Adult Neurologic Flashcards
Werneckie’s aphasia
- unable to understand the spoken and written word
- speech may have a normal rate, rhythm, and grammar
- content is word salad.
Homonymous hemianopia (HH)
- vision loss on the same side in both eyes
- teach client to scan the room
Myasthenia gravis (MG)
- Diplopia
- ptosis
- facial muscle weakness
- may progress to respiratory failure
Permissive hypertension during an ischemic stroke
- blood pressure up to 185/110 mm
- not lower than 150/100
Alzheimer’s
- leading cause of cognitive impairment in old age
- provide low stim environment with good lightening
- dementia
- insidious (gradual) onset, NOT abrupt
- NEVER ARGUE
Symptoms of dementia
- agnosia
- inability to recognize loved ones
- apraxia
- inability to perfrom familiar tasks (brush hair/teeth)
- agraphia
- difficulty writing
- aphasia
- trouble finding correct work
- babbling/mutism
Parkinson’s
- blurred vision (not diplopia)
- emotional lability
- exaggerated changes in mood
- fatigue
- muscle incoordination
- urinary urgency
Migraine headache (MH)
- unilateral frontotemporal pain (throbbing or dull)
- not episodic
- migraine can last for days
- one side
- photophobia
- phonophobia
- nausea, vomiting!!!
- altered mentation (drowsiness)
- dizziness
- numbness, and tingling sensations
- may feel like stroke because of facial paralysis and numbness
Cluster headache
- abrupt onset, episodic (daily at same time)
- lasts weeks/months
- more common in men
- localized behind eye (unilateral/spasms)
- significat photosensitivity
- tearing up
- nasal drainage
- pulsating
- aggitated
- pacing
- remaining still makes it worse
- TREATMENT
- oxygen via nonrebreather
- trying to stop vasospasms
- oxygen via nonrebreather
- significat photosensitivity
Tension headache
- dull on both sides of head
- does not cause tearing up
- not episodic
Trigeminal neuralgia
- brief ‘spasms’ occuring spontaneously
- spasms of face
- normally occurs in late 40s
Bacterial meningitis
- fever
- nuchal rigidity (neck pain)
- photophobia
- emergency
- blood cultures for antibiotics
- establish PVAD
- encourage fluids
| droplet precautions
Neurogenic shock
- hypotension
- bradycardia
- hypothermia
- decrease in urinary output
- tachypnea
- thready pulse
Septic shock
- serum lactate level above 2 mmol/L
- due to inadequate tissue perfusion
- anaerobic glycolysis increases
- goal is MAP greater than 65 mmHg
- hypergylcemia expected, but detrimental
- hypotension
- metabolic acidosis
- low bicarb levels
Spinal shock
- absent bowl sounds
- gastric distention
- bradycardia
- hypotension
- flaccid paralysis
- depressed reflexes
Brown-Sequard syndrome
- incomplete spinal cord injury
- hemi-paraplegia
- ipsilateral (same side)
- hemi-anesthesia (sensory loss)
- contralateral (opposite side)
- loss of pain and temp
Central cord symdrome
- most common form in incomplete SCI
- inability to move arms and hands
- pain, temp, pressure sensation lost below injury
Complete paraplegia
- inability to move bottom half of body
- complete spinal cord injury
Anterior cord syndrome
- incomplete SCI
- anterior injury or decreased blood supply from anterior spinal artery
- paralysis below injury
- pain/temp sensation below injury is lost
- touch and position sensation is preserved
Complete SCI
- total loss of motor function and sensation below body
- both sides affected
- Spinal shock syndrome
- Complete paraplegia
Spinal injury location
- C5-T1= arm
- T1-T8 = chest
- T9-T12 = abdomen
- L3 = legs
Autonomic Dysreflexia
- life threatening
- bradycardia
- hypertension
- facial flushing
- nasal congestion
- sweating
- headache
- cerebral hemorrhage
- pulmonary edema
- NOT RESPIRATORY FAILURE
- distended neck veins
- seizures
- constipation CAN CAUSE THIS
- distended abdomen
Autonomic dysreflexia treatment
- First BP
- first elevate HOB and lower legs
- loosen clothes
- insert urinary catheter if none present
- irrigate catheter to check for kinks or obstruction
- Vitals and BP every 5 min
- avoid pressure on bladder
Frontal lobe
- primary motor area
- voluntary eye movement
- sensory perception
- Broca’s area = expression of speech on dominant side
- left hemisphere
- behavior/congnition/judgement
- long-term goals
- reasoning, consentration
Parietal lobe
- controls sensory interpretation for opposite side of body
- controls ability to interpret spoken words
- read and write
- see body images
Temporal lobe
- controls auditory functions
- hold Wernicke’s area
- ability to organize and understand speech
- controls limbic and hippocampus
- emotions (limbic)
- memory (hippocampus)
Choice A is correct. Visual disturbances are expected for a client with a stroke impacting the occipital lobe of the brain. The occipital lobe is the primary optical center of the brain. Homonymous hemianopia is a complete left or right visual field defect. The client may need to be taught to scan the room, and the nurse should place objects in the unaffected visual field.
Choice B is incorrect. Proprioception is for the client to have an awareness of their body position. Testing a client’s proprioception is done via the Romberg test. If the client should have impairments with proprioception, this highly suggests an insult to the parietal lobe, which primarily processes sensory input, proprioception, and taste.
Choice C is incorrect. Expressive aphasia and impulsivity can be explained as an insult to the frontal lobe, which is the brain’s executive center. Broca’s area can be found in the frontal lobe and, if damaged, may cause the client to have expressive aphasia.
Choice D is incorrect. Impulsivity is also a feature of a stroke that primarily affects the frontal lobe, as this lobe controls cognition, judgment, affective response to situations, and reasonable deduction.
- Visual disturbances are expected for a client with a stroke impacting the occipital lobe of the brain.
- Expressive aphasia and impulsivity can be explained as an insult to the frontal lobe, which is the brain’s executive center. Broca’s area
- Impulsivity is also a feature of a stroke that primarily affects the frontal lobe, as this lobe controls cognition, judgment, affective response to situations, and reasonable deduction.
Cranial nerves
CN I: Olfactory
CN II: Optic
CN III: Oculomotor
CN IV: Trochlear
- eye movement
CN V: Trigeminal
- face
CN VI: Abducens
- eye movement
CN VII: Facial
CN VIII: Vestibulocochlear
- auditory/balance
CN IX: Glossopharyngeal
- mouth/throat/swallow
CN X: Vagus
- uvula deviation
CN XI: Accessory
CN XII: Hypoglossal
- move tongue/speak
Basilar skull fracture
- bruising around eyes
- rhinorrhea
- place drop on guaze
- CSF will form ring
- Halo sign
Guillain-Barré
- usually follows respiratory or gastro infection
- body attacks nerves
- paralysis of muscles (respiratory failure!)
- muscle weakness
- imbalance/clumsy
- dyspnea/chest pain
- tingling/paralysis
- pain in limbs and spine
- trouble speakig
Bell’s Palsy
- damage to nerve VII
- unilateral face paralysis
- abnormal blink
- earache
- tinnitus
- facial droop
- tearing of eye
Electroconvulsive therapy (ECT)
- monitor HR and BP
- experience temporary rise in BP
- conset requried
- brief seizures induced
- short term memory loss is normal
Atonic seizures
- drop attack/seizure
- sudden loss of muscle tone
- client collapses
Tonic-clonic seizure
- tonic
- stiffness
- clonic
- muscle jerking
Complex partial seizures
- cause impairment in consciousness
- lip-smacking
- repeating words/phrases
Myoclonic seizure
- sudden, brief, shock-like contractions
- sudden jerking
Amyotrophic lateral sclerosis (ALS)
- muscle weakness, esp lungs
- will need respiratory support via tracheostomy
- coughing when drinking is sign of aspiration
Neuropathic pain
- phantom limb pain
- neuralgia
- carpal tunnel syndrome
- burning, sharp, shooting
- chronic
Nociceptive pain
- damage to body tissue
- sharp, aching, throbbing
- stubbing toe
- sports injury
- dental procedure
Somatic pain
- sharp
- gnawing
- crushing
- throbbing
Cutaneous or superficial somatic pain
- originates from the skin or underlying tissues
- sharp, localized, and easily pinpointed
- cluthing abdomen, cramping
Deep somatic
- originates in ligaments, tendons, nerves, blood vessel, and bones
- localized
- achy and tender
- fracture/sprain, arthritis, bone cancer
Visceral pain
- organ/skull/thoorax pain
- poorly localized
- diffuse
- deep
- cramping
- tight pressure (squeezing)
Ischemic pain
- sneezing
- crushing
- heavy
- lack of blood flow
- like myocardial infarction (MI)
Neuropathic pain
- poorly localized
- shooting
- burning
- numbness
- thingling
- shock like
Tetanus
- jaw and neck contractions
- lock jaw
- life threatening
- caused by bacteria
- Clostridium tetani spores
Peripheral pain
- apply pressure to outer body parts
- toes, fingers, nails
Meniere’s disease
- excessive endolymphatic fluid
- causes vertigo
- feeling of spinning
- increased risk of falls
- tinnitus
- hearing loss
- REDUCE SODIUM, caffeine, and alcohol
Romberg test
- arms at sides, knees close, eyes open
- check for swaying
- close eyes and maintain position
- Romberg sign
- client sways with clsoed eyes but not open
Brudzinski’s sign
- client lays supine
- flexing neck causes flexion of knees and hips
- diagnose bacterial meningitis
Phalen’s test
- carpal tunnel test
- hold wrists in forced flexion
- pain is positive sign, not good
Increased ICP
- restlessness
- do not perform lumbar puncture
- give hypertonic fluid
- 3% saline
- dextrose 10%-20%
- NOT dextrose and water
- dextrose and saline instead
- NOT dextrose and water
Semmes-Weinstein
- test for foot sensation
Contralateral stimulation
stimulating the skin in an area opposite to the painful site
Ischemic stroke
- hypertensive
- atherosclerotic plaque
