ne r vo us sys t e m ( sh o r t r e vie w ) · 1. d ur a m at t e r :- यहo ut er m os t layer...

Anil Kantiwal ( OM Nursing Academy )

Introduction :-

Nervous System यह शरीर क� सभी activities को control करता ह� और यह Other Systemक� तलुना �यादा तजेी से काय� करता ह� ।

Classification :-

Nervous System यह दो अ�य System से �मलकर बना होता ह� ।

1. Central Nervous System [ इसम� Brain एवं Spinal Cord शा�मल ह� ]

2. Peripheral Nervous System [ इसम� Cranial Nerve एवं Spinal Nerve शा�मल ह� ]

◆ Nervous System यह Nervous tissue से �मलकर बना होता ह� ।

Nervous Tissue

Neuron Neuroglia

Neuron :- यह Nervous System क� Structural & Functional Unit ह� ।

इसे Parenchyma of Nervous System, Basic Unit of Nervous System के नाम से भी जानते ह� ।

एक Neuron को Survive ( जी�वत ) रहने के �लए Oxygen एवं Glucose क� आव�यकता होती ह� ।

Part of Neuron :-

Cell Body ( Soma ) :- इसके Cytoplasm म�Nucleus, Nissels's granules, Lysosome &neurofibrills पाये जाते ह� ।

Dendrides :- Branched Process of Neuron

Axon :- longer process of Neuron & EachNeuron has only one Axon.

Synapse :- दो Neuron के बीच के Junction कोSynapse कहते ह� । AIIMS & PGI

Nervous System ( Short Review )

OM Nursing Academy

Anil Kantiwal


Synapse यह Impulse को एक Neuron से �सरे neuron म� Transmit करने का काम करता ह� ।

Neuroglia :- / Glial Cells

Neuroglia यह Nervous System क� supporting cells ह�, ये Nerve impulse को transmitनह� करती, इस कारण इनको Non-neural cells भी कहा जाता ह� ।

Neuroglia neuron से smaller होती ह� ले�कन सं�या म� Neuron से 10-15 गनुा �यादा होती ह� ।

Types of Neuroglia :-

1. Astrocytes :- ये Largest Neuroglia ह� जो Star ★ shape क� होती ह�

ये CNS म� पायी जाती ह�, ये BBB ( Blood Brain Barrier ) का �नमा�ण करती ह� ।

2. Microglia :- ये Smallest Neuroglia ह� जो CNS म� पाई जाती ह�

ये Phagocytic Action के �ारा Microorganism को destroy करने का काम करती ह� ।

Other Neuroglial cells - Oligodendrocyte , Swan Cells & satellite cells.

( Swan Cells यह PNS Peripheral Nervous System क� Major glial cells ह� । )

________________________________________________________________

Nervous System

CNS - Central Nervous systemMeninges :- Meninges यह CNS ( Brain and Spinal Cord ) क� covering का काम करती ह� ।

Meninges यह 3 Layer से �मलकर बनी होती ह� ।

1. Dura matter :- यह Outer most layer ह�

2. Arachnoid matter :- यह Middle layer है

3. Pia matter :- यह Inner most layer ह� यह एक Highly Vascular layer ह� ।

[ Subarachnoid Space - Space between Arachnoid matter and Pia matter.

CSF :- Cerebro Spinal Fluid

यह Clear, Transparent एवं colorless fluid ह� जो Brain के Ventricles, Spinal Cord &Brain के चार� ओर व Spinal क� Central canal म� पाया जाता ह� ।

CSF secreted by :- Choroid Plexus

CSF Volume :- 0.5 ml/�मनट ( Average 500-720 ml/day )


CSF Pressure - 10-15 cm H2O

Constant Amount of CSF :- 120 ml

Specific gravity :- 1.005

CSF म� Glucose क� Normal Value 42-60 mg/dl होती ह�, अगर Glucose कम �आ तो यहBacterial infection को show करगेा और अगर Glucose का level �यादा पाया गया तो यहDiabetes malitus को indicate करगेा ।

o CSF का Absorption Arachnoid villi �ारा होता ह� ।

o CSF का collection mostly lumber Puncture �ारा करते ह� Site - L3-L4 ( Child - L4-L5 ).

Brain :-

Weight of Brain :- 1300 - 1400 gm

Brain म� 100 billions neurons एवं 10-15 trillion neuroglia पायी जाती ह� ।

Part of Brain :- Three Part ( Fore Brain, Mid Brain & Hind Brain )

1. Fore Brain :-

Cerebrum :-

Cerebrum Brain का largest Part ह�, Cerebrum यह दो Cerebral hemisphere से बना होताह� जो आपस मे Carpus Callosum के �ारा जड़ेु होते ह� ।

Carpus callosum is the largest commisured fibre.

��येक Cerebral Hemisphere चार lobes म� बटंा होता ह� ।

1. Frontal lobe

2. Parietal lobe

3. Occipital Lobe

4. Temporal Lobe


Frontal Lobe :-

Motar Area :- Responsible For Control Motor Activity

Pre-Motor Area :- Responsible for Planning Just Prior to Motor Activity

Pre frontal Area :- Responsible for Thinking, Reasoning, Judgement एवंIntelligence

Broca's Area :- Motor Speech Area ( Expressive Speech )

Parietal Lobe :-

Somatosensory Area :- Responsible for Sense of Touch, Temperature, Pain &Pressure.

Gustatory Area :- Responsible for Taste

Temporal lobe :-

Olfactory Area :- Area of Smell

Acoustic Area :- Area of Hearing

Wernicke's Area :- Sensory Speech Area ( Comprehensive Speech )

Hippocampus Area :- Area of Memory

Occipital Lobe :-

Visual Area :- Area of Vision AIIMS 2017

Parieto-Temporalo-Occipiatal Area :- Responsible for Naming of Objects.

Note :- ��येक Cerebral Hemisphere यह opposite side of body को control करता ह� ( मतलबRight cerebral hemisphere यह left side body को control करगेा व Left Side CerebralHemisphere यह Right Side Body को Control करगेा । )

___________________

Basal Ganglia :-

यह Grey matter से बना होता ह� ( Relay Centre of Motor Activity ).

Responsible for Control complex movement.

Basal nuclei म� injury के कारण Parkinson's disease देखने को �मल सकती ह� ।

Thalamus :-

यह Sensory Activity का Relay Centre ह�, इसे Pain gate के नाम से भी जानते ह� ।


Hypothalamus :-

Hypothalamus यह Autonomic Nervous system को Control करता ह�

ईसके साथ यह Pitutary gland को भी control करता ह�

यह Sleep-Awake Cycle ( Circadian Rhythm ) को भी Adult म� control करता ह�, इस�लए इसेBiological Clock Organ भी कहते ह� ।

( ब�च� म� Circadian Rhythm को Pineal Gland Control करती ह� )

Hypothalamus यह Biological Needs ( Hunger, Thirst & Sex ) को भी Control करता ह�

इसके साथ यह Body Temperature को भी Control करता ह�

2. Mid Brain :- ( Mesencephalon )

Mid Brain यह Grey matter से बना होता ह�

Mid Brain म� Corpora Quadrigemina एवं Substantia Nigra पाये जाते ह�

यह Visual Reflex को भी Control करता ह� ।

यह Auditory Sense का Relay Center ह� ।

3. Hind Brain :- ( Rhombencephalon )

1. Pons :-

Pons म� Pneumotaxic एवं Apneustic centre पाये जाते ह� जो Respiration क� depth कोcontrol करते ह� ।

2. Medulla Oblongata :-

Cardiovascular Centre :-

o यह Heart के Force of Contraction एवं Heart Rate को control करता ह� ।

o यह Vasomotor centre का काम करता ह� �जससे Vasoconstriction & vasodilation कोcontrol करता ह� ।

Respiratory Centre :- यह Respiratory rate को Control करता ह�

Reflex Centre :- यह कई �कार के Reflexes को भी control करता ह�

eg :- Sneezing, Coughing & Vomiting.


3. Cerebellum :-

यह Brain का Second Largest Part ह�, इसम� भी 2 Cerebeller hemisphere पाये जाते ह� जोएक long strip से जड़ेु रहते ह� �जसको Vermis के नाम से जानते ह� ।

Cerebellum यह Posture balance एवं equilibrium को control करता ह� ।

Spinal Cord :-

Spinal Cord यह long Cylindrical Structural ह� जो Neural tube म� पाई जाती ह� ।

यह Foramen magnum ( Part of occipital bone ) से लेकर 1st

Lumber Vertebrae ( L1 ) तक फैली रहती ह� ।

Length - 45 cm

Diameter - 2-2.5 cm

Spinal Cord के end part से Nerve का एक ग�ुछा �नकलता ह� �जसेCauda Equina के नाम से जानते ह� ।

Reflex :- Unconscious ( involuntary ) response toward a Stimuli.

Reflex Arch को Spinal Cord Control करता ह� ।

o Receptor :- यह Stimulus को receive करते ह� और उसको Impulse म� convert कर देते ह�,इनको Biological Transducer के नाम से भी जानते ह� ।

Elements of Reflex Arch :-

Posterior Part of Spinal cord is related to Sensory Activity.

Anterior Part of Spinal cord is related to Motar Activity.


PNS ( Peripheral Nervous System )

PNS यह Cranial Nerve ( 12 Pair ) एवं Spinal Nerve ( 31 Pair ) से �मलकर बना होता ह� ।

Cranial Nerves are related to Brain and Spinal Nerves are related to Spinal Cord.

Cranial Nerves :- Number 12 Pairs

S.No Name of Cranial Nerve Description & Function Type of Nerve

1. Olfactory Nerve Smell Sensory Nerve

2. Optic Nerve Vision Sensory Nerve

3. Oculomotor Nerve Occulo ( Eye ) + Motar ( Movement )

यह Mid Brain से Arise होती ह� एवं कुछExtra Occular Muscles को Supply करतीह� ।

Superior Rectus

Inferior Rectus

Medial Rectus

Inferior Oblique

Levator Palpatrae ( WinkMuscle )

Function :- Movement of Eye Ball( Upward, Inward, Downward andUpward Outward. )

Motar Nerve

4. Trochlear Nerve Movement of Eye Ball ( OutwardDownward )

Motar Nerve

5. Trigeminal Nerve Largest Cranial Nerve

Dentist Nerve

1. Opthalmic Branch - Sensory

2. Maxillary Branch - Sensory

3. Mandibulary Branch - Mixed( Motar & Sensory )

Function - Mastication ( Chewing )

Mixed Nerve( Motar &Sensory )


6. Abdusence Nerve Lateral Rectus Muscle को Supply करतीह� जो Eyeball को Lateral ( Outward )movement करवाती है ।

Motor Nerve

7. Facial Nerve Sensory Function - Taste ( Anterior2/3 of tongue ).

Motar function - Facial Expression

Mixed Nerve

8. VestibulocochlearNerve

Vestibule - Balance & Equilibrium

Cochlear - Hearing

Sensory Nerve

9. GlossopharyngealNerve

Sensory function - Taste ( Posterior1/3 of Tongue ).

Motor Function - Swallowing

Mixed Nerve

10. Vagus Nerve • Longest Cranial Nerve

• Arise From Medulla oblongata andSupply ( Parasympathetic Supply ) toSalivary Gland, Esophagus, stomach,intestine, liver, Pancreas, transversecolon.

• trachea , Bronchi, Lungs, heart, BloodVessels, Kidney and Ureters.

Mixed Nerve

11. Accessory Nerve • Forcefully Respiration

• Movement Of Head and Shoulder.

Motar Nerve

12. Hypoglossal Nerve • Movement of Tongue

• Help in Speech.

Motar Nerve

● Bell's Palsy :- 7th Cranial Nerve ( Facial Nerve ) म� injury होने के कारण Face का एक भागParalysis हो जाता ह� ।

● Facial Palsy :- Face के दोन� Side म� Paralysis होने को Facial Palsy कहते ह� ।

• Dropping of Eye lids ( Ptosis ) यह 3rd Cranial Nerve Occulomotar का Disorder ह� ।

• Vagus Nerve Has Highest number of Branches. [ Longest Cranial Nerve ]

• Trigeminal Nerve :- Largest Cranial Nerve


• Nerve Which help in detect the Taste - Facial Nerve

• Trigeminal - Chewing ( Mastication )

• Hypoglossal - Tongue movement

Spinal Nerve :- ( 31 Pairs )

Cervical Nerves - 8 Pairs

Thoracic Nerves - 12 Pair

Lumber Nerves - 5 Pair

Sacrum Nerves - 5 Pair

Coccyx Nerve - 1 Pair

Plexus :- Network of Spinal Plexus.

Erb's Palsy / Paralysis :- Brachial Nerve ( C5-C6 ) म�Injury होना ।

इसे Waiter's Tip Position के नाम से भी जानते ह� ।

Klumke's Paralysis :- Brachial Plexus के lower trunk ( C8 - T1) म� Injury होना ।

Longest Nerve in human body is - Sciatic Nerve

Hemiplegia :- Paralysis of Half Body ( Right / Left )

Paraplegia :- Paralysis of Both lower limbs

Radial Nerve Paralysis को Honeymoon Palsy एवं Saturday Night Palsy के नाम से भीजानते ह� ।


Meningitis :- inflammation of Meninges ( 1st Meninges involves Piameter )

Most common cause of meningitis in Adult - Streptococcal Pneumoniae

Most common cause of meningitis in Children - Haemophilus Influenza

Children म� Hemophilus influenza meningitis म� Isolation ज�री ह� ।

Nisseria Meningitis or Meningococcal Meningitis यह Community Group म�common ह� तथा यह Droplet Infection से फैलता ह� ।

Most common viral meningitis in Adult - Herpes Simplex Virus - 1st

Most common viral meningitis in Children - Herpes Simplex Virus - 2nd

Fungle meningitis is caused by Cryptococcus Neoformans.

Sign Symptoms of Meningitis :-

Kerning sign

Brudzinski Sign

Nuchle Rigidity

Photophobia

Lumber Puncture is Confirmatory Test for Meningitis.

PCR for Viral Reaction + TB Meningitis

Cob - Wave Appearance in CSF indicates - Tuberculosis Meningitis

Q.1 A Major priority of nursing care of a child suspected of having meningitis is to be -

Ans - Isolate the Child immediately

Q.2 If is suspected that a patient has meningococcal meningitis and should therefore,be isolated -

Ans - Until his Culture are Negative

Encephalitis :- Inflammation of Brain Parenchyma.

● Arbovirus / Flavi Virus also known as West nile virus or St. Luis Virus Cause JapaneseEncephalitis.

Neurological Disorders


Stroke / Cerebrovascular Disease :- Brain क� Blood Supply म� Interruption के कारण BrainTissues क� Injury होना ।

Stroke is Second most common cause of death.

Coronary Artery disease is a First most common cause of death.

Ischaemic Stroke :- Brain Attack के नाम से भी जानते ह�, यह Brain को Blood Supply म�Interruption के कारण होता ह� ।

S/S :- Numbness & Weakness, Paralysis of Face, Extremities & Half of Body Part.

Surgical Management :- Endarterectomy - Removal of layer of Carotid Artery.

Ischaemic Stroke के Management म� Streptokinase Use म� लेते ह�, अगर Nurse �कसीPatient को Streptokinase दे रही ह� तो उसे Patient का Blood Pressure Regularmonitor करना चा�हये ।

Complication of Streptokinase is Bleeding .

Hemorrhagic Stroke :- इसे Brain Hemorrhage के नाम से भी जानते ह�, यह Brain क� BloodVessels के rupture होने के कारण होता ह� ।

S/S :- Exploding Headache & Fever

Surgical Management :- Clot Evacuation

TIA ( Transient Ischaemic Attack ) :- यह Stroke क� Precondition or Warning Sign ह�।

Stroke के Patient म� सबसे पहले MRI/CT Scan करवाते ह�, Investigations के बाद हीTreatment शु� करते ह� ।

Q.1 When Helping a Stroke Patient Nurse Should Assist the Patient on.....?

Ans :- on Weak Side

Q.2 Which of the priority nursing assessment in the first 24 hours after admission ofclient with Thrombolytic Cerebrovascular accident ?

Ans :- Pupil Size and Pupillary Response

Aphasia :- loss of Speech.

o Expressive Aphasia :- Known as Broka's Aphasia, इसम� Person बात तो करना चाहता ह�ले�कन कर नह� पाता ।

o Receptive Aphasia :- Known as Wernicke's Aphasia, Inability to ComprehensiveSpeech.

o Global Aphasia :- इसम� Expressive एवं Receptive दोन� Aphasia देखने को �मलते ह� ।


Myasthenia Gravis :- यह एक Autoimmune disease ह� �जसम� Acetylcholine Receptors के�खलाफ Antibody बनने लगती ह� जो Acetylcholine के Action को कम करता ह� �जससे Muscle क�Tone कम होने लगती ह� ।

It is a Disease of Neuromuscular Junction. AIIMS

Sign & Symptoms :- Ptosis ( Dropping of Eye lid ) , Diplopia, Dysphonia &Dyspnoea.

Test for Myasthenia Gravis is - Endrophonium Test / Tensilon Test

Drug of Choice for Myasthenia Gravis is - Neostigmine

Myasthenia Crisis :- यह एक Life threatening Condition ह� जो Myasthenia Gravis काComplication है जो M.G को Treat ना करने के कारण होता ह� ।

Multiple Sclerosis :- यह एक Autoimmune disease ह� �जसम� Myelin Sheath के againstAntibody बनने लगती ह� ( �जससे myelin Sheath damage होने लगती ह� । )

CNS म� Neuron का Demylination होना ।

Investigation -

MRI ( White Opacity in Ventricular System of Brain ).

Electrophoresis of CSF - Oligoclonal Band ( IgG ) देखने को �मल�गे ।

Management - Interferon

Guillain Bare Syndrome :- ( GBS ) यह भी एक Autoimmune disease ह� �जसम� PeripheralNerves क� Myelin Sheath के against Antibody बनने लगती ह� ( PNS म� )

इसे Infectious या Inflammatory Demylination के नाम से भी जानते ह� ।

Clinical Investigation :- NCT Nerve Conduction Test

Management :- D.O.C - IV IgG ( Intravenous Immunoglobulin Gamma )

Tic Doulorax / Trigeminal Neuralgia :-

Sensory Disorder of 5th Cranial Nerve Trigeminal, It's Result in Severe RecurrentSharp Pain during touch of Face, Lips and Scalp.

Management - Carbamazepine ( D.O.C )

Surgical Management - Microvascular Decompression

Rhizotomy - Surgical Resection of root of Nerve.


Parkinson's Disease :-

यह Second most degenerative brain disease ह� । ( First Most degenerative Braindisease is Alzheimer's disease ).

Parkinson's disease यह Progressive Brain Disease ह� जो Dopamine क� कमी के कारणहोती ह� �जसके प�रणाम�व�प Muscles Tone बढ़ जाती ह� �जसके कारण Patient म� Tremor,Rigidity और Other Postural changes देखने को �मलते ह� ।

Causes - Injury in Basal Nuclei ( Dopamine क� कमी )

Symptoms :-

Tremors :-

Resting Tremor Present

Pill Rolling Movement ( Movement of Thumb & Finger in Opposite Direction ).

Rigidity :-

Mask like Face

Micrographia ( Small Hand Writing )

Bradykinesia :- Slow body Movement due to Rigidity.

Postural Changes :- Shuffling Gait

Autonomic Symptoms :- Constipation, Hypotension & Drooling ( ExcessiveSalivation )

Investigation :- CT, MRI & Levodopa Test

Management :-

Levodopa :- यह Dopamine क� synthetic form ह� यह Dopamime क� Availability को बढ़ादेती ह� ।

_______________

Q.1. �या Reason ह� �क Direct Dopamine का use Parkinson disease म� �य� नह� करते ह� ?

Ans - �य��क Dopamine यह Blood Brain Barrier को Cross नह� कर पाता ह� ।

Q.2 वो कौनसी AntiParkinson drug है जो Hyperprolactinemia को treat करने के �लए काम मे लेते ह� ?

Ans :- Bromocriptine


Epilepsy :-

Epilepsy यह एक ऐसी Disease condition ह� �जसम� Seizures के बार-बार दौरे आते ह� ।

Seizures :- ये Brain के अंदर Sudden Abnormal Electrochemical discharge के कारणउ�प� होते ह� �जससे Consciousness, Behaviour, Motor function एवँ Perception म�Alteration देखने को �मलते ह� ।

Stages of Seizure :-

1. Aura :- First Stage of Tonic Clonic Seizure.

Feeling of Coming Seizures ( Restlessness & Bed Smell ).

2. Unconsciousness :- Unconsciousness Present

3. Tonic stage :- ( Duration :- 10 - 15 Seconds )

Tremors

Hand Clutch

Jaw Fix

4. Clonic Stage :- ( Duration :- 30 Seconds )

इसम� Altered Contraction एवं Relaxation देखने को �मलता ह� ।

Risk of Tongue Bite

5. Post Ictal Stage :- ( End Stage of Grandmal seizures )

Retrograde Amnesia

Confusion & Drooling

Investigation :- EEG ( Electro Encephalography )

Management :-

Phenytoin & Cabamazepine ( Use in All types Seizures except Patetmal Seizure ).

Sodium Volproate - D.O.C for all types of Seizures.

Role of Nurse During Seizures :-

1. Wait for Resolving Seizure

2. Provide medication if Prescribed

3. Maintain Patent Airway if Required


Increased Intracranial Pressure :- ( ICP )

Normal ICP is 5-15 mmHg, अगर ICP Normal Value से अ�धक हो जाये तो इसे IncreasedICP कहते ह� ।

First Symptom of Increased ICP is - Change in Level of Consciousness

Late Sign of ICP is - Cushing Triad ( Hypertension + Bradycardia + Bradypnea ).

Increased ICP म� कभी भी Lumber Puncture ना कर� �य��क इससे Brain Stem Herniationके chance रहते ह� ।

Cerebrum also known as "Seat of Intelligence".

Omnius Sign Seen in - Bilateral Dilated, Fixed Pupils

Pinpoint Pupils - Pons damage or drugs.

GCS Glasgow Coma Scale -

Score Below 8 Indicates Coma

Score 3 Points indicates - Deep Coma or Death

Concussion :- Slightly Brain Injury

Contusion :- Nervous tissue Destruction occurs.

Halo Sign Seen in CSF Leakage.

GBS Guillan Bare Syndrome is the Most Common cause of Acute FlaccidParalysis.

Meningiomas and Gliomas are the most common type of Primary Brain Tumours.

Cold Caloric Test यह Brain Stem के Function को assess करने के �लए करते ह� ।

Brain Stem = Medulla Oblongata + Pons + Mid Brain )

Ataxia - Uncoordinat Movement of Extremities.

Group of Cell body in CNS - Grey matter

Group of Cell body in PNS - Ganglia

Brain को Total Cardiac Output का 15% Blood जाता ह� ।

• Summery & Other Special Points of Neurology •


Brain म� Betz Cells Primary Motor Cortex म� पाई जाती ह� ।

Waiter's tip position :- Erb's Palsy

Nerve Injury Which leads to "Wrist Drops" is Radial Nerve.

Klumke's Palsy - C8 & T1 Injury

Fever, Headache & Nuchle Rigidity are Classic Symptoms of Meningitis.

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