Patients Profile i.

Biographic Data Name: DIF Age: 60 years old Gender: Male Civil Status: Married Birth Place: Upi, Maguindanao Religion: Roman Catholic Occupation: Engineer Address: B5 L13 PH3, Alpha Homes, Matina Aplaya, Davao City

ii.

Past Health History The client had a hypertension and he takes Norvasc (10mg OD) for management of the disease. He was negative for diabetes mellitus, renal failure and other diseases. According to the clients relative he had undergone a surgery, external fixation of the left leg (year not stated). Client had also experienced common cough and cold, and fever. The client was also a smoker and drinks alcoholic beverages occasionally. Mr. DIF had also no food and drug allergies.

iii.

Present Health History Before the client was admitted he was been active for his work and performs his daily routine. As stated by his watcher he had experienced a high grade fever, and nine days prior for his admission he had self-medicated himself with 500mg of paracetamol, still without relief. Days after, some symptoms persisted which associated with vomiting. He was then brought to the hospital near them after the particular thing had happened he was then admitted to that hospital with the diagnosis of dehydration and urinary tract infection. After two days of being admitted, above symptoms prolonged associated with delirium. Then it was managed as typhoid fever. One day prior to admission still above symptoms persisted now with unpredictable movements. The family opted to transfer client to Davao Doctors hospital hence confined to Intensive Care Unit I.

iv.

Family History (with Genogram) According to the clients son their family had no communicable diseases. It was their grandfather from his father side who had a hypertension in their family. The clients parents were also negative from diabetes mellitus, bronchial asthma and cancer. Except from the disease mentioned above there was no other diseases in their family.

Family Medical Genogram

Maternal Grandmother

Maternal Grandfather

Paternal Grandmother

Paternal Grandfather

Mother

Father

CLIENT

Legend: Smoking Heart disease Alcoholic Diabetes Cancer Mental illness

Anatomy and Physiology of the Brain and Spinal Chord The brain is a spongy organ made up of nerve and supportive tissues. It is located in the head and is protected by a bony covering called the skull. The base, or lower part, of the brain is connected to the spinal cord. Together, the brain and spinal cord are known as the central nervous system (CNS). The spinal cord contains nerves that send information to and from the brain. The CNS works with the peripheral nervous system (PNS). The PNS is made up of nerves that branch out from the spinal cord to relay messages from the brain to different parts of the body. Together, the CNS and PNS allow a person to walk, talk, throw a ball and so on. Structure and function of the brain The brain is the bodys control centre. It constantly receives and interprets nerve signals from the body and responds based on this information. Different parts of the brain control movement, speech, emotions, consciousness and internal body functions, such as heart rate, breathing and body temperature.

Parts of the Brain

Cerebrum The cerebrum is the largest part of the brain. It is divided into 2 parts (halves) called the left and right cerebral hemispheres. The 2 hemispheres are connected by a bridge of nerve fibres called the corpus callosum. The right half of the cerebrum (right hemisphere) controls the left side of the body. The left half of the cerebrum (left hemisphere) controls the right side of the body. The outer surface of the cerebrum is called the cerebral cortex or grey matter. It is the area of the brain where nerve cells make connections, called synapses, that control brain activity. The inner area of the cerebrum contains the insulated (myelinated) bodies of the nerve cells (axons) that relay information between the

brain and spinal cord. This inner area is called the white matter because the insulation around the axons gives it a whitish appearance. The cerebrum is further divided into 4 sections called lobes. These include the frontal (front), parietal (top), temporal (side) and occipital (back) lobes.

Each lobe has different functions:

The frontal lobe controls movement, speech, behaviour, memory, emotions and intellectual functioning, such as thought processes, reasoning, problem solving, decision making and planning.

The parietal lobe controls sensations, such as touch, pressure, pain and temperature. It also controls spatial orientation (understanding of size, shape and direction).

The temporal lobe controls hearing, memory and emotions. The left temporal lobe also controls speech.

The occipital lobe controls vision.

Cerebellum The cerebellum is the next largest part of the brain. It is located under the cerebrum at the back of the brain. It is divided into 2 parts or hemispheres and has grey and white matter, much like the cerebrum. The cerebellum is responsible for:

movement posture balance reflexes complex actions (walking, talking) collecting sensory information from the body

Brain stem

The brain stem is a bundle of nerve tissue at the base of the brain. It connects the cerebrum to the spinal cord and sends messages between different parts of the body and the brain. The brain stem has 3 areas:

midbrain pons medulla oblongata

The brain stem controls:

breathing body temperature blood pressure heart rate hunger and thirst

Cranial nerves emerge from the brainstem. These nerves control facial sensation, eye movement, hearing, swallowing, taste and speech. Other important parts of the brain Cerebrospinal fluid (CSF)

The cerebrospinal fluid (CSF) is a clear, watery liquid that surrounds, cushions and protects the brain and spinal cord. The CSF also carries nutrients from the blood to, and removes waste products from, the brain. It circulates through chambers called ventricles and over the surface of the brain and spinal cord. The brain controls the level of CSF in the body. Meninges The brain and spinal cord are covered and protected by 3 thin layers of tissue (membranes) called the meninges:

dura mater thickest outer layer arachnoid layer middle, thin membrane pia mater inner, thin membrane

CSF flows in the space between the arachnoid layer and the pia mater. This space is called the subarachnoid space. The tentorium is a flap made of a fold in the meninges. It separates the cerebrum from the cerebellum.

The supratentorial area of the brain is the area above the tentorium. It contains the cerebrum, the first and second (lateral) ventricles, the third ventricle, and glands and structures in the centre of the brain.

The infratentorial area is located at the back of the brain below the tentorium. It contains the cerebellum and brain stem. This area is also called the posterior fossa.

Corpus callosum The corpus callosum is a bundle of nerve fibres between the 2 cerebral hemispheres. It connects and allows communication between both hemispheres. Thalamus The thalamus is a structure in the middle of the brain that has 2 lobes or sections. It acts as a relay station for almost all information that comes and goes between the brain and the rest of the nervous system in the body. Hypothalamus The hypothalamus is a small structure in the middle of the brain below the thalamus. It plays a part in controlling body temperature, hormone secretion, blood pressure, emotions, appetite, and sleep patterns. Pituitary gland The pituitary gland is a small, pea-sized organ in the centre of the brain. It is attached to the hypothalamus and makes a number of different hormones that affect other glands of the bodys endocrine system. It receives messages from the hypothalamus and releases hormones that control the thyroid and adrenal gland, as well as growth and physical and sexual development.

Ventricles The ventricles are fluid-filled spaces (cavities) within the brain. There are 4 ventricles:

The first and second ventricles are in the cerebral hemispheres. They are called lateral ventricles.

The third ventricle is in the centre of the brain, surrounded by the thalamus and hypothalamus.

The fourth ventricle is at the back of the brain between the brain stem and the cerebellum.

The ventricles are connected to each other by a series of tubes. The fluid in the ventricles is cerebrospinal fluid (CSF). The CSF flows through the ventricles, around the brain in the space between the layers of the meninges (subarachnoid space) and down the spinal cord.

Pineal gland The pineal gland is a very small gland in the third ventricle of the brain. It produces the hormone melatonin, which influences sleeping and waking patterns and sexual development. Choroid plexus The choroid plexus is a small organ in the ventricles that makes CSF. Cranial nerves There are 12 pairs of cranial nerves that perform specific functions in the head and neck area. The first pair starts in the cerebrum, while the other 11 pairs start in the brain stem. Cranial nerves are indicated by number (Roman numeral) or name.

Cranial nerves and their functions

Number

Name

Function

olfactory

smell

II

optic

vision and light detection by the pupil

III

oculomotor

eye movement upward, downward or inward narrowing and widening of the pupil lifting of the eyelid

IV

trochlear

eye movement downward and inward

trigeminal

facial sensation chewing

VI

abducens

outward eye movement

VII

facial

facial expression closing of the eyelid taste in the front part of the tongue

VIII

acoustic

hearing balance

IX

glossopharyngeal

swallowing gag reflex

speech

vagus

swallowing gag reflex speech (vocal cords) control of muscles in internal organs

XI

accessory

neck turning shoulder shrugging

XII

hypoglossal

tongue movement

Blood-brain barrier The blood-brain barrier is a specialized system of blood vessels

and enzymes that protect the brain from chemicals or toxins produced by bacteria. It helps maintain a constant environment for the brain. The blood-brain barrier is made up of very small blood vessels (capillaries) that are lined with thin, flat endothelial cells. In other parts of the body, endothelial cells have small spaces between them that allow substances to move in and out of the capillary so they can reach other cells and tissues. In the brain, the endothelial cells are packed tightly together so substances cannot pass out of the

bloodstream into the brain. The enzymes also restrict the types of substances that can be carried from the bloodstream into the brain. Some substances can pass through the blood-brain barrier, such as very small molecules and molecules that can be dissolved in fat (are lipid soluble). Types of cells in the brain The brain is made up of neurons and glial cells:

neurons
o

These cells carry the signals that make the nervous system work. They cannot be replaced or repaired if they are damaged.

glial cells (neuroglial cells)

o

These cells support, feed and protect the neurons. The different types of glial cells are:

astrocytes oligodendrocytes ependymal cells microglial cells

Structure and function of the spine The spine is made up of:

vertebrae, sacrum and coccyx bony sections that house and protect the spinal cord (commonly called the spine)
o

The vertebral body is the biggest part of a vertebra. It is the front part of the vertebra, which means it faces into the body.

spinal cord a column of nerves inside the protective vertebrae that runs from the brain to the bottom of the spine

disc a layer of cartilage between each vertebra that cushions and protects the vertebrae and spinal cord.

5 sections of the spine:

cervical the vertebrae from the base of the skull to the lowest part of the neck

thoracic the vertebrae from the shoulders to mid-back lumbar the vertebrae from mid-back to the hips sacrum the vertebrae at the base of the spine
o

The vertebrae in this section are fused and do not flex.

coccyx the tail bone at the end of the spine

o

The vertebrae in this section are fused and do not flex.

Spinal nerves The spine relays messages between the body and the brain. These nerve messages control body functions like movement, bladder and bowel control and breathing. Each vertebra has a pair of spinal nerves that receive messages from the body (sensory impulses) and send messages to the body (motor impulses). The spinal nerves are numbered from the cervical spine to the sacral spine.

Spinal nerves and their functions

Number

Part of spine

Function

C1 C8

to cervical

send messages to the back of the head, neck, shoulders, arms, hands and diaphragm

(8 pairs)

T1 T12 (12 pairs)

to thoracic

send messages to the chest, some back muscles and parts of the abdomen

L1 to L5 lumbar (5 pairs)

send messages to the lower parts of the abdomen and the back, some of the legs and some parts of the external genital organs

S1 S5

to sacral

send messages to the thighs, lower parts of the legs, feet, most of the external genital organs, the groin area, the bladder and the anal sphincter

(5 pairs)

(http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/anatomyand-physiology/?region=bc#ixzz2lHo2R0E5).