Neurosensory & Integumentary Systems Exam Study Guide 1

Question 1

What are the structures in the ear each and function for each structure?

Answer 1

• External ear:
  
  • Auditory canal, eardrum or tympanic membrane
  • Pinna or auricle, ceruminous glands, secrete cerumen
• Middle ear
  
  • Have Ossicles bones: malleus, incus and stapes
  • Air-filled cavity just beyond tympanic membrane in temporal bone
  • Eustachian tube or auditory tube:
    
    • Opens during swallowing or yawning to equalize the pressure in the middle ear
• Inner ear
  
  • Oval window separates middle ear from inner ear
  • Labyrinths: contain fluid like CSF
  • Consists of:
  • Cochlea:
    
    • True organ of hearing
  • Vestibule:
    
    • utricle and saccule;
    • relay changes in body position
  • Semicircular canals:
    
    • Shaped like horseshoes, they lie behind the cochlea and are primarily concerned with balance when the body is moving (acceleration/deceleration or head movements).

Question 2

What is the definition of Tinnitus, Vertigo, Presbycusis

Answer 2

• Presbycusis
  
  • Progressive hearing loss (highest pitches lost first);
  • certain consonants difficult to hear (K, T, S, P)
• Tinnitus
  
  • A high-pitched buzzing or “ringing in the ears.”
• Vertigo
  
  • True vertigo is the sensation that either you or the room is spinning; dizziness is a sensation of lightheadedness.
  • Inner ear diseases or defects in conductive pathways and/or the central nervous system cause true vertigo.
  • Nausea often accompanies vertigo, as does tinnitus

Question 3

What are terms for all terms for assessments for eyes and ears?

Question 4

What are all lobe structures and their functions?

Answer 4

• Frontal Lobe:
  
  • Located at front of the skull, forehead
  • Location of higher mental processes (intelligence, motivation, mood, aggression, and planning);
  • Site for verbal communication and voluntary control of skeletal muscles
• Parietal Lobe:
  
  • Between frontal and occipital lobes
  • Location of skin, taste, and muscle sensations;
  • Speech center;
  • Enables formation of words to express thoughts and emotions;
  • Interprets textures and shapes
• Temporal Lobe:
  
  • Located at sides of the skull
  • Location of sense of smell and auditory interpretation
  • Stores auditory and visual experiences
  • Forms thoughts that precede speech
• Occipital Lobe:
  
  • Located at back of the skull
  • Location of eye movements;
  • Integrates visual experiences

Question 5

What is the cerebellum, medulla, pons, cerebrum and their functions?

Answer 5

Cerebellum (“little brain”)
Second largest part of the brain (part of hindbrain);
Attached to back of brainstem, below the curve of cerebrum.
Connected, via midbrain, to the spinal cord and motor area of the cortex
Location of involuntary movement, coordination, muscle tone, balance, and equilibrium (semicircular canals);
Coordinates some voluntary muscles

Medulla (oblongata)
Located at floor of the skull below midbrain
Connects brain to spinal cord Vital for life
Descending nerve tracts from the brain cross here to the opposite side;
Contains centers for many body functions (cardiac, vasomotor, and respiratory center; swallowing, coughing, and sneezing reflexes)

Pons (bridge)
Between cerebrum and medulla
Carries messages between cerebrum and medulla
Acts as respiratory center to produce normal breathing patterns

Cerebrum (forebrain)
Largest portion of the brain
Center of conscious thought and higher mental functioning (intelligence, learning, and memory)

Question 6

What fluid protects spinal cord?

Answer 6

Cerebrospinal Fluid (CSF)

Question 7

What are the functions of CSF?

Answer 7

• Cerebrospinal Fluid (CSF)
  • Acts as shock absorber for the brain and spinal cord
  • Carries nutrients to the brain
  • Carries wastes away from the brain
  • Keeps the brain and spinal cord moist, thus preventing friction
  • Can be tested to determine the presence of some disorders
  • Can be used to transmit medications

Question 8

What is the procedure for LP (Spinal Tap)?

Answer 8

• Identify the client and ask the client to empty the bladder.
• Identify the client and ask the client to empty the bladder.
• Take and record the client’s vital signs before the procedure.
• Assist the client with removing any clothing and putting on a gown that opens in the back.
• Drape the client with a bath blanket or sheet.
• Place equipment within the healthcare provider’s reach.
• Open packs and make sure extra sterile gloves are available.
• Provide extra lighting, as necessary.
• Position the client on their side with the lower part of the back at the edge of the bed.
• Help the client to draw their knees up toward the chin and to bend their head forward.
• When the procedure begins, move the drape to uncover the client’s back.
• Tell the person to lie very still, holding the client in place, if necessary.
• Talk to the client during the procedure, offering reassurance, as necessary.
• Assist, as requested, such as with removing caps on bottles, labeling specimens, or assisting with dressing placement over the LP site.
• Assistance helps to minimize the possibility of contamination.
• Note the beginning cerebrospinal fluid (CSF) pressure, as measured by the healthcare provider.
• Also, look at the color and clarity of the CSF, which should be pale and clear.
• Monitor the client for any difficulties or problems.
• After the procedure, return the client to a comfortable position in bed.
• Keep the client’s head flat (supine) for at least 6 hr or as otherwise ordered.
• Follow ENDDD steps
• Monitor and document the client’s vital signs and neurologic signs, comparing them with baseline data.
• Determine the client’s level of consciousness.
• Report any unusual findings to the healthcare provider.
• Encourage fluids (unless contraindicated) and record intake and output (I& O).
• Encourage the client to lie flat to minimize headache.
• Monitor the insertion site for leakage of CSF, hematoma formation, or edema.
• Determine the severity of any headache that occurs.
• Report severe headache unrelieved by mild analgesics or lasting more than 24 hr.

Question 9

What are the nursing implications of LP (Spinal Tap) Before, during and After?

Answer 9

Before beginning, be sure the procedure has been thoroughly explained to the client and that the client has signed the consent form. (Nursing students do not witness these permits.)

During the procedure, observe the client closely for signs of an adverse reaction, for example, elevated pulse rate, pallor, or clammy skin. Talk to the client during the procedure, offering reassurance, as necessary. Rationale: This procedure can be frightening. The client needs to relax and remain still.

After the procedure, return the client to a comfortable position in bed. Keep the client’s head flat (supine) for at least 6 hr or as otherwise ordered. Rationale: Proper positioning promotes comfort while also decreasing the possibility of CSF leakage and post puncture headache.

Question 10

How do you adjust and elderly patient with a skin disorder?

Question 11

What is a neuron and its function?

Answer 11

• The neuron is the basic structural and functional cell of the nervous system.
• Neurons are specialized to respond to electrical, chemical, and physical stimuli (e.g., pain, pressure, hot/ cold), and messages are conducted and transferred through them (neurotransmission).
• The human brain regulates more than 10 billion neurons throughout the body at all times.
• Neuroglia (described later) outnumber neurons by a ratio of ten to one;
  
  • they support and connect nervous tissue but do not transmit impulses.

Question 12

What is an axon and its function?

Answer 12

An axon is an extension that carries impulses away from the neuron cell body.

Question 13

What are functions of the nervous system?

Answer 13

Functions of Nervous System (communication and control)

• Responds to danger, pain, and other situations
• Response to internal and external changes
• Helps maintain homeostasis
• Response to conscious decisions and thoughts
• Stores and retrieves memories, including previous learning
• Maintains blood pressure, respiration, and other vital functions
• Regulates body systems
• Coordinates reflex actions
• Controls conscious movement and activities
• Stores unconscious thoughts

Question 14

What are structures of the nervous system?

Answer 14

The nervous system is made up of neurons (nerve cells) and neuroglia (glial cells).
The neuron is the basic structural and functional cell of the nervous system.

Question 15

How are messages transmitted around the body?

Answer 15

• Neurotransmitters
  • Are your body’s chemical messengers.
  • They carry messages from one nerve cell across a space to the next nerve, muscle or gland cell.
  • These messages help you move your limbs, feel sensations, keep your heart beating, and take in and respond to all information your body receives from other internal parts of your body and your environment.

Question 16

Know what and EEG is for?

Answer 16

• An electroencephalogram ( EEG ) is a visual record of the electrical activity of the millions of neurons in the brain.
• Brain wave activity helps diagnose neurological problems, and in many states, cessation of brain wave activity is an important legal consideration in the confirmation of biologic death.

Question 17

Nursing Implications for EEG (Before, during and After)

Answer 17

• In preparation for an EEG, the client may be asked not to sleep the night before the test (for a sleeping EEG), or they may receive sedation (for a resting EEG). It may be necessary to wash and dry the client’s hair before the procedure.

After the procedure, the client may need a shampoo to remove collodion.

Question 18

Know what nerves are located in the spine (Respiratory, blood pressure and pulse)

Answer 18

Cervical nerves C1-C8
Head and Neck
Diaphragm
Deltoid, Biceps
Wrist extenders
Triceps
Hands

Thoracic Nerves T1-T12
Chest Muscles
Abdominal Muscles

Lumbar Nerves L1 - L5
Leg muscles

Sacral Nerves S1-S5
Bowel, Bladder
Sexual function

Question 19

What is sebum and its function?

Answer 19

• Sebum is the oily secretion of these glands;
  
  • it travels to the surface of the skin through hair follicles.
  • Sebum helps make the skin soft and hair glossy.
  • Sebum prevents drying of the skin, thereby protecting it from cracking.
  • Cracked skin can lead to infection and can allow foreign substances to be absorbed.
  • Sebum also helps waterproof the top layer of the epidermis ( stratum corneum ).
  • Sebaceous secretions increase at puberty.
  • Sebum may trap bacteria in the pores, causing inflammation or infection (“pimples” or acne).

Question 20

Where is the the subarachnoid space and what are its functions?

Answer 20

• The space between the arachnoid membrane and the pia mater is the subarachnoid space .
• (The subarachnoid space contains CSF, the tissue fluid of the CNS.) and due to the curtain-like structure with holes, it allows the flow of CSF. [2]
• Besides trabeculae, there are major cerebral blood vessels that penetrate the nervous tissue within this space

Question 21

What structure is responsible for the sense of balance (Inside the ear)

Answer 21

• It is also essential to our sense of balance: the organ of balance (the vestibular system) is found inside the inner ear.
• It is made up of three semicircular canals and two otolith organs, known as the utricle and the saccule.
• The semicircular canals and the otolith organs are filled with fluid.

Question 22

What is the CNS,PNS parasympathetic, sympathetic and their functions?

Answer 22

• Central Nervous System
  • The spinal cord is the major communication pathway between the body and the brain.
  • The brain interprets this information and directs body responses.
  • The CNS is protected by the CSF and meninges
  • The CNS encompasses the brain, spinal cord, and accessory structures.
• Peripheral Nervous System
  • The peripheral nervous system is all the nerves in your body, aside from the ones in your brain and spinal cord.
  • It acts as a communication relay between your brain and your extremities
  • The afferent (sensory) division of the PNS conveys information to the brain , primarily from sensory organs, such as the skin.
  • Muscle spindles convey information regarding posture and joint position.
  • The sense of proprioception conveys awareness of where parts of the body are, in relation to space. (If you close your eyes and wave your hand, you still know where your hand is.)
  • Several areas of the brain (the cerebellum and red nucleus) coordinate movements and positioning, using this proprioceptive feedback.
  • The efferent (motor, descending) division of the PNS sends voluntary and involuntary commands from the CNS to muscles and stimulates glands to secrete hormones.
  • Signals to muscles nearly always originate in the primary motor cortex of the frontal lobe, just in front of the central sulcus, dividing the brain’s frontal and parietal lobes.
• Sympathetic
  • The sympathetic division of the ANS produces a response that prepares individuals for an emergency, extreme stress, or danger.
  • This “fight or flight” response readies people to defend themselves or flee from danger.
  • During an emergency, the heart beats faster and the breathing rate and blood pressure increase.
  • The skin becomes pale, secondary to the diversion of blood flow to more vital organs.
  • Blood flow also decreases to structures such as external genitalia and abdominal organs.
  • Thus, body processes such as digestion slow or stop, allowing more blood to flow to the brain, lungs, and large muscles that move the body during an emergency.
  • Involuntary defecation or urination can occur.
  • The homeostatic mechanism that balances the sympathetic nervous system ( SNS ) is the parasympathetic nervous system (PNS).
• Parasympathetic
  • The parasympathetic division of the ANS is involved in relaxation.
  • The parasympathetic division generally produces responses that are normal functions of the body while at rest or not under unusual or extreme stress.
  • The effects are usually opposite to the effects of the SNS.
  • The parasympathetic system does not normally activate in a way that affects the total body.
  • To return to homeostasis after a “fight or flight” episode, the parasympathetic nerves return the heart rate to normal, resume digestive processes, and restore blood flow to the skin, abdominal organs, and genitalia.
  • Previously normal patterns of defecation and urination return.

Question 23

Which of these do you have control over and which are automatic? CNS, PNS, parasympathetic, sympathetic

Question 24

What are the functions of myelin sheath?

Answer 24

• The Myelin Sheath
  • This myelin sheath electrically insulates one nerve cell from another.
  • Without this sheath, these particular nerve cells would short circuit.
  • Myelin is formed by the plasma membranes of specialized glial (neuroglial) cells, the Schwann cells , which provide nutrition and support.

Question 25

What is melanin and its function?

Answer 25

• Melanin gives color to hair, skin, and other structures
  
  • Melanocytes are cells within the epidermis that, through a complex process, create the pigment melanin

Question 26

What are nursing interventions for integumentary system? (How to assess the skin)

Question 27

What is the function of the integumentary system?

Answer 27

Functions of Integumentary

• Protection
  
  • Provides a physical barrier against microorganisms and foreign materials
  • Helps prevent absorption of harmful substances from outside the body
  • Defends against many chemicals
  • Protects against water loss or gain
  • Protects underlying structures, such as fragile organs
  • Protects against excessive sun exposure (ultraviolet rays)
  • Cushions internal organs against trauma
  • Produces secretions for protection and water regulation
  • Absorbs helpful medicines
  • Prevents nutrients from being washed out of the body
  • Serves as a containment structure to give shape and form to the body
• Thermoregulation
  
  • Controls body temperature by convection, evaporation, conduction, and radiation, as well as changes in size of superficial blood vessels
  • Helps body adjust to external changes in temperature
  • Helps dissipate heat during exercise
  • Produces shivering and “goose flesh” to keep body warm in cool temperatures
• Metabolism
  
  • Provides insulation (skin hairs, subcutaneous fat)
  • Helps produce and use vitamin D
  • Helps the body eliminate certain waste products
  • Contributes to changes in cardiac output and blood pressure
  • Absorbs gases; some oxygen, nitrogen
• Sensation
  
  • Perceives stimuli: heat, cold, pain, pressure, touch, vibration, injury
  • Provides social and sexual communication
  • Allows for physical intimacy
• Communication
  
  • Communicates feelings and moods through facial expressions
  • Portrays feelings of anger, embarrassment, or fear (e.g., flushing, sweating, pallor)
  • Communicates cultural and sexual differences through skin and hair color
  • Portrays body image via skin’s general appearance
• Storage
  
  • Stores water
  • Stores Fat
  • Stores Vitamin D

Question 28

How does aging affect the Integumentary system?

Answer 28

• Melanin is either lost or migrates and clusters in the epidermal layer
  
  • “Age spots” or “liver spots” (senile lentigo) result White areas (vitiligo) may appear
• Epidermal and dermal layers flatten, skin becomes thinner.
  
  • Skin tends to tear (“fragile” or friable skin).
• Glandular secretion decreases
  
  • More susceptible to skin breakdown and infection. Slower healing.
• Capillary bed in dermis becomes more friable (fragile), blood can ooze into dermis
  
  • Dark red patches in the skin (purpura) are commonly seen on arms of older adults
  • Person may bruise easily
• Capillaries leak small amounts of blood into tissues
  
  • Petechiae occur (small red dots on the skin [senile angioma])
• Individual may have loss of sensation
  
  • Person is unable to detect or treat the cause of ulcerated areas; pressure wounds may develop more quickly May be more susceptible to falls. May not sense heat or cold
• Loss of elasticity in dermis, loss of subcutaneous layer of fat, and loss of collagen fibers
  
  • Wrinkles. Decreased strength of skin layer. Women’s skin is thinner and dryer; thus, wrinkles appear earlier. Skin may sag
• Skin turgor (tension or fullness) is lost
  
  • Wrinkles Pinched skin does not return to normal position. “Tenting”
  • on some areas can give false-positive (for dehydration) results
• Some insulating function is lost with loss of subcutaneous fat
  
  • Heat is lost more rapidly. Older person may be chilly
• Dermal layer thins
  
  • Skin becomes transparent and less elastic
• Changes occur in hair distribution, influenced by heredity and other factors.
• General loss of body hair occurs. Hair pigment (melanin) decreases
  
  • Axillary, pubic, and scalp hair thins Men may develop thicker hair in nose, ears, and eyebrows; hair on head becomes thinner Hair appears white or gray
• Female and male hormones are lost
  
  • Women may develop facial hair (hirsutism)
  • Males have decrease in beard and scalp hair (male pattern baldness)
• Nails grow more slowly and become thicker
  
  • Nails, especially toenails, become thick and brittle.
  • May be malformed or discolored
• Glands in skin decreases secretions
  
  • Less perspiration and less oily skin than before; skin may become very dry (may appear scaly [senile keratosis]). Hair becomes coarser
• Thermoregulation abilities lost
  
  • More susceptible to heatstroke or chilling
• Circulation reduced Mucous membranes dryer;
  
  • Decreased number and output of sweat glands
  • Wound healing takes longer
  • Old or damaged cells not readily replaced
  • More difficult to maintain body temperature;
  • Painful intercourse (dyspareunia);
  • Dry eyes;
  • Dry mouth

Question 29

How does aging affect the Nervous system?

Question 30

How does aging affect the Sensory system?

Answer 30

• Vision/Eye Changes
• Lens accommodation decreases: lens loses elasticity
  
  • Presbyopia (farsighted); difficulty seeing close objects or reading
  • Depth perception decreases
  • Difficulty judging height of curbs and steps Falls common
    
    • Peripheral vision decreases
    • Driving may be dangerous
• Pupil size decreases: ability to react to darkness and bright light decreases; night vision decreases
  
  • Takes longer for eyes to adjust when entering a dark room or bright sunlight May require additional light for reading
• Color perception decreases Depth perception decreases
• Clouding of lens
  
  • Difficulty discerning hues of blue, green, and violet and distances Cataract (may occur at any age)
• Grayish white ring (arcus senilis ) forms around iris due to deposits of calcium and cholesterol salts
  
  • May lower self-esteem and body image (does not affect vision)
  • Vitreous gel liquefies
  • Posterior visual detachment (PVD), causing “floaters” in eyeball
  • Tear formation decreases
    
    • Dry, itchy eyes More susceptible to infections
    • Fluid circulation in eye decreases
      
      • Increased risk for glaucoma

Question 31

What do you do as a nurse for a Skin disorder?