Chapter 43 Flashcards
Frontal Lobe Functions
- Primary motor area
- Broca’s speech center on the dominant side
- Voluntary eye movement
- Access to current sensory data
- Access to past information or experience
- Affective response to a situation
- Regulates behavior based on judgement
- Judgement
- Ability to develop long-term goals
- Reasoning, concentration, abstraction.
Parietal Lobe Functions
- Understand sensation, texture, size, shape and spatial relationships.
- Three-dimensional perception
- Important for singing, playing musical instruments, and processing nonverbal visual experiences.
- Perception of body parts and body position awareness
- Taste impulses for interpretation
Temporal Lobe Functions
- Auditory center for sound interpretation
- Complicated memory patterns
- Wernicke’s area for speech
Occipital Lobe Function
- Primary visual center
Limbic Lobe Functions
- Emotional and visceral patterns connected with survival
- Learning and memory
Motor cortex control of the body is …..
contra-lateral (in controlled by the opposite side)
Cerebellar control of the body is …
ipsilateral (situated on the same side)
Medulla Functions
- Cardiac-slowing center
- Respiratory center
- Cranial nerves IX (glossopharyngeal), X (vagus), XI (accessory) and XII (hypoglossal) emerge from the medulla, as do portions of cranial nerves VII (facial) and VIII (acoustic).
Pons Functions
- Cardiac acceleration and vasoconstriction centers
- Pneumotaxic center helps control respiratory pattern and rate
- Four cranial nerves originate from the pons: V (trigeminal), VI (abducens), VII (facial) and VII (vestibulocochlear)
Midbrain Functions
- Contains the cerebral aqueduct or aqueduct of Sylvius
- Location of periaqueductal gray, which may abolish pain when stimulated
- Cranial nerve nuclei III (oculomotor) and IV (trochlear) located here.
Proprioception
awareness of position and movements of body parts
How many pairs of spinal nerves?
31 pairs
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
How many cranial nerves?
12
Cranial Nerve I
Name, Origin, Type, Function
Olfactory
Origin: Olfactory Bulb
Type: Sensory
Function: Smell
Cranial Nerve II
Name, Origin, Type, Function
Optic
Origin: Midbrain
Type: Sensory
Function: Central and peripheral vision
Cranial Nerve III
Name, Origin, Type, Function
Oculomotor
Origin: Midbrain
Type: Motor
Function: Eye movement via medial and lateral rectus and inferior oblique and superior rectus muscles; lid elevation via the levator muscle. Pupil constriction; ciliary muscles.
Cranial Nerve IV
Name, Origin, Type, Function
Trochlear
Origin: Lower midbrain
Type: Motor
Function: Eye movement via superior oblique muscles
Cranial Nerve V
Name, Origin, Type, Function
Trigeminal
Origin: Pons
Type: Sensory
Function: Sensation from skin of face and scalp and mucous membranes of mouth and nose.
Cranial Nerve VI
Name, Origin, Type, Function
Abducens
Origin: Inferior Pons
Type: Motor
Function: Eye movement via lateral rectus muscles
Cranial Nerve VII
Name, Origin, Type, Function
Facial
Origin: Inferior Pons
Type: Sensory & Motor
Function: Pain and temperature from ear area; deep sensations from the face; taste from anterior two thirds of the tongue. Muscles of the face and scalp. Lacrimal, submandibular, and sublingual salivary glands.
Cranial Nerve VIII
Name, Origin, Type, Function
Vestibulocochlear
Origin: Pons-medulla junction
Type: Sensory
Function: Hearing, equilibrium
Cranial Nerve IX
Name, Origin, Type, Function
Glossopharyngeal
Origin: Medulla
Type: Sensory and Motor
Function: Pain and temperature from ear; taste and sensations from posterior one third of tongue and pharynx. Skeletal muscles of the throat. Parotid glands
Cranial Nerve X
Name, Origin, Type, Function
Vagus
Origin: Medulla
Type: Sensory and Motor
Functions: Pain and temperature from ear; sensations from pharynx, larynx, thoracic and abdominal viscera. Muscles of the soft palate, larynx and pharynx. Thoracic and abdominal viscera; cells of secretory glands; cardiac and smooth muscle innervation to the level of the splenic flexure
Cranial Nerve XI
Name, Origin, Type, Function
Accessory
Origin: Medulla
Type: Motor
Function: Skeletal muscles of the pharynx and larynx and sternocleidomastoid and trapezius muscles
Cranial Nerve XII
Name, Origin, Type, Function
Hypoglossal
Origin: Medulla
Type: Motor
Function: Skeletal muscles of the tongue.
Cognitive decline is frequently caused by….
drug interactions or toxicity or by an inadequate oxygen supply to the brain. Mental status may also decline as a result of infection. Often this change is a key early sign of an infectious process especially of UTI.
A change in _______ is the FIRST indication that central neurologic function has declines
Level of Consciousness
Scoring for Gordon’s Functional Health
Level 0: Full self-care
Level I: Requires use of equipment or device
Level II: Requires assistance or supervision of another person
Level III: Requires assistance or supervision of another person and equipment or device.
Level IV: Is dependent and does not participate in care.
Test recall memory
Can be tested during the history and checked on the medical record.
ex. time of admission, Mode of transport to the hospital, physicians seen recently.
Immediate Memory test
tested by giving the patients two or three unrelated words such as “apple, street, and chair”. Ask the pt to repeat the words to make sure they were heard properly and then ask them to repeat them in about 5 minutes
Serial- Seven test
to determine attention.
Pt is asked to count backwards from 100 by 7. (Stop the patient when they reach 65.)
Abstract reasoning test
can be evaluated by asking for the meaning of proverbs (eg. “A rolling stone gathers no moss”) People from countries other than the US or young adults may be unfamiliar with some of these abstract statements
Judgement test
Assess by asking questions such as “What would you do if stopped for speeding?” or “What would you do if there was a fire in the wastepaper basket?”
Pronator Drift
Ask the patient to close their eyes and hold arms perpendicular to the body with the palms up for 15-30 seconds. If there is a cerebral or brainstem reason for muscle weakness, the arm on the weak side will start to fall, or “drift” with the palm pronating
Romberg sign
test for equilibrium in which the patient is able to remain steady while standing with arms at sides, and feet and knees close together, and eyes open; but begins to sway when eyes are shut in the same position
a Positive Babinski’s sign is abnormal in what age group
anyone over the age of 2
* Babinskis sign can occur in people over the age of 2 with drug and alcohol intoxication, after a seizure, or in patients with multiple sclerosis, or liver disease.
Hyperactive reflexes indicate..
possible upper motor neuron disease, tetanus, or hypocalcemia
Hypoactive reflexes indicate…
lower motor neuron disease (damage to spinal cord), disease of the neuromuscular junction, muscle disease, or health problems such as diabetes mellitus, hypothyroidism, or hypokalemia.
Asymmetry of reflexes is an important finding because…
it probably indicates a disease process.
The results of reflex testing are documented on a stick figure using + signs. (0 - ++++) the meaning is…
0 - Absent, no response \+ - weaker than normal, hypoactive \++ - Normal \+++ - Stronger or more brisk than normal \++++ - Hyperactive Note: 1 and 3 may be normal for some individuals.
Glasgow coma scale categories
Eye opening
Motor response
Verbal response
Eye opening
Glasgow coma scale scoring
Spontaneous - 4
To sound - 3
To pain - 2
Never - 1
Motor Response
Glasgow coma scale scoring
Obeys commands - 6 Localizes pain - 5 Normal flexion (withdrawal) - 4 Abnormal flexion - 3 Extension - 2 None - 1
Verbal Response
Glasgow coma scale scoring
Oriented - 5 Confused conversation - 4 Inappropriate words - 3 Incomprehensible sounds - 2 None - 1
Glasgow coma score interpretation
The lower the score the lower the pts LOC
15 represents normal neurologic function.
7 or below represents a comatose state.
Decortication
abnormal posturing seen in patients with lesions that interrupt the corticospinal pathways. The pts arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.
Decerebration
abnormal posturing and rigidity characterized by the extension of the arms and legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which body is bowed forward. Usually associated with dysfunction in the brainstem.
Pupillary reactions in pts with glaucoma/cataracts
pts who have had eye surgery often have irregular shaped pupils. Those using eyedrops may have unequal pupils if only one eye is being treated, and pupillary response may be altered.
Cerebral Angiography Pt Prep
- Assess for allergy to shellfish or iodine.
- Ensure NPO for 4-6h prior
- teach importance of maintaining very still during testing.
- teach that head will be immobilized
- teach feel warmth when dye is injected
- assess and document neurologic signs, vitals, and neuro check.
Cerebral Angiography Pt follow up
- Check dressing for signs of bleeding and swelling around site.
- Apply ice pack to site
- keep extremity straight and immobilized
- maintain pressure dressing for 2 hours
- check for adequate circulation in extremity
CSF pressure
Normal: less than 20 cm H20
>20cm H20 - Indicates spinal pressure, most often from bleeding, tumors, or infection within the CNS
CSF colors
Clear, Colorless - Normal
Pink-red to orange - RBC present
Yellow - Bilirubin present owing to hemolysis of RBC; possible causes include subarachnoid hemorrhage, jaundice, increased CSF protein, hypercarotenemia, or hemoglobinemia.
Brown - methemoglobin present, indicating previous meningeal hemorrhage
Unclear/hazy - Cell count is elevated
CSF Cell Count
0-5 small lymphocytes/mm3 - Normal
>5 lymphocytes/mm3 - reaction to infection; chemical substance, or blood.
CSF protein
15 - 45 (upto 70 in older adults) - normal
45-100 - paraventricular tumor
50 - 200 - viral infection
more than 500 - bacterial infection; guillain-barre syndrome
less than 15 - meningismus, pseudotumor cerebri, hyperthyroidism.
CSF IgG
3% - 12% of total protein - Normal
> 12% of TP - MS, neurosyphilis, or viral infection
CSF albumin/globulin ratio
8:1 - Normal
CSF Glucose
50 - 75 or 60 - 70% of BG level- Normal
<50 - bacterial, fungal, or viral meningitis; CNS leukemia; or cancer
CSF Lactic acid
10 - 25 - Normal
> 25 - Systemic acidosis or increased CSF glucose metabolism
CSF glutamine
6 - 15 - Normal
>15 - Hepatic coma or cirrhosis of liver
CSF Dehydrogenase
10% of serum level or 2.0-7.2 - Normal
>10% of serum level - Bacterial meningitis, inflammatory diseases of CNS.
Complications of lumbar puncture
Although not common, include brainstem herniation, infection, CSF leakage, and hematoma formation.
