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NUR 3066 Health Assessment > CH 24 Neuro > Flashcards

CH 24 Neuro Flashcards

1
Q

Structure/Function: CNS

A

central nervous system

contains: brain and spinal cord

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2
Q

Structure/Function: PNS

A

peripheral nervous system

12 cranial nerves
31 pairs of spinal nerves

autonomic nervous system (ANS) - automatic
somatic nervous system (SNS) - controlled

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3
Q

CNS 4 lobes (functions)

A

frontal - personality, emotion, behavior, intellectual function, skilled movement
- Broca’s area injury = expressive aphasia (able to understand but cannot verbally communicate)

parietal - main processing center for sensory information

occipital - vision and interpretation of visual data

temporal - perception/interpretation of sounds and smell
- Wernicke’s area injury = receptive aphasia (cannot interpret/understand what is being said)

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4
Q 
CNS (parts of brain and their function)
Basal Ganglia
Thalamus
Hypothalamus
Cerebellum
Brainstem
A

Basal ganglia - important for initiating movement and maintaining automatic coordination (large bands of gray matter)

Thalamus - relay station//emotion and creativity

Hypothalamus - maintains homeostasis and basic vital signs

Cerebellum - for coordination of voluntary movement/ does not initiate movement

Brainstem - regulates HR, breathing, and swallowing
- contains: midbrain, pons, medulla

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5
Q

CNS Pathway

A

crossover representation

- right cerebrum controls left sided motor function and vice versa

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6
Q

PNS Spinal Nerves

A 
cervical (8)
thoracic (12)
lumbar (5)
sacral (5)
coccyygeal (1)
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7
Q

How messages travel in PNS

A

sensory (afferent) goes FROM sensory receptors TO CNS

motor (efferent) goes FROM CNS TO muscles and glands

PNS sends automatic messages TO internal organs and blood vessels

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8
Q

Autonomic Nervous System (ANS) Components

A

innervates smooth muscle

Parasympathetic NS - rest and digest
Sympathetic NS - fight or flight

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9
Q

Reflex Arc (3 types)

A

Deep tendon reflex
LE: patellar, achilles, hamstring
UE: triceps, biceps, brachioradialis

Superficial reflexes
visceral reflexes - pupillary response to light and accommodation

Pathologic Reflexes
Plantar reflex - Babinski Sign
- positive finding after 24 months (abnormal)

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10
Q

Mental Status Assessment (4 things)

A

judgment
abstraction
memory
LOC

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11
Q

LOC (5 different levels)

A

alert - pt able to look at you and fully respond to stimuli

lethargy - drowsy but eyes open; responds to questions then falls asleep

obtunded - opens eyes, responds slowly, somewhat confused; may need repeated stimuli

stuporous - arouses from sleep after painful stimuli; verbal responses are slow or no response at all

comatose - verbal and tactile stimuli do not arouse
them

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12
Q

CN I

A

olfactory

normal if patient identifies common odors accurately

test if reports of loss of smell or head injury

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13
Q

CN II

A

optic

visual acuity and visual fields

color - ishihara plates
visual field - peripheral vision test

pupillary reflex - carries sensory information (sends to CNS)
- CN III deals with actual movement (motor function)

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14
Q

CN III, IV, VI

A 
CN III (oculomotor)
CN IV (trochlear)
CN VI (abducens)

Cardinal Field of Gaze
- all tested together for conjugate movement

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15
Q

CN V

A

trigeminal

3 branches

  • ophthalmic
  • maxillary
  • mandibular

assess:

  • sensory supply to face (tests all three branches) with light touch in each area
  • sensory reflex (corneal reflex)
  • motor supply to muscles of mastication (maxillary and mandibular)
    • palpate jaw and temple and ask patient to clench teeth
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16
Q

CN VII

A

Facial

innervates muscles for facial expression
- tell patient to raise eyebrows, clench eyes, puff out cheeks, and smile

17
Q

CN VIII

A

vestibulocochlear

innervates hearing apparatus of the ear

auditory acuity - whisper test (detects high-pitch hearing loss)
conductive vs sensorinueral
air conduction vs bone conduction
vestibulo (balance) /// cochlear (hearing)

18
Q

CN IX, CN X

A 
CN IX (glossopharyngeal)
CN X (vagus)

tested together with tongue depressor and pt saying “ahh”

CN IX - sensory supply to soft palate (gag reflex)
CN X - motor supply to pharynx (uvula and soft palate rise to midline)

19
Q

CN XI

A

spinal accessory

tests strength of sternocleidomastoid (SCM) and trapezius muscle

have pt turn head against resistance (SCM)
have pt shrug shoulders against resistance (trap)

20
Q

CN XII

A

hypoglossal

tongue strength

21
Q

Cerebellar Function Assessments (4)

A

Rapid rhythmic alternating movements

  • alternate patting knees with both hands
  • airplay piano
  • touch thumb to finger tips on both hands

Accuracy of movements
- finger to nose

Balance

  • very light sternal nudge
  • Romberg Test (stand with feet together, eyes closed)
    • swaying = positive

Gait
- tandem walking (heel-to-toe)

22
Q

Muscular (contraction) Grade Scale

A

(higher number = better response)

0 = no contraction detected
1 = barely detectable contraction
2 = active movement with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and some resistance
5 = active movement against resistance w/o evident fatigue (NORMAL)
23
Q

Glascow Coma Scale

A

objective assessment for LOC

3 categories:

eye opening response
verbal response
motor response

15-13 = mild (15 being the best response)
12-9 = moderate 
8-3 = severe 
  - 8 or less = compatose
  - 3 = unresponsive
24
Q

Glascow (eye opening response)

A
  • Spontaneously: 4
  • to speech: 3
  • to pain: 2
  • no response: 1
25
Q

Glascow (verbal response)

A
  • Oriented to time, place, and pattern: 5
  • confused : 4
  • inappropriate words: 3
  • incomprehensible sounds: 2
  • no response: 1
26
Q

Glascow (motor response)

A
  • obeys commands: 6
  • moves to localized pain: 5
  • flexion withdrawal from pain: 4
  • abnormal flexion (decorticate): 3
  • Abnormal extension (decerebate): 2
  • No response: 1
27
Q

Spot a Stroke

A 
FAST
face - drooping
arm - weakness
speech - difficulty
time - call 911 ASAP
28
Q

Posturing

A

decorticate (abnormal flexing inward)

deceberate (abnormal extension outward) (WORSE)

29
Q

Meningitis

A

Kernig’s Sign
assess by resistance to straightening leg from 90 degrees
- positive if pain on posterior thigh

Burdzinski’s Sign
assess by passive flexion of neck
- positive if flexion of hips and knees with flexion of neck

30
Q

Aging Neurological Consideration (cognition impairment)

A

cognition impairment is NOT NORMAL AGING

- due to pathological circumstances and diseases such as dementia, Alzheimer’s, and Parkinson’s

31
Q

Parkinson’s Disease

A

motor tract disorder

  • loss of dopamine-producing neurons in substantia nigra and through basal ganglia
  • resting tremor
  • loss of balance
  • shuffling, short-step gait
32
Q

Nursing Diagnoses

A

Impaired verbal communication
Risk for aspiration
Ineffective brain tissue perfusion

NUR 3066 Health Assessment (20 decks)

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