Week 8 Discussion Question Paper

The Nervous System

The nervous system is made up of a complex collection of specialized cells called neurons and nerves that transmit signals across different parts of the body. This body system is structurally made up of two components. These are the central nervous system (CNS) and the peripheral nervous system. Further, the CNS includes the spinal cord, the brain, and the nerves. On the other hand, the peripheral nervous system comprises ganglia, which are clusters of neurons, sensory neurons, and nerves connected to each other and the CNS (Caruso et al., 2019).Week 8 Discussion Question Paper

In terms of function, the nervous system is divided into two. These subdivisions are the autonomic component, which is involuntary, and the somatic component, which is voluntary. The autonomic nervous system works to regulate some body processes such as breathing and blood pressure. The system works void of conscious effort. The somatic system is made up of nerves connected to the brain and the spinal cord with sensory receptors on the skin and muscles.

Nerves can be described as cylindrical bundles of fiber beginning in the brain, and the central cord then branches out to all other body parts. Nerves function to send signals to different cells in the body through axons. Axons are thin fibers that cause that cause chemicals referred to as neurotransmitters to be released at synapses. The average human being has over 100 trillion neural connections in the brain. The number and location of these connections may, however, vary. For instance, Caruso et al. (2019) state that the brains of highly creative people have more connections in specific regions of their brains than those of less creative individuals.

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Relevant Health History Questions (Subjective Data) Pertaining To the Nervous System

Like with all body systems, subjective data is imperative if a diagnosis is to be made. Subjective data pertaining to the nervous system is obtained from the patient’s point of view and will, therefore, refer to perceptions, feelings, and concerns that the patient has regarding this particular body system. Interview questions to facilitate such data would include;

  • Does the patient have any history of head injury? If so, what is the location? Was there a loss of consciousness?
  • Does the patient experience severe or frequent headaches? If so, where? When? And how often?
  • Does the patient experience dizziness? If so, when?
  • Is there any loss of feeling or tingling sensation?
  • Does the patient experience memory loss?

The above line of questioning will give clues as to ant underlying neurological damage, which could make later the patient’s baseline. Pain is a neurological symptom, and therefore the presence of headaches could also indicate an alteration of the patient’s baseline. Most patients do not experience pain in their neurological system. Their complaints about pain are often associated with the back, extremity, or head assessment (Caruso et al., 2019). Week 8 Discussion Question Paper

Objective Data and Expected Normal Physical Examination Findings for the Nervous System

Unlike subjective data, objective data are measurable and observable data collected through physical examination, observation, and diagnostic and laboratory testing. Specific tests are carried out to establish that the patient’s baseline is not affected or altered. On examination of a patient’s mental status, short and long-term memory should be intact (A&O x 3). Cranial nerve examination should yield grossly intact, meaning that facial function is symmetric, and therefore there was no need for a cranial nerve examination. Motor system results for a healthy patient should show strength 5/5 throughout with muscle tone being within normal limits. A healthy patient’s sensation should be found to be intact to sharp and dull throughout. Finally, the baseline for the examination of the cerebellum should be intact finger-to-nose, with the patient’s gait falling within normal limits. 

Special Physical Assessment Examination Techniques or Procedures Specific to the Nervous System

As the nervous system is composed of trillions of microscopic components, physical examination can only give so much information. For this reason, a variety of special techniques have been developed to assess this system. One such technique is the computerized tomography (CT) scan. This imaging test uses computer technology and x-rays to create axial images or slices of the body. The scan shows detailed images of all body parts, including the bones, brain, fat, muscles, and organs, and is therefore useful for detecting defects in the nervous system. Electroencephalograms or EEG are used to record the electrical activity of the conscious brain through electrodes that are attached to the patient’s scalp (Caruso et al., 2019).

Magnetic resonance imaging, also known as MRI, uses a combination of radio frequencies, large magnets, and computers to create detailed images of structures and organs, including the brain. Another critical examination technique for the nervous system is the positron emission tomography (PET) scan. PET scans are also computer-based imaging tests that provide pictures of activity in the brain instead of their structure. This is achieved by measuring the levels of injected substances with tracer molecules. Analysis of a patient’s cerebral spinal fluid takes a sample of their spinal fluid, which can, in turn, be analyzed in the laboratory for signs of infection in the CNS.

Adaptation of Physical Assessment Skills or Interviewing Techniques to Different Demographics

Pregnancy has been found to involve a number of physiological changes that may trigger the onset of pathologies in both the central nervous system and the peripheral nervous systems. These pathologies are also sometimes associated with hypertensive disorders. For this reason, assessment of pregnant individuals should be done based on the trimester of pregnancy as well as the clinical findings. Peripheral facial palsy and carpal tunnel syndrome are some of the more common peripheral neurological disorders that frequent the second half of pregnancy.Week 8 Discussion Question Paper

Where infants are concerned, interviewing techniques will need to be altered/ this is because the patient cannot provide subjective data. Therefore objective data will need to be obtained after patient history is determined. Questions to be asked should revolve around whether the mother experienced any complications during pregnancy, the child’s birth weight, and whether they were born term or premature. It is also essential to determine the presence of any congenital defects. Finally, the interview should also cover whether the baby turns their head towards touch and if they startle with loud noises.

Common symptoms of neurological disorders in the elderly include balance, cognitive difficulties, gait disorders, neuropathy, and tremors. Therefore, specialized approaches to elderly patients must include assessing every domain, including executive function, attention, learning and memory, social cognition, and perceptual-motor function. In older adults, gait and balance are essential parts of this form of examination, especially if the patient has a history of falls and mobility issues. In patients displaying tremors, the examination will include careful observation of the quality of tremor. This includes the frequency, amplitude, and the exacerbating/alleviating factors such as movement, posture, and rest may aid in diagnosis. The evaluation of neuropathy includes the determination of modality and the distribution of symptoms so as to localize the site where nerves are injured that can be supplemented with electromyography or nerve conduction studies to further guide diagnosis and treatment (Caruso et al., 2019).

Major Disease of the Nervous System

Alzheimer’s disease is a form of dementia that affects an individual’s thinking, memories, and behavior. Symptoms of this disease eventually grow so severe that the individual may be unable to undertake daily tasks. It is important to note that Alzheimer’s is not a normal part of the aging process even though increasing age is the most significant known risk factor as most Alzheimer’s patients are above the age of 65. The disease has two pathologic hallmarks. These are extracellular beta-amyloid deposits and intracellular neurofibrillary tangles. The neurofibrillary tangles and beta-amyloid deposition result in a loss of neurons and synapses, thereby causing gross atrophy of the affected areas in a person’s brain. This is understood to begin at the medial temporal lobe. The mechanisms through which neurofibrillary tangles and beta-amyloid peptide remains to be understood, but several theories on the same exist (Caruso et al., 2019).Week 8 Discussion Question Paper

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Abnormal Physical Examination Findings of Alzheimer’s Disease

Apart from the findings relating to mental status, there are other more useful examination findings that differentiate Alzheimer’s disease from other forms of dementia. These include the presence of impaired stereognosis, olfactory deficit, the presence of release signs, gait disorder, tremor, and abnormalities on cerebellar testing. The above abnormalities are through to reflect the different areas of the CNS that are pathologically affected in Alzheimer’s disease. When conducting a clinical diagnosis for AD, specific attention needs to be paid, therefore, to the above aspects of the neurologic exam.

Summary

As this response has illustrated, the nervous system is a complex body system that works through the transmission of electrical signals. The central and peripheral nervous systems span across the body to ensure both voluntary controls of body movements and regulate bodily functions. Therefore, these complex functions mean that understanding and assessing the CNS requires specialized attention to the functioning of its microscopic elements. As explained above, in Alzheimer’s disease, neurons sustain injury resulting in their death throughout the brain. As connections between neurons breakdown, some regions of the brain start to shrink. At the final stages of this disease, the patient experiences a significant loss of brain volume and can no longer perform daily tasks.

References

Caruso Bavisotto, C., Scalia, F., Marino Gammazza, A., Carlisi, D., Bucchieri, F., Conway de Macario, E., … & Campanella, C. (2019). Extracellular vesicle-mediated cell-cell communication in the nervous system: focus on neurological diseases—international journal of molecular sciences, 20(2), 434.Week 8 Discussion Question Paper