[Music] okay good evening are you all excited midterms so anyway I will do at these parts with chapter 13 14 and 15 so a bad day this chapter is important because when you work as future nurses you will be dealing with patients who may suffer from nervous system disorders and example with that of the a patient whose stroke we're in half of the body's paralyzed whether the problem is in the brain right so in chapter 13 we deal with neural tissues and all the deficit is classified so whenever we say central nervous system what is involved in okay so a memory system can either be CNS or TNS CNS tasks for central nervous system from the other hand pns tasks for peripheral nervous system so whatever we take said that they're resistant you're dealing with what brain on the other hand when we're dealing with the peripheral nervous system what are we dealing with peripheral nervous system if the central nervous system deals with the brain and spinal cord what would be classified for the peripheral nervous system outside the central nervous system it can you be more specific than that so if example you did the brain here by the phone here which one will be the peripheral nervous anybody what spoiler alert what did they come from somewhere where do they arise from where did they come from okay I thought to have been active me how many of you love and not all of us should have this is a plantation of nurse I'm a smart nurse is good in anatomy and in computers nerdist.com isn't after me and she would not patent Nursing Board Exam why school spinal nerve because they come from where how many pairs of spinal nerve do we have how many 31 pairs right on the other hand what will arise from the brain there you go cranial nerves well and I mean spine alert 31 pairs pairs of cranial nerves so what do most people say what do most people do and say if I asked them what includes the peripheral nerves they will always tell you anything outside the center because that is what is found in the book so that is not what we need you to know if you want to be more specific than that what simply means is that most of the time in the PowerPoint slides in what slide there it says everything that's outside one more than the brain but if I ask you which one you don't know the answer because you practically memorized the part but without understanding when so when you say outside the brain the answer would be one way the nerves what does cranial mean pertaining to the brain discover and mania right and spinal nerves as we said refers to the nerves coming from where spinal cord these two structures brain spinal cord are part of the central nervous system while your cranial nerves and by the nodes are part of what we call peripheral nervous system do you understand top what is another name word for nerve cell you want very good you're onto nerve cell it is a dendrite cell body and an accent that right there it can give us to the cell body the somebody just like any typical cell does it contain a nucleus contain your mitochondria and the plasmic reticulum because both are up yes because it's a it's a cell and then the accent carries the Nervii password away from the cell body right does that make sense okay now what is a struck Purcell that supports the new 100 glia all right so neuroglia versus Iran is a difference mr. s which one's the nerve cell you rod which one will transmit the nerve impulse has everybody signed your attendance here for review from this one to expiate the new round impulse of nerve impulses what about the neuroglial cells do they transmit the nerve impulse no they thought the only what support the neurons a little elaborate later okay is that clear glass now but it come to neuroglial cells some of them are found where the neuroglial cells some of them can be found in the central nervous system tombé peripheral nervous system under peripheral nervous system what are the examples given there what is Oak is it one or spam it is van why is it spam it's German how many of you speak German here am I the only one whose picture - vans Volkswagens mr. Dahle - which I know or up - you're watching all those German movies you know what war - action Esbern what's the other one satellite so this is what every metric is - this what you call the concept map the concept map a concept map is an idea map the idea map is a map decided to make you learn better in a more organized manner so that your brain will not be like it what what is that there a trust kind of information you want your brain to be very very sharp you want your brain to be able to cut the base piece of paper there can you brain cut that piece of paper where's not talking about a sharp my a smart mind not dog when you have a dull knife and you cut no I want you to talk the sharpest minds in the world and one way of doing that is coming up with what we call a 1 a concept map like what I'm doing here right so will you do this at home do this without looking if - no don't look in your books and the only way to come up with what short term or long term memory we wonder students as well short term or long term do you want a short-term memory you know that that's our today and tomorrow you forget why because what did you do your crab but it's grimy turning that last night that it is suddenly right okay now in one or two words what is the role of AIDS van cell what myelination very good of what free from her friend what about the satellite cell when you find them in the Ganga very good and what is a ganglia or ganglion a bundle of neuron cell bodies exactly cell bodies that are a bundle okay now what exactly so if this where does let's go to the so we say myelination if this were at the dendrite cell body like this accent exact then right cell body arcs and is to see me represent assists with the myelin what is my name Aida what is the chemical substance that the myelin is made of in one what yes very good so the word for fact lipid liposuction what is lipo removal of what is this fact so cute this is the one that will kill me why what will happen to the excess fat here they will deposit way in the coronary arteries of my heart and I will die today I'm just kidding of course not this finish takes a friend like that is fine it's amazing people will not be knocking on my coffin where is your midterm exam result of the gum I'm just joking okay lipid or fact and why is it that myelin is important in the nervous system what does it do what does myelin do speech of what production of the nerve impact how oh how does it speed up the conduction of the nerve impulse do you understand what they're trying to drive out here you may know the answer but you have to know what is why where how I said ask what I said finally what does it do speed up production how is there any way now yes anyone don't be afraid to answer this is a free country all answers are correct unless I say it's wrong and don't be afraid to be a yes I'll tell you what is the answer but anybody else okay okay it's called the note on what notes of what that the notes of Mylene they do not contain what no no no my any note note notes okay let's pretend this is the cell body this is the action and this is what the dendritic cell body that are sent away from the colony look at me if this were doctored guapo a common way of finding that well what do you say what Pope means what well it's corporal thank you so much the only person who's in Antwerp or and suppose my mom not even if I never cook me I was handsome so compared to me up till now she hasn't told me I was handsome anyway I'm just joking she doesn't have to say I already know okay if mr. Cobb dr. gawa representing the nervion bus without the modelling look at me now top of the axle on the other hand in the presence of mine Lee which is lipid or fact the nerve impulse robot we'll jump from nerve impulse will jog for one note over a vein to the nectar which are this faster without the myelin or with the mainly focus state is one the one in the mine you understand and therefore it's important that we know that my little axes are faster okay do you understand now but no too much but no children vay run it's French why is it fun German okay now under central nervous system which one will produce a violin which was important for the blood-brain barrier these were already exam you would have two questions with two correct answers right amazing we go by any where rated spinal cord Astro blood-brain barrier what does BBB is time for why do you think I just put BBB there I went to what st. what one able to say one ATP energy just have to break the word rod brain I'm gonna waste my time what else for micro what is my crew mean what kind of ball Leo sail and that's the other one this will be seen if anything what so it contains what it produces what CSS has for what cerebrospinal so what do you think I wrote in this concept map did I write only the important word that you need to remember if I said produces bile in in the peripheral nerves answer would be what if I say produce myelin in the brain and spinal cord the answer would be what is it so both of them produce Mylene but the location is different brain bag or the good end-to-side bad once that hi my name is brain my link what is your name hi my name is mylène peripheral nerves what is your name this is completely or sunny the answer is actually it's part of you Sunday take your time be afraid don't don't find those people and you can you read the what could give a pair of glasses right what is that word my innit what is that word Mylene what is it word below can you read that co-wrote that it's not my fault but I used to write in the Charter there to the doctor gamma I can't understand you are writing for now if I ask you now which one for smiling in the peripheral nerves Sunday what's up are you suddenly I'm going to take the nursing fort except for her I thought is your name Briana you better leave without really take the missing words okay you can be whispering tour yeah what you said what is it Taylor uh Sunday what that is that trying to be what is this what is that and what is pianist Sunday this what's the answer now what produces the Milan in the peripheral nerves I think what self it's fine it's okay I think you need to maybe change your glass a little bit you can see better what does a lot of time here do passes that's a double check it okay because I believe there's something it's fine live in three problems I'm actually converting these to a question now where do you find commuter princess by the satellite I'm give me your temperature oMG for dr. G ratify the satellite cells and was the ganglia a collection somebody's okay if I say hi my name is blood-brain barrier brain what would that be what is your name hi my name is after sec what is your name so easy I should get a perfect score in my exams every time you take an ID to the Excite oh my god I know everything talking to me will ask me actually got a perfect score here right okay now we're dealing with this work the vesicular Singapore the synapse a junction between the nerves I will never serve with dendrite and accent okay it's the cell body here axon here then right so about here actually they're in a particular type of synapse your vesicles what did the vesicles container and neurotransmitters right so the ticular vesicles are found at the tip of your accents vesicular synapse a synapse is what a junction between one neuron and another neuron or in Iran or respect or sale and what is fall inside here near all trucks guitars such as dopamine ACS or acetylcholine adrenaline otherwise dose epi nor adrenaline or known as nor epi cero tuning and GABA which means gamma butyric acid so with the nerve impulse travel here because there then you twist well the Splinter is like a what FedEx guy what is the FedEx guy do just meet what bring them a packet to your to your house what do you find here in the Denver receptors receptors so if is dopamine is dopaminergic receptor if it's acetylcholine is calling nergic receptor serve tonic receptors adrenaline adrenergic receptor so the nerdy about saw us here and then what will the NutraSweet you do carry the nerve impasse to where the receptor via the synaptic class what is a class space why not club space these neutrals with us released here in class it carries the nerve impulse and it attaches to we're very specific receptors so in other words if it dopamine it has to be dopaminergic receptors like the key I need to be able to open the door with a yard right key and then what happens now it travels here there is a wave of depolarization goes any busier than the same thing happens right what happens if you do not have enough of dopamine develop Parkinson's disease now does anybody know Muhammad Ali Lord Ali knows not to be what cash was played before he became Muslim and the became woman Ali his my idols I know him but he doesn't know me besides their intent float like a butterfly and then what like the beam but with repeated trauma to his head if damaging his basal ganglia and substantia he ended up developing one Parkinson's disease he has tremors can he cannot control his movements because this particular neurotransmitter is what inhibitory there's Brady what is Brady slow kidney chemise movements like doing what tai chi's and here's what no facial expression when Muhammad Ali at the peak of his career in 1973 he went to the bank micron I come from the Polo Philippines and he was fighting with Joe Frazier every time you see him on television I am the greatest thrilla in manilla against that goal Riddler it was the gorilla Joe freezer it says it's handsome just like me okay but when he suffered for part of the disease mask you know some asked mas que pasa Smith's facial expression F 80ies George wanted amphibians tear or rip tail has two already ever seen the frog in the parlor that they don't do they blink no they don't today laughs as much why because if the fly or mosquito passes by okay what about if you lack serotonin in developer impression have you ever heard of clinical depression if people are depressed what do they do to kill themselves we silent tendencies how do you know the patient is depressed well they do not like to eat they have lost their appetite he do not cooperate with you and we look at that me they appear to be like this right now what drug can we give them antidepressant like prop how have you heard of prozac prozac manufactured by jaycara industries nineteen thirties I have a dream I get the Roman seal off the media and China and repackage it now somebody in the border simply would you give them prozac so after doing this give the Prozac I feel good because it's an antidepressant and you will learn to make a dish of there in pharmacology so he's anatomy and physiology the basics basis for medicine and nursing yes it is if you do not know this that you should not be nursing because you have to know what drugs we gave so what do you think we gave this patient with Parkinson's ok levodopa dopamine don't you that but not to meteorology the patient lacks this what do we give them leave for dopamine the problem is that this drug is only good for three months after three months they don't work so we still doing a lot of research at the J gamma four days of research as we are trying to find out what exactly is wrong with these patients hopefully with better PET scans for certain emission tomography so we can find the answer remember Michael J Fox is he suffering from Parkinson's is he a boxer so the mechanism of damage to the basal ganglia is different and I've a theory called the commotion theory that we have suffered from encephalitis through a virus damaging the part of the brain that stores and produces dopamine which happened to be the basal ganglia and the substantia warning talked about is next week what about serotonin the same thing we don't give serotonin but we gave them what now what is that Tommy green very uptick because when when the circle is released we have take me to go back we don't want them to go back they want it to remain there to have high levels of certain certain reuptake inhibitors so this drug prozac will do that we want to have high levels of serotonin particularly in the cleft which is Cornell bien mr. Issa why they have a better advantage over you guys if you are at an area but the playing field with the same in the moment to go to the corners in right time do you understand now for example under nergic receptors adrenaline what does it doesn't do to your heart rate right and if we equate heart rate what will be the effect in a blood pressure it goes up so if I say beta adrenergic doctor the means it's have drawn attach to the receptor so when the adrenaline is released and it attach to the receptor no it cannot it's a beta adrenergic blocker or beta blocker the doctors and nurses are lazy develops a adrenergic of anymore we don't what do you say we just say what splainin safe of beta blocker but it actually means what beta adrenergic or sympathetic blocker which means supposed to an individual heart rate if it is simple adrenaline but because you block adrenaline what will be the effect on heart rate if you block scepters air so these drugs will attach to the receptor therefore the adrenaline with no longer attached what happens a dark-gray can give a blocker make them lucky things aren't great decrease what they neither where there is nothing that you cannot answer in their saying if you know you're an optimist holiday you can actually perfect or examine the Nursing Board Exam you understand am I still good at the fair and when I do a review nurse nursing is class but oh my god dr. Campbell there's so many drugs thousands and thousands but you have to be smart you look at patterns in life most is not all of these beta blockers they end with what lol laugh out loud such as what propranolol up $10 or metoprolol and gamma no you have not heard about gamma walls where do you think was this manufactured here in Tijuana what company jconway in the streets named after me before I die they told my kids I want to be remembered gamma zone I'm just kidding so if you're taking a nursing board exam and you're given a choice of drugs to give a patient with hypertension or elevated blood pressure and one of the answers has lol suffix could it be the possible answer for after hypertension do you understand so you don't have to memorize all these although all know you understand now so we've talked about this now let's move on to the spinal cord where did the spinal cord end now though leather l1l do the spinal cord passes to the foramen magnum is it an extension of the brain is it is the physical part of central nervous system correct okay and the spinal cord as we said has turned too much spinal nerve coming out from them if it comes out in the intervertebral foramina remember that in the spinal column table so whenever we say spinal column or vertebral column you think of all when I say spinal cord is made up of one nervous tissues which part central nervous system right okay if this where the spinal cord it's protected by what the spinal column then what the meninges just like the brain skull meninges brain vertebral column spinal column spinal cord protected by the meninges what is the outermost layer Dora means what matter means mother durham is tough mother what's the next layer the middle layer the rachni arachnoid refers to what spiderweb appearances it's Arachne the clasp that's my pre-med cord so ology i want to work at a zoo what's the third layer the innermost layer p.m. after so which one is found on the surface of the spinal cord in the brain which one is found on the surface of the spinal cord and brain wait why because why what's on the surface of the brain because it's the innermost layer some people during a quiz they get confused which one is animals and outermost counter laws means what outside bow dura next round their necks yeah what people the space above the drum epidural space so the epidural space is above the dirac it contains fat and fat contains a lot of some blood vessels there too right now what about the space below the arachnoid and why in the subarachnoid space important it contains what CSF cerebrospinal fluid do you understand in other words a separate space is far between what the rock noise and the PMF so what are called space below the dura central space how many of you here we're pregnant and we're given epidural you top why what why did you ever bother to ask yourself why did I not feel anything right in other words the pain it box up in how see what I mean anybody anybody see this is where you have to be smart by knowing the answer to all the questions the board I said how where when why if you want to cut my sexy booty wish may go like this you cut here this is what your seat going to see gray matter contains what cell bodies gray matter contain what that letter H what they call this part here dorsal horn the horn if this is the dorsal Horn this must be what dorsal what root or understand both times and then what would this mean vector one fan war and so on root can anybody tell me what is the word for dorsal boss they are very good I say this gambling daily right with me laughs who steer horn what's another word for better out there for oh don't you have enough to mean it's amazingly one lovable what's another word for mental horn at the or dorsal horn in the gray matter dorsal root what do you find in there sensory or sensory century what about methyl group ventral horn define here motor or motor dorsal means at the back like this so with this way men when you raise your hand and you said you were given epidural anesthesia what happened here the drug was given here is the dura rock Nora appear the dog was not even penetrated was not penetrated because LP means above the door and what did you do you released what the anesthetic agent and where did it go sensory or motor so that is part of sensory loss there is less pain so a woman without epidural anesthesia look at me your goal is to make one now if I showed it before I did vagina here down here push push with the up the muscles contract is there pain histories and then we made pregnant I would really knows I have made somebody pregnant my wife very painful but we gave my epidural so a woman would all I put on would be like this never again no more nothing no but babies would be if then epidural what happens [Laughter] if you know we call it beta analog scale which ones can we tell of the visions I used to do the pictures ma'am if the pain scale is from zero zero means no pain to 10 that being the most painful experience should ever happen and they would say nine give it at the drug it went down to one maybe two maybe one so amazing what people looking for you okay we don't want to give too much because it might affect for motor and maybe my stay there for one year because you paralyze the muscles and the baby would come out do you understand okay no now what is different spinal anesthesia and spinal is what you benefit what the Dora you put it in there at night then you go where into the subarachnoid space a spinal anesthesia we release the anesthetic agent we're on the some reference base if you perform that same major surgery or the pelvic organs if we want remove your ovaries uterus spinal now the question is that because you've penetrated the dura and the arachnoid you are now in the suburb in space which contain the cerebrospinal fluid can that CSF leak out yes so what do you tell her to do tell the patient to lie down on one flat one bed this is the bed here by back lie down 1/4 how many hours 12 hours 10 to 12 we put a sterile gauze what was the way to put pressure it's like when you have a would you put pressure to stop the bleeding here we put one sterile classroom wait to put pressure we did the bed in you your weight and the bed would put pressure to prevent the leakage or what should we expect the nurses therefore to follow instruction to tell the patient's complete bed rest man poor dr. Karma what for to prevent one final headache are you in over here have you ever experienced by the headaches have you ever undergone spinal anesthesia now in spinal taps or lumbar tops we want we get through it when you do that the take patient come to the register over this what am i suffering from generalized tonic-clonic upward rolling of the eyeballs seizure with neck rigidity Omega travel to the music board exam in fact I always tell me nurses think like a doctor and act like a nurse that's how you pass the exam you have to know the knowledge get the knowledge of the factor and let say they'll give you my knowledge maybe when a patient comes with emergency room with seizures high-grade fever with very thick frigid night rigidity or with Nicole Nicole Nicole Smith neck and you see HDL think of meningitis I regretted perform a spinal tap Blumberg top who would perform the procedure a doctor who will assist the doctor smart nurse from West Coast we only hire people from Westco they're smart you are smart because you are one students of West Coast the best in the west after doing it until we get a spinal needle but is there remove the CSF is a manometer mastering pressure we get a sterile Y sterile because we do not want any contamination so the clean container means care containers send it to the lab and grow for anyone talk to your organism so if it's what you can tell if it's been attended to by viral meningitis or bhakti of India's vigorous wife like my wife works at cedars-sinai we send them a specimen and they control they feed them with blood Agra freedom and that rollin rollin in rough weather oh my god Staphylococcus streptococcus gamma caucus or Pseudomonas aeruginosa Neisseria meningitidis or min ago could see me and the worst kind and they can tell which one is what what kind of drug is best resistant to penicillin sensitive to self doesn't like we do not give one penicillin because the bacteria is resistant to that if we give it sensitive to sell faster than the third-generation cephalosporin yes we do so we are men and women of science once I gave the talk what up into the fever the frequency of seizures will also lesser and how are we going to give C anti-seizure drugs which we could you understand glass are we going to London light not in bed for the next 10 or 12 hours again because in spite of the seizure who put the anesthesia in spinal tap we get the fluid and the best site will be where iliac crest even a crest before l4 l5 level 1 because spinal cord ends where and one so one we intern at the elbow l4 l5 we want to avoid one spying on some Rapids if the stupid doctor in insert the diesel at anyone it could hit spinal cord teachers because paraplegic 100 million malpractice and it will also show the nurse and everybody but of course the most important person will be the hospital you know they have more money right okay now this meninges directly via the pier or the spinal nerves spinal cord is longer than the spinal column it's like s an l1 l2 now what we call the spinal nerve that goes down into the from the what is the last part of spinal cord is called corners when last part is parkours conus medullaris or the terminal end corners co and us mental errors and in the they are is and from there the loom or sacral spinal nerves would look like the tail of the horse cauda equina that is made up of a blue mosaic of spinal nerve LUMO sacral spinal nerves loose like the tail of the horse now in the middle of the tail there is a whitish layer of Pia mater never Dora or the beard extend all the way down that's connection see if this where the brain spinal cord address which is Pia right on the surface via the pxn like this what is the code begins with other earth [Music] you're the man so what is this therefore made of a wrap knowing we just connected tissue right matter now remember arachnoid I'm sorry yeah my goodness something may be stupid absolutely yeah then how long does the dura goes down here at the level of s 2 this is l1 right s 2 here the dura joins the PR on both sides so dura Pia in the middle around the sides dura and he adjoints at s2 level to become the what coccidia wa ligament and where do you think this coccygeal ligament attached to the coccyx what to prevent the court from what jumping up and down if I go like this it protects us by the court because it's awkward to this context so coccidia ligament is made out of Pia and dura but this one is just purely Pia is made up it's called filum terminale the pair together with Laura at s2 becomes go to jail ligament attached to where coccyx through the window box a table now what is part of the PR here paired fear fear attached to the dura on the sides and when you look at it in the cadaver specimens we have it you say lady just like the teeth it's bare Pia adapt to the court that I'm trying to do repair to the door appeared in Europe what it does it prevents the court from moving from side to side if I go like this it prevents movement of the court side to side coccidia ligament prevents over one and down movement what prevents movement side to side what does Dendi mean when you have a problem when your teeth who do you go to then this and what is the name of the ligament then take your leg don't you love Anatomy again it's an exciting then particularly from the word dentist and you look at this it looks like what this you understand so what to go in the end of the spinal cord corners been to Lars I've talked about filum terminale a thought what karlie quite a bit of spinal nerve roots we talked about those service branch off now I tell you this when you have heard of polio member who is FDR Franklin Delano was what he suffered for polio the virus attacks what what is it what do you think the virus will attack the dorsal horn or the venture Lord or the air horn the anterior horn cells on the ventral horn what is father Walter patients with polio will have paralysis from the neck if depending on the cervical cord or paraplegia like in the case of what FDR doesn't have to be on a wheelchair now if it affects the cervical spinal cord you cannot breathe the neuron because it will affect your diaphragm intermittent by the phrenic nerve when you breathe in your home now if you look at google it they call it iron lung in the 1920s and 30s all these kids were placed inside this big white thing to breathe through them okay do you understand class now the that's the last chapter is actually just dealing purely with modern tracks you don't have to memorize them but it's very simple if you pinch me here what kind of talk about sensory or motor sensory go to the spinal of sensory spinal nerves by the court enters here and then what goes with the goes into the medulla oblongata which is the last part in crosses to the opposite side goes into the fur right you will learn is next week it's called the parietal lobe the primary sensory cortex what about what is a lose what's another name for sensory tracks ascending our parent sensory nerve tracts our parent ascend even with the ascent to the central nervous system what is descending efferent descent efferent motor example if I picture I feel the pain in the temporal parietal lobe and what is the frontal lobe and the frontal lobe is the motor cortex area so it tells what your muscles to contract so it says that nerve impulse from the left go to the right left and what does it do closest to the opposite side in the medulla oblongata time to go down to the right side so it controls the right part of the body opposite so if you say painful the body's ok remove your head and this just must have kissed a person you know how many of you love pain okay now nobody wants pain imagine you have a toothache oh my god I love this to take [Music] this step or top the chart in fact pain is a reminder that there's something wrong like if you have right lower quadrant pain it means that it would be appendicitis right the right upper quadrant loved under pain or liver pain with Jordan is right okay it's a clear so the idea here is that unfortunately talked about the nerve tracts you should talk about the brain for today they made the brain next week in chapter 16 17 18 and they're already talking about the memorize okay I'll give you a five-minute break when you come back we will have the midterm exam so you don't have the covers from 1 to 15 except for 12 I only gave you a study guide for every five-minute break go to the restaurant [Music]