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NRS235: Med/Surg 3 > Chapter 43 > Flashcards

Chapter 43 Flashcards

1
Q

Frontal Lobe Functions

A
  • 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.
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2
Q

Parietal Lobe Functions

A
  • 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
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3
Q

Temporal Lobe Functions

A
  • Auditory center for sound interpretation
  • Complicated memory patterns
  • Wernicke’s area for speech
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4
Q

Occipital Lobe Function

A
  • Primary visual center
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5
Q

Limbic Lobe Functions

A
  • Emotional and visceral patterns connected with survival

- Learning and memory

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6
Q

Motor cortex control of the body is …..

A

contra-lateral (in controlled by the opposite side)

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7
Q

Cerebellar control of the body is …

A

ipsilateral (situated on the same side)

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8
Q

Medulla Functions

A
  • 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).
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9
Q

Pons Functions

A
  • 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)
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10
Q

Midbrain Functions

A
  • 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.
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11
Q

Proprioception

A

awareness of position and movements of body parts

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12
Q

How many pairs of spinal nerves?

A

31 pairs

  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
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13
Q

How many cranial nerves?

A

12

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14
Q

Cranial Nerve I

Name, Origin, Type, Function

A

Olfactory
Origin: Olfactory Bulb
Type: Sensory
Function: Smell

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15
Q

Cranial Nerve II

Name, Origin, Type, Function

A

Optic
Origin: Midbrain
Type: Sensory
Function: Central and peripheral vision

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16
Q

Cranial Nerve III

Name, Origin, Type, Function

A

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.

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17
Q

Cranial Nerve IV

Name, Origin, Type, Function

A

Trochlear
Origin: Lower midbrain
Type: Motor
Function: Eye movement via superior oblique muscles

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18
Q

Cranial Nerve V

Name, Origin, Type, Function

A

Trigeminal
Origin: Pons
Type: Sensory
Function: Sensation from skin of face and scalp and mucous membranes of mouth and nose.

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19
Q

Cranial Nerve VI

Name, Origin, Type, Function

A

Abducens
Origin: Inferior Pons
Type: Motor
Function: Eye movement via lateral rectus muscles

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20
Q

Cranial Nerve VII

Name, Origin, Type, Function

A

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.

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21
Q

Cranial Nerve VIII

Name, Origin, Type, Function

A

Vestibulocochlear
Origin: Pons-medulla junction
Type: Sensory
Function: Hearing, equilibrium

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22
Q

Cranial Nerve IX

Name, Origin, Type, Function

A

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

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23
Q

Cranial Nerve X

Name, Origin, Type, Function

A

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

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24
Q

Cranial Nerve XI

Name, Origin, Type, Function

A

Accessory
Origin: Medulla
Type: Motor
Function: Skeletal muscles of the pharynx and larynx and sternocleidomastoid and trapezius muscles

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25
Q

Cranial Nerve XII

Name, Origin, Type, Function

A

Hypoglossal
Origin: Medulla
Type: Motor
Function: Skeletal muscles of the tongue.

26
Q

Cognitive decline is frequently caused by….

A

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.

27
Q

A change in _______ is the FIRST indication that central neurologic function has declines

A

Level of Consciousness

28
Q

Scoring for Gordon’s Functional Health

A

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.

29
Q

Test recall memory

A

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.

30
Q

Immediate Memory test

A

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

31
Q

Serial- Seven test

A

to determine attention.

Pt is asked to count backwards from 100 by 7. (Stop the patient when they reach 65.)

32
Q

Abstract reasoning test

A

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

33
Q

Judgement test

A

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?”

34
Q

Pronator Drift

A

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

35
Q

Romberg sign

A

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

36
Q

a Positive Babinski’s sign is abnormal in what age group

A

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.

37
Q

Hyperactive reflexes indicate..

A

possible upper motor neuron disease, tetanus, or hypocalcemia

38
Q

Hypoactive reflexes indicate…

A

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.

39
Q

Asymmetry of reflexes is an important finding because…

A

it probably indicates a disease process.

40
Q

The results of reflex testing are documented on a stick figure using + signs. (0 - ++++) the meaning is…

A 
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.
41
Q

Glasgow coma scale categories

A

Eye opening
Motor response
Verbal response

42
Q

Eye opening

Glasgow coma scale scoring

A

Spontaneous - 4
To sound - 3
To pain - 2
Never - 1

43
Q

Motor Response

Glasgow coma scale scoring

A 
Obeys commands - 6
Localizes pain - 5
Normal flexion (withdrawal) - 4
Abnormal flexion - 3
Extension - 2
None - 1
44
Q

Verbal Response

Glasgow coma scale scoring

A 
Oriented - 5
Confused conversation - 4
Inappropriate words - 3
Incomprehensible sounds - 2
None - 1
45
Q

Glasgow coma score interpretation

A

The lower the score the lower the pts LOC
15 represents normal neurologic function.
7 or below represents a comatose state.

46
Q

Decortication

A

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.

47
Q

Decerebration

A

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.

48
Q

Pupillary reactions in pts with glaucoma/cataracts

A

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.

49
Q

Cerebral Angiography Pt Prep

A
  • 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.
50
Q

Cerebral Angiography Pt follow up

A
  • 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
51
Q

CSF pressure

A

Normal: less than 20 cm H20

>20cm H20 - Indicates spinal pressure, most often from bleeding, tumors, or infection within the CNS

52
Q

CSF colors

A

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

53
Q

CSF Cell Count

A

0-5 small lymphocytes/mm3 - Normal

>5 lymphocytes/mm3 - reaction to infection; chemical substance, or blood.

54
Q

CSF protein

A

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.

55
Q

CSF IgG

A

3% - 12% of total protein - Normal

> 12% of TP - MS, neurosyphilis, or viral infection

56
Q

CSF albumin/globulin ratio

A

8:1 - Normal

57
Q

CSF Glucose

A

50 - 75 or 60 - 70% of BG level- Normal

<50 - bacterial, fungal, or viral meningitis; CNS leukemia; or cancer

58
Q

CSF Lactic acid

A

10 - 25 - Normal

> 25 - Systemic acidosis or increased CSF glucose metabolism

59
Q

CSF glutamine

A

6 - 15 - Normal

>15 - Hepatic coma or cirrhosis of liver

60
Q

CSF Dehydrogenase

A

10% of serum level or 2.0-7.2 - Normal

>10% of serum level - Bacterial meningitis, inflammatory diseases of CNS.

61
Q

Complications of lumbar puncture

A

Although not common, include brainstem herniation, infection, CSF leakage, and hematoma formation.

NRS235: Med/Surg 3 (2 decks)

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