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Nursing Semester 3 > Beth - Week 1 - Exam 1 > Flashcards

Beth - Week 1 - Exam 1 Flashcards

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1
Q

what are the functions of the frontal lobe?

A
  • emotional state
  • problem solving
  • broca judgement
  • *impulsive, emotional**
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2
Q

what are the functions of the occipital lobe?

A

visual disturbances

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3
Q

what are the functions of the parietal lobes?

A
  • sensory
  • spatial orientation
  • concept formation
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4
Q

what are the functions of the temporal lobe?

A
  • auditory
  • spoken memories
  • wernicke
  • *speak, write, understand**
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5
Q

what is the first sign that something is wrong neurologically?

A

LOC changes

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6
Q

what are the levels of progression for changes in LOC?

A 
consciousness
confusion or unusual agitation
lethargy or drowsy
obtunded 
stupor 
deep coma
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7
Q

what is AVPU and what does it stand for?

A 
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
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8
Q

what are s/sx of a confused/combative patient?

A

restlesss, confused, agitated, combative, argumentative (covering confusion)

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9
Q

what should we look for in a confused pt?

A

the source of confusion → take VS → call MD (could need O2)

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10
Q

what is in the general part of the long neuro assessment?

A
  • Vital Signs
  • Current Health (sepsis?)
  • Past History (diabetic? ↓ BG → confusion)
  • Meds (opoids, benzos, hypnotics, sedatives, blood pressure meds, beta blockers)
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11
Q

what is in the cerebral part of the long neuro assessment?

A
  • 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)
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12
Q

what cranial nerves are in the cerebrum?

A

only CN 1 and 2

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13
Q

what CN are in the brain stem?

A

CN 3 - 12

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14
Q

what are the cranial nerves?

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
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15
Q

what is cranial nerve 1? what are it’s characteristics?

A

olfactory - sense of smell

- sensory nerve

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16
Q

what is cranial nerve 2? how is it assessed?

A

optic - sense of vision, visual acuity, and vision fields

  • “how many fingers … “
  • sensory
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17
Q

what is cranial nerve 3?

A

oculomotor - eyelid control, accommodations (reflex to light), direct/consensual, conjugate and disconjugate, and blurred
- mixed nerve

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18
Q

what cranial nerves are assessed together, and what are the possible assessment findings?

A
  • assess III, IV, VI together
  • anisocoria: normal, unequal
  • nystagmus
  • hippus: rapid constrict, dilate
  • ptosis: drooping eyelid
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19
Q

what are cranial nerves IV and VI? what is assessed?

A
  • Trochlear and Abducens

- assess the “6 cardinal fields of gaze”

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20
Q

what is cranial nerve V? what does it assess?

A
  • Trigeminal - mixed nerve
  • motor: place hands on cheeks and clench jaw
  • sensory: eyes closed; touch face @ least 3 times
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21
Q

what is cranial nerve VII? how do we assess?

A

Facial - mixed nerve

- assess by having pt smile big, puff out cheeks, squeeze eyes closed

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22
Q

what is cranial nerve VIII? how is it assessed? what should we be aware of?

A

Acoustic/Vestibulocochlear - sensory nerve

  • whisper test, Rinnes test, tuning fork
  • *hearing deficit**
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23
Q

what is cranial nerve IX? how is it assessed?

A

Glossopharyngeal - mixed nerve

- back of tongue, taste, gag and swallow

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24
Q

what is cranial nerve X? how is it assessed?

A

Vagus - mixed nerve

- gag/cough “say ahh”

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25
Q

what is cranial nerve XI? how is it assessed?

A

Accessory (spinal) - motor nerve

- shoulder shrug, place pressure on mandible

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26
Q

T/F CN 9 - 11 are assessed together

A

TRUE

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27
Q

what is cranial nerve 12 and how is it assessed?

A

hypoglossal - motor nerve

- tongue out, side to side

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28
Q

long neuro assessment: how is balance tested?

A
  • Romberg test (feet together, eyes closed)

- hopping

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29
Q

long neuro assessment: how is upper extremity coordination tested?

A
  • rapid movement (hands on lap)
  • fine motor test (nose to finger - make sure they don’t need visual aid)
  • finger coordination (fingers to thumb)
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30
Q

long neuro assessment: how is lower extremity coordination tested?

A

by having the patient lie down and have one heel steady from knee to foot

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31
Q

long neuro assessment: what senses do we test?

A

all of them: sight, smell, hearing, taste, touch

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32
Q

long neuro assessment: how do we test the senses for touch?

A
  • 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)
33
Q

long neuro assessment: what are 3 other ways to test the senses?

A
  • stereognosis
  • two point discrimination
  • graphesthesis
34
Q

what is stereognosis?

A

holding a well known object; eyes closed; trying to figure out what it is

35
Q

what is two point discrimination?

A

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.

36
Q

what is graphesthesis?

A

making numbers and letters on the pt’s hand; eyes closed; they tell you what is spelled`

37
Q

long neuro assessment: how is motor function tested?

A

dorsiflexion/planter flexion (push/pulls)

deep tendon reflexes

38
Q

what are the 7 deep tendon reflexes?

A
  • tricep
  • bicep
  • brachioradial
  • patellar
  • achilles
  • ankle tonus
  • babinski
39
Q

when is a babinski used and what does a positive babinski look like/mean?

A

used on semicomatose/comatose pts

  • if big toe goes up, may mean trouble
  • indicative of severe damage to the CNS
40
Q

long neuro assessment: what are cheyne-stokes respirations?

A

breathing really fast followed by periods of apnea

- indicates the brain is at the very end

41
Q

what are limitations to a neuro assessment?

A
  • LOC
  • attitude (teens → kick parents out)
  • physical weakness
  • inability to follow directions
  • culture/language barrier
  • immobility
42
Q

what are the categories for the GCS?

A
  • eye opening
  • motor response
  • verbal response
43
Q

what is Glasgow Coma Scale?

A

a tool to measure LOC and ID the severity of a neurological injury of a patient with altered alertness

44
Q

what are the point values for GCS

A

3 - 15
3 being the worst
15 being the best

45
Q

what are neuro changes that occur with aging? (9)

A
  • sleep patterns
  • balance
  • movement
  • memory loss
  • reaction time
  • learning slower
  • temp regulation
  • feeling pain
  • vision
46
Q

what are neuro changes that occur with aging? (9)

A
  • sleep patterns
  • balance
  • movement
  • memory loss
  • reaction time
  • learning slower
  • temp regulation
  • feeling pain
  • vision
47
Q

how does aging affect the cranial nerve function? (1-10)

A

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

48
Q

why do we run diagnostics for a neuro assessment?

A
  • to ID location and severity of the injury so that interventions can be started timely
  • to confirm brain death
49
Q

what 8 diagnostic tests are performed for neuro?

A
  • 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)
50
Q

what 8 diagnostic tests are performed for neuro?

A
  • 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)
51
Q

why and how is an MRI done?

A
  • hydrogen atoms excited→ scanner measures oscillations

- better for anatomical info.,bone, tissue, soft structures

52
Q

what are the NI associated with MRIs?

A
  • metal? Pt. and You (magnetic field)
  • Pacermaker
  • Tattoos with red ink/metal flex
  • noisy–ear plugs
  • claustrophobic/ sedation?
  • MRA pt needs an Saline lock
53
Q

why and how is a CT done?

A
  • radiographic images–”slices”

- assess bone, fluid collections, tissue

54
Q

what are NIs associated with CTs?

A
  • invasive vs non-invasive? Consent?
  • immobile during test
  • claustrophobia?–“I’m nervous in small/confined places
55
Q

why and how is a cerebral angiogram done?

A
  • contrast study–threading the cath up the femoral artery

- patency, narrowing, occlusions, aneurysms, tumors, alterations in bld. flow

56
Q

EXAM: why and how is a EEG (electroencephalogram) done?

A

• 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)

57
Q

what are the NI for an EEG?

A
  • no stimulants
  • Keep patient calm
  • anti-convulsants?
58
Q

EXAM: why do we do lumbar punctures?

A
  • obtain CSF
  • measure ICP
  • diagnostic for SAH or Epidural bleed (if already suspected it’s contraindicated)
59
Q

where is the lumbar punctured inserted?

A

‘L3-4 or L4-5

- needle tip must be in the subarachnoid space

60
Q

what are the NIs for a lumbar puncture?

A
  • Consent
  • Bladder (empty)
  • Positioning (left side/legs up)
  • Specimens to the Lab (normal/abnormal)
  • Stat finger stick with puncture?????
  • Check injection site
61
Q

what are the NIs for a lumbar puncture?

A
  • 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
62
Q

what if you ID CSF leak from site?

A
  • blood patch may be used

- 10 - 20 cc of pts own blood injected into epidural space to “plug”

63
Q

what is the teaching for lumbar punctures?

A
  • ice pack
  • bed rest at home
  • hydrate
  • no ASA or NSAIDS
  • no straining
64
Q

what is myelography/myelogram and what is its purpose?

A

• 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

65
Q

what is myelography/myelogram and what is its purpose?

A

• 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

66
Q

why and how is a myelogram done?

A

• 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

67
Q

what are the NIs for myelogram?

A 
• 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
68
Q

what are the NIs for cerebral angiogram? preprocedure vs postprocedure

A 
• 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
69
Q

why and how is a transcranial doppler done?

A
  • Ultrasound

- Flow velocity of blood through the vessels; ID vasospasms

70
Q

what are the NIs for a transcranial doppler?

A
  • noninvasive (done by a tech)

- plan to hold still for 30-60 min

71
Q

what is the goal of the TCD test?

A
  • confirm cerebral blood flow

- ordered on pts looking brain dead → looking for spasms

72
Q

why and how is evoked potential done?

A
  • 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
73
Q

what are the NIs for evoked potential?

A
  • no interference - peace and quiet

- 30 - 45 min (time management)

74
Q

why and how is positron emission tomography (PET) done?

A
  • radiographic images-shows organ function

- Metabolic changes in the brain

75
Q

what are the NIs for a PET scan?

A
  • Consent
  • immobile during test
  • Relaxation techniques
  • Possible sensations (dizzy, HA, light-headed)
76
Q

for a healthy brain, what does the cerebellum control?

A

balance and coordination

77
Q

if the cerebellum is injuried, what occurs?

A
  • difficulty coordinating fine movements
  • difficulty walking
  • tremors
  • dizziness
  • slurred speech
78
Q

for a healthy brain, what does the brainstem control?

A

breathing, heart rate, alertness/consciousness

79
Q

if the brainstem is injuried, what occurs?

A

changes in breathing
difficulty swallowing food/water
problems with balance and movement
dizziness and nausea.

Nursing Semester 3 (29 decks)

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