands, foot or face then
Aura may be flashing lights, unusual smells,
it precedes to grand mal seizures.
spots before the eyes, dizziness.
- Tonic-clonic phase of grand mal seizures is
accompanied by dyspnea, drooling of saliva
and urinary incontinence.

- Post-ictal phase of grand mal seizures are

Psychomotor seizures
characterized by exhaustion, headache,
drowsiness, deep sleep of 1-2 hours and - aura (hallucinations or delusions) is present.
disorientation. - characterized by mental clouding (being out of
- Other types: Petit mal, Jacksonian, touch with the environment). The client
psychomotor and febrile seizures. appears intoxicated. During the time of loss of
consciousness, there are ongoing physical
Petit mal seizures (absence seizure or little sickness)
activities. It is manifested by confusion,
- not preceded by aura. There is little or no amnesia and need for sleep.
tonic-clonic movements. The is sudden - the client may commit violent or antisocial
cessation of ongoing physical activities. acts.
- characterized by blank facial expression and
Epilepsy
automatism like lip chewing, cheek-smacking.
Rosanna Bucag
- a group of clinical disorders characterized by
the repeated occurrence of any of the various
forms of seizures.
COLLABORATIVE MANAGEMENT:
1. Stay with the client
2. Protect the client from injury
o put up padded side rails
o if the client is sitting or standing, ease him
up onto the floor, protect the head with a
small pillow or place the head into the lap.
o NEVER apply restraints.
o NEVER insert tongue blade.
3. Promote patent airway.
o turn the client to the side
o loosen constrictive clothings especially
around the neck.
4. Make relevant observation and documentation.
5. Pharmacotherapy:
o Anticonvulsants – suppress the abnormal
electrical impulses from the seizure focus to
other cortical areas, thus preventing
seizures but not eliminating the cause of
seizures.
o Phenytoin (Dilantin)
- Side effects: anorexia, nausea and vomiting,
drowsiness, gingival hyperplasia,
hyperglycemia, bone marrow depression,
headache, alopecia, constipation, nystagmus,
sedation, hirsutism, slurred speech
Parkinson’s Disease (Paralysis Agitans)
- a degenerative disease that affects the
extrapyramidal system caused by decrease
dopamine production.
- Cause: unknown
- Precipitating factors: viral infections, drugs,
disequilibrium between dopamine and
acetylcholine, encephalitis, arteriosclerosis and
carbon monoxide poisoning.
- The initial sign is tremors (pill-rolling
tremors), to and fro tremors of the head.
- Resting tremors (non-intentional tremors),
which become sever when the client is not
performing physical activities.
- Rigidity- due to decreased dopamine
production.
- Cogwheel rigidity and absence of arm swing
when walking.
- bradykinesia- slow muscle movement
- akinesia- absence of muscle movement
- the characteristic gait is shuffling, festinating
gait. (Tiptoe walking, starting at a slow pace
which keeps on increasing until the client
assumes a running pace. The client is unable to
stop until obstruction is met.)
- In Parkinson’s disease, no intellectual
impairment, no paralysis, no loss of sensation.
- Other signs and symptoms:
 Flattened affect (mask-like facial
expression)
 Stooped posture
 Moist, oily sin (sticky skin)
 Emotional instability
 Fatigue
 Soft, monotonous voice (microphonia)
 Shaky, small handwriting
(micrographia)
COLLABORATIVE MANAGEMENT:
1.Thickened liquid diet to soft diet for dysphagia.
2.Firm bed to prevent contractures.
3.Aspiration precaution.
4.Increase fluid intake and fiber-rich food.
5.Pharmacotherapy:
 Anticholinergics- reduce rigidity and tremors
o Artane (trihexyphenidyl)
o Cogentin (benztropin)
o Akineton (biperiden)
o Kemadrin (procyclidine)
o Parsidol (ethopropazine)
 Dopaminergics- to improve muscle flexibility.
o Levodopa- precursor of dopamine
o Carbidopa with levodopa (sinemet)
Rosanna Bucag
Responsibilities as health care providers: - the main problem is DOB.

1. WOF the SIDE EFFECTS : N/V, dyskinesia, Clinical Manifestations:

orthostatic hypotension, cardiac dysrhythmias
1. Ascending or descending paralysis which may
and psychosis.
progress to respiratory muscle paralysis
2. Avoid certain drugs:
2. Tingling and numbness
 Phenothiazines, pyridoxine (Vit. B6) and
3. Cardiac dysrhythmias
reserpine. They block the levodopa effects.
4. Elevated protein level in the CSF
 Mono Amine Oxidase Inhibitors
5. Abnormal EEG
Pa-rnate (Tranylcypromine)
Na-rdil (Phenelzine) COLLABORATIVE MANAGEMENT:
Ma-rplan (Isocarboxacid)
Note: MAOIs + Carbidopa with levodopa = 1. Symptomatic and supportive
HYPERTENSIVE CRISIS 2. Monitor and promote respiratory function.
3. .Avoid the following foods when in Carbidopa- 3. Prevent complications of immobility.
Levodopa therapy. 4. Monitor cardiac status.
 Vit. B6 rich food- tuna, pork, dried bean,
salmon, beef and liver. They block the effects of
levodopa.
 Tyramine-rich foods- HYPERTENSIVE CRISIS
Cheese, Cream, Yogurt, Coffee, Chocolate,
Bananas, Raisins, Italian green beans, liver,
sausage, soy sauce, pickled herring, yeast, beer,
red wine
Note: These foods are proteins, aged, smoked
and fermented

B. PERIPHERAL NERVOUS SYSTEM (PNS)

Guillain- Barre Syndrom
- acute infectious neuritis of the cranial and
peripheral nerves.
- destruction of the myelin sheath due to
autoimmune disorder.
- It may follow swine flu vaccine.
- usually preceded by mild URI and
gastroenteritis.
- the recovery is slow process.
- consists of all the nerves that connect the brain
and the spinal cord with sensory receptors,
muscles and glands.
AFFERENT PNS/Sensory neurons
- convey information from the periphery of the
body to the brain and spinal cord
EFFERENT PNS/ Motor neurons
Rosanna Bucag
- convey information from the CNS to the
muscles and glands

NERVE
1) Cranial Nerve I
- bundles of nerve fibers enclosed by connective - Olfactory (smallest/ shortest CN)
tissue. - Smell
- If the nerve fibers carry impulses from the - Abnormal Findings: Anosmia(Absence Of Smell)
sense organs to the brain or spinal cord, it is
called a sensory nerve (afferent nerve).
- If the nerve fibers carry impulses from the
brain and spinal to muscles and glands, they
are called motor nerve (efferent nerve).
- If it both contains a sensory and motor fibers, it
is called a mixed nerve.

CRANIAL NERVES

- 12 pairs of cranial nerves that originate from

the brain and brain stem
- functions are mainly concerned with the
activities of the head and neck EXCEPT for the
CN X (vagus nerve).
- they can be classified according to sensory,
motor or mixed nerve as to their functions.

2) Cranial Nerve II
- Optic
- Vision
- Abnormal Findings: Papilledema, Blurred
vision, Scotoma, Blindness
Rosanna Bucag
3) Cranial Nerve III TRIGEMINAL NEURALGIA (tic douloureux)
- Oculomotor
- manifested by excruciating, recurrent
- Pupil constriction; Elevation of Upper lid
paroxysms of sharp, stabbing facial pain along
- Abnormal findings: Anisocoria, Pinpoint pupils,
the trigeminal nerve (lips, gums, nose and
Fixed, dilated pupils
cheek).
- pain aggravated by cold, washing the face,
chewing, hot and cold food and fluids, touch of
wind on the face.

COLLABORATIVE MANAGEMENT:

4) Cranial Nerve IV 1. Avoid hot or cold food and beverages.

- Trochlear 2. Provide liquid and soft foods.
- Eye movement; Controls, superior, oblique, 3. Chew the food on the UNAFFECTED side.
muscle 4. Pharmacotherapy
- Abnormal findings: Nystagmus  Elavil (amitriptiyline)
 Lioresal ( Baclofen)
 Tegretol (carbamazepine)
 Valium (diazepam)
 Dilantin (Phenytoin)

6) Cranial Nerve VI
- Abducens
- Eye movement; controls the lateral rectus
muscles
- Abnormal findings: Diplopia, Ptosis

5) Cranial Nerve V
- Trigeminal (largest CN)
- Controls muscles of mastication; Sensations for
the entire face and cornea
- Abnormal findings: Trigeminal neuralgia (tic
douloureux)

7) Cranial Nerve VII

- Facial
- Controls muscles for facial expression
- Anterior 2/3 of the tongue
- Abnormal findings: Bell’s Palsy, Anterior third
Ageusia

BELLS PALSY
Rosanna Bucag
- caused by a lower motor neuron lesion, - Abnormal findings: Loss of gag reflex; Ptyalism,
infection, trauma, hemorrhage, or meningitis of Dysphagia, Dysphonia, Posterior third ageusia
the CN VII.
- manifested by a paralysis of one side of the
face along with ptosis.
- the client is unable to raise the eyebrows,
frown, smile, close the eyelids, or puff out the
cheeks.

COLLABORATIVE MANAGEMENT:

1. Encourage facial exercises.

2. Protect the eyes from dryness and prevent
from injury.
3. Promote frequent oral care.
4. Chew on the unaffected side.
5. Pharmacotherapy
 Steroids
 Analgesics

8) Cranial Nerve VIII

- Acoustic a.k.a Vestibulocochlear
- Balance and hearing
- Abnormal findings: Tinnitus, Vertigo

10) Cranial Nerve X

- Vagus nerve
- Controls muscles of the throat; PNS stimulation
of thoracic & abdominal organs
- Abnormal findings: Loss of gag reflex; Ptyalism,
Dysphagia, Dysarthria, Bradycardia, Increased
HCI, secretion

9) Cranial Nerve IX
- Glossopharyngeal
- Controls muscles of the throat: Posterior 1/3 of
the tongue
Rosanna Bucag

12) Cranial Nerve XIII

- Hypoglossal
- Tongue Movement
- Abnormal findings: Tongue protrusion or
deviation of the tongue to one side of the
mouth

11) Cranial Nerve XI

- Spinal Accessory
- Functions: Controls sternocleido-mastoid
muscles and trapezius muscles
- Abnormal findings: Inability to rotate the head
and shoulder muscles
Rosanna Bucag
- The anterior, or ventral root- the motor root
and contains motor nerves only.
 conducts impulses from the spinal cord
to the periphery.
- There are 31 pairs of spinal nerves, and all are
mixed nerves.
- They are named according to the region and
level from which they emerge.
Cervical nerves – 8 pairs
Thoracic nerves – 12 pairs
Lumbar nerves – 5 pairs
Sacral nerves – 5 pairs
Coccygeal nerves – 1 pair

SPINAL NERVES

- originate at the spinal cord and connected to a

specific segment of the spinal cord.
- each pair of spinal nerves is connected to a
segment of the cord by two pairs of
attachments called roots.
- The posterior, or dorsal root- the sensory root
and contains sensory nerves only.
 conducts impulses from the periphery
to the spinal cord.
Rosanna Bucag
- Function: supplies motor movement to
shoulder, wrist and hand and receive messages
from these areas. Radial nerve stimulates the
wrist and hand. Impairment may result to wrist
drop.

SPINAL NERVE PLEXUS

I. Cervical Plexus
- Location: C1- C4 III. Lumbar Plexus
- Function: supply motor movement to - Location: T12, L1- L4
muscles of neck and shoulders and receives - Function: supplies motor
messages from these areas. Phrenic nerve movement to buttocks, anterior leg and thighs
stimulates the diaphragm. and receives messages from these areas.
Femoral nerve stimulates the hip and leg.

IV. Sacral Plexus

- Location: L4- L5, S1- S2
II. Brachial Plexus - Function: supplies motor movement to
- Location: C5- C8, T1 posterior leg and thighs and receives messages
from these areas. Sciatic nerve (largest spinal
nerve) passes through the gluteus maximus and
Rosanna Bucag
down the back of the thigh and leg. It extends alimentary canal, kidney, urinary bladder, and
the hip and flexes the knee. reproductive organs).
1. Sympathetic Nervous System (SNS)/
Anticholinergic/Adrenergic
- “flight or flight response”; catecholamines
2. Parasympathetic Nervous System (PNS)/
Cholinergic
- “rest and digest”/ “house-keeping” response;
acetylcholine

C. AUTONOMIC NERVOUS SYSTEM (ANS)

- includes nerves, and plexuses which carry
impulses to smooth muscles, secretory glands
and heart muscles.
- regulates activities of the visceral organs
(heart and blood vessels, respiratory organs,
High Impact Concepts:
Rosanna Bucag
SYMPATHETIC – “Everything is high and fast except GI
and GU.

PARASYMPATHETIC – “Everything is low and slow,

except GI and GU.”

Cholinergic (PS) or Adrenergic (S)

1. Restlessness -
2. Pupillary constriction -
3. Elevated BP -
4. Tachypnea -
5. Bradycardia -
6. Diarrhea -
7. Dilation of pupils -
8. Diaphoresis -
9. Hypoglycemia -
10. Increased gastric acid secretion -
11. Constipation -
12. Urinary frequency -
13. Hyperglycemia -
14. Increased salivation -
15. Hypotension -
16. Pallor -
17. thirst, dryness of mouth -
18. Urinary retention -
19. Increased salivation -
20. cold, clammy skin -