1. ANATOMY AND PHYSIOLOGY OF THE
NERVOUS SYSTEM
 DR.FATMA ABBAS SALEM ( PHD IN MED.SURG.NG.)

2. ANATOMY AND PHYSIOLOGY OF THE
NERVOUS SYSTEM
 Nervous system

Central nervous peripheral nervous autonomlc nervous
 system system system


 brain spinal cord cranial spinal sympathetic parasympathetic
 nerves nerves
 12pairs 31pairs


 Cerebrum cerebellum brain stem
 All lobes
 1-frontal
 2-parital
 3-temporal
 4-occipital
 b- diencephalon
 1-thalamus
 2-hypothalamus

3. ANATOMY AND PHYSIOLOGY OF THE
NERVOUS SYSTEM

5. GENERAL FUNCTION OF THE
NERVOUS SYSTEM
 control & coordinates all parts of the body
 receives stimuli from the body’s interior and from
the external environment through the system.
 determines the body’s responses to these impulse –
messages-through the motor system.
 Contains the human higher functions e.g memory
,reasoning.

7. Assessment of the Nervous System
 Identification data.
 Neurologic history (health)
 Present condition, is the important aspect.
 Presence of pain and impairment (Assessment of pain).
 Seizures which manifest as an alteration in sensation, behavior,
movement, perception or consciousness it may be short as in blank stare
that lasts only a second or of longer aeration as a tonic – clonic ground
mal seizure that can last several minutes.
 Dizziness and vertigo: Dizziness is an abnormal sensation of imbalance
or movement but vertigo declined as an illusion of movement, usually
rotation
 Visual disturbances.
 Muscle weakness.
 Abnormal sensation.

8. Assessment of the Nervous System
 Past history.
Trauma (at birth of through life)
Pervious neurologic problems e.g.
Convulsions, headache etc.
 Family History: Hereditary Neurologic disorder.
 Examination:
 A neurologic assessment is divided into five
components: consciousness and cognition , Cranial
nerves, Motor system,
 Sensory system
 Reflexes

9. Assessment of the Nervous System
 Assessing consciousness and cognitive.
 Mental status
 It begins by observing the patient's
appearance and behavior, noting dress,
grooming, and personal hygiene. Posture
gestures, movements and facial expressions
often provide important information about the
patient.
 Assessing orientation to time, place, person.
 Assessment of immediate (recent) and remote
memory

10. Assessment of the Nervous System
 Intellectual function:
 A person with an average IQ can repeat seven digits
without faltering and recite five digits backward. The
examiner might ask the pt. to count backward from
100 or then 7 from that and so forth called serial 7s.
 Thought content
 During the interview, are the patient's though
spontaneous, natural, clear, relevant and coherent?

11. Assessment of the Nervous System
 Emotional status :
 Is the patient's effect (external manifestation of mood) natural
and even or irritable and angry, anxious, apathetic or flat or
euphoric?
 Does the patent unpredictably swing from joy to sadness during
the interview?
 Language ability
 The person can understand and communicate in spoken and
written language.
 Impact on lifestyle
 The nurse assesses the impact any impairment has on the
patient’s lifestyle , the patient’s role in society including family
and community role.

12. Assessment of the Nervous System
level of consciousness
To be assessed the examiner observes for alertness
and ability to follow commands.
a)Alert; disoriented ; drowsy ,stupor, comatose .
b) The examiner observes for eye opening, verbal
response and motor response to stimuli according to
glascoma scale.

13. Assessment of the Nervous System
2. examining the cranial nerves : is assessed when level
of consciousness is decreased.
3. examining the motor function:
a. motor ability including assessment of muscle
size and tone(spasticity. rigidity ,flaccidity)
b. muscle strength
c. Balance and coordination
- by having the patient perform rapid, alternating
movements and point to point testing.
- Gait & balance (cerebellar function).

14. Assessment of the Nervous System
 Examining the sensory system
It involves tests for tactile sensation superficial pain,
temperature, vibration and position sense
(proprioception).
Also disturbances in pain perception (paresthesia,
anesthesia, hyposthesia, hyperesthesia)

15. Assessment of the Nervous System
 Examining the reflexes
 Reflexes are involuntary contractions of muscles or muscle
groups in response to a stimulus.
 Reflexes are classified as deep tendon, superficial or
pathologic
 Deep tendon reflexes, examining the following.
 Biceps reflex.
 Triceps reflex
 Brachio radialis reflex
 Patellar reflex
 Achilles reflex
 Clonus.

16. Assessment of the Nervous System

17. Assessment of the Nervous System
b. Superficial reflex, including corneal, gag and plantar
reflexes and upper or lower abdominal .
c. Pathologic Reflex, are seen in the presence of
neurologic disease.
 A wall known pathologic reflex indicative of central
nervous system disease affecting the corticospinal
tract is the Babinski reflex, in which a person who has
central nervous system disease of the motor system,
the toes fan out and draw back.


18. Assessment of the Nervous System
 Assessment of signs of meningeal irritation
 Neck stiffness.
 Retracted head.
 Arched back
 Photophobia.
 Unusual sensitivity of skin and muscles.
 Pain if the leg is extended with the thigh flexed.
 With an attempts to flex the head involuntary
flexion of hip occurs associated with pain.

19. Assessment of the Nervous System
 Assessment of disorders behavior / throught
disturbance.
 Hallucination.
 Illusion.
 Delusional thinking.
 Delirious.

20. Assessment of the Nervous System
 Assess for associated observation.
 Respiratory pattern (hyperventilation).
 Pupillary signs.
 Ocular movements.
 Motor response: monoplegia, hemiplegia
 Assess vital signs.
 Assess associated symptoms e.g. nausea ,
vomiting .

21. Diagnostic evaluation
 Imaging procedure.
 Skull x-ray.
 Computed Tomography scanning uses a narrow x-ray
beam to scan body parts in successive layers.
 The images provide cross-sectional views of the
brain, distinguishing differences in tissue densities of
the skull, cortex sub cortical structures and
ventricles.
 Abnormalities of tissue density indicate possible
tumor mass brain infection, ventricular displacement.

22. CT SCAN
Preparation includes teaching the patient, about the need to lie
quietly throughout the procedure.
 A review of relaxation techniques may be helpful for patients with
claustrophobia. Sedation can be used if agitation, restlessness or
confusion interferes with a successful study.
 Ongoing patient monitoring during sedation is necessary.
 If a contrast agent is used, the patient must be assessed before
the CT scan for an iodine shellfish allergy, because the contrast
agent used may be iodine based. Renal function must be
evaluated. A suitable I.V. line for contrast injection and a period
of fasting usually 4 hrs are required prior to the study.

23. Magnetic Resonance Imaging
 uses a powerful magnetic field to obtain
images of different areas of the body. The
magnetic field causes the hydrogen nuclei
(protons) within the body to align like small
magnets in a magnetic field. In combination
with radiofrequency pulses, the protons emit
signals which are converted to images.

24. Magnetic Resonance Imaging

25. Magnetic Resonance Imaging
 It can provide information about the
chemical changes within cells, allowing to
monitor a tumor's response to treatment. It
is particular useful in the diagnosis of
brain tumor, stroke and multiple sclerosis.

26. OTHER DIAGNOSTIC STUDIES
Nerve conduction stuies.
Cerebral angiography.
 Single photon emission computed
tomography

27.  Nursing interventions.
 Patient preparation includes teaching and obtaining an
adequate history. Ferromagnetic substances in the body may
become dislodged by the magnet. The patient is questioned
about any implants of any metal objects (eg. Aneurysm clips,
orthopedic hardware, pacemakers, artificial heart values,
intrauterine devices ).
 These object could malfunction, be dislodged, or
heat up as they absorb energy.
 Allmetal objects and credit cards must be removed including
medication patches that have a metal backing and metallic
lead wired.

28. OTHER DIAGNOSTIC STUDIES
4. Positron Emission tomography
5-Electron encephalo – graphy.

29. ANALYSIS
 CSF
 Lumber puncture (Spin tap) is carried out by
inserting a needle into the lumber
subarachnoid space to withdraw CSF.
Purpose:
 To obtain CSF for examination
 To measure and reduce CSF pressure
 To determine the presence or absence of
blood in the CSF and WBC for infection .

30. CSF
 To administer medication intrathecally (into the
spinal canal)
Site:
 The needle is usually inserted into the
subarchnoid space between the third and
fourth or fourth and fifth lumbar vertebrae.

31. EEG

32. EEG

33. EEG