Question

Mr. Johnson is a 63-year-old client who has been admitted to the emergency department following traffic accident. He is exhibiting manifestations of an increased heart rate, increased cardiac output. His Accu-Chek shows an elevated blood glucose level. His respiratory rate is increased, and he has audible wheezes. During a neurological check, he exhibits pupil dilation.

1. Compare and contrast the sympathetic nervous system with that of the parasympathetic nervous system.

2. Discuss the difference between the efferent neurons and afferent neurons of the peripheral nervous system.

3.What are the primary neurotransmitters of the ANS?

4.Discuss how albuterol may be effective with this client.

Frank Brown is a 72-year-old retired accountant. An accomplished musician and composer, Mr. Brown also worked as an organist in various churches during all of his adult life. Over the past several years, Mr. Brown has had increasing difficulty with his memory, finding that he is now unable to play familiar pieces of music that he had memorized years before. His increasing difficulty with memory and with cognitive ability has recently forced him to retire from his organist positions. Mr. Brown, accompanied by his wife, is seen at the medical clinic today. The Browns are informed that Frank is exhibiting symptoms of early Alzheimer’s disease.

1. Mr. Brown is given a prescription for rivastigmine. Mrs. Brown asks if this medication will cure the Alzheimer’s disease. How should the nurse respond?

2. Mr. Brown states that a friend of his was diagnosed with Alzheimer’s disease and is on donepezil. He asks why he has not been given this drug. How should the nurse answer this question?

3. Discuss the major points that the nurse should include in a teaching plan for the Browns regarding rivastigmine.

Answer 1

1. Compare and contrast the sympathetic nervous system with that of the parasympathetic nervous system.

Sympathetic Nervous System vs Parasympathetic Nervous System

	Sympathetic nervous system	Parasympathetic nervous system
Introduction	The sympathetic nervous system (SNS) is one of two main divisions of the autonomic nervous system (ANS). Its general action is to mobilize the body's fight-or-flight response.	The parasympathetic nervous system is one of the two main divisions of the autonomic nervous system (ANS). Its general function is to control homeostasis and the body's rest-and-digest response.
Origin	Originated from the cranial, thoracic and limbar region of the central nervous system	Originated from the cranial and sacral region of the central nervous system. Sacral region of spinal cord, medulla, cranial nerves 3, 7, 9, and 10.
Function	Prepare the body for intense physical activity. Control the body's response during perceived threat.	Relax the body and inhibit high energy functions. Control the body's response while at rest.
Position of ganglion	Close to the spinal cord, away from the effector	Away from the spinal cord, close to the effector
Size of pre-ganglionic fibres	Short	Long
Size of post-ganglionic fibres	Long	Short
Number of post ganglionic fibres	Large numbers	Very few numbers
Coverage area of pre-ganglionic fibres	Covers a wide area	Covers only a restricted area
Neuron Pathways	Very short neurons, faster system	Longer pathways, slower system
Mode of effect	Show diffused effects in the area of influence	Shows localized effects in the area of influence
Transmitter substance	Noradrenaline released at the effector	Acetylcholine released at the effector
General Body Response	Body speeds up, tenses up, becomes more alert. Functions not critical to survival shut down.	Counterbalance; restores body to state of calm.
Control	Control reactions to stress	Control routine body activates
Homoeostatic effect	Excitatory homoeostatic effect	Inhibitory homeostatic effect
Musculoskeletal System	Muscles contract	Muscles relax
Effect on blood level	Increase	Decrease
Effect on metabolic rate	Increase	Decrease
Cardiovascular System (heart rate)	Increase	Decrease
Effect on sensory awareness	Raise sensory awareness	Restore sensory awareness to normal level
Effect on pupil	Dilate pupils	Constrict pupils
Salivary Glands	Inhibit saliva secretion	Stimulate saliva secretion
Pulmonary System (lungs)	Dilates bronchial tubes	Constrict bronchial tubes
Adrenaline release	Release adrenaline from adrenal gland	No action of adrenal gland
Effect on the conversion of glycogen to glucose	Increase the rate of glycogen to glucose for muscle power	No action in the conversion
Urinary Response	Decrease urinary output	Increase urinary output
Effect on rectum	Rectum is contracted	Rectum is relaxed

2. Discuss the difference between the efferent neurons and afferent neurons of the peripheral nervous system.

The neuron is the structural and functional unit of the nervous system. These cells are specialized to respond to chemical and physical stimuli and to conduct and transfer messages throughout the body. Depending on the shapes and functions of the neurons, there are three types of neurons; namely, afferent neurons, interneurons, and efferent neurons.

Afferent Neurons	Efferent Neurons
Afferent neurons are responsible for receiving and transmitting messages to the central nervous system from all parts of the body.	Efferent neurons are responsible for receiving and transmitting the messages from the central nervous system to all parts of the body.
Afferent neurons make up sensory nerves.	Efferent neurons make up motor nerves.
Afferent neurons have a single long dendrite and a short axon.	Efferent neurons have a single long axon and several dendrites.
The cell body of afferent neuron is perfectly rounded and smooth.	Efferent neuron is satellite shaped.
Afferent neurons are located just outside the central nervous system.	Efferent neurons are located inside the central nervous system.
Afferent neurons are activated by external stimuli such as vision, hearing, touch etc.	Efferent neurons get their input from the other neurons including interneurons and afferent neurons.

3.What are the primary neurotransmitters of the ANS?

The Primary Neurotransmitters of the ANS Are Acetylcholine and Norepinephrine.

Acetylcholine (ACh) - is the transmitter released by the preganglionic nerve terminals of both the sympathetic and the parasympathetic divisions.

Norepinephrine (NE) - is the neurotransmitter for postganglionic synapses of the sympathetic division.

4.Discuss how albuterol may be effective with this client.

Albuterol also known as salbutamol, Albuterol belongs to a class of drugs known as bronchodilators. It is used to treat wheezing and shortness of breath caused by breathing problems such as asthma.
In this case , Mr. Johnson has increased respiratory rate and audible wheeze, Albuterol can act as a quick-relief medication which works in the airways by opening breathing passages and relaxing muscles which helps in controlling his symptoms.