CHAPTER 1

INTRODUCTION

1.1 Background
The nervous system includes all the neural tissue in the body. The nervous system coordinates
the activity of the mucles, monitors the organs, constructs and also stops input from the senses, and
initiates actions. Prominent participants in a nervous system include neurons and nerves, which play
roles in such coordination.our nervous tissue only consists of two types of cells. These cells are
neurons and neuroglia cells. The beurons are responsible for transmitting nerve impulses. Neuroglia
cells are responsible for supporting and nourishing the neuron cells.

The nervous system can be divided into the central and the pheripheral nervous
system. The central nervous system (CNS) consist of the brain and spinal cord. The brain has
several regions, which will be discussed later in this chapter. The pheripheral nervous system
(PNS) consist of nerves and ganglia, which lie outside the CNS.

Functions of the nervous system the nervous system is involved in some way in every
body functions. Some of the major functions of the nervous system are sensory input,
integration, homeostatic, mental activity, and control of skeletal muscles.

Some etiologies of nervous system are meningitis and migraine. Meningitis is an

inflammation of the membranes that cover the brain and spinal cord. It can be caused by a
number of infectious agents including viruses and bacteria.

1.2 Purpose

1) General Constructional Purpose

After this learning process of English in Nursing, students are expected to
understand about the anatomy and phisiology, types and clasification, etiology, and
clinical appearances of neurologic system.
2) Specific Constructional Purpose
After this learning process of English in Nursing, students are expected to
understanding the nursing process of neurologic system.
1.3 Benefit
1) Advancing knowledge and experience about neurologic system.

2) Adding more vocabularies and grammar.

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 CHAPTER 2
FUNDAMENTAL THEORIS

2.1 Anatomy and Physiology of Neurologic System

1. The Neuron
Neuron is the basic functional unit of the nervous system. Neurons are highly
specialized for the processing and transmission of cellular signals. Neurons are sometimes
called nerve cells, though this term is technically imprecise, as many neurons do not form
nerves. We have sensory neurons, interneurons, and motor neurons. In vertebrates, neurons
are found in the brain, the spinal cord, and in the nerves and ganglia of the peripheral nervous
system . Their main role is to process and transmit information. Neurons have excitable
membranes, which allow them to generate and propagate electrical impulses. Sensory neuron
takes nerve impulses or messages right from the sensory receptor and delivers it to the central
nervous system. A sensory receptor is a structure that can find any kind of change in its
surrounding.

Structure of a Neuron

Neurons have three different parts to them. They all have an axon, a cell body and
dendrites.

a) The axon is the part of the neuron that conducts nerve impulses. Axons can get to be
quite long. When an axon is present in nerves , it is called a nerve fiber. The axon
ternimal is a specialized structure at the end of the axon that is used to release
neurotransmitter chemicals and communicate with target neurons.
b) Soma (cell body) is the central part of the neuron. It contains the nucleus of the cell,
and therefore is where most protein synthesis occurs. The nucleus ranges from 3 to 8
micrometers in diameter. The cytoskeleton surrounding the nucleus called
perikaryon.

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 c) The dendrites are the short pieces that come off of the cell body that receive the
signals from sensory receptors and other neurons. The dendrites of a neuron are
cellular extensions with many branches, and metaphorically this overall shape and
structure is reffered to as a dendrite tree. This is where the majority of input to the
neuron occurs. However, information outflow can also occur. This explain one way
conduction of nerve impulse.

2. The Brain

The brain has four regions; the cerebrum, the dincephalon, the brainsteam, and the
cerebellum. The cerebral hemispheres contain the greatest mass of the brain tissue. Each hemisphere
is subdevided into frontal, parietal, temporal, and occipital lobes. The brain is a vast network of
interconnecting nervous (nerve cells). These consist of cell bodies and their axons-single long fibers
that conduct impulses to other parts of the nervous system.

The main section of the brain :

a. Frontal
b. Parietal
c. Occipital
d. Temporal

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 The brain is found in central cavity. Within it found the higher nerve centers
responsible for coordinating the sensory and motor system of the body (forebrain). The
brainstem houses the lower nerve centers (consisting of midbrain, pons, and medulla).

3. The Spinal Cord

The spinal cord is structurally and functionally integrated with the brain

The spinal cord is surrounded by three meninges and convey sensory and motor
information. The spinal cord consist of gray matter outer and the white matter inner.

The spinal cord extends from the foramen magnum at the base of the skull to the
second lumbar vertebra. The cord consist of a central gray part and a peripheral white part.
The gray matter, seen in cross section, is shaped like the letter H, with posterior (dorsal)
horns containing association neurons and cell processes of sensory neurons and anterior
(ventral) horns containing motor neurons. In the thoracic and upper lumbar regions, an
additional gray horn, the lateral horn, contains sympathetic autonomic motor neurons.
Ascending axon carrying action potentials to the brain or descending axon carrying action
potentials from the brain are grouped by function as nerve pathways, or nerve tracts, within
the white matter of the spinal cord.

4. Meninges

The nervous system is surrounding by a membrane called meninges. Meninges

divided into spinal meninges and cerebral meninges . The spinal meninges is a series of
specialized membranes surrounding the spinal cord and the cerebral meninges is a series of
specialized membranes surrounding the brain. Its provide the necessary physical stability and
shock absorpstion.

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2.2 Types and Classification
The nervous system is comprised of two major parts, or subdivisions: The Central
Nervous System (CNS) and the Peripheral Nervous System (PNS).
1. Central Nervous System (CNS)
The central nervous system (CNS) consist of the brain and the spinal cord. The CNS is
responsible for integrating, processing, and coordinating sensory data and motor commands.
It is conceived as a system devoted to information processing, where an appropriate motor
output is computed as a response to a sensory input.
A. Cerebrum
The cerebrum in the largest part of the brain. It is divided into left and right
hemispheres by a longitudinal fissure. The most conspicuous features on the
surface of each hemisphere are numerous folds called gyri , which greatly
increase the surface area of the cortex , and intervening grooves called sulci.
Each cerebral hemisphere is divided into lobes, named for the skull bones
overlying them. The frontal lobe is important in voluntary motor functions,
motivation, aggression, mood, and olfactory reception. The parietal lobe is
the principal center for the reception and evaluation of most sensory
information, such as touch, pain, temperature, balance, and taste. The occipital
lobe functions in the reception and integration of visual input and is not
distinctly separate from the other lobes. The temporal lobe evaluates olfactory
and auditory input and plays an important role in memory.
B. Cerebellum

Cerebellum means little brain. The cerebellar cortex is composed of gray

matter and has gyri and sulci, but the gyri are much smaller than those of the
cerebrum. Internally, the cerebellum consists of nuclei and nerve tracts. The
cerebellum is involved in balance, maintenance of muscle tone, and
coordination of fine motor movement. If the cerebellum is damaged, muscle
tone decreases, and fine motor movements become very clumsy. A major
function of the cerebellum is that of a comparator, at least with respect to its
role in muscle control. A sample the motor command from the cerebral cortex
to the skeletal muscles is relayed to the cerebellar cortex for evaluation.
Cerebellum is the part of the brain that is located posterior to the medulla
oblongata and pons. It coordinates skeletal muscles to produces smooth,

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 graceful motions. The cerebellum receives information from our eyes, ears,
muscles, and joints about what position our body is currently in. It also
receives output from the cerebral cortex about where these parts should be.
After processing this information, the cerebellum sends motor impulses from
the brainstem to the skeletal muscles. The main function of the cerebellum is
coordination. The cerebellum is also responsible for balance and posture. It is
also assists us when we are learning a new motor skill, such as playing a sport
or musical instrument.

C. Medulla
The medulla is the control center for respiratory, cardiovascular, and digestive
functions. The medulla oblongata is the most inferior portion of the brainstem
and is continuous with the spinal cord. In addition to ascending and
descending nerve tracts, the medulla oblongata contains discrete nuclei with
specific functions such as regulation of heart rate and blood vessel diameter,
breathing, swallowing, vomiting, coughing, sneezing, balance, and
coordination.
D. Pons

The pons houses the control centers for respiration and inhibitory functions.
Here it will interact with the cerebellum. Immediately superior to the medulla
oblongata is the pons. It contains ascending and descending nerve tracts, as
well as several nuclei. Some of the nuclei in the pons relay information
between the cerebrum and the cerebellum. The term pons means bridge, and it
describes both the structure and function of the pons. Not only is the pons a
functional bridge between the cerebrum and cerebellum, but on the anterior
surface, it resembles and arched footbridge.

2. Peripheral Nervous System (PNS)

The peripheral nervous system includes all the neural tissue outside the CNS. The PNS
delivers sensory information to the CNS and carries motor commands to peripheral tissues

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and systems. Nerves connected to the brain are called Cranial Nerves, and those attached to
the spinal cord are called Spinal Nerves.
A. Cranial Nerve

There are 12 cranial nerves, they are :

1. Olfactory nerve for smell
2. Optic nerve for vision
3. Oculomotor for looking around
4. Trochlear for moving eye
5. Trigeminal for feeling touch on face
6. Abducens to move eye muscles
7. Facial to smile, wink, and help us taste
8. Vestibulocochlear to help with balance, equilibrium, and hearing
9. Glossopharengeal for swallowing and gagging
10. Vagus for swallowing, talking, and parasympathetic actions of disgestion
11. Spinal accessory for shrugging shoulders
12. Hypoglossal for tongue more divided into different regions as muscles

There are two general categories of cranial nerve function:

a. Afferent (sensory)
Afferent division brings sensory information to the CNS from rceptors in
peripheral tissues and organs. The afferent (sensory) function can be devided
into the special senses such as vision and the more general senses such as
touch and pain the face.

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 b. Efferent (motor).
The efferent division carries motor command from the CNS to muscles,
glands, and adipose tissue . These target organs, which respond by doing
something are called effectors.
The motor function of the cranial nerves are further subdivided into :
1) Somatic Nervous System (SNS)
Somatic Nervous System controls skeletal muscle constractions. The SNS
divided into:
i. Voluntary contraction : under concious control
ii. Involuntary contraction : controlled at the subcosncious level outside the
awarness (reflex)

2) Autonomic Nervous System (ANS)

The Autonomic Nervous System provides automatic regulation of

smooth muscle, cardiac muscle, glandular secretions, and adipose tissue at the
subsconcious level. The ANS divided into :

i. Sympathetic division

Examples: accelerates the heart rate, increase the blood pressure

ii. Parasympathetic division

Commonly have antagonistic effects.

Examples : slows the heart rate, and decrease the blood pressure

Some cranial nerves are only sensory, and some are only somatic motor, whereas other
cranial nerves have more than one function. Cranial nerves with both afferent and efferent
function are called mixed nerves.

B. The spinal nerves

The spinal nerves take their origins from the spinal cord. They control the
functions of the rest of the body. Spinal nerves are categorized by the region of the vertebral
column from which they emerge – cervical (C), thoracic (T), Lumbar (L), Sacral (S), and

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coccygeal (Cx). In humans, there are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5
lumbar, 5 sacral, and 1 coccygeal. The naming convention for spinal nerves is to name it after
the vertebra immediately above it. Thus the fourth thoracic nerve originates just below the
fourth thoracic vertebrae. This convention breaks down in the cervical spine.

The first spinal nerve originates above the first cervical vertebra and called C1. This
continues down to the last cervical spinal nerve, C8. There are only 7 cervical vertebrae and 8
cervical spinal nerves. The spinal nerves arise along the spinal cord from the union of the
dorsal roots and ventral roots. All the spinal nerves are mixed nerves because they contain
both sensory and somatic motor neuron cell processes. Some spinal nerves are also
parasympathetic or sympathetic. Most of the spinal nerves exit the vertebral column between
adjacent vertebrae.

Functions of the nervous system

The nervous system is involved in some way in every body functions. Some of the major
functions of the nervous system are:

1. Sensory input
Sensory input is when the body gathers information or data by way of neurons, glia
and synapses. The nervous system is composed of excitable nerve cells to one

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 another, to centers throughout the body, or to other neurons. These neurons operate on
excitation or inhibition and although nerve cells can vary in size and location their
communication with one another determines and their function. These nerve conduct
impulses from sensory receptors to the brain and spinal cord.
2. Integration of data
The data is then processesd by way of integration of data, which occurs only in the
brain.
3. Motor Output
After the brain has processed the information, impulses are then conducted from the
brain and spinal cord to muscles and glands, which is called motor output.
4. Homeostasis. The nervous system plays an important role in the maintenance of
homestasis. This funcation depends on the ability of the nervous system to detect,
interpret, and response to changes in internal and exsternal conditions. The nervous
system can stimulate or in hibit the activities of other systems to help maintain
homeostasis.
5. Mental activity. The brain is the center of mental activitiy, including consciousness,
memory, and thinking.
6. Controls of skeletal muscles. Skeletal muscles normally contract only when
stimulated by the nervous system. Thus, through the contral of skeletal muscle, the
nervous system controls the major movements of the body.

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The Limbic System and Higher Mental

The limbic systems a complex set of structures found just beneath the cerebrum and on both
sides of the thalamus. It combines higher mental functions, and primitive emotion, into one
system. It s often reffered to as the emotional nervous system. It is not only responsible for
our emotional lives. The limbic system explains why somethings seem so pleasurable to us,
such as eating and why some medical conditions are caused by mental stress, such as high
blood pressure. There are two significant structures within the limbic system and several
smaller structures that are important as well. They are:

1. The Hippocampus
2. The amygdale
3. The Thalamus
4. The Hypothalamus
5. The Fornix and parahippocampus
6. The cingulated gyros

2.3 Etiology

The central nervous system, including the meninges, neural tissues and blood vessels,
may be directly affected by bacteria, viruses, fungi, protozoans, and rickettsiae. The CNS
may also be affected by toxin from bacterial infection. In general organisms enter the brain in
two ways: through the bloodstream by crossing th blood-brain barrier or by direct invasion
through a skull fracture or bullet hole. Very rarely, a CNS infection occurs as a result of
contamination of a surgical filled or lumbar puncture. The main CNS infection include
meningitis, encephalitis and brain abscesses.

The incidence of phatogenic infection of the CNS increases with the onset of AIDS.
Clients who are HIV positive may have CNS infection caused by toxoplasmosis,
cryptococcus, tuberculosis, herpes simplex, cytomegalovirus (CMV) or a polyomavirus
(resulting in progressive multifocal leucoencephalopathy).

Pathophisiology

When patogens enter the CNS and the meninges, an inflammatory process result. The
patology of CNS infection includes the invading patogens, the subsequent inflammation and
the increase in intracranial pressure that may result from the inflammatory processes. Both
the patogenic damage and the IICP may result in brain damage and life-threatening
complication.

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Meningitis

Meningitis is an inflammation of the pia mater, the arachnoid in the subarrachnoid

space. Inflammation space inflammation spreads rapidly throughout the CNS because of the
circulation of CSF arround the brain and spinal cord. Meningitis maybe acute or chronic, and
it maybe bacterial, viral, fungal or parasitic in origin. Meningococcal meningitis may occur in
epidemic among people who are in close contact with one another, such as members of the
armed forces and students living in residential college. Pneumococcal meningitis, in contrast,
primarily affects the very young and very old.

The organism responsible for meningitis must overcome nonspecific and specific host
defence mechanism to invade and replicate in the CSF . These defences include the skin
barrier, the blood-brain barrier, the non specific inflammatory response and the immune
response. Host response to the particular patogen is responsible for the manifestation of
clinical meningitis. Th organism that initiate the host response in meningitis demonstrate an
affinity for the nervou system. The colonism and invade the nasopharyngeal mucosa, survive
intravascularly and penetrate the CNS if the blood-brain barrier is damaged, as can happen
during surgery.

Infection of the CSF and meninges causes an inflammatory response in the pia,
arachnoid, and CSF. Because the meninges and subarachnoid space are continous around the
brain, spinal cord, and optic nerves, the infection and the inflammatory response are always
cerebrospinal, involving both the brain and the spinal cord. Inflammed the blood vessels in
the area leak fluids as cell permeability increases. Purulent exudate infiltrates cranial nerve
sheaths and blocks the choroid plexus and subarachnoid villi. IICP occurs as brain tissue
responds to the pathogen. With an increase in ICP, cerebral perfusion decreases and cerebral
autoregulation is lost.

1. Bacterial meningitis

The causative organism of bacterial meningitis include neisseria meningitis,

meningococcus, streptococcus pneumoniae, haemophilos influenzae and escherichia coli.
Risk factors include head trauma with a basal skull fracture, otitis media, mastoiditis,
sinusitis, neuro surgery, systemic sepsis or immunocompromise (porth, 2005). Even when
appropriate antibiotics are used, the mortality rate for adults remains at aproximately 25%.

Once the pathogen enters the central nervous system, it or its toxic products (free
radicals) initiate an inflammatory response in the meninges, CSF and ventricles. Meningeal
vessels become engorged and their permeability increases. Phagocytic white blood cells
migrate into the subarachnoid space, forming a purulent exudate that thickens and clouds the
CSF and interferes with its flow. Rapid exudate formation causes further inflammation and
oedema of meningeal cells. Blood vessels engorgement, exudate formation, impaired CSF
flow and cellular oedema cause the intracranial pressure to increase.

Clinical appearances

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The client with acterial meningitis typicallybprsents with fevr and chills, headache, back and
abdominal pain, and nausea and vomiting. (the older adult may not have a high fver, but
mayinstad exhibit confuision). Meningeal irritation causes nuchal rigidity (stiff neck) and
positive Brudzinski’s sign (flexion of the neck that causes the hip and kne to flex) and
positive Kerning’s sign (inability to extend the knee while th hip is flxed at a 90-degree
angle). Photophobia is present; the client may also experience diplopia. With meningococcal
meningitis, a rapidly spreading petechial rash involving the skin and mucous membranes may
b noted. The client may also have IICP, manifestated by decreased LOC, seizures, changes in
vital signs and respiratory pattern, and papilloedema. The manifestations of bacterial
meningitis are listed in the box below

Clinical appearances of bacterial meningitis

1. Restlssness, agitation and irritability
2. Severe headache
3. Signs of meningeal irritation:
a. Nuchal rigidity
b. positive Brudzinski’s sign
c. positive Kernig’s sign
4. Chills and high fever
5. confuision, altered LOC
6. photophobia (avrsion to light), diplopia
7. seizure
8. signs of increaseed ICP (widened pulse pressure and bradicardia, rspiratory
irregularly, decreased LOC, headach and vomiting)
9. petechial rash (in mningococcal meningitis)

2. Viral meningitis

Acute viral meningitis, also called aseptic meningitis is a less svere diseas than
bacterial meningitis. It can be caused by numerouse viruses, such as herpes simplex, herpes
zozter, epstein-barr virus or cytomegalo virus (CMV). Viral meningitis most often appears
after a case of mumps. Although viral infection also triggers the inflammatory respons, the
course of the disease is benign and of short duratioon. Recovery is uneventful.

Clinical appearances

The clinical appearances of viral meningitis are similar to those of bacterial

meningitis, although usually milder. The client may have a mild flu-like illness prior of the
onset of meningitis. Headache is intense and is a accompanied by malaise, nausea, vomiting
and lethaegy. Photophobia may be present. The client generally remains oriented, although
possibly drowsy. Temperature stiffness, positive Brudzski’s sign and positive Kernig’s sign
are usually present

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 BIBLIOGRHAPY

Bartholomew.2012.Fundamentals of anatomy & physiology (ninth edition).Pearson

education: Frederic H.Martini,inc.Judi L.Nath, LLC, and Edwin F.Bartholomew,Inc
Basavanthappa, BT. 2003. Medical-Surgical Nursing. New Delhi: EMCA House.
Salamon, Lisa. 2005. Pathophysiology: A 2-in-1 Reference for Nurses. United States of
America.

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