requirement for msc 1st yr a helping hand for dear all students

1. PSYCHODYNAMICS OF
DISEASES

7. STRESS

10.  internal stressors
 external stressors
 acute time limited-such as studying for final
examination
 chronic intermittent-such as daily hassles
 chronic enduring- that persist over time such as
chronic illness and disability.

11. AUTONOMIC NERVOUS SYSTEM
SYMPATHETIC NERVOUS SYSTEM PARASYMPATHETIC SYSTEM
FLIGHT FIGHT RESPONSE
INCREASED PULSE INCREASED PERISTALSIS
PERIPHERAL VASOCONSTRICTION INCREASED G.I SECRETION
INCREASED RESPIRATION DECREASED PULSE
DILATATION OF PUPILS FORMATION OF GLYOCOGEN
INCREASED BLOOD SUGAR
PHYSIOLOGICAL RESPONSE TO
STRESS

12. • health is dynamic process rather than something
static.
• the healthy person is reacting constantly to the
stimuli & adjusting to it
• In nursing there are balancing of various
factors:-
 biological
 psychological
 social
 cultural
 economic
EQUILIBRIUM THEORY

13. oBehaving in a realistic &
responsive manner to the world
around you
oCapable of experiencing a wide
range of feelings
oEntering into lasting & satisfying
human relationships
Four components of normal
psychological equilibrium

14. CELL
ORGAN
ORGAN SYSTEM
HUMAN
EXTERNA L
ENIRONMENT
TISSUE
Model of equilibrium

15. • It assist nurses to identify the stressors.
• It help the nurse to predict individual
response.
• Nurse can use this model to assist patient
in strengthening healthy coping & in
adjusting unhealthy response.
MODELS OF STRESSMODELS OF STRESS

16. Stress may considered as response.
 Acc. to Selye stress response is characterized by a
chain or pattern of physiological events called GAS.
The General Adaptation Syndrome (GAS) is
physiological response of the body towards stress.
It involves the autonomic nervous system
& the endocrine system
RESPONSE BASED
MODEL

17. Three stages of stress :-
 ALARM STAGE
 RESISTANCE STAGE
 EXHAUSTION STAGE

18.  increased mental
activity
Dilated pupils
Bronchiolar
dilatation
Increased respiratory
rate
Increased heart rate
Increased glucose
Increased cardiac

19.  CHARACTERSTICS
the response is localized. it
does not involve entire body
the response is adaptive
the response is short term
the response is restorative

20.  this response is a localized response
of the CNS to pain. it is an adaptive
response and protects tissues from
further damage . the response involves
a sensory, motor response.
Example:- reflex removal of hand
from a hot surface

21. SECOND PHASE
INFLAMMATORY RESPONSE
FIRST PHASE THIRD PHASE
Injury site
Narrowing of
blood vessels
histamine
WBCs
Combat infect
Wound
Exudates
Cut or surgically
incised
Regeneration
Damaged tissues
Scar formation
Healing

22. MENTAL STATE
Inability to concentrate
 Poor judgment
 Racing thoughts
 Moodiness
 Agitation
 Irritability
 Loneliness
INDICATORS OF STRESSINDICATORS OF STRESS

23.  Constant worrying
 Negativity
 Restlessness
 Quick temper
 Sense of being overwhelmed
 Unhappiness
 Fearful
 Anxiousness
 Indecisiveness
 Inability to relax
 Feeling on edge
INdIcATorS coNTd….

24. Physical & behavioral
indicators
Headache
Muscle tension
Nausea
Insomnia
Acne breakout
Diarrhea
Loss of sex derive
Frequently being sick
Dizziness
Weight gain

25. Change in appetite
Neglect
Drug use
Nail biting
Excessive spending
Tooth grinding
Excessive exercise
Overreaction
Sleeping to much or little
Starting fight
INdIcATorS coNTd….

26. MANAGEMENTMANAGEMENT
 Improving
Psychological response
 Improving
developmental response
 Improving intellectual
response
 Promoting healthy life
style
 Teaching relaxation
techniques
 Family factors
 Enhancing social
support

27. • It is also referred to coping mechanism
• The most imp nursing intervention is to
enhance the coping mechanism of the
disease person
• Mc closkey & bulecheck(1999) identifies
“ coping enhancement” as a nursing
intervention and defined it as “assisting
a patient to adapt to perceive stressors,
changes or threats that interfere with
PSYCHOLOGICAL RESPONSE

28. Trying to be optimistic about the
outcome
Using social support
Using spiritual resources
Trying to accept the situation
Trying to maintain control over
the feelings
ACC TO NURSING RESEARCH (JALOWIEC
1993)

29. Psychological response contd
……….
Psychological response
Constructive Destructive

30. Psychological response contd ……
COPING STRATEGIES
Problem
focused
Emotion focused Long term Short term

31. • Prolonged stress can affect the
developmental tasks.
• It can also lead to maturational
crisis.
• If the parent prevent young
child from developing a sense of
autonomy the child may
experience stress.
DEVELOPMENTAL RESPONSEDEVELOPMENTAL RESPONSE

32. • Stress effect the short term
memory.
• A person ability to acquire new
knowledge or skills may also be
impaired.
• The client is unable to learn
INTELLECTUAL
RESPONSE

33. • Regular exercise
• Adequate rest
• Nutrition diet
• Positive lifestyle
• Stop smoking, alcohol
• Time management
• Meditation
PROMOTING
HEALTHY LIFESTYLE

34. TEACHING RELAXATION TECHNIQUETEACHING RELAXATION TECHNIQUE
 Quiet
environment
Comfortable
position
Passive attitude


35. • Breathing exercises
• Massage
• Imagery
• Yoga
• Meditation
• Therapeutic touch
• Music therapy
• Laughter therapy
TYPES OF RELAXATION
THERAPY

36. • Lowered B.P
• Lowered heart rate
• Dec cardiac dysrhythmia
• Dec oxygen consumption
• Dec muscle tension
• Lowered metabolic rate
• Improved concentration
• Improved ability to
cope with stress
CHANGES RESULTING FROM
RELAXATION

37. Do the assessment of
the family .
Major life events should
be
explored.
Family coping strategies.
 Encourage the family
members to stay with
pt.
FAMILY FACTORS

38. • Individual personality involves a
complex relationship among many
factors.
• The emotional issues determined by
examine the client’s current lifestyle,
stressors, prior experience with
stressors, past successful coping
mechanism
EMOTIONAL BEHAVIORAL
ISSUES

39. • Kozier & Erb’s, fundamental of nursing; 8th
edition; 1067:71.
• Joyce M black, Medical surgical nursing; 5th
edition; 21:25
• Potter & Perry, Fundamental of nursing; 5th
edition; 645:55
• Brunner & Suddarth , Medical surgical nursing;
10th
edition; 80:96
• Donald & smelter, psychiatry essential for
clinical practice,1983 edition; 2:3
• Nightingale nursing times ,Vol I,issue-8, Nov
2005; 27
• Prism nursing practice, journal of clinical Nsg
`education,vol-II,no-2 Oct 07; 155:60
• The journal of Nursing,Vol I, no I, march 2005;
1:6
References

42. PHYSICAL RESPONSE TO
STRESS
According to Hans Selye’s GeneralAccording to Hans Selye’s General
Adaptation Model, the body reactsAdaptation Model, the body reacts
to stress in the stages depictedto stress in the stages depicted
belowbelow..
FUNDAMENTALS
OF
PATHOPHYSIOLOG
Y

43. PHYSICAL OR PSYCHOLOGICAL STRESSOR
ALARM REACTION (FIGHT-OR-FLIGHT RESPONSE)
* Arousal of the central nervous system begins.
* Epinephrine and norepinephrine, along with other hormones, are released,
causing an increase in heart rate, force of heart contractions, oxygen
intake, and mental activity.
RESISTANCE
* The body responds to the stressor and attempts to return to homeostasis.
* Coping mechanisms come into play.
RECOVERY
* If stress ceases, the body should return to a normal state,
leading to recovery.
EXHAUSTION
* The body can no longer produce hormones as it did in the alarm stage.
* Organ damage begins.

44. KEY FACTS ABOUT THE HEMATOLOGICKEY FACTS ABOUT THE HEMATOLOGIC
SYSTEMSYSTEM
 Blood is a major body tissueBlood is a major body tissue
 Plasma factors and platelets control clottingPlasma factors and platelets control clotting
 Erythrocytes carry oxygen; remove carbon dioxideErythrocytes carry oxygen; remove carbon dioxide
 Leukocytes act in inflammatory and immuneLeukocytes act in inflammatory and immune
responsesresponses
 Plasma carries antibodies and nutrients to tissuesPlasma carries antibodies and nutrients to tissues
and carries away wasteand carries away waste
 Hematopoiesis occurs primarily in marrowHematopoiesis occurs primarily in marrow
 Average person has 5 to 6 L of circulating bloodAverage person has 5 to 6 L of circulating blood

45. • Bone marrow cells particularly vulnerableBone marrow cells particularly vulnerable
to physiologic changesto physiologic changes
• Disease can affect structure orDisease can affect structure or
concentration of any hematologic cellconcentration of any hematologic cell

46. CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
• Begins when the fetus is barely 4 weeks old; last system to ceaseBegins when the fetus is barely 4 weeks old; last system to cease
activityactivity
• Helps define presence of lifeHelps define presence of life
• Comprises the heart, arteries, veins, and lymphaticsComprises the heart, arteries, veins, and lymphatics
• Serves as the body’s transport systemServes as the body’s transport system
• Brings oxygen and nutrients to cells, removes metabolic wasteBrings oxygen and nutrients to cells, removes metabolic waste
products, and carries hormonesproducts, and carries hormones
• Commonly called the circulatory systemCommonly called the circulatory system
• Pulmonary circulation: blood picks up oxygen and eliminates carbonPulmonary circulation: blood picks up oxygen and eliminates carbon
dioxidedioxide
• Systemic circulation: blood carries oxygen and nutrients to active cellsSystemic circulation: blood carries oxygen and nutrients to active cells
and transports waste for excretionand transports waste for excretion
• Blood circulates through arteries, veins, and capillariesBlood circulates through arteries, veins, and capillaries

47. RENAL SYSTEMRENAL SYSTEM
Key facts about the renal systemKey facts about the renal system
• Kidneys produce and excrete urine to maintain homeostasisKidneys produce and excrete urine to maintain homeostasis
• Ureters transport urine to bladder from kidneysUreters transport urine to bladder from kidneys
• Bladder: reservoir for urine until it leaves body throughBladder: reservoir for urine until it leaves body through
urethraurethra
PATHOPHYSICAL CHANGESPATHOPHYSICAL CHANGES
• Filtration and reabsorption changes affect total filtrationFiltration and reabsorption changes affect total filtration
efforteffort
• Capillary pressure and interstitial fluid colloid osmoticCapillary pressure and interstitial fluid colloid osmotic
pressure affect filtrationpressure affect filtration
• Interstitial fluid pressure and plasma colloid osmotic pressureInterstitial fluid pressure and plasma colloid osmotic pressure
affect filtrationaffect filtration
• Altered renal perfusion; disease affecting vessels, glomeruli,Altered renal perfusion; disease affecting vessels, glomeruli,
tubules; obstruction to urine slow the GFRtubules; obstruction to urine slow the GFR

48. RESPIRATORY SYSTEMRESPIRATORY SYSTEM
KEY FACTS ABOUT THE RESPIRATORY SYSTEMKEY FACTS ABOUT THE RESPIRATORY SYSTEM
• Major function is gas exchangeMajor function is gas exchange
• Upper airway allows airflow into lungs; warm, humidify, filterUpper airway allows airflow into lungs; warm, humidify, filter
airair
• Lower airway consists of trachea, mainstream bronchi,Lower airway consists of trachea, mainstream bronchi,
secondary bronchi, bronchioles, terminal bronchiolessecondary bronchi, bronchioles, terminal bronchioles
• Structures are anatomic dead spaces, function only asStructures are anatomic dead spaces, function only as
passageways for moving air into and out of the lungspassageways for moving air into and out of the lungs
• Distal to terminal bronchioles are acinus- respiratoryDistal to terminal bronchioles are acinus- respiratory
bronchioles, alveolar ducts, alveolar sacs.bronchioles, alveolar ducts, alveolar sacs.
• Bronchioles and ducts function as conduitsBronchioles and ducts function as conduits
• Alveoli: chief units of gas exchangeAlveoli: chief units of gas exchange
• Clearance mechanisms: cough reflex and mucociliary system.Clearance mechanisms: cough reflex and mucociliary system.

49. KEY FACTS ABOUT THE RESPIRATORY SYSTEMKEY FACTS ABOUT THE RESPIRATORY SYSTEM
((continuedcontinued))
• Lower airway protects lungs with defense mechanismsLower airway protects lungs with defense mechanisms
• Respiration delivers inspired air to lower respiratory tract and alveoliRespiration delivers inspired air to lower respiratory tract and alveoli
• Contraction and relaxation of respiratory muscles moves air into and outContraction and relaxation of respiratory muscles moves air into and out
of lungsof lungs
• Normal expiration is passiveNormal expiration is passive
• Adult lung contains 300 million alveoli; each supplied by many capillariesAdult lung contains 300 million alveoli; each supplied by many capillaries
• To reach capillary lumen, oxygenmust cross alveolar capillary membraneTo reach capillary lumen, oxygenmust cross alveolar capillary membrane
• The pulmonary alveoli promote gas exchange by diffusionThe pulmonary alveoli promote gas exchange by diffusion
• Circulating blood delivers oxygen to cells for metabolism and transportCirculating blood delivers oxygen to cells for metabolism and transport
metabolic wastes and COmetabolic wastes and CO22 back to lungsback to lungs
• COCO22 reaches alveolar capillaries, diffuses into the alveoli; removed fromreaches alveolar capillaries, diffuses into the alveoli; removed from
the alveoli during exhalationthe alveoli during exhalation

50. ENDOCRINE SYSTEMENDOCRINE SYSTEM
KEY FACTS ABOUT THE ENDOCRINE SYSTEMKEY FACTS ABOUT THE ENDOCRINE SYSTEM
• Consists of glands, specialized cell clusters,Consists of glands, specialized cell clusters,
hormones, tissueshormones, tissues
• Glands and cell clusters secrete hormones, chemicalGlands and cell clusters secrete hormones, chemical
transmitters in response to stimulationtransmitters in response to stimulation
• With nervous system, regulates metabolic activities,With nervous system, regulates metabolic activities,
maintains internal homeostatismaintains internal homeostatis
• Hormones connect with receptors in target tissuesHormones connect with receptors in target tissues
• Resulting hormone-receptor complex triggers targetResulting hormone-receptor complex triggers target
cell’s responsecell’s response

51. HORMONAL REGULATIONHORMONAL REGULATION
• Hypothalamus helps control some endocrine glandsHypothalamus helps control some endocrine glands
• Neural stimulation of posterior pituitary causes secretionNeural stimulation of posterior pituitary causes secretion
of ADH, oxytocinof ADH, oxytocin
• Hypothalamic hormones stimulate pituitary gland toHypothalamic hormones stimulate pituitary gland to
synthesize and release trophic hormones.synthesize and release trophic hormones.
• Trophic hormones stimulate adrenal cortex, thyroidTrophic hormones stimulate adrenal cortex, thyroid
gland, gonads.gland, gonads.
• Hypothalamic hormones stimulate pituitary to release orHypothalamic hormones stimulate pituitary to release or
inhibit release of effector hormonesinhibit release of effector hormones
• Negative feedback system regulates endocrine systemNegative feedback system regulates endocrine system
• Simple feedback occurs when level of one substanceSimple feedback occurs when level of one substance
regulates secretion of a hormoneregulates secretion of a hormone

52. RHYTHMSRHYTHMS
• Circadian rhythm increases and decreases hormone levels byCircadian rhythm increases and decreases hormone levels by
time of daytime of day
• Infradian rhythm” biorhythm that repeats in patterns > 24Infradian rhythm” biorhythm that repeats in patterns > 24
hourshours
HORMONAL EFFECTSHORMONAL EFFECTS
• Oxytocin: stimulates contractionof uterus, milk- letdownOxytocin: stimulates contractionof uterus, milk- letdown
reflexreflex
• ADH: controls concentration of body fluidsADH: controls concentration of body fluids
• Proclactin: controls milk secretion , GHProclactin: controls milk secretion , GH
• GH: triggers growthGH: triggers growth
• Iodinated hormones: affect growth, developmentIodinated hormones: affect growth, development
• PTH: regulates calcium, phosphate metabolism.PTH: regulates calcium, phosphate metabolism.

53. REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM
KEY FACTS ABOUT THE REPRODUCTIVE SYSTEMKEY FACTS ABOUT THE REPRODUCTIVE SYSTEM
• Must function properly to ensure survival of speciesMust function properly to ensure survival of species
• Male reproductive system produces sperm, deliversMale reproductive system produces sperm, delivers
them to female reproductive tractthem to female reproductive tract
• Female reproductive system produces ova, nurturesFemale reproductive system produces ova, nurtures
and protects embryo and fetus; delivers it at birthand protects embryo and fetus; delivers it at birth
• Functioning is determined by anatomic structure,Functioning is determined by anatomic structure,
hormonal, neurologic, vascular, psychogenic factorshormonal, neurologic, vascular, psychogenic factors

54. FLUIDS AND ELECTROLYTESFLUIDS AND ELECTROLYTES
Key facts about fluid balance and exchangeKey facts about fluid balance and exchange
• Kidneys regulate fluid componentsKidneys regulate fluid components
• Fluid inside each cell is ICF; blood plasma and otherFluid inside each cell is ICF; blood plasma and other
fluid in the spaces outside cells is ECFfluid in the spaces outside cells is ECF
• ECF transport nutrients and oxygen to cells andECF transport nutrients and oxygen to cells and
carries away waste products for eliminationcarries away waste products for elimination
• Fluid is moved out of vessels by hydrostatic pressureFluid is moved out of vessels by hydrostatic pressure
of blood and osmotic pressure and hydrostaticof blood and osmotic pressure and hydrostatic
pressure of interstitial fluidpressure of interstitial fluid
• When the capillary wall is normal, fluid escapes atWhen the capillary wall is normal, fluid escapes at
the arteriolar end of the capillary and is returned atthe arteriolar end of the capillary and is returned at
the venular end.the venular end.

55. KEY FACTS ABOUT PATHOPHYSIOLOGIC CHANGES IN ACID-BASEKEY FACTS ABOUT PATHOPHYSIOLOGIC CHANGES IN ACID-BASE
IMBALANCEIMBALANCE
AcidemiaAcidemia
• Arterial pH<7.35 – excess acid in the bloodArterial pH<7.35 – excess acid in the blood
• Hydrogen ion content increasesHydrogen ion content increases
• Potassium leaves cells to neutralize, causing hypokalemiaPotassium leaves cells to neutralize, causing hypokalemia
AcidosisAcidosis
• Systemic increase in hydrogen ion concentrationSystemic increase in hydrogen ion concentration
• Occurs when lung can’t eliminate C02, or if diarrhea causesOccurs when lung can’t eliminate C02, or if diarrhea causes
loss of bicarbonate anions or if the kidneys fail to reabsorbloss of bicarbonate anions or if the kidneys fail to reabsorb
bicarbonate or secrete hydrogen ionsbicarbonate or secrete hydrogen ions
AlkalemiaAlkalemia
• Arterial blood pH> 7.45 – excess base in the bloodArterial blood pH> 7.45 – excess base in the blood
• Potassium moves into cells to neutralize, causing hypokalemiaPotassium moves into cells to neutralize, causing hypokalemia

56. AlkalosisAlkalosis
• Bodywide decrease in hydrogen ion concentrationBodywide decrease in hydrogen ion concentration
• Caused by hyperventilation and loss of nonvital acids duringCaused by hyperventilation and loss of nonvital acids during
vomiting or from excessive ingestion of basevomiting or from excessive ingestion of base
CompensationCompensation
• Lungs, kidneys, other chemical buffer systems work togetherLungs, kidneys, other chemical buffer systems work together
to maintain normal plasma pH rangeto maintain normal plasma pH range
• Buffer systems consists of a weak acid and correspondingBuffer systems consists of a weak acid and corresponding
basebase
• Four major buffers or buffer systems work to restore normalFour major buffers or buffer systems work to restore normal
pHpH
• The kidneys normalize pH by altering handling of hydrogenThe kidneys normalize pH by altering handling of hydrogen
and bicarbonate ionsand bicarbonate ions
• Responds in hours or days to respiratory alteration of pHResponds in hours or days to respiratory alteration of pH
• Compensation by the lungs regulates respiratory rate toCompensation by the lungs regulates respiratory rate to
adjust pH; respiration increases or decreases to raise or loweradjust pH; respiration increases or decreases to raise or lower
PacoPaco22 levelslevels

57. CHARACTERISTIC OF RESPIRATORY ACIDOSISCHARACTERISTIC OF RESPIRATORY ACIDOSIS
• Characterized by alveolar ventilationCharacterized by alveolar ventilation
• Patient can’t clear enough C0Patient can’t clear enough C022 from the bodyfrom the body
• PacoPaco22 buildup causes hypercapnia (Pacobuildup causes hypercapnia (Paco22 > 45 mm Hg) and> 45 mm Hg) and
acidosisacidosis
• May be acute or chronicMay be acute or chronic
CAUSESCAUSES
• OpioidsOpioids
• General anestheticsGeneral anesthetics
• HypnoticsHypnotics
• Injury to the medullaInjury to the medulla
• Reduced cardiac outputReduced cardiac output
• Neuromuscular or respiratory diseaseNeuromuscular or respiratory disease
• Sleep apneaSleep apnea

58. HOW IT HAPPENSHOW IT HAPPENS
• Pulmonary ventilation decreases, PacoPulmonary ventilation decreases, Paco22 increases, and C0increases, and C022 levels rise in alllevels rise in all
tissuestissues
• Respiration increases; pH fallsRespiration increases; pH falls
• Respiratory mechanisms fail; kidney buffer mechanisms take over, thenRespiratory mechanisms fail; kidney buffer mechanisms take over, then
failfail
• Electrolyte imbalances critically depress neurologic and cardiac functionsElectrolyte imbalances critically depress neurologic and cardiac functions
KEY SIGNS AND SYMPTOMSKEY SIGNS AND SYMPTOMS
• RestlessnessRestlessness
• ConfusionConfusion
• ApprehensionApprehension
• SomnolenceSomnolence
• AsterixisAsterixis
• ComaComa
• HeadacheHeadache
• Dyspnea and tachypneaDyspnea and tachypnea
• PapilledemaPapilledema

59. GASTROINTESTINAL SYSTEMGASTROINTESTINAL SYSTEM
KEY FACTS ABOUT THE GI SYSTEMKEY FACTS ABOUT THE GI SYSTEM
• Supplies essential nutrientsSupplies essential nutrients
• Serves to digest food and eliminate wasteServes to digest food and eliminate waste
• Profoundly affects quality of lifeProfoundly affects quality of life
• Two major components: GI tract and accessory organsTwo major components: GI tract and accessory organs
• Malfunction in system can produce life – threatening metabolicMalfunction in system can produce life – threatening metabolic
effectseffects
GI TRACTGI TRACT
• Hollow muscular tube from mouth to anusHollow muscular tube from mouth to anus
• Oral cavity, pharynx, esophagus, stomach, small and large intestineOral cavity, pharynx, esophagus, stomach, small and large intestine
• Peristalsis propels ingested, material; sphincters prevent refluxPeristalsis propels ingested, material; sphincters prevent reflux
PATHOPHYSIOLOGIC CHANGESPATHOPHYSIOLOGIC CHANGES
• Disorders typically nonspecific, reflect disruption in functionsDisorders typically nonspecific, reflect disruption in functions

60. NERVOUS SYSTEMNERVOUS SYSTEM
KEY FACTS ABOUT THE NERVOUS SYSTEMKEY FACTS ABOUT THE NERVOUS SYSTEM
• Coordinates and organizes functions of all bodyCoordinates and organizes functions of all body
systemssystems
• Has three main divisions: CNS, peripheral nervousHas three main divisions: CNS, peripheral nervous
system, ANSsystem, ANS
• Neurons transmit nerve impulses through bodyNeurons transmit nerve impulses through body
• Most neurons have several dendrites, only one axonMost neurons have several dendrites, only one axon
• Three types: sensory, motor, and interneuronsThree types: sensory, motor, and interneurons
• Nervous system disorders can cause signs andNervous system disorders can cause signs and
symptoms in any body system; hard to diagnosesymptoms in any body system; hard to diagnose

61. REVIEWING THE CNSREVIEWING THE CNS
• Cerebrum – frontal lobe, temporal lobe, parietal lobe,Cerebrum – frontal lobe, temporal lobe, parietal lobe,
occipital lobeoccipital lobe
• Cerebellum – maintains muscle tone, coordinationCerebellum – maintains muscle tone, coordination
• Brain stem – pons, midbrain, medulla oblongataBrain stem – pons, midbrain, medulla oblongata
• Primitive structures – thalamus, hypothalamus, limbic system,Primitive structures – thalamus, hypothalamus, limbic system,
RASRAS
• Spinal cord – relays sensory, motor impulsesSpinal cord – relays sensory, motor impulses
REVIEWING THE PERIPHERAL NERVOUS SYSTEMREVIEWING THE PERIPHERAL NERVOUS SYSTEM
• Cranial nerves –Cranial nerves – 112 pairs: olfactory, optic, oculomotor,2 pairs: olfactory, optic, oculomotor,
trochlear, trigeminal, abducens, facial, acoustic,trochlear, trigeminal, abducens, facial, acoustic,
glossopharyngeal, vagus, spinal accessory, hypoglossalglossopharyngeal, vagus, spinal accessory, hypoglossal
• Spinal nerves - 3Spinal nerves - 311 pairs with sensory and motor neuronspairs with sensory and motor neurons
• ANS – innervates internal organs; sympathetic nervousANS – innervates internal organs; sympathetic nervous
systemsystem

62. PATHOPHYSIOLOGIC CHANGESPATHOPHYSIOLOGIC CHANGES
• Typically involve alteration in arousal, cognition, movement,Typically involve alteration in arousal, cognition, movement,
muscle tone, homeostatic mechanisms or painmuscle tone, homeostatic mechanisms or pain
• Most cause more than one alterationMost cause more than one alteration
• One alteration may lead to anotherOne alteration may lead to another
KEY FACTS ABOUT AROUSALKEY FACTS ABOUT AROUSAL
• Level of consciousness or state of awarenessLevel of consciousness or state of awareness
SEVERAL MECHANISMS CAN ALTER AROUSALSEVERAL MECHANISMS CAN ALTER AROUSAL
• Direct destruction of RAS and pathwaysDirect destruction of RAS and pathways
• Destruction of brain stemDestruction of brain stem
• Compression of RAS by disease processCompression of RAS by disease process
• Mechanisms may result from structural, metabolic, orMechanisms may result from structural, metabolic, or
psychogenic disturbancespsychogenic disturbances