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INFORMATION The Brain (Part 4)

The brain is a complex organ that controls thought, memory, emotion, touch, motor skills, vision, breathing, temperature, hunger and every process that regulates our body. Together, the brain and spinal cord that extends from it make up the central nervous system, or CNS.

INFORMATION the Brain (Part 4)

Weighing about 3 pounds in the average adult, the brain is about 60% fat. The remaining 40% is a combination of water, protein, carbohydrates and salts. The brain itself is a not a muscle. It contains blood vessels and nerves, including neurons and glial cells.

Gray and white matter are two different regions of the central nervous system. In the brain, gray matter refers to the darker, outer portion, while white matter describes the lighter, inner section underneath. In the spinal cord, this order is reversed: The white matter is on the outside, and the gray matter sits within.

Each region serves a different role. Gray matter is primarily responsible for processing and interpreting information, while white matter transmits that information to other parts of the nervous system.

The brain sends and receives chemical and electrical signals throughout the body. Different signals control different processes, and your brain interprets each. Some make you feel tired, for example, while others make you feel pain.

The cerebrum (front of brain) comprises gray matter (the cerebral cortex) and white matter at its center. The largest part of the brain, the cerebrum initiates and coordinates movement and regulates temperature. Other areas of the cerebrum enable speech, judgment, thinking and reasoning, problem-solving, emotions and learning. Other functions relate to vision, hearing, touch and other senses.

The spinal cord extends from the bottom of the medulla and through a large opening in the bottom of the skull. Supported by the vertebrae, the spinal cord carries messages to and from the brain and the rest of the body.

The pineal gland is located deep in the brain and attached by a stalk to the top of the third ventricle. The pineal gland responds to light and dark and secretes melatonin, which regulates circadian rhythms and the sleep-wake cycle.

The ventricles manufacture cerebrospinal fluid, or CSF, a watery fluid that circulates in and around the ventricles and the spinal cord, and between the meninges. CSF surrounds and cushions the spinal cord and brain, washes out waste and impurities, and delivers nutrients.

The external carotid arteries extend up the sides of your neck, and are where you can feel your pulse when you touch the area with your fingertips. The internal carotid arteries branch into the skull and circulate blood to the front part of the brain.

The vertebral arteries follow the spinal column into the skull, where they join together at the brainstem and form the basilar artery, which supplies blood to the rear portions of the brain.

The circle of Willis, a loop of blood vessels near the bottom of the brain that connects major arteries, circulates blood from the front of the brain to the back and helps the arterial systems communicate with one another.

If you are the oncoming nurse, be sure you get to work on time and be ready to get report at 7:00. I had a couple situations where I worked night shift and the oncoming day shift nurse would roll in around 7:07 A.M and get her coffee and chitchat and she really didn't come to get report until almost 7:15. And it's not really respectful and it really condenses that 30 minutes into a much shorter window to convey a lot of information. Just try to be respectful, get there early, get your lunch put away and just be ready to get that report at 7:00.

When you are giving report, what information is important to convey? Because, again, you only have about five, seven minutes per patient. You want to communicate the patient's name, their age, their date of birth.

In addition, gastrointestinal and the urinary system. Let the oncoming nurse know if the patient is incontinent and whether they have a Foley catheter in place or maybe a condom cath or a Purewick. If you know the patient's last bowel movement, that's always really helpful information for the oncoming nurse to know.

Then you want to let the oncoming nurse know what kind of IV access the patient has. Is it a peripheral line? Is it a PICC line or a central line? Are they getting continuous IV fluids and if so, what is it? Is it normal saline, 75ml an hour? You want to give all of that information.

As far as other details, like specific labs and some of those comorbidities and other medications, the nurse can look up that information. You're really going to focus on those essential things when you are giving report to a nurse.

Hopefully, this video has been helpful. It takes some practice to get really good at report but I know you can do it. If you can, have your Nurse's Brain in front of you to keep track of stuff. But again, don't go through everything. Just focus on those few vital pieces of information that I shared in this video.

Video transcriptionWe live in an age of innovation. Combined with our desire to self-track, self-assess, and self-improve, this gives us the ability to monitor our own physical and cognitive health. Neurocognitive tests (part 1) are a noninvasive way to get a detailed view of how your brain is doing along multiple axes.

The person who has confusion or impaired judgment may be unable to remember where dangers lie or to judge what is dangerous (stairs, stoves, medications). Fatigue and inability to make the body do what one wants can lead to injury. Therefore it is very important that a brain injured person live in an environment that has been made as safe as possible. The following are some safety guidelines to use in the home:

Individuals with brain injury should receive permission from a health care professional prior to using alcohol or other substances at any point after their injury. Also, NO DRIVING until approved by your doctor.

Disclaimer: This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.This publication was originally produced by the TBI Model Systems in collaboration with the University of Washington Model Systems Knowledge Translation Center with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education (grant number H133A060070). It was updated by the TBI Model Systems in collaboration with the Model Systems Knowledge Translation Center at the American Institutes for Research with fuding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

The human nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS, in turn, is divided into the brain and the spinal cord, which lie in the cranial cavity of the skull and the vertebral canal, respectively. The CNS and the PNS, acting in concert, integrate sensory information and control motor and cognitive functions.

The adult human brain weighs between 1,200 to 1,500 g and contains about one trillion cells. It occupies a volume of about 1400 cc - approximately 2% of the total body weight, and receives 20% of the blood, oxygen, and calories supplied to the body. The adult spinal cord is approximately 40 to 50 cm long and occupies about 150 cc. The brain and the spinal cord arise in early development from the neural tube, which expands in the front of the embryo to form the three primary brain divisions: the prosencephalon (forebrain), mesencephalon (midbrain), and rhombencephalon (hindbrain) (Figure 1.1A). These three vesicles further differentiate into five subdivisions: telencephalon, diencephalon, mesencephalon, metencephalon, and the myelencephalon (Figure 1.1B). The mesencephalon, metencephalon, and the myelencephalon comprise the brain stem.

The telencephalon includes the cerebral cortex (cortex is the outer layer of the brain), which represents the highest level of neuronal organization and function (Figures 1.2A and 1.2B). The cerebral cortex consists of various types of cortices (such as the olfactory bulbs, Figure 1.2B) as well as closely related subcortical structures such as the caudate nucleus, putamen, globus, amygdala and the hippocampal formation (Figure 1.2C).

The mesencephalon (or midbrain) consists of several structures around the cerebral aqueduct such as the periaqueductal gray (or central gray), the mesencephalic reticular formation, the substantia nigra, the red nucleus (Figure 1.4), the superior and inferior colliculi, the cerebral peduncles, some cranial nerve nuclei, and the projection of sensory and motor pathways.

The caudal end of the myelencephalon develops into the spinal cord. The spinal cord is an elongated cylindrical structure lying within the vertebral canal, which includes the central canal and the surrounding gray matter. The gray matter is composed of neurons and their supporting cells and is enclosed by the white matter that is composed of a dense layer of ascending and descending nerve fibers. The spinal cord is an essential link between the peripheral nervous system and the brain; it conveys sensory information originating from different external and internal sites via 31 pairs of spinal nerves (Figure 1.5). These nerves make synaptic connections in the spinal cord or in the medulla oblongata and ascend to subcortical nuclei.

In general, the CNS can be divided into three main functional components: the sensory system, the motor system, and homeostatic and higher brain functions. The sensory system consists of the somatosensory, viscerosensory, auditory, vestibular, olfactory, gustatory, and visual systems. The motor system consists of motor units, and the somatic (skeletal muscle) system, the spinal reflexes, the visceral (autonomic) system, the cerebellum, several subcortical and cortical sites, as well as the brain stem ocular motor control system. The homeostatic and higher functional system includes the hypothalamus, cortical areas involved in motivation, insight, personality, language, memory, imagination, creativity, thinking, judgment, mental processing, and subcortical areas involved in learning, thought, consciousness, memory, attention, emotional state, sleep and arousal cycles.


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