Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 3020 exams > brain disorders > Flashcards

brain disorders Flashcards

1
Q

review: what makes up the nervous system

A

1) central nervous system: composed of brain + spinal cord
2) peripheral nervous system: composed of 12 pairs of cranial nerves, 31 pairs of spinal nerves, and autonomic nervous system
- somatic: voluntary movements
- autonomic: involuntary movements (sympathetic/parasympathetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

sympathetic nervous system

A

“fight/flight”
- dilated pupils
- increase HR/BP
- increased rate of breathing
- decreased peristaltic movements of digestive tube
- thick viscid saliva secretion
- increased conversion liver glycogen to glucose
- relaxed urinary bladder muscles
- increased secretion of sweat
- secretion of epinephrine and norepinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

parasympathetic nervous system

A

“rest/digest”
- constricted pupils
- decreased HR/BP
- decreased rate of breathing
- increased peristaltic movements of digestive tube
- thin, watery saliva secretion
- contracted urinary bladder muscles
- dilated blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

review: neurotransmitters acetylcholine

A
  • major transmitter of the parasympathetic nervous system
  • source: many areas of the brain, autonomic nervous system
  • action: EXCITATORY, parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerves)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

review: neurotransmitters serotonin

A
  • source: brain stem, hypothalamus, dorsal horn of spinal cord
  • action: INHIBITORY, controls mood and sleep, inhibits PAIN PATHWAYS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

review: neurotransmitters dopamine

A
  • source: substantia nigra and basal ganglia
  • action: usually INHIBITORY, affects behavior (attention/emotions) and fine movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

review: neurotransmitters norephinephrine

A
  • major transmitter of the sympathetic nervous system
  • source: brain stem, hypothalamus, postganglionic neurons of the sympathetic nervous system
  • action: usually EXCITATORY, affects mood and overall activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

review: gamma aminobutyric acid (GABA)

A
  • source: spinal cord, cerebellum, basal ganglia, some cortical areas
  • action: INHIBITORY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

review: endorphin

A
  • source: nerve terminals in spine, brain stem, thalamus, hypothalamus, pituitary gland
  • action: EXCITATORY, pleasurable sensation, inhibits PAIN transmissions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

excitatory

A

excites (activates) activity of target cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

inhibitory

A

inhibits (stops) activity of target cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

meninges

A

fibrous connective tissue that cover brain/spinal cord provides protection, support, and nourishment
- 3 layers: dura mater, subarachnoid, arachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

dura mater

A

tough, inelastic, fibrous, gray
- “top mother”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

subarachnoid mater

A

“weblike, cushions, delicate”
- arachnoid villi absorbs CSF -> venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pia mater

A

“inner most layer of the brain, delicate”
- thin, goes into different folds of the brain
- transparent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

frontal lobe

A

largest lobe, front of brain
function:
- concentration
- abstract thought
- information storage or memory
- motor function
- affect
- judgement
- personality
- inhibitions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

parietal lobe

A

sensory lobe, posterior to frontal
function:
- analyzes sensory information and relays interpretation of this information to other cortical areas
- essential to person’s awareness of body position and orientation
- taste, touch, pressure, body awareness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

temporal lobe

A

inferior to parietal and frontal lobe
- auditory receptive areas, memory of sound and understanding language and music
- facial recognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

occipital lobe

A

back of head
- visual interpretation, memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cerebellum

A

coordination, positional (postural) sense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

changes in nervous system related to aging (neuro changes associated with aging) (7)

A

1) slower processing time (provide sufficient time for patient to respond to questions or instructions)
2) recent memory loss (reinforce teaching by repetition, written language, employing memory aids like electronic alarms or applications for devices that provide recurrent alerts)
3) decreased sensory perception of touch (remind patient to look where they are positionally)
4) change in perception of pain (assess pain and monitor for health problems)
5) change in sleep patterns (assess sleep habits and preferences and provide usual routine)
6) altered balance and/or decreased coordination (move slowly when changing positions, assess needs for mobility aids)
7) increased risk for infection (monitor carefully for infection s/sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

brain disorder assessment PE

A

1) compare each assessment with pt. baseline, R vs L, UE vs. LE
2) evaluate mental status, cranial nerves, mobility, motor function, sensation, reflexes and cerebellar function
- brainstem, thalamus, cortex lesions -> loss of sensation on contralateral sides of the body (opp)
- cerebellar lesions -> sensory deficits on same side of the body
3) assess memory
- long term, recall/recent, immediate memory
- loss of memory, especially recent memory, tends to be an early sign neurologic problems (dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

decorticate

A

damage to hemispheres (higher functioning)
- flexed hands
- adducted arms
- flexed elbows
- internally rotated legs
- plantar flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

decerebrate

A

damage to brain stem
- adducted arms
- extended elbows
- pronated forearm
- flexed hands
- plantar flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Romberg test

A

close eyes and balance, can be standing/sitting
- positive: loss of balance (abnormal)
- negative: no loss of balance (normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

babinski test

A
  • stroke lateral aspect of sole, patient toes will contract and draw together
  • CNS disorder
  • if toes fan out and draw back (adult) -> abnormal
  • if toes fan out and draw back (newborn) -> normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

diagnostic evaluation labs

A

1) labs: glucose, cmp, cbc, abg, blood cultures, toxins, lumbar puncture (CSF)
- “spinal tap”
- needle is subarachnoid space to draw CSF -> lab (trauma at site, bit will be come more clear as continue to draw up)
- meds can be given through spinal canal
- tense/nervous: might artificially change pressure reading
- complications: post lumbar puncture headache, infection, nerve damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

normal CSF values

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

diagnostic evaluation imaging

A
  • XRAY
  • cerebral angiography (arteriography)
  • ultrasound
  • computed tomography (CT)
  • magnetic resonance imaging/angiogram (MRI/MRA)
  • positive emission tomography (PET)
  • electroencephalography (EEG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

altered level of consciousness

A
  • present when patient is not oriented, does not follow commands, or needs persistent stimuli to achieve a state of alertness
  • most important indicator of the patient’s condition
  • LOC is gauged on a continuum, with normal state of alertness and full cognition (consciousness) on one end and coma on other end
  • initial alterations in LOC may be reflected by subtle behavioral changes, such as restlessness or increased anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

stages of altered LOC

A

1) coma
2) akinetic mutism: no voluntary movements
3) persistent vegetative state
4) minimally conscious state
5) locked in syndrome: lesions affects pons -> paralysis, doesn’t speak, have vertical eye movement and lid elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

nursing assessment for altered LOC (12)

A

1) level of responsiveness or consciousness (eye opening, verbal and motor responses, pupils)
2) pattern of respiration (RR, cheyne-stroke respiration, hyperventilation, ataxic respiration with irregularity in depth/rate)
3) eyes/pupils (size, equality, reaction to light) (PERLA)
4) eye movements (side to side)
5) corneal reflex (brisk response when touched with clean cotton)
6) facial symmetry (asymmetry - sagging, decrease in wrinkles)
7) swallowing reflex (drooling vs. spontaneous swallowing)
8) neck (stiff neck)
9) respond of extremity to noxious stimuli (firm pressure on a joint of UE/LE)
10) deep tendon reflexes (tap patellar and biceps tendon)
11) pathologic reflexes (firm pressure w/ blunt object on sole of foot, moving along lateral margin and crossing ball of foot)
12) abnormal posture (observation for posturing, flaccidity with absence of motor response, decorticate or decerebrate posturing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

altered LOC nursing interventions

A
  • maintain airway
  • aspiration precautions
  • protect the patient
  • maintain fluid balance and nutritional needs
  • provide oral hygiene
  • maintaining skin and joint integrity
  • preserve corneal integrity
  • maintain body temperature
  • promoting urinary elimination and bowel function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

increased intracranial pressure (what, cause, example)

A
  • rise in pressure inside the skull that can result from or cause brain injury
  • causes: decreases cerebral perfusion, stimulates further swelling (edema), and may shift brain tissue, resulting in herniation
  • monro Kellie hypothesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is monro Kellie hypothesis

A

pressure volume relationship that aims to keep. dynamic equilibrium among the essential non-compressible components inside rigid compartment of the skull
- blood
- CSF
- brain matter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

changes in ICP are closely linked with

A

cerebral perfusion pressure (CPP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

cerebral perfusion pressure

A
  • pressure gradient over which the brain is perfused
  • through auto regulation, normal cerebral vasculature maintains an adequate cerebral blood flow with a wide range (50-150 mmHg) of mean arterial blood pressure (MAP) -> perfusion
  • maintenance of CPP above 70 mmHg is generally accepted as an expected outcome of therapy
  • rise in MAP -> elevated ICP
  • decrease in MAP -> hypoperfusion
  • equation: MAP - ICP = CPP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

s/sx increased intracranial pressure (9)

A
  • decreased LOC
  • behavior changes (restlessness, irritability, confusion)
  • headache
  • N/V
  • changes in speech (aphasia, slurred speech)
  • seizures
  • changes in sensorimotor status (pupillary changes, cranial nerve dysfunction, ataxia)
  • Cushing’s triad (increased SBP w/ widened pulse pressure, bradypnea, bradycardia)
  • abnormal posturing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

complications of increased intracranial pressure

A

1) brainstem herniation
2) diabetes insipidus (DI)
3) syndrome of inappropriate antidiuretic hormone (SIADH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

brainstorm herniation

A

shifting of brain tissue from an area of high pressure to an area of lower pressure
- herniated tissue exerts pressure on the brain area into which it has shifted, which interferes with the blood supply in that area -> cessation of cerebral blood flow results in cerebral ischemia, infarction, and brain death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

diabetes insipidus (DI)

A

result of decreased secretion of antidiuretic hormone (ADH). excessive urine output, decreased urine osmolality, and serum hyperosmolarity
- tx: fluid replacement, electrolyte replacement, VASOPRESSINsyn

42
Q

syndrome of inappropriate antidiuretic hormone (SIADH)

A

result of increased secretion of ADH. volume overload, urine output diminishes serum sodium concentration becomes diluted
- tx: fluid restriction (<800cc/day with no free H2O), careful hypertonic solution administration (3% hypertonic solution)

43
Q

increased intracranial pressure nursing interventions

A
  • ABC’s
  • frequent neurological checks
  • decreasing cerebral edema
  • monitor intracranial pressure and cerebral oxygenation
  • maintaining cerebral perfusion
  • controlling fever
  • maintaining oxygenation and reducing metabolic demands
44
Q

how to control ICP in patients with severe brain injury

A
  • elevate HOB 30-45 degrees
  • maintain pt. head and neck in neutral alignment (no twisting or flexing the neck)
  • initiate measures to prevent valsalva maneuver (eg. stool softeners)
  • maintain body temp normal
  • administer O2 to maintain partial pressure of arterial oxygen (PaO2) >90mmHg
  • maintain fluid balance with normal saline solution
  • avoid noxious stimuli (eg. excessive suctioning, painful procedures)
  • administer sedation to reduce agitation
  • maintain cerebral perfusion pressure of 50-70 mmHg >70mmHg
45
Q

intracranial surgery

A
  • craniotomy
  • transsphenoidal
  • burr holes
  • craniectomy
  • cranioplasty
46
Q

complications of intracranial surgery(8)

A
  • increased ICP
  • bleeding/hypovolemic shock
  • seizures
  • DI or SIADH (pituitary gland)
  • CSF leakage
  • visual disturbances
  • postoperative meningitis
  • pneumocephalus (air in intracranial cavity)
47
Q

dementia

A

permanent cognitive impairment, an irreversible and degenerative condition
- chronic and progressive loss of brain function, affects the ability to learn new information and impairs language, judgement, and behavior
- at least 2 must be significantly impaired: memory, communication and language, attention span or ability to focus and pay attention, reasoning and judgement, visual perception

48
Q

delirium

A

acute, confusional state characterized by new and sudden cognitive impairment; symptoms tend to fluctuate over the course of a day and include disturbances in consciousness, attention, memory deficits, and perceptual disturbances
- can be manifested by delusional (paranoid) thoughts and behavior
- MEDICAL EMERGENCY and specifically places geriatric patients at risk for harm and prolonged cognitive impairments

49
Q

potential causes of cognitive impairment in older adults (8)

A

1) neurological: vascular insufficiency, infections, trauma, tumors, normal pressure hydrocephalus
2) cardiovascular: MI, dysrhythmias, HF, cardiogenic shock, endocarditis, stroke
3) pulmonary: infection pneumonia, hypoventilation
4) metabolic: electrolyte imbalance, acid/base imbalance, hypo/hyperglycemia, CKD, fluid volume deficit, UTI, hepatic failure
5) drug intoxication: misuse of prescribed medications, side effects of medications, incorrect use of medications, ingestion of heavy metals
6) nutritional deficiencies: B vitamins, vitamin C, hypoproteinemia
7) environmental: hypo/hyperthermia, unfamiliar environments, sensory deprivation/overload
8) psychological: depression, anxiety, pain, fatigue, grief, paranoia

50
Q

alzheimers disease

A

neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults
- most common demetia
- microscopic changes include neurofibrillary tangles, amyloid rich neuritic plaques, and granulovascular degeneration
- 6th leading cause of death in US

51
Q

s/sx Alzheimer’s disease: early (mild) or stage 1 (first symptoms up to 4 years)

A
  • independent ADLs
  • no social/employment problems initially
  • denies symptoms
  • forgets names
  • misplaces household items
  • short term memory loss
  • subtle changes in personality and behavior
  • loss of initiative (less engaged in social relationships)
  • mild impaired cognition
  • problems with judgment
  • decreased performance
  • unable to travel alone to new destinations
  • decreased sense of smell
52
Q

s/sx Alzheimer’s disease: middle (moderate) or stage 2 (2-3 years)

A
  • impairment of all cognitive function
  • problems with handling or unable to handle money and finances
  • disorientation to time/place/event
  • possible depression
  • agitation
  • increasingly dependent ADLs
  • visuospatial deficits (difficulty driving, gets lost)
  • speech and language deficits (less talkative, decrease vocab, increasingly nonfluent)
  • incontinent
  • wandering
  • trouble sleeping
53
Q

s/sx Alzheimer’s disease: late (severe) or stage 3

A
  • completely incapacitated/bedridden
  • totally dependent in ADLs
  • motor and verbal skills lost
  • general and focal neurological deficits
  • agnosia (loss of facial recognition)
54
Q

Alzheimer’s disease nursing interventions

A
  • health promotion
  • maintaining a safe, structured and consistent environment
  • cognitive stimulation, memory training, orientation and validation therapy (frequent reorientation, promote self care, reality reorientation)
  • promoting self care and ADLs
  • reality orientation vs. validation therapy
55
Q

Alzheimer’s disease nursing interventions pharmacological

A

1) cholinesterase inhibitors: treats AD symptoms by delaying the destruction of Acetylcholine to slow onset of cognitive decline in some patients
- meds: donepezil (aricept), galantamine (reminyl), rivastigmine (exelon)

2) N-methyl-d-aspartate receptor antagonists (NMDA): blocks excess amounts of glutamate that can damage nerve cells (advanced AD)
- meds: mematine (Namenda)

3) Atypical antipsychotics: reserved for patients with emotional and behavioral health problems that can accompany dementia
- meds: risperidone (risperdal), quetiapine (Seroquel), olanzapine (zyprexa)

4) antidepressants: for patients that develop depression
- meds: SSRIs (paroxetine - Paxil, sertraline - zoloft)

56
Q

Alzheimer’s disease nursing interventions r/t promoting communication with patients with AD

A
  • simple, direct questions that require yes or no answers if patient can communicate
  • provide instructions with pics that patient will see if he/she reads them
  • simple, short sentences and one step instructions
  • gestures to help patients understand what is being said
  • validate patients feelings as needed
  • limit choices, too many choices cause frustration and increased confusion
  • never assume patient is totally confused and cannot understand what is being communicated
  • try to anticipate patient’s needs and interpret nonverbal communication
57
Q

seizures

A

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons within brain that may result in change in LOC, motor, or sensory ability and/or behavior
- 3 broad categories: partial/focal, generalized, unclassified

REVIEW slide 47

58
Q

epilepsy

A

two or more seizures experienced by a person
- chronic disorder which repeated unprovoked seizure activity occurs

59
Q

partial seizures

A
  • AKA focal/local seizures that begin in part of one cerebral hemisphere
60
Q

absence seizures

A
  • characteristic automatisms
  • where patient is unaware of the environment and may wander at the start of the seizure and afterwards they may have amnesia
61
Q

generalized seizures

A

involves both cerebral hemispheres
- tonic clonic
- tonic
- clonic
- myoclonic
- atonic

extra: bilateral, intense rigidity of body followed by alternating muscle relaxation and contraction (tonic clonic), epileptic cry, tongue chewed, incontinent feces/urine, lasts 1-2 minutes

62
Q

postictal seizures

A

fatigue, acute confusion and lethargy that can last up to an hour after the seizure
- depression, headaches

63
Q

seizures assessment and diagnostics

A
  • CBC
  • CMP
  • MRI
  • EEG: brain electrical activity for seizures
  • SPECT: new diagnostics that identify and locate epileptic zone to determine where seizure occurs and to remove surgically
64
Q

seizures care during

A
  • protect patient from injury
  • DO NOT force anything into patient’s mouth
  • turn the patient to the side to keep airway clear (MAIN)
  • loosen any restrictive clothing patient is wearing
  • maintain patient’s airway and suction oral secretions as needed
  • do not restrain or try to stop the patient’s movement; guide movements if necessary
  • record time of seizure beginning and end
65
Q

seizure care after

A
  • take VS
  • perform neuro checks
  • keep patient on their side
  • allow the patient to REST
  • document

TIP: pad side rails, low positioning of bed, SUCTION EQUIPMENT

66
Q

seizure nursing interventions

A
  • removing or treating the underlying cause if possible
  • antiepileptic drugs (AED) or anticonvulsants: seizure control sometimes is controlled only with combo of drugs, take them on time to maintain therapeutic blood levels and maximize effectiveness
  • balanced diet
  • proper rest
  • vagal nerve stimulation (VNS): refractory epilepsy, for patients who are drug resistant, outpatient, electrode attached to vagus nerve programmed to deliver pulses at regular intervals on L chest placement
67
Q

status epilepticus

A

MEDICAL EMERGENCY, prolonged seizure lasting longer than 5 minutes or related seizures over the course of 30 minutes

treatment:
- lorazepam (Ativan) IVP: 4mg over 2 minutes
- diazepam (Valium) IVP/rectal: 5-10 mg Q10-15 min PRN
- phenytoin (dilantin) IVPB: 15-20 mg/kg, additional 10mg/kg after 20 minutes PRN, maintenance: 100mg PO/IV Q6-8H

68
Q

headaches

A

AKA cephalalgia
- one of the most common of all human physical complaints
- symptom rather than a disease entity
- may indicate organic disease (neurological or other)
- stress response
- vasodilation (migraine)
- skeletal muscle tension (tension)
- combination of factors

69
Q

primary headache

A
  • NO organic cause can be identified
  • types: migraine, tension type, cluster headache
70
Q

migraine headache (what, cause, s/sx)

A

characterized by recurrent episodic attacks of head pain that serve no protective purpose, usually described as throbbing and unilateral in the front-temporal area
- cause: vascular disturbances, strong familial tendency
- s/sx: N/V, sensitivity to light (photophobia), sensitivity to sound (pognophobia), sensitive to head movement

71
Q

what are the 4 phases of migraine headaches

A

1) premonitory phase
- light, sound, smell sensitivity (can last hours to days)
- sx: depression, irritability, feeling cold, cravings, anorexia, decreased activity, increase urine/diarrhea/constipation

2) aura phase
- focal neurological sx: numbness/tingling, mild confusion, extremity weakness, drowsiness/dizziness, visual disturbances

3) migraine headache
- photophobia (light), phonophobia (sound), allodynia (abnormal perception innocuous stimuli),

4) post headache
- subsided sx., mood changes, muscle contractions, sleep longer, weak/fatigue, muscle contraction

72
Q

migraine headache nursing interventions

A

1) priority is PAIN MANAGEMENT
- abortive therapy: aims at alleviating pain during beginning of an episode
- preventative therapy: aims at preventing headache from occurring
2) educate patient on avoidance of possible triggers
3) environmental manipulation

73
Q

abortive pharmacological interventions

A
  • NSAIDS/acetaminophen
  • ergotamine preparations (aborts headache if taken early)
  • beta blockers
  • calcium channel blockers
  • triptan preparations: 1st line for moderate/severe pain
  • isometheptene combinations - vasoconstriction to relieve headache
  • antiepileptic drugs (AEDs)

TIP: timing is KEY, know ONSET and DURATION of meds

74
Q

preventative interventions

A
  • yoga
  • meditation
  • massage
  • exercise
  • biofeedback
  • pharmacological (vitamin B12, coQ10, magnesium, botox, calcitonin gene related peptide (CGRP) antagonists)
75
Q

cluster headaches

A

manifested by brief (15 minutes to 4 hours), intense unilateral pain that generally occurs in the spring and fall without warning
- “weight on top of my head”

s/sx:
- ipsilateral tearing of the eye
- rhinorrhea
- ptosis (drooping eyelid)
- eyelid edema
- facial sweating
- mitosis (excessive contstriction of pupils)

76
Q

cluster headache nursing interventions

A
  • consistent sleep wake cycle
  • pharmacological: lithium and corticosteroids
  • CAM therapy: capsaicin nasal spray, melatonin, glucosamine
  • oxygen therapy
  • be mindful of onset and duration of meds)
77
Q

cranial nerve 1

A

olfactory (sensory)
- sense of smell
- test each nostril for smell reception with various agents and interpretation

78
Q

cranial nerve 2

A

optic (sensory)
- sense of vision (acuity and field of vision)
- test vision for acuity and visual fields

79
Q

cranial nerve 3

A

oculomotor (motor)
- pupil constriction + raise eyelids
- PERRLA, ability to open and close eye

80
Q

cranial nerve 4

A

trochlear (motor/proprioceptor)
- downward, inward eye movement
- test for downward and inward movement of eyes

81
Q

cranial nerve 5

A

trigeminal (motor)
- jaw movements - chewing and mastication
- ask patient to open and clench jaws while palate jaw muscles

(sensory)
- sensation of the face and neck
- test face and neck for pain sensations, light touch, and temp.

82
Q

cranial nerve 6

A

abducens (motor)
- lateral movements of the eyes
- test ocular movements in all directions

83
Q

cranial nerve 7

A

facial (motor)
- muscles of the face
- ask the patient to raise eyebrows, smile, show teeth, puff out cheeks

(sensory)
- sense of taste on the anterior two thirds of tongue
- test of the taste sensation with various agents

84
Q

cranial nerve 8

A

acoustic (sensory)
- sense of hearing
- test hearing ability

85
Q

cranial 9

A

glossopharyngeal (motor)
- pharyngeal movement and swallowing
- ask patient to say “ah” and have patient yawn to observe upward movement of soft palate, elicit gag response and note ability to swallow

(sensory)
- sense of taste on posterior one third of tongue
- test for taste with various agents

86
Q

cranial nerve 10

A

vagus (motor/sensory)
- swallowing and speaking
- ask patient swallowing and speak, note hoarseness

87
Q

cranial nerve 11

A

accessory (motor)
- movement of shoulder and muscles
- ask the patient to shrug shoulders against your resistance

88
Q

cranial nerve 12

A

hypoglossal (motor)
- movements of the tongue, strength of tongue
- ask the patient to protrude tongue, ask patient to push tongue against cheek

89
Q

CT scan

A
  • uses narrow XR beams to scan body parts in successive layers
  • provides cross sectional views of the brain, distinguishes differences in tissue densities of skill, cortex, subcortical structures and ventricles
  • IV contrast agent may be used to highlight different further
  • quick, painless
  • small amounts of radiation to produce images
  • high degree of sensitivity for detecting lesions
  • can detect: tumor/masses, infarction, hemorrhage, displacement of ventricles, and cortical atrophy
90
Q

CT angiography

A

allows visualization of blood vessels
- eliminates need for formal angiography
- injection of water soluble iodinated contrast agent into subarachnoid space through lumbar puncture

91
Q

CT nursing interventions

A
  • sedation for agitation, restlessness, confusion
  • education about lying quietly throughout procedure
  • relaxation for claustrophobia
  • assess: iodine/shellfish allergy, kidney function (contrast), IV patient
  • encourage fluid intake to facilitate contrast clearance through kidney
92
Q

MRI

A

powerful magnetic field to obtain images of different areas of the Boyd
- causes hydrogen nuclei (protons) within body to align like small magnets on magnetic field
- radio frequency pulses and protons emits signal that are converted to images
- provides info about chemical changes within cell, allowing monitoring of tumor response to treatment, brain blood flow and metabolism

diagnosis: brain tumor, stroke, multiple sclerosis
- NO IODINE USE
- 30-90 minutes
- costly

93
Q

MR angiography

A

separate visualization of cerebral vasculature without arterial contrast agent

94
Q

MRI nursing interventions

A
  • assess any cardiac implantable electronic device, metal (aneurysm clips, orthopedic hardware, artificial heart valves, intrauterine devices), cochlear implants, credit cards
  • no metal anything can be on patient (oxygen tanks, IV poles, ventilators, stethoscopes)
  • loud thumping sound so educate patient to expect that, claustrophobia can occur so sedation may be required
95
Q

PET

A
  • positron emission tomography is composted based nuclear imaging technique that produces images of actual organ functioning
  • patient inhales radioactive gas or is injected with radioactive substance that emits positively charged particles, which combine with negative charged electrons (found in body).
  • provides composite picture of the brain at work
  • permits measure of blood flow, tissue composition, brain metabolism and brain function
  • detects alzheimers, locating lesions (brain tumor), identifying blood flow and oxygen metabolism in patients with strokes, distinguishing tumors from areas of necrosis, and revealing biochemical abnormalities associated with mental illness
96
Q

PET nursing interventions

A
  • patient prep, explaining test and educating the patient about inhalation techniques and sensations (dizziness, lightheadedness, headache) that may occur. IV injection of radioactive substance produces similar side effects
  • relaxation exercises may reduce anxiety during the test
97
Q

SPECT

A

single photon emission computed tomography
- three dimensional imaging technique that uses radionuclides and instruments to detect single photons
- perfusion study that captures moment of cerebral blood flow at the time of injection of a radionuclides
- allows areas behind overlying structures or background to be viewed, greatly increasing the contrast between normal and abnormal tissue
- inexpensive, duration similar to CT scan

  • detects extent and location of abnormally perfused areas of the brain, thus allowing detection, localization, and sizing of stroke, location of seizure foci in epilepsy, detection of tumor progression
98
Q

SPECT nursing interventions

A
  • patient prep and monitoring
  • providing education about what to expect before test can allay anxiety and ensure patient cooperation during the test
  • pregnancy and breast feed are CONTRAINDICATION to SPECT
99
Q

cerebral angiography

A

XR study of cerebral circulation with contrast agent injected into selected artery
- detects for vascular disease or anomalies, determine vessel latency, identify presence of collateral circulation
- less frequently performed

100
Q

cerebral angiography nursing interventions

A
  • assess blood urea nitrogen (BUN) and creatine (kidney function basically) to ensure contrast can be excreted
  • well hydrated with clear liquids
  • remain immobile during angiogram process and expect brief feeling of warmth in the face, behind the eyes, or in the jaw, teeth, tongue, and lips, and metallic taste when contrast agent injected
  • neuro assessments conducted during (LOC, weakness, motor/sensory deficits, speech disturbances)

POST: assess injection site for bleeding or hematoma, frequent peripheral pulse assessment, fluids encouraged, monitors for allergic reaction to the contrast agent, hypotension assessment (d/t vasodilatory meds)

NUR 3020 exams (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions