Beth - Week 1 - Exam 1 Flashcards
what are the functions of the frontal lobe?
- emotional state
- problem solving
- broca judgement
- *impulsive, emotional**
what are the functions of the occipital lobe?
visual disturbances
what are the functions of the parietal lobes?
- sensory
- spatial orientation
- concept formation
what are the functions of the temporal lobe?
- auditory
- spoken memories
- wernicke
- *speak, write, understand**
what is the first sign that something is wrong neurologically?
LOC changes
what are the levels of progression for changes in LOC?
consciousness confusion or unusual agitation lethargy or drowsy obtunded stupor deep coma
what is AVPU and what does it stand for?
It's a quick neuro assessment tool. • A-The Patient is Awake • V-The Patient Responds to Verbal • P-The Patient Responds to Painful • U-The Patient is Completely unconscious
what are s/sx of a confused/combative patient?
restlesss, confused, agitated, combative, argumentative (covering confusion)
what should we look for in a confused pt?
the source of confusion → take VS → call MD (could need O2)
what is in the general part of the long neuro assessment?
- Vital Signs
- Current Health (sepsis?)
- Past History (diabetic? ↓ BG → confusion)
- Meds (opoids, benzos, hypnotics, sedatives, blood pressure meds, beta blockers)
what is in the cerebral part of the long neuro assessment?
- LOC
- Memory
- Intellectual performance (problem w/ learning)
- Judgement and Insight (Thinking is logical; “what is this?” “a pen vs for writing”)
- Language and communication (appropriate)
- Mood and affect (cussing → talk to family; tearful, crying → frontal lobe damage)
- Cranial nerves (function)
what cranial nerves are in the cerebrum?
only CN 1 and 2
what CN are in the brain stem?
CN 3 - 12
what are the cranial nerves?
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
what is cranial nerve 1? what are it’s characteristics?
olfactory - sense of smell
- sensory nerve
what is cranial nerve 2? how is it assessed?
optic - sense of vision, visual acuity, and vision fields
- “how many fingers … “
- sensory
what is cranial nerve 3?
oculomotor - eyelid control, accommodations (reflex to light), direct/consensual, conjugate and disconjugate, and blurred
- mixed nerve
what cranial nerves are assessed together, and what are the possible assessment findings?
- assess III, IV, VI together
- anisocoria: normal, unequal
- nystagmus
- hippus: rapid constrict, dilate
- ptosis: drooping eyelid
what are cranial nerves IV and VI? what is assessed?
- Trochlear and Abducens
- assess the “6 cardinal fields of gaze”
what is cranial nerve V? what does it assess?
- Trigeminal - mixed nerve
- motor: place hands on cheeks and clench jaw
- sensory: eyes closed; touch face @ least 3 times
what is cranial nerve VII? how do we assess?
Facial - mixed nerve
- assess by having pt smile big, puff out cheeks, squeeze eyes closed
what is cranial nerve VIII? how is it assessed? what should we be aware of?
Acoustic/Vestibulocochlear - sensory nerve
- whisper test, Rinnes test, tuning fork
- *hearing deficit**
what is cranial nerve IX? how is it assessed?
Glossopharyngeal - mixed nerve
- back of tongue, taste, gag and swallow
what is cranial nerve X? how is it assessed?
Vagus - mixed nerve
- gag/cough “say ahh”
what is cranial nerve XI? how is it assessed?
Accessory (spinal) - motor nerve
- shoulder shrug, place pressure on mandible
T/F CN 9 - 11 are assessed together
TRUE
what is cranial nerve 12 and how is it assessed?
hypoglossal - motor nerve
- tongue out, side to side
long neuro assessment: how is balance tested?
- Romberg test (feet together, eyes closed)
- hopping
long neuro assessment: how is upper extremity coordination tested?
- rapid movement (hands on lap)
- fine motor test (nose to finger - make sure they don’t need visual aid)
- finger coordination (fingers to thumb)
long neuro assessment: how is lower extremity coordination tested?
by having the patient lie down and have one heel steady from knee to foot
long neuro assessment: what senses do we test?
all of them: sight, smell, hearing, taste, touch
long neuro assessment: how do we test the senses for touch?
- superficial tactile (cotton ball to foot)
- superficial pain (pinprick to foot)
- vibration (tuning fork)
- position sense of joint (pushing toes up or down and telling what position its in)
long neuro assessment: what are 3 other ways to test the senses?
- stereognosis
- two point discrimination
- graphesthesis
what is stereognosis?
holding a well known object; eyes closed; trying to figure out what it is
what is two point discrimination?
having a two pronged item; eyes closed; pressing either one or two prongs on the pt’s hand and have them say which it is.
what is graphesthesis?
making numbers and letters on the pt’s hand; eyes closed; they tell you what is spelled`
long neuro assessment: how is motor function tested?
dorsiflexion/planter flexion (push/pulls)
deep tendon reflexes
what are the 7 deep tendon reflexes?
- tricep
- bicep
- brachioradial
- patellar
- achilles
- ankle tonus
- babinski
when is a babinski used and what does a positive babinski look like/mean?
used on semicomatose/comatose pts
- if big toe goes up, may mean trouble
- indicative of severe damage to the CNS
long neuro assessment: what are cheyne-stokes respirations?
breathing really fast followed by periods of apnea
- indicates the brain is at the very end
what are limitations to a neuro assessment?
- LOC
- attitude (teens → kick parents out)
- physical weakness
- inability to follow directions
- culture/language barrier
- immobility
what are the categories for the GCS?
- eye opening
- motor response
- verbal response
what is Glasgow Coma Scale?
a tool to measure LOC and ID the severity of a neurological injury of a patient with altered alertness
what are the point values for GCS
3 - 15
3 being the worst
15 being the best
what are neuro changes that occur with aging? (9)
- sleep patterns
- balance
- movement
- memory loss
- reaction time
- learning slower
- temp regulation
- feeling pain
- vision
what are neuro changes that occur with aging? (9)
- sleep patterns
- balance
- movement
- memory loss
- reaction time
- learning slower
- temp regulation
- feeling pain
- vision
how does aging affect the cranial nerve function? (1-10)
I → ↓ sense of smell
II → reduced ability to differentiate color; farsighted
III, IV, VI → reduced upward gaze; slow accommodaton
V → ↓ corneal reflex
VII → diminished taste
VIII → high frequency hearing loss
IX, X → reduced gag reflex
why do we run diagnostics for a neuro assessment?
- to ID location and severity of the injury so that interventions can be started timely
- to confirm brain death
what 8 diagnostic tests are performed for neuro?
- Lumbar Puncture (LP)
- Myelogram
- Cerebral Angiogram (good brain blood flow)
- Evoked Potential
- Transcranial Doppler (TCD) (some people thick skulls/no windows → brain has brain flow)
- Computed Tomography Scanning (CT)
- Magnetic Resonance Imaging (MRI) (MRA)
- Electroencephalography (EEG)
what 8 diagnostic tests are performed for neuro?
- Lumbar Puncture (LP)
- Myelogram
- Cerebral Angiogram (good brain blood flow)
- Evoked Potential
- Transcranial Doppler (TCD) (some people thick skulls/no windows → brain has brain flow)
- Computed Tomography Scanning (CT)
- Magnetic Resonance Imaging (MRI) (MRA)
- Electroencephalography (EEG)
why and how is an MRI done?
- hydrogen atoms excited→ scanner measures oscillations
- better for anatomical info.,bone, tissue, soft structures
what are the NI associated with MRIs?
- metal? Pt. and You (magnetic field)
- Pacermaker
- Tattoos with red ink/metal flex
- noisy–ear plugs
- claustrophobic/ sedation?
- MRA pt needs an Saline lock
why and how is a CT done?
- radiographic images–”slices”
- assess bone, fluid collections, tissue
what are NIs associated with CTs?
- invasive vs non-invasive? Consent?
- immobile during test
- claustrophobia?–“I’m nervous in small/confined places
why and how is a cerebral angiogram done?
- contrast study–threading the cath up the femoral artery
- patency, narrowing, occlusions, aneurysms, tumors, alterations in bld. flow
EXAM: why and how is a EEG (electroencephalogram) done?
• ID Electrical/Seizure Activity
- at rest
- hyperventilation
- phobic stimulation
- Sleep (currently done at the patient bedside)
• Brain Death Evaluation
- no opioids, stimulants, or sedation (could potentially change test)
what are the NI for an EEG?
- no stimulants
- Keep patient calm
- anti-convulsants?
EXAM: why do we do lumbar punctures?
- obtain CSF
- measure ICP
- diagnostic for SAH or Epidural bleed (if already suspected it’s contraindicated)
where is the lumbar punctured inserted?
‘L3-4 or L4-5
- needle tip must be in the subarachnoid space
what are the NIs for a lumbar puncture?
- Consent
- Bladder (empty)
- Positioning (left side/legs up)
- Specimens to the Lab (normal/abnormal)
- Stat finger stick with puncture?????
- Check injection site
what are the NIs for a lumbar puncture?
- Consent
- Bladder (empty)
- Positioning (lateral recumbent position - left side/legs up)
- Specimens to the Lab (normal/abnormal)
- Stat finger stick with puncture?????
- Check injection site
what if you ID CSF leak from site?
- blood patch may be used
- 10 - 20 cc of pts own blood injected into epidural space to “plug”
what is the teaching for lumbar punctures?
- ice pack
- bed rest at home
- hydrate
- no ASA or NSAIDS
- no straining
what is myelography/myelogram and what is its purpose?
• Fluoroscopy imaging examination that uses a spinal needle placed in the spinal canal
- injection of contrast material in the space
around the spinal cord and nerve roots
• Purpose
- View of the subarachnoid space
- Spinal Canal
what is myelography/myelogram and what is its purpose?
• Fluoroscopy imaging examination that uses a spinal needle placed in the spinal canal
- injection of contrast material in the space
around the spinal cord and nerve roots
• Purpose
- View of the subarachnoid space
- Spinal Canal
why and how is a myelogram done?
• Provides a very detailed image of the spinal cord, nerve roots, subarachnoid space, and spinal column
• If any abnormalities are found CT is done
to define anatomy and findings
what are the NIs for myelogram?
• Pre and Post • Obtain consent and allergies • General - Post procedure - hydration IV or oral - VS - pain level - lie flat if HA otherwise 30-45 degrees
what are the NIs for cerebral angiogram? preprocedure vs postprocedure
• pre-procedure - Obtain consent/allergies - Check orders for NPO - IV for hydration • post-procedure - neuro deficits - Assess puncture site for hematoma/bleeding - VS - Distal pulses
why and how is a transcranial doppler done?
- Ultrasound
- Flow velocity of blood through the vessels; ID vasospasms
what are the NIs for a transcranial doppler?
- noninvasive (done by a tech)
- plan to hold still for 30-60 min
what is the goal of the TCD test?
- confirm cerebral blood flow
- ordered on pts looking brain dead → looking for spasms
why and how is evoked potential done?
- assesses neuron transmission through sensory pathways (integrity of the pathway)
- senses central/cortical activity via electrodes in response to peripheral stimulation
- can be used before/during/after surgery
what are the NIs for evoked potential?
- no interference - peace and quiet
- 30 - 45 min (time management)
why and how is positron emission tomography (PET) done?
- radiographic images-shows organ function
- Metabolic changes in the brain
what are the NIs for a PET scan?
- Consent
- immobile during test
- Relaxation techniques
- Possible sensations (dizzy, HA, light-headed)
for a healthy brain, what does the cerebellum control?
balance and coordination
if the cerebellum is injuried, what occurs?
- difficulty coordinating fine movements
- difficulty walking
- tremors
- dizziness
- slurred speech
for a healthy brain, what does the brainstem control?
breathing, heart rate, alertness/consciousness
if the brainstem is injuried, what occurs?
changes in breathing
difficulty swallowing food/water
problems with balance and movement
dizziness and nausea.
