Ch 22: Neurological and mental status Flashcards
What parts does the nervous system
include
What part did the peripheral nervous system include
Nervous system parts:
- CNS
- Brain
- spinal cord
Peripheral nervous system parts:
- cranial
- spinal
- peripheral + associated nerves
How is the nervous system classified
Give the parts of classification
Nervous system classified by function
Somatic (voluntary)
- Control skeletal muscle
- Motor
Autonomic (involuntary)
- Controls everything else
- senses
What bigger system or the sympathetic and parasympathetic nervous system is a part of
Differentiate sympathetic versus parasympathetic nervous system
Sympathetic and parasympathetic nervous system‘s a part of autonomic (involuntary) nervous system
Sympathetic: fight V flight
Parasympathetic: rest and digest
What will a patient exhibit if they have a CVA on the left side
What will the patient exhibit if they have a CVA on the right side
L CVA: motor and sensory deficit on R
R CVA: motor and sensory deficit on L
What is the brain considered
Give the parts of the neuron including characteristics of axon and How neurons communicate
 Brain: network of interconnecting neurons that control/integrate body
Neuron: -cell body (control) -dendrites (receiving fibers) -axon (connecting fibers) • White because of my sheet that spreads impulse
Neurons communicate at synapse
What is the function of the cerebral cortex where is it located within
Give the divisions of the cerebrum and would each known for
Cerebral cortex: contributes to motor and sensory function, language
Cerebrum divided into two hemispheres
-L: analytical
(math logic lang)
-R: creative
(art music emotion)
Where is the precentral gyrus and what is it known for
what does it control
How does this relate to the CVA
Precentral gyrus located in the frontal lobe is the primary motor area
Precentral gyrus controls motor to opposite side of body

Pre-central gyrus associated with CVA presentation
Give the function of the frontal lobe
What is the function of the Broca area
Frontal:
- cogn
- mem
- personality/emotion
Broca area: expresses communication and regulates verbal/writing ability
Give the function of the perinatal lobe
Where is the warnicke area and what is it known for
Parietal:
- interprets touch
- pressure/pain
Warnicke area: LOC left hemisphere
-known for the perception of communication (spoken and written)

Give the function of the occipital lobe
give the function of the temporal lobe
Occipital: primary visual area
Temporel: hearing, speech, behavior
Give the 4 parts of the brain stem their function
Brain stem:
- Medulla (autonomic)
- resp,cardio, vasomotor
- cells bodies of CN3 – 12 - Midbrain: relays info from brain using ascending (sensory) and descending (motor)
- Ponds: controls inspiration/expiration + resp rate
- Reticular formation: wakefulness and attention
What is a brainstem known for as far as stimuli ans where the stimuli goes + Direction of stimuli
•Afferent (sensory): ascending
-travels sensory information to cerebral cortex
•Efferent (Motor): descending
-from cortex to brainstem and spinal cord 
What function of the brain controls involuntary function like sneezing and swallowing
The medulla of the brainstem controls involuntary function like sneezing and swallowing
Give the section of the brain stem and the cranial nerves that correspond to
(Think of a picture green, purple, blue, they’re already in order 2,4,4)
Midbrain: 3&4
Ponds: 5,6,7,8
Medulla: 9,10,11,12
What is the function of the cerebellum
how do you test the cerebellum
and what may affect the cerebellum
Cerebellum functions for coordination and equilibrium
Cerebellum tested with Romberg
Alcohol can affect the balance and coordination in the cerebellum
What are brain ventricles
How far does a spinal cord extend
Brain ventricles are fluid filled cavities that connect to spinal cord
Spinal cord extends from base of skull to coccyx

What is the function of CSF
- carries nutrients
- cushions
- allows for fluid to shift between brain and spinal cord to prevent increased intercranial pressure (ICP)
In the peripheral nervous system:
How many cranial nerves do we have
How many spinal nerves do we have
if a spinal nerve becomes injured where does injury take place what kind of injury
 12 pairs of CN
31 pairs of spinal nerves
-depending on the level of injury to the spinal cord injury can affect at or below side of trauma both century and motor
What are dermatomes
Dermatomes are afferent sensory fibers
 Give the major divisions of the autonomic nervous system,
The neurotransmitter associated and actions
(2 previously stated, think back)
Autonomic nervous system (involuntary)
-sympathetic: fight the flight
• Epinephren ⬆️ vitals (BP/ HR)
-parasympathetic: rest and digest
• acetylcholine⬇️
What does the autonomic nervous system make changes based on
What innervates bilat regions of skin
Autonomic nervous system makes changes based on received info
Bilat regions of skin intervated by spinal nerves
Give the 4 reflex arc components
-With their real world comparison
- Receptor sensing organ
- Patellar tendon - Afferent sensory neuron
- root of ganglion
Synape in spinal cord
- Efferent motor neuron
- Effector motor organ
- quadriceps contracts and jerks
How would you define reflexes
Reflexes are involuntary response to stimuli
Lifespan considerations for older adults related to CNS age related changes
Brain vol Mylin sheath Thought process Bal Sensation
•Brain ⬇️ in volume: ⬇️ in neurons
•Myelinated axon length shortens
- slow delayed response to stimuli
• cognitive changes
-Slower thought process
•Mobility issues
-Poor bal
- **Decreased sensation
- Risk for injury
What is not completed in newborns at birth
-why is it needed
What changes do you see in a pregnant woman
Myelin sheath not completed at birth needed for a quick nerve transmission
PREG
- changes in hypothalamus, pituitary hormones prolactin/oxytocin
- increase pressure on nerves
Give situations of urgent assessment related to the neurological and mental status
- Acute change in mental status
- A&OX4 suddenly confused - History of seizure
- protect head and extremities - Change in PERRLA
- Assess paresis: progressing weakness or paralysis
- Unilateral extremity loss
What do you do if a patient who was A&O x4 suddenly becomes disoriented
What are types of disorientation
In this situation what do you want to check for in the patient
What do you want to assess for especially if there is no clear definitive cause of disorientation
If patient A&Ox4 suddenly becomes disoriented ACTIVATE RAPID RESPONSE
disorentation:
- confused
- stupor: not conscious not arousable
- coma
Check AVPU
Assess for
- toxins/viruses
- vaccinations
- pesticides
- spider/snake/mosquito bites

Abnormal body positions:
Describe deCORticate
What does decorticate posture indicate as far as injury
deCORticate = flexor
- clinched fish bent arms on chest
- plantar flexed
Decorticate posture indicates damage to cerebral cortex (path of brain and spinal cord) 
Abnormal body positions:
Describe dEcErEbratE
What does decerebrate position indicate
dEcErEbratE = Extensory
-Extended body E hands
-plantar flexed
dEcErEbratE indicates damage to mid brain/upper ponds
SEVERE BRAIN INJURY


 abnormal body positions:
Describe HEMIplagia
What does HEMIplagia arise from
HEMI= SEMIplagia

-unilateral loss of sensation/motor strength
HEMI (SEMI)plagia arises from stroke
What does the Glasgow coma scale evaluate
What are the three areas of assessment within the Glasgow coma scale
What do the point system indicate
GCS assesses level of consciousness
Assessment areas: GCS= EVM
1. Eye-opening
2 verbal response
4. Motor function
 Point system 15-12: normal 9: being intubated 5: coma 3: deep coma
 What are acute assessments that can be done for neurological assessment
GCS
PERRLA
Extremity strength
-Lift extremity and let drop see if patient can hold limb up
Sensation were gag reflex/ corneal reflex
 what kind of sensation would you assess neurologically
When would you opt for the gag/ corneal reflex instead of sensation
Describe the corneal reflex
What are normal findings
Sensations include
- sternal rub
- nail
Only do sensation if patient CAN communicate if unconscious do gag/corneal reflex
Corneal reflex:
- tested by touching patiets cornea or eyelashes
• blinking = intact
What is another name for dolls eyes
Who and How do you perform technique
What are normal findings and what do they indicate
Dolls eyes a.k.a. Occulocephalic reflex
Technique: in coma patients
- hold upper eyelids open
- quickly turn patient’s head
Norm:( -)
Eyes moving opposite direction of head
= Intact brain stem
What is the Cushing’s reflex and what does it result in
Cushing’s reflex: nervous system response to increased ICP resulting in Cushing’s triad
Give the components (signs) to Cushing’s triad and what they indicate
Cushing’s triad signs
- ⬆️ICP
- ⬆️SBP
- ⬇️ in pulse and resp rate
Cushing’s triad Indicates brainstem compression
If a patient presents with increased ICP /
Brain herniation how are pupils going to look
With increased ICP/ brain herniation pupils will be sluggish
What is our goal in the neurological and mental status assessment
Our goal is to identify likelihood of developing or experiencing consequences of neurological neurovascular disease
When assessing risk factors who do we refer to if the patient is not reliable
what do we want to know about past medical history
what is the role of seizure medications
If the patient is not reliable refer to a secondary source
We want to know about any CVA, head/cord injuries, seizure history or meningitis
Which seizure medications we wanna know if they are within therapeutic levels
For risk reduction health promotion what are our health goals in relation to the neurological and mental status assessment
Prevent disease
Identify difficulties early
Reduce complication
For risk reduction and health promotion what are the two main focuses in risk reduction on
 1. Stroke prevention
- decrease weight/
- decrease HTN/Dm/cholesterol/smoke
- increase physical activity
- Injury prevention
- Use a helmet
- use a seatbelt
- avoid head injuries with alcohol and drugs
Give common neurological symptoms
Headache
Limb/unilateral weakness
Involuntary movements/tremors
Bal/coordination difficulties
Dizziness, vertigo, difficulty swallowing
** intellectual changes speech language difficulties
-  change and taste, touch, smell
- Blurred vision, lost vision, lost hearing, tinnitis
What do you want to test for if patient is having speech and language difficulties and how
(1 very specific word)
If speech and language difficulties test for aphasia
: loss of ability to understand/express speech
-memory test, cognition tests
What does it mean if a patient has a SUDDEN loss of smell/touch/taste
Efficient has sudden loss of smell/touch/taste assess for brain tumor
What can cause paralysis
Give signs and symptoms of paralysis

Paralysis can be caused by:
- STROKE
- spinal injury
- neuromuscular disease
S&s:
- decrease motor function
- Flacidity
What is 4 extremity paralysis called
What is leg paralysis called
4 extremity paralysis: quadriplegia
Leg paralysis: paraplegia
What can cause a tic
Give sign and symptoms for tic
tic can be caused by:
-Tourette’s
-Side effect of psychotropic (psych) meds
-amphetamines
S&S:
• Brief repetitive but irregular movement
What can cause dystonia
What are signs and symptoms of dystonia
Dystonia can be caused by:
-use of psych meds
S & S:
-slow incoherent trunk twisting and twisting posture
What culture population was exposed to pesticides and what do they develop because of the pesticides
Mexicans were exposed to pesticides and developed neurological symptoms because of the pesticides
When can you integrate the Nuro exam
 give a few examples as to hell
You can integrate the neuroexam well taking health history
- LOC
- AVPU
- GCS
- knowledge/memory questions
What is stereognosis
How do you test it
Stereognosis: done to identify objects
Technique:
- have patient close eyes
- place key, paperclip, coin in patient’s hand
- have patient identify object
What does Graphesthesia test
and how do you test it
Graphesthesia tests sensory function
Technique:
- have patient close eyes
-  draw # on palm
- have patient ID #drawn
What does the finger to nose target test and how do you test it on a patient
Finger to nose target evaluates sensory function
Technique:
- put your finger out
- have patient touch your finger then touch their nose
- move your finger around
What does it mean to note any asterixis
When would asterixis be present what would be elevated
Noting asterixis means noting slapping of wrist uncontrollably
Asterixis would be present with alcoholic hepatic encephalopathy and you wiuld note ⬆️ amonia levels
Give the DTRs
Give the DTR scale
DTRs:
-bicep tricep patella Achilles
Scale: 4+: very brisk 3+: brisker than average 2+:normal 1+: diminished 0: no reflex
Name your superficial reflexes
Abdominal
Scrotal
Babinski
Anal reflex
 how do you complete the Babinski
What are normal findings
What are abnormal findings
What is the special consideration within findings
Babinski technique:
-stroke lateral aspect of patient’s Sole
(-)Normal finding: toes curl or no response
(+)Abnormal finding: great toe extends other toes fanout
Special consideration within findings:
-children UP TO 2 yoa May have positive Babinski sign and that is normal
How do you conduct vibration sensation
Technique:
- Close patient’s eyes
- Activate tuning fork place on each tone
- patient will see if they feel sensation
What are some of the most common lifespan considerations for your older population
Slower thought, memory, reflexes
CNS atrophy
How do you assessfor meningitis (signs)
 explain the Brodinski and Kernig’s sign
Headache
Fever
Nuchal rigidity
- Brudzinski sign: positive resistance (pain) in neck with flexion of hips and knees
- Kernig sign : pain in lower posterior when hips are flexed and neck is straightened
What do you want to assess in an unconscious patient
In an unconscious patient assess four:
- dolls eyes
- gag reflex
- corneal reflex
- Babinski
What are signs and symptoms of brain herniation
- Ipsilateral pupil dilation:
pupil sluggishly reactive indicates worsening neurological status
 - Irregular slow breathing
 after doing an MRI preforming angiography requiring lumbar puncture
How long was the patient’s stay bedrest
What happens if the patient still has a headache
What does a persistent headache mean
After lumbar puncture patient must be bed rest 6 to 8 hours
If patient displays headache bedrest required for 24 hours plus fluids
If persistent headache it indicates a CSF leak
After a lumbar puncture That results in CSF leak what is done to clot and seal the preparation
After lumbar puncture with known CSF leak do blood patch
Blood patch: is personal blood introduced to the epidural space that will clot and seal the perforation
Give common lab and diagnostic tests
EEG test brain electrical activity
CSF spinal procedures
Give nursing outcomes related to the neurological and mental status assessment
Patient cares for both sides of body and keeps affected side safe
Patient improved motor function, become independent with activities of daily
Give nursing interventions related to the neurological and mental status assessment
Assess neurological and mental status as ordered inform Dr of changes
Orient patient to time place in person frequently
