Introduction to the

Nervous System
Frengki apryanto,
S.Kep.,Ners.,M.Kep
Medical/Surgical Nursing: X

Learning Objectives

Name the two anatomic divisions of the nervous system.

Name the three parts of the brain.
List the four lobes of the cerebrum.
Give two functions of the spinal cord .
Name and describe the function of the two parts of the
autonomic nervous system.
Describe methods used to assess motor and sensory
function.
List six diagnostic procedures performed to detect
neurologic disorders.
Discus s the nursing management of the client
undergoing neurologic diagnostic testing

 The nervous system consists of the

brain, spinal cord, and peripheral
nerves. It is responsible for
coordinating body functions and
responding to changes in or stimuli
from the internal and external
environment.

ANATOMY AND PHYSIOLOGY

The nervous system is divided into
two anatomic divisions:
1. the central nervous system
(CNS)
2. and the peripheral nervous
system (PNS)

 The basic structure of the nervous

system is the nerve cell or neuron.
Neurons are either sensory or motor.
Sensory neurons transmit impulses
to the CNS; motor neurons transmit
impulses from the CNS

 A neuron is composed of a cell body,

a nucleus, and threadlike projections
or fibers called dendrites and
axons.
Dendrites conduct impulses to the
cell body and are called afferent
(to or toward) nerve fibers.

 An axon is a nerve fiber that projects

and conducts impulses away from
the cell body. It is therefore called an
efferent (away from) nerve fiber.
The axon usually is larger than the
dendrites.

 Neurons are separate units and not

directly connected to one another.
Impulses travel along neurons, moving
from one neuron to the next by means of
synapses, junctions between the axon of
one neuron to the dendrite of another.
Substances called neurotransmitters (or
neurohormones) accomplish the
transmission of an impulse from one
neuron to the next.
Neurotransmitters can either excite or
inhibit neurons.

 A fatty substance called myelin

covers some axons in the CNS and
PNS

FIGURE 1. A neuron, or nerve cell.

Central Nervous System

The CNS consists of the brain and
spinal cord.
Brain
The brain is divided into three parts:
the cerebrum, the cerebellum, and
the brain stem

 The cerebrum consists of two

hemispheres connected by the corpus
callosum, a band of white fibers that
acts as a bridge (penghubung) for
transmitting impulses between the left
and right hemispheres.
Each hemisphere has four lobes:
frontal, parietal, temporal, and occipital

FIGURE 2. Lateral view of the brain showing the four lobes. Shaded areas show
the regions of the cerebral cortex that are responsible for different functions.

 Motor tracts are pyramidal or

extrapyramidal.
The cerebellum, which is located
behind and below the cerebrum,
controls and coordinates muscle
movement.

 The brain stem consists of the

midbrain, pons, and medulla
oblongata.
The medulla contains vital centers
concerned with respiration,
heartbeat, and vasomotor activity
(the control of smooth muscle
activity in blood vessel walls).

 The brain is protected by the rigid bones of

the skull and is covered by three
membranes or meninges:
1. the duramater
2. the arachnoid
3. the pia mater

FIGURE 3. Frontal section of the top of the head showing the meninges of the
central nervous system (piamater, arachnoid, and duramater) and related
parts.

 Within the brain are four hollow

(lubang) structures called ventricles.
The ventricles manufacture and absorb
cerebrospinal fluid (CSF)
the CSF protects these structures and
helps maintain relatively constant
intracranial pressure .

FIGURE 4. Ventricles of the brain seen

from a lateral view.

 Spinal Cord
The spinal cord, which is covered by the
meninges, is a direct continuation of the
medulla and is surrounded and protected
by the vertebrae (or vertebral column).
The spinal cord ends between the first
and second lumbar vertebrae, where it
divides into smaller sections called the
cauda equina

 The spinal cord functions as a

passageway for ascending sensory
and descending motor neurons.
Its two main functions are to provide
centers for reflex action and to serve
as a pathway for impulses to and
from the brain.

FIGURE 5. Reflex arc showing the pathway of

impulses and cross-section of the spinal cord.
Numbers show the sequence of impulses through

Peripheral Nervous System

The PNS consists of all the sensory
and motor nerves outside the CNS.
The PNS includes the cranial, spinal,
and sympathetic and
parasympathetic nerves of the
autonomic nervous system.

Cranial Nerves
The 12 pairs of cranial nerves, identified by Roman
numerals, are as follows:
I: Olfactory nerve: sense of smell
II: Optic nerve: sight
III: Oculomotor nerve: contraction of iris and eye
muscles
IV: Trochlear nerve: eye movement
V: Trigeminal nerve: sensory nerve to face,
chewing
VI: Abducens nerve: eye movement

 VII: Facial nerve: facial expression, taste, secretions of

salivary and lacrimal glands
VIII: Vestibulocochlear (or auditory) nerve: hearing, balance
IX: Glossopharyngeal nerve: taste, sensory fibers of
pharynx and tongue, swallowing, secretions of parotid
gland
X: Vagus nerve: motor fibers to glands producing digestive
enzymes, heart rate, muscles of speech, gastrointestinal
motility, respiration, swallowing, coughing, vomiting reflex
XI: Accessory (or spinal accessory) nerve: head and
shoulder movement
XII: Hypoglossal nerve: movement of the tongue

Spinal Nerves
There are 31 pairs of spinal nerves: 8
cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal.

Autonomic Nervous System

The autonomic nervous system
consists of the sympathetic nervous
system and the parasympathetic
nervous system.

Sympathetic Nervous System

This division of the autonomic nervous
system regulates the expenditure
(penggunaan) of energy.
The neurotransmitters of the sympathetic
nervous system, collectively known as
catecholamines, are epinephrine,
norepinephrine, and dopamine.

 Parasympathetic Nervous
System
This division of the autonomic
nervous system works to conserve
body energy and is partly responsible
for slowing heart rate, digesting food,
and eliminating body wastes.

TABLE 1. Autonomic Effects of the Nervous

System

ASSESSMENT
A neurologic assessment is
performed to identify and locate
disorders of the nervous system.
The scope and extent of the
neurologic examination often depend
on the symptoms and the probable
or actual diagnosis.

Pharmacologic Considerations
The use of morphine, heroin, or
other narcotic or CNS depressants
shortly before a neurologic
examination affects the results of a
neurologic assessment because
these drugs decrease the level of
consciousness

History
A thorough history is essential. The nurse
explores all symptoms and asks questions to
clarify each symptom. The history must
include a record of trauma to the head or
body within the past 6 to 12 months, a drug
history, an allergy history, and a family
medical history.
The nurse observes the clients speech
pattern, mental status, intellectual
functioning, reasoning ability, and movement
or lack of movement of all extremities.

Gerontologic considerations
When taking the health history of an
older adult who has difficulty
remembering recent or past events,
symptoms, drug and medical history,
and other necessary facts, obtain or
confirm the information from a family
member or friend.

Physical Examination
The physical examination consists of
assessment of the cerebral, motor, and
sensory areas.
The nurse usually assesses intellectual
function and speech pattern during the
history by noting responses to questions.
Additional testing of intellectual function
includes asking various questions that
require mental tasks (see discussion of
Mini-Mental Status Examination)

 The nurse evaluates the clients body posture

and any abnormal position of the head, neck,
trunk, or extremities.
If head trauma has occurred, the nurse examines
the ears and nose for evidence of bleeding or
other drainage .
He or she carefully examines the head for
bleeding, swelling, or wounds.
The nurse does not move or manipulate the
clients head during this part of the assessment,
especially if there is a recent history of trauma

Cranial Nerves
The experienced examiner evaluates
all or some of the 12 cranial nerves.
(Table 2)

Motor Function
Assessment of motor function
includes muscle movement, size,
tone, strength, and coordination.
The nurse inspects large muscle
areas for evidence of atrophy and
assesses opposing muscles for
equality of size and strength

 Clients with impaired cerebral function

manifest abnormal posturing .
Decorticate posturing (decorticate
rigidity) is a position in which the arms
are flexed, fists are clenched, and the
legs are extended (7).
Decerebrate posturing (decerebrate
rigidity) is when the extremities are
stiff and rigid

FIGURE 7. Abnormal posture responseto stimuli: (A)

decorticate posturing,(B) decerebrate posturing. (C)
Flaccidity is when the client makes no motor
response to stimuli

TABLE 2. Cranial Nerve Assessment

Sensory Function
The nurse evaluates the extremities
for sensitivity to heat, cold, touch,
and pain.
He or she can use various objects
such as cotton balls, tubes filled with
hot or cold water, and sharp objects
(that do not pierce the skin) to check
sensation in the extremities.

Level of Consciousness
The following classification of LOC
applies to altered consciousness from
any cause.
Differentiating between each level
can be
difficult; some clients show
characteristics of two or more levels:

 Conscious: The client responds immediately, fully, and

appropriately to visual, auditory, and other stimulation.
Somnolent or lethargic: The client is drowsy or sleepy
at inappropriate times but can be aroused, only to fall
asleep again. Responses to questions and verbal
commands are delayed or inappropriate. Speech is
incoherent. Painful stimuli elicit a response.
Stuporous: The client is aroused only by vigorous and
continuous stimulation, usually by manipulation or
strong auditory or visual stimuli. Stimulation results in
one- or two-word answers or in motor activity or
purposeful behavior directed toward avoiding further
stimulation.

 Semicomatose : The client is unresponsive

except to superficial, relatively mild painful
stimuli to which the client makes some
purposeful motor response (movement) to
evade stimulation. Spontaneous motion is
uncommon, but the client may groan or mutter.
Comatose: The client responds only to very
painful stimuli by fragmentary, delayed reflex
withdrawal; in deeper stages, he or she loses
all responsiveness. There is no spontaneous
movement, and the respiratory rate is irregular.

Glasgow Coma Scale

Pupils
The size and equality of the pupils and
their reaction to light are an assessment of
the third cranial (oculomotor) nerve.
Pupil size (normal, pinpoint, dilated),
equality (equal, unequal in size), and
reaction to a bright light (normal, sluggish
(ngantuk), no reaction, fixed), are noted.
When the pupils are examined, any
abnormal movement or position of one or
both eyes is noted.

Neck
The neck is examined for stiffness or
abnormal position.
The presence of rigidity is checked by
moving the head and chin toward the
chest.
Do not perform this maneuver if a
head or neck injury is suspected
or known or trauma to any part of
the body is evident.

Vital Signs
The blood pressure, pulse and respiratory rates, and
temperature are closely monitored on all clients with
a potential or actual neurologic disorder.
The temperature often needs to be monitored every
hour because CNS disorders can affect the
temperature regulating ability of the hypothalamus.
A sudden increase or decrease in any of the vital
signs indicates a change in the neurologic status,
and the physician is notified immediately .

Diagnostic Tests
Imaging Procedures
Imaging procedures such as computed
tomograph y (CT), magnetic resona nce
imaging (MRI), positron emissio n
tomography (PET), and single-photon
emission compu ted tomography (SPECT)
are used in the diagnosis of neurologic
disorders.

MRI

Lumbar Puncture

FIGURE 9. (A) Positioning of the client for lumbar puncture. (B)

Insertion of the spinal needle into the subarachnoid space.

 Contrast Studies
Electroencephalogram (EEG)
Ect..

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