Chapter 60/62: Neuro Flashcards
______________ are the cells of the nervous system
neurons
Branch-type structures for receiving electrochemical messages are structures known as:
Dendrites
An _________ is a long projection that carries electrical impulses away from the cell body
axon
______________ are at the end of an axon, which transmits messages to other cells via the neurotransmitters known as synapses
Terminals
A __________ is the place where neurons connect and communicate with each other
synapse
The major transmitter of the sympathetic nervous system is known as __________________. Imbalances of this neurotransmitter includes:
- high levels cause mania
- low levels cause anxiety, depression, ADHD
norepinephrine
_____________ affects behavior and fine movements
Imbalances of this hormone leads to diseases such as Parkinson’s
Dopamine
_________________ is the transmitter of the parasympathetic nervous system. Imbalances lead to diseases such as:
- Myasthenia gravis
Acetylcholine
The three main areas of the brain include:
Cerebrum
Brain Stem
Cerebellum
The __________ is responsible for thinking
The ________ ______’s major function is to sustain life
The ___________’s function is the integration of information for movement
cerebrum
brain stem
cerebellum
The __________ lobe is responsible for concentration, abstract thought, information storage or memory, and motor function. This lobe contains the Broca’s area, which is critical for the motor functions of speech.
frontal
The ________ lobe has the main responsibility of Sensation
parietal
The _________ lobe has the main responsibility of Hearing. Cranial Nerve VII, the acoustic nerve is assessed when checking this lobe.
temporal
The ___________ lobe has the main responsibility for Vision
occipital
Cerebral Spinal Fluid (CSF) is produced in the choroid plexus of the ______________ and circulates around the surface of the brain and the spinal cord
ventricles
CSF is important for ___________ and____________ function in the brain
metabolic
immune
What should CSF look like?
clear, colorless fluid
The meninges consists of these 3 layers:
Duramater
Arachnoid
Pia Mater
The duramater is the _____________ layer that covers the brain AND the spinal cord
outermost
The arachnoid is the ________ membrane; an extremely thin, delicate membrane that closely resembles a spider web. The arachnoid membrane has _______ in the space below it (subarachnoid membrane)
middle
CSF
The pia mater is the ____________ layer; thin, transparent layer that hugs the brain closely and extends into every fold of the brain’s surface
innermost
The _______ _______ _________ is used to describe the unique properties of the microvasculature of the central nervous system (CNS). It consists of blood vessels that vascularize the CNS. This helps to prevent the transmission of ____________ and _______ to the brain. This is made of endothelial cells and mural cells
blood brain barrier
pathogens/toxins
A __________ represents the area of skin that provides cutaneous inner action by fibers of specific nerve. For each CN and spinal nerve, there is a dermatologist (skin surface area) associated with it
dermatomes
Assessment of the sensory system involves test for _________ sensation, superficial pain, temperature, vibration, and position sense (proprioception). During the sensory assessment, the patient’s eyes are ________. Simple directions and reassurance that the examiner will not hurt or startle the patient. Encourage the cooperation of the patient. Tactile sensation is assessed by lightly touching a _______ _____or finger tip to corresponding areas on each side of the body. The sensitivity of proximal parts of the extremities is compared with that of ________ parts, and the right and left sides are compared
tactile
closed
cotton wisp
distal
MRIs with or without contrast is useful in diagnosing brain _________, strokes, and multiple sclerosis. It also shows how cells change in response to treatments.
tumors
Computed Tomography (CT) is a non-___________ test that shows tissue densities. Only ______ of ischemic strokes are found this way
contrast
10%
An electroencephalography (EEG) represent a record of electrical activity in the _______ ( a snapshot in time )
What is the main thing that this test is looking for?
brain
Seizures
A cerebral angiography is a radiography study using ____ and fluoroscopy to find vascular abnormalities in the __________ circulation. Similar to _______ catheterization except the catheter goes into the _____ and dye shows the blood supplying the brain
dye
cerebral
cardiac
brain
Before a cerebral angiography is performed , the nurse should assess the patients ______ and ___________, the nurse should __________ the patient, and ensure the patient has a working ______
BUN, creatinine
hydrate
PIV
After a cerebral angiography is performed, the nurse should observe for __________ at the insertion site, should perform frequent _______ checks, and assess pulse, color, and ____________ checks of the affected extremity
bleeding
neuro
temperature
The brain requires a constant supply of __________ — it does not does not store nutrients
oxygen
The circle of Willis allows collateral __________ and blood flow to be redirected as needed
circulation
The cerebral blood vessels one have ____ layers, which increased the risk for rupture
2
The circle of Willis is formed by ____ arterial sources:
- The internal _________ arteries
- The Vertebrobasilar system — formed by 2 vertebral arteries and the basilar artery
2
carotid
What are the 2 major types of strokes?
ischemic (approx 87%)
hemorrhagic (13%)
An ischemic CVA is due to vascular __________ and significant hypoperfusion
Occlusion
A hemorrhagic CVA is due to extravasating of _______ into the brain or subarachnoid space
blood
What are some risk factors for a stroke/ CVA?
age
gender
ethnicity
HTN is the primary risk factor
Elevated cholesterol
Obesity
Diabetes — especially uncontrolled DM
oral contraceptive use
Smoking and drug/alcohol abuse
Prevention of Recurrent Stroke or TIA
- Moderate — Severe Carotid Stenosis
- Carotid E______________ (CEA)
- Carotid angioplasty and S_________
- Atrial fibrillation : Anticoagulation
Anticoagulation:
- Dose adjusted ___________(Coumadin): target= therapeutic INR level 2-3
- Direct oral Anticoagulants
Dabigartran (Pradaxa)
Apixaban (Eliquis)
Edoxaban (Savaysa)
Rivaroxaban (Xarreto)
Endarterectomy
Stenting
Warfarin
If anticoagulants are contraindicated:
- Antiplatelet therapy
Aspirin (ASA) alone
Dual antiplatelet therapy = ASA + Clopidogrel (Plavix)
Extended release dipyridamol plus aspirin (Aggrenox)
**Platelet inhibiting medications decrease the incidence of _______ or recurrent stroke in patient s who have experienced TIAs and stroke from suspected emboli or thrombotic causes. These are taken for a period of ___-___ days after the stroke or TIA. May be taken indefinitely if high risk
stroke
21-90
Statins reduce coronary events and ___________ strokes
ischemic
Preferred drugs for secondary stroke prevention:
Angiotensin converting enzyme (ACE) inhibitors or ARB is cannot tolerate ACE
Thiazide diuretics
Combination of both
Manifestations of a stroke depend on the location and size of the affected area. What are some common signs and symptoms of a stroke?
be FAST
Facial drooping
Arm weakness
Speech change
Time — get help now!
Numbness/weakness of face/ arm/ or leg one one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty walking, dizziness, or loss of balance/ coordination
Sudden, severe headache
Perceptual disturbances
A transient ischemic attack (TIA) is a ______________ neurological deficit resulting from a _____________ impairment of blood flow.
There is ______ permanent damage
However Warning of an impending stroke
Usually resolve within _____ hours
temporary
temporary
NO
24
What is the initial test used to diagnose a stroke?
Non-contrast CT
**Should be initiated within 20. minutes of the arrival to the ER
Seizures are abnormal episodes of motor, sensory, autonomic, or psychic activity resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral _____________
neurons
Classifications of Seizures
- F_______: originates in one hemisphere
- G______________: occur and engage bilaterally
- P_________: related to acute, reversible condition
focal
generalized
provoked
What are some causes of provoked seizures?
Stroke
Hypoxemia
Fever (childhood)
Head injury
HTN
CNS infections (Meningitis)
Brain tumor
Drug and alcohol withdrawal
Allergies
________________ medications are given to prevent seizures such as Phenytoin
Anticonvulsant
A __________ diet is believed to prevent seizures. High fat, Low carb to create ketotic
ketogenic
Tonic clonic : total body __________ and stiffing
Myoclonic : brief jerking
Atonic : sudden loss of __________ tone and client falls
Complex focal: may loose _______________ briefly
Simply focal : remains conscious with jerking in ____ _____
jerking
muscle
consciousness
one area
One of the number one priorities for a patient having a seizure is to ensure they remain __________
SAFE! protect form injury, raise side rails/ ease person to the floor, pad side rails, monitor onset, duration, pattern, adm meds
** After care for seizures**
- Position patient to prevent __________
- Provide oxygen and ___________ if needed
- Reorient patient
- Record event
aspiration
suction
Multiple Sclerosis is an autoimmune nervous system disorder causing progressive __________________ of neurons resulting in impaired transmission of nerve impulses
demyelination
MS is a progressive disease that may lead to ______________( muscle weakness in all 4 extremities)
quadriparesis
What are some MS manifestations?
Fatigue
Depression
Weakness
Numbness
Difficulty with coordination and balance
Spasticity
Pain
Diplopia
The main nursing outcome for MS is maintaining ______________
independence
Nursing interventions for MS
- Teach coordination __________
- Teach active ROM
- Encourage _______mL fluids a day
- Administer medications: immunosuppressants, corticosteroids, antispasmodics
- Bladder and bowel __________
- Self-help devices
- ___________ support
exercises
2000
training
Emotional
Myasthenia travis is an autoimmune disorder affecting the __________ junction. Patients experience varying degrees of weakness of the ______________ muscles
myoneural
voluntary
Clinical manifestations of myasthenia gravis
- ____ muscles often affected: diplopia and ptosis (drooping of __________)
- Weakness in _____ and _______ leading to dysphonia and dysphagia
- Weakness of the intercostal muscles
eye, eyelids
face, throat
Medical treatment of myasthenia gravis
- ** Improve function and remove _________**
- Plasmapheresis
- IVIG
- Immunosuppressive therapy
- Anticholinesterases
antibodies
Main outcome for myasthenia gravis is to maintain mobility and prevent _______________
complications
Nursing interventions of Myasthenia Gravis
- Promote family understanding of dx. it is not _____________
- Administer medications before eating
- Good _____ care
- Passive and active _____
- Teach rest and recovery
hereditary
eye
ROM
Bell’s Palsy is an idiopathic facial paralysis caused by inflammation of Cranial Nerve ___. It usually resolves completely over time. Medical treatment includes _________________ medication
7
corticosteroid
The nursing outcome for bell’s palsy is to minimize any ______________.
- Cover affected eye if eyelids do not ________
- Keep eye moist with ______ or ____________
- Assess swallow and phonation / consult ________ therapy
- Psychological support
complications
close
drops, ointment
speech
