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NSG 2321 Final > CNS > Flashcards

CNS Flashcards

1
Q

What is the function of glial cells?

A

Provide structural and physiological support, they are more numerous than neurons

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2
Q

What are the five jobs of the glial cells?

A
  1. Blood-brain barrier
  2. Phagocyte capability
  3. Restore
  4. Assist with repair
  5. Secretion of CSF
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3
Q

What is neurogenesis?

A

Damaged nerve cells attempt to grow back - a slow process that is not as successful in the CNS as other areas

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4
Q

Define the following terms: ascending tract, descending tract, lower motor neurons, upper motor neurons, reflex arc

A

Ascending tract: carries sensory information to higher levels of the CNS

Descending tract: carries information responsible for muscle movement

Lower motor neurons: final pathway of descending tract influencing skeletal muscles

Upper motor neurons: influences skeletal muscle movement

Reflex Arc: involuntary response to a stimulus

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5
Q

What is the difference between dorsal and ventral nerves?

A

Dorsal is afferent and sensory (toward the spinal cord) and ventral are efferent and motor (away from the spinal cord)

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6
Q

What types of medications can and cannot pass the blood-brain barrier?

A

Lipid soluble medications CAN pass the barrier, whereas water soluble cannot

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7
Q

What are the three protective structures of the CNS?

A

Meninges, skull, and vertebral column

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8
Q

Define a migraine/headache

A

Unilateral throbbing pain that has a triggering event or factor

Manifestations are associated with neurological and ANS dysfunction

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9
Q

Are headaches/migraines bilateral or unilateral?

A

Unilateral

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10
Q

Are headache/migraines more common in men or women?

A

Women

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11
Q

What is the average age window for individuals to undergo headaches/migraines?

A

35-55

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12
Q

What is the exact cause of migraines and headaches?

A

It is unknown

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13
Q

What are the six risk factors for chronic migraine?

A
  1. Overuse of acute migraine treatment medications
  2. Ineffective treatment
  3. Obesity
  4. Depression
  5. Low education levels
  6. Life stressors
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14
Q

What co-morbidities are chronic migraines associated with?

A
  1. Epilepsy
  2. Stroke
  3. Depression
  4. Anxiety
  5. IBS
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15
Q

What are the eight trigger factors for chronic migraines?

A

Dietary factors, menses, head trauma, physical exertion, fatigue, stress, weather, and medications

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16
Q

What eight food products may exacerbate headaches/migraines?

A

Chocolate, cheese, oranges, tomatoes, onions, MSG, aspartame, and alcohol (specifically, red wine)

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17
Q

Name the three migraine phases?

A

Prodrome, headache, and postdrome phase

With each phase, the condition of the patient worsens

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18
Q

Describe the prodrome phase of a headache

A

First phase - Psychic disturbances, low mood, food cravings, frequent yawning, stiff or painful neck

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19
Q

Describe the headache phase

A

Second phase - Shelter from noise, light, odors, people and stressors

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20
Q

Describe the postdrome phase

A

Third phase - Inability to concentrate, fatigue, depressed/euphoric mood, lack of comprehension

Most egregious phase

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21
Q

What does an aura mean for headaches?

A

Visual field defects, tingling or burning sensations, paresthesia, motor dysfunction, dizziness, confusion, loss of consciousness
* May feel unsteady walking

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22
Q

What diagnostic studies can determine a migraine or headache?

A

No tests that definitively show the presence of a migraine

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23
Q

What is metoclopramide? What are its contraindications and side effects?

A

Used as an anti-emetic for migraines

Contraindicated in individuals with seizures or allergies

Side effects - extra pyramidal (dyskinesia and dystonia). With long-term use >12 weeks, tardive dyskinesia can occur

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24
Q

What is tardive dyskinesia? What medication is it associated with?

A

Involuntary and abnormal movements of the jaw, lips and tongue

Associated to long-term use (>12 weeks) of metoclopramide

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25
Q

What are non-pharmacological therapies for migraines/headaches?

A

Acupuncture, biofeedback, cognitive therapy, and relaxation therapy

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26
Q

How many mL/min of blood get circulated to the brain?

A

750-1000 mL/min (20% of CO)

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27
Q

What five things can occur if blood supply to the brain is altered?

A
  1. Neurological metabolism can change in 30 seconds (due to inadequate glucose)
  2. Metabolism stops in 2 mins
  3. Cellular death in 5 mins
  4. Cerebral auto regulation
  5. Collateral circulation may develop
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28
Q

Does stroke increase with age?

A

Stroke risk increases with age, doubling each decade after 35

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29
Q

What disease’s risk doubles each decade after 35?

A

Stroke

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30
Q

What are the 11 modifiable risk factors of stroke?

A

Hypertension, heart disease, diabetes, increased cholesterol and carotid stenosis, smoking, alcohol, obesity, decreased PA, diet, use of illicit drugs, birth control pills

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31
Q

What are the major types of stroke? Briefly define them

A

Ischemic - inadequate blood flow from the partial or complete occlusion

Hemorrhagic - bleeding into the brain tissue

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32
Q

What is the most common type of stroke?

A

Ischemic

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33
Q

What are the three types of ischemic stroke? Define each

A
  1. TIA - temporary episode of neurological dysfunction
  2. Thrombotic stroke - blood clot forms, vessel is narrowed and occlusion happens
  3. Embolic stroke - emboli lodges and occludes
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34
Q

What are the two types of hemorrhagic strokes? Define each

A
  1. Intracerebral hemorrhage - rupture of a vessel
  2. Subarachnoid hemorrhage - aneurysm, bleeding into CSF
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35
Q

What are the motor function clinical manifestations of stroke?

A

Impairment of mobility, respiratory function, swallowing and speech, gag reflex, and self-care abilities

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36
Q

Define akinesia, hyporeflexia, and hyperreflexia

A

Akinesia - loss of skilled voluntary movements

Hyporeflexia - depressed reflexes

Hyperreflexia - hyperactive reflexes

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37
Q

Define aphasia and dysphasia

A

Aphasia - affects comprehension of language, inability to speak, or both

Dysphasia - impaired ability to communicate

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38
Q

Define expressive aphasia and receptive aphasia

A

Expressive aphasia - Broca’s aphasia, difficulty expressing thoughts through speech or writing, know what they want to say can’t find the words

Receptive aphasia - Wernicke’s aphasia, difficulty understanding spoken or written language, difficult to understand, incorrect words, no hesitation

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39
Q

Define anomic/amnesic aphasia, global aphasia, and dysarthria

A

Anomic/amnesic aphasia - difficulty finding correct names for specific objects, people, places, or events

Global aphasia - loss of all expressive and receptive function

Dysarthria - disturbance in muscular control of speech

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40
Q

What are the four types of spatial-perceptual alterations that occur from stroke?

A
  1. Incorrect perception of self and illness
  2. erroneous perception of self in space
  3. agnosia - inability to recognize an object by sight, touch, or hearing
  4. apraxia - inability to carry our learned sequential movements on command
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41
Q

Define agnosia and apraxia

A

Agnosia - Inability to recognize an object by sight, touch, or hearing

Apraxia - Inability to carry our learned sequential movements on command

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42
Q

How quickly should an individual presenting with a stroke receive a CT scan?

A

When any individual presents to the ER with stroke symptoms, they must be getting into the CT within 25 minutes and the CT must be read within 45 minutes of the patient walking in the door

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43
Q

What percentage of clogging does the carotid vessel need to be to NOT hear a bruit?

A

85%

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44
Q

What are the two goals of ambulatory and home care for stroke recovery?

A
  1. Prevent deformity
  2. Maintain and improve function
45
Q

What is the duration after a stroke that the major part of neurological recovery occurs?

A

First three months, and may continue for up to 1 year or longer

46
Q

How can we improve/accommodating eating in stroke patients?

A

Use unaffected side, provide cutlery that the patient can use, plate guards, adjust diet to the patient’s ability (i.e., pureed, cut up)

47
Q

How can we accommodate incontinence in stroke patients?

A

Toilet to accommodate periods of incontinence - every 2 hours

48
Q

What type of diet should a post-stroke patient be on?

A

Low sodium, high fibre, low cholesterol, high protein, and many fruits/vegetables

49
Q

What 4 things can we implement to aid constipation in stroke patients?

A
  1. Fluid intake 2500-3000 mL daily
  2. Prune juice 120 mL or stewed prunes daily
  3. Cooked vegetables/fruits 3x daily
  4. Whole grain cereal/bread 3-5x daily
50
Q

Define functional incontinence

A

Individual cannot get to the bathroom fast enough

51
Q

What six things can be implemented to promote continence?

A
  1. assessing for distention
  2. offer bedpan/urinal/commode/bathroom every 2 hours during waking and every 3-4 hours at night
  3. focus patient with direct command
  4. assist with clothing and mobility
  5. majority of fluid intake from 0700-1900
  6. encourage usual position
52
Q

What are short-term interventions for urinary incontinence?

A

In-dwelling catheter, intermittent catheter, frequent toileting, incontinence briefs

53
Q

What are post-void residuals?

A

Scanning the bladder for urine left over after toileting

54
Q

What sensory-perceptual function changes occur in RCVA?

A

Difficulty judging position, distance, and rate of movement

Impulsive, impatient, deny problems

55
Q

How can we help RCVA individuals with sensory-perceptual function?

A

Break tasks down into simple steps

56
Q

What sensory-perceptual function changes occur in LCVA?

A

Slower in organization and performance of tasks, impaired spatial discrimination

Admits to deficits, fearful, anxious response - patients are very fearful

Behaviours are slow and cautious

57
Q

Which CVA will present with anxiety and fearfulness in completing tasks?

A

LVCA

58
Q

How does an LCVA affect present?

A

Exaggerated mood swings - inappropriate laughter to inappropriate crying

59
Q

How 4 things can a nurse do to respond to inappropriate emotional responses in stroke patients?

A

Distract, explain, maintain (be consistent and reinforce), and avoid (avoid certain topics or completely disregard comments)

60
Q

What 10 broad things are the inter-professional team concerned with in managing in stroke patients?

A

Medication, surgical therapy, ambulatory/home care, bowel function, bladder function, sensory-perceptual function, affect, coping, sexual function, community reintegration

61
Q

Define MS

A

Chronic, progressive, degenerative, autoimmune disorder

Disseminated demyelination of nerve fibres in the brain, spinal cord, and optic nerve

62
Q

What country has the highest rate of MS?

A

Canada

63
Q

Are men or women more affected by MS?

A

Women

64
Q

What is the general age of MS and what age is the typical onset of symptoms?

A

20-50 years of age

Onset of symptoms is usually 30-35 years

65
Q

What four ethnic groups is MS the least common in?

A

Hispanics, asians, blacks, and indigenous

66
Q

What is the cause of MS?

A

Unknown cause, unlikely due to a single cause

67
Q

What are the 7 precipitating factors (event or trigger of onset) of MS?

A

Infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy, poor state of health

68
Q

What are the 3 processes that are part of MS?

A

Chronic inflammation, demyelination, gliosis

69
Q

What is gliosis? What disease is it related to?

A

Hypertrophy of glial cells - MS

70
Q

What is the life expectancy since time of onset for someone with MS

A

More than 25 years

71
Q

Is MS symptoms slow and gradual or rapid?

A

Slow and gradual clinical manifestations - may be initially missed

Vague symptoms for months to years

72
Q

Do some individuals present with rapid, progressive deterioration of MS?

A

Yes. Some have severe long-lasting symptoms, others occasional mild symptoms

73
Q

How effect do MS exacerbations have on individuals?

A

with each exacerbation, individual will have significant deterioration of CNS function

74
Q

Is there a definitive diagnostic test for MS?

A

No

75
Q

Why would we use an MRI for MS diagnosis?

A

Multiple MRIs over time to visualize the progression of brain degeneration

76
Q

What will be present in CSF upon biopsy for MS?

A

WBCs may be present due to inflammation

77
Q

What needs to be present in order to diagnose MS?

A

Evidence of at least two inflammatory demyelinating lesions in two different locations within CNS

All other diagnoses must be ruled out

Damage/attack at different times

78
Q

How does medication manage MS?

A

Decreases progression and control symptoms

79
Q

Why is physiotherapy and speech therapy important for MS management?

A

Aids with developing and preserving strength

SLP - maintains the structure and function of the mouth to be able to eat and speak

80
Q

What diet should MS patients be on? What supplement is necessary?

A

Diets in low-fat, gluten-free, and raw vegetables, supplementation of a megavitamin

Note: No diets have been linked that are perfect/best for MS management

81
Q

Define conventional, alternative, and complementary therapy

A

Conventional – heavily tested and scientifically backed

Alternative therapy – not a ton of science backing it, but has shown evidence of aiding specific symptoms

Complementary – a mixture of both therapies

82
Q

What is Betaseron? What are its contraindications? What are its side-effects?

A

Interferon beta blocker - helps to reduce the number of flareups and clinical symptoms, decreases inflammation

Harmful to embryo/fetus and may cause miscarriage, allergies

Depression, suicidal thought, liver (abnormal LFTs), fever, chills, SOB, and chest tightness

83
Q

What medication may cause abnormal LFTs?

A

Betaseron

84
Q

Who can Betaseron exclusively be prescribed to?

A

Only prescribed to patients with DIAGNOSED MS

85
Q

Who would corticosteroids be prescribed to?

A

Administered to patient’s where there is a suspicion of MS but no formal diagnosis yet or relapse management

86
Q

What is the concern with administering corticosteroids to MS patients?

A

Increased risk of infection, decreased immune response – an even higher risk of infection in MS patients, as they are autoimmune

87
Q

Define dementia

A

The collection of symptoms caused by various diseases affecting the brain

88
Q

What ethnic group is dementia higher in?

A

Higher among indigenous people, younger age of onset

89
Q

Does dementia effect men or women more?

A

Men

90
Q

Is dementia considered primary or secondary to a treatable condition?

A

Dementia is secondary to a treatable condition, and is not a normal part of aging

91
Q

Define Alzheimer’s

A

A chronic, progressive, degenerative disease with an unknown etiology

92
Q

What is familial Alzheimer’s? What age does it effect?

A

Younger than 60 onset, and is known as early onset AD

93
Q

Where are amyloid plaques typically first noticed in the brain? Which disease are they related to?

A

Present in the brain in abnormal quantities, first develop in areas used for memory and cognitive function, then areas responsible for language and reasoning

Related to AD/dementia

94
Q

What are neurofibrillary tangles?

A

Abnormal collection of twisted protein threads inside nerve cells that alter the responsiveness of the brain in AD patients

95
Q

What is vascular dementia? What does it result from?

A

Multi-infarct dementia that results from ischemic, ischemic-hypoxic, or hemorrhagic brain damage caused by cardiovascular disease

It may be single or multiple infarcts

96
Q

Define dementia w/ Lewy Bodies

A

Presence of Lewy bodies throughout the cortex, brainstem, and autonomic structures

Could be a single area of the brain or multiple

97
Q

Define frontotemporal dementia and what changes you will initially see

A

Degeneration of the frontal lobe, temporal lobe, or both

Notice changes in personality and behaviour initially

98
Q

How do clinical manifestations between vascular dementia and all other types differ?

A

Vascular presents as a sudden change due to inhibited oxygen supply, whereas all other types are gradual with progressive deterioration

99
Q

What are the seven As of dementia? Briefly define each

A

Amnesia - memory loss
aphasia - language comprehension or expression deficits
agnosia - not familiarizing common objects or people
apraxia - inability to perform motor tasks
altered perception - LOC and orientation
apathy - lack of interest or enthusiasm
anosognosia - unaware of their condition

100
Q

Why is it pertinent to do routine labs for someone when diagnosing dementia?

A

Dementia may mimic other conditions, therefore labs are pertinent to ruling out other conditions

101
Q

What six things does cognitive testing evaluate?

A

Memory, attention, ability to perform calculations, language, visuospatial skills, and alertness

102
Q

What are the three assessments often used for dementia/alzheimer’s

A

o MMSE (Mini-Mental State Examination)
o MoCA (Montreal Cognitive Assessment
o CICA (Canadian Indigenous Cognitive Assessment)

103
Q

What are the six medical conditions that may increase the risk of dementia?

A

Type 2 diabetes, stroke & TIA, hyperlipidemia, hypertension, obesity, and chronic inflammatory conditions (arthritis)

104
Q

Aside from medical conditions, what three additional modifiable risk factors may increase the risk of dementia?

A

Head injury, history of clinical depression, and inadequate intellectual stimulation

105
Q

What is donepezil? What condition is it used for? What are the contraindications and side effects?

A

Cholinesterase inhibitors

Works in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase; is used with mild to moderate AD

Allergy

Increases ulcer risk, seizures, drowsiness, dizziness, insomnia, muscle cramps, GI bleed, bradycardia, tachycardia, hypotension

Can cause changes in dreams, specifically nightmares

106
Q

What drug increases the presence of nightmares?

A

Donepezil

107
Q

What is clopidogrel? What condition is it used for? Contraindications? Side effects?

A

Prevents platelet aggregation

Used to reduce thrombotic events

Allergy, thrombocytopenia (low platelet count), active bleeding, leukaemia, traumatic injury, GI ulcer, vitamin K deficiency, recent stroke

Side effects - bleeding

108
Q

What is Aspirin used for in stroke/thrombosis? Contraindications? Side effects?

A

Prevents platelet aggregation

Contraindicated in allergy, thrombocytopenia, active bleeding, leukaemia, traumatic injury, GI ulcer, vitamin K deficiency, recent stroke

Side effects - bleeding

NSG 2321 Final (4 decks)

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