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Health Assessment > Exam II Mental and Neuro > Flashcards

Exam II Mental and Neuro Flashcards

1
Q

2 types of mental disorders

A

Organic and Psychiatric

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2
Q

What is an organic mental disorder?

A

Related to a medical disorder like dementia or a psychological disorder.

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3
Q

What are 2 psychiatric mental disorders?

A

Depression, schizophrenia

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4
Q

What is mental status?

A

A person’s emotional (feelings) and cognitive (knowing) functioning.

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5
Q

With a mental disorder what signs do patient’s have?

A

Significant behavorial or psychological patter of distress, disability, impaired functioning that can lead to suicide.

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6
Q

Causes of mental dysfunction

A
  • Traumatic life events
  • Organic disorder (delirium, dementia, alcohol and drugs withdrawal)
  • Psychiatric mental illnesses (anxiety, schizophrenia).
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7
Q

What does Lewy Body dementia cause?

A

Depression and hallucinations

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8
Q

How is consciousness assessed for mental status?

A

Awake, alert and oriented x3

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9
Q

When should you perform a mental status examination?

A

When see:
- Behavioral changes
- Brain lesions
- Aphasia
- Psychiatric illness

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10
Q

Define delirium

A

Acute confused change or less of consciousness and perceptual disturbance that may accompany acute illness; usually resolved when underlying cause is treated.

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11
Q

Define dementia

A

gradual progressive process causing decreased cognitive function even though the person is fully conscious and awake; not reversible.

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12
Q

What’s the difference between dementia and delirium?

A

Dementia is gradual, not reversible
Delirium is usually resolved when the underlying cause is treated; is acute.

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13
Q

Four main components of mental status examination.

A

A B C T’s
Appearance
Behavior
Cognition
Thought processes

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14
Q

Objective assessment of mental status examination looks at what 5 categories?

A

Appearance
Behavior
Orientation
Cognitive funcitons
Thought processes and perceptions

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15
Q

In a mental health assessment, what do nurses evaluate when assessing the appearance of a person?

A

Posture
Body movements
Dress
Grooming and hygiene

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16
Q

In a mental health assessment, what do nurses evaluate when assessing the behavior of a person?

A
  • Alert
  • Lethargic - not fully awake, drifts off to sleep
  • Obtunded - Sleeps most of the time, difficult to arouse
  • Stupor - Spontaneously unconscious
  • Coma - completely unconscious
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17
Q

What to ask a patient to determine orientation in a mental status assessment?

A

Today’s date
Where live
Address, phone, building
City, state
Name, age, employment

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18
Q

Recent vs remote memory in a mental status evaluation

A

Recent: “What did you have for breakfast this morning?”
Remote: “Where did you go to elementary school?”

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19
Q

What is the Mini Mental Status Examination (MMSE)?

A

11 questions about time, repeating words and recall, naming, reading, copying, writing, max score 30. Good screening tool, useful for initial and serial measurements.

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20
Q

What is the Mini Mental State Examination (MMSE) good for?

A

Initial and serial measurements.

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21
Q

What is the Mini-Cog

A

A mental status examination where you ask the patient to repeat three words and draw the face of a clock and the time you select.

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22
Q

Why is the Mini-Cog a great mental status exam tool?

A

It takes all four lobes of the brain to tell time analog.

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23
Q

What is Dysphonia?

Know this

A

Trouble speaking due to physical problem, inability to produce voice sounds (hoarse)

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24
Q

What is aphasia?

Know this

A

Disorder of language comprehension and production

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25
Q

Two types of aphasia

A
  • Expressive: difficulty producing language
  • Receptive: difficulty understanding what is said
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26
Q

What is Broca’s aphasia?

A

Left frontal lobe voluntary speech center is damaged; non-fluent staccato speech.

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27
Q

About what percentage of strokes present with some type of aphasia?

A

20%

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28
Q

What is Wernike’s aphasia?

A

Superior temporal gyrus; Cranial nerve VIII; fluent speech but don’t make sense (guy on YouTube)

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29
Q

Screening test for mental status for infants and children is

A

Denver II screening test: birth to 6 years

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30
Q

Screening test for mental status for school-age children?

A

Behavioral checklist for 7-11 year olds

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31
Q

What mental status screening do you use for adolescents?

A

The same as for adults: A B C T:
Appearance
Behavior
Cognition
Thought processes

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32
Q

What to check first for screening for mental health status in older adults

A

Sensory status, vision, hearing.

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33
Q

In older adults, what is commonly misdiagnosed as mental status change?

A

Confusion

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34
Q

When screening for suicidal thoughts, how do you question a patient?

A

Ask general and then specific questions

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35
Q

How would you asses abstract reasoning in an adult patient?

A

Proverbs: “How are a car, a plane and a boat alike? Transportation.”

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36
Q

Subjective data for a mental status exam?

A

A B C T’s
- Appearance - posture erect, no involuntary movements, dress and grooming are appropriate.
- Behavior - Alert, appropriate facial expression, understandable speech, appropriate responses.
- Cognitive functions - Oriented to time, person, place, cooperates with examiner, recent and remote memory intact, recall four unrelated words at 5, 10 and 30 minutes, future plans.
- Thought processes - perception and thought processes are logical and coherent, no suicidal ideation.

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37
Q

What is normal score on Min Mental Health Examination?

A

25 or >
Perfect is 30

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38
Q

What is the most common type of dementia?

A

Alzheimer’s

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39
Q

2 parts to the nervous system

A

CNS and peripheral

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40
Q

What does afferent nerve transmission do?

A

Carry sensory information to the CNS.

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41
Q

What does efferent nerve transmission do?

A

Carries motor messages from CNS to muscles and glands.

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42
Q

What is the cerebral cortex?

A

Cerebrum’s outer layer

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43
Q

What are the four lobes of the cerebral cortex?

A

4 lobes: frontal, parietal, temporal and occipital.

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44
Q

In a stroke of the pre-central gyrus of the frontal lobe of the cerebral cortex, what is affect?

A

Voluntary movement

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45
Q

The parietal lobe’s post-central gyrus is responsible for what?

A

Primary center for sensation (touch, pressure, vibration and proprioception)

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46
Q

What sense does the occipital lobe of the cerebral cortex handle?

A

Sight

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47
Q

What sense does the temporal lobe of the cerebral cortex handle?

A

Auditory, taste, smell, memory, visual recognition

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48
Q

Where is Wernike’s area?

A

In the temporal lobe of the cerebral cortex.

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49
Q

When Wernike’s area is damaged, what happens to the patient?

A

Hears sounds but have no meaning.

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50
Q

When Broca’s area of the frontal lobe is damaged, what happens?

A

Expressive aphasia results: person cannot can understand and knows what they want to say but can’t say it.

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51
Q

What is the frontal lobe responsible for?

A

Personality
Behavior
Emotion
Intellectual functions

52
Q

Where is Broca’s area and what does it handle?

A

In frontal lobe;
motor speech

53
Q

What does the pre-central gyrus of the frontal lobe handle?

A

Motor skills

54
Q

What does the post-central gyrus of the parietal lobe handle?

A

Sensory (touch, pressure, vibration and proprioception)

55
Q

What does Wernike’s area do and where is it?

A

In the temporal lobe; speech comprehension

56
Q

What does the temporal lobe handle?

A

Hearing
Taste
Smell
Memory
Visual recognition

57
Q

What does the occipital lobe handle?

A

Vision

58
Q

What neurotransmitter controls the frontal lobe?

A

GABA

59
Q

What lobe comprises 1/3rd of your brain?

A

The frontal lobe

60
Q

What does the frontal lobe do as influenced by GABA?

A

Inhibitory when mature at about 22 years.

61
Q

At what age does the frontal lobe mature?

A

17-22

62
Q

What is different about the frontal lobe in infants and children vs. adults?

A

The frontal lobe is not matured.

63
Q

Where is Broca’s Center?

A

Left inferior frontal gyrus

64
Q

What condition is associated with Broca’s center?

A

Broca’s aphasia

65
Q

What signs occur with Broca’s aphasia?

A

Telegraphic, staccato speech

66
Q

What part of the brain is responsible for abstract thought: “What does don’t cry over spilled milk mean?”

A

Frontal lobe

67
Q

The neurons located in the pre-central gyrus are called what?

A

Upper motor neurons.

68
Q

What happens when UMN send signal thorugh the medulla?

A

Crossover. The left side of the brain controls the right and vice versa.

69
Q

What side of the body does the left pre-central gyrus control?

A

The right.

70
Q

What side of the body does the right pre-central gyrus control?

A

The left

71
Q

Corticospinal tract is what type of pathway?

A

Motor

72
Q

What type of movements does the corticospinal tract have?

A

Voluntary

73
Q

What type of movement is the pre-central gyrus responsible for?

A

Voluntary movement

74
Q

What percentage of strokes present with hemiparesis?

A

70%

75
Q

What is hemiparesis?

A

Paralysis on one side of the body

76
Q

What does damage to the UMN/CS tract result in?

A
  • Contralateral
  • Hemiparesis
  • Pronator drive
  • Positive Babinski sign
77
Q

With UMN/CS tract damage, what is an abnormal/+ Babinski sign?

A

Fanning of all toes when running an object down the length of the bottom of a patient’s foot.

78
Q

What do baby’s have that is comparable to UMN/CS Tract damage?

A

Positive Babinski sign until they start to walk.

79
Q

What is a negative Babinski sign?

A

Dorsiflexion

80
Q

What reflex does the Babinski sign test?

A

The plantar reflex

81
Q

What type of memory is the first to go?

A

Recent memory

82
Q

Where is Wernike’s area located?

A

Left temporal lobe

83
Q

What is associated with loss of recent memory?

A

Loss of hippocampal cell function

84
Q

What tests are used with parietal lobe testing?

A

Two-point test - touch two areas at the same time
Superficial pain, light touch and vibration in a few distal locations
Stereognosis and graphesthesia.

85
Q

Who can you not test with the two-point test for the parietal lobe?

A

Kids under 6 because kids recognize touch on the face.

86
Q

What is Stereognosis?

A

Recognizing a 3-dimensional shape with eyes closed.

87
Q

What is graphesthesia?

A

Recognize symbols when they’re traced on the skin.

88
Q

What CN and lobe are involved in sight?

A

See with CN II and interpreted by occipital lobe

89
Q

What does cerebellum do?

A
  • Coordinates and smooths muscle movements
  • Synergy
  • Balance
  • Equilibrium
  • Muscle tone
90
Q

Some tests to test the cerebellum

A

Observe walking
Tandem walking
Close eyes and touch fingers to nose
Heel to shin test
Rapid alternating movements

91
Q

At what alcoholic level do you lose cerebellum function

A

0.08

92
Q

In what is the cerebellum not well developed?

A

Babies

93
Q

What three structures are in the brainstem?

A
  • Midbrain - most anterior part; motor neurons and tracts
  • Pons
  • Medulla - all fibers connecting brain to spinal cord
94
Q

Damage to pons results in what?

A

Coma

95
Q

What function does the brainstem support?

A

Cardiorespiratory function

96
Q

What is the hangman’s fracture and what part of the brain does it affect?

A

C2, C3, the brainstem

97
Q

Oh, oh, oh, to touch and feel very good vagina. Such heaven?

A

O: olfactory nerve (CN I)
O: optic nerve (CN II)
O: oculomotor nerve (CN III)
T: trochlear nerve (CN IV)
T: trigeminal nerve (CN V)
A: abducens nerve (CN VI)
F: facial nerve (CN VII)
A: vestibulocochlear) nerve (CN VIII)
G: glossopharyngeal nerve (CN IX)
V: vagus nerve (CN X)
S: spinal accessory nerve (CN XI)
H: hypoglossal nerve (CN XII)

98
Q

CN I function

A

Olfactory (smell)

99
Q

CN II

A

Optic nerve (Visual accuity)

100
Q

PERRLA

A

CN II (Optic) and III (Oculomotor)

101
Q

CN III, IV, VI test what?

A

Extraocular movements - “Follow my finger”

102
Q

Argyll Robertson pupil

A

Will accommodate but not react to light “Prostitute’s pupil”

103
Q

Argyll Roberson puli affects which cranial nerves?

A

CN II and CN III

104
Q

CN V

A

Trigeminal - Huge nerve
Cornel reflex (light touch to cornea, both eyes blink)

105
Q

CN VII

A

Facial nerve
Smile, puff cheeks, frown, close eyes tightly, life eyebrows, show teeth

106
Q

What is biggest concern with trigeminal neuralgia

A

Pain

107
Q

Three places on skull innervated by CN V

A

Opthalmic
Mandible
Maxillary

108
Q

What disorder affect CN VII?

A

Facial nerve - Bell’s Palsy

109
Q

CN IX

A

Glossopharyngeal

110
Q

What two CNs are responsible for the gag reflex and the uvula?

A

IX and X

111
Q

What do you do with someone with no gag reflex.

A

Don’t put anything in mouth

112
Q

Impaired functioning of the XI and X CNs put the patient at risk for?

A

Choking

113
Q

CN XII

A

Hypoglossal; tongue movement and strength, L, R, midline.

114
Q

CN I test

A

Olfactory: close one nostril and smell familiar scent

115
Q

CN II

A

Optic, check visual acuity and peripheral vision

116
Q

CN III, IV and VI

A

Oculomotor, Trochlear and Abducens
Check pupils for size, equality, accommodation, consensual to light.
Cardinal gaze (IV and VI)
Nystagmus

117
Q

CN V test

A

Trigeminal
Motor: Palpate muscles of mastication as patient
clenches teeth
Sensory: light touch on forehead, cheeks, chin, corneal reflex,

118
Q

CN VII test

A

Facial nerve
Motor: facial symmetry with smile, frown, close eyes tightly, left eyebrows, show teeth, puff cheeks
Sensory: Test only when suspect facial nerve injury

119
Q

CN VIII

A

Vestibulocochlear
Hearing

120
Q

CN IX and X

A

Glossopharyngeal and vagal nerves
Watch uvula as say “Ah.”
Gag reflex

121
Q

How many spinal nerves?

A

31 pairs

122
Q

How many of each section of spinal nerves?

A

8 cervical
12 thoracic
5 lumber
5 sacral
1 coccygeal

123
Q

What are dermatomes?

A

Areas of skin that send their sensory info into specific spinal cord segments

124
Q

Levels of dermatomes

A

C4 C4 shoulder and referred pain
T1 axilla
T4 nipple (know when checking reflexes)
T10 umbilicus
L1 bikini (know when checking reflexes)
L3 L4 knees
S1 S2 back of leg
S3-S5 perineum

125
Q

What levels are the reflexes found? (Know)

A

C5-C6 biceps
C7-C8 triceps
L2-L4 Patellar (knee jerk)
L5-S2 Achilles (ankle jerk)

126
Q

How does a reflex arch work?

A

Sensory info goes into spinal cord (afferent)
Synapses in same spinal cord segment
Sent out via lower motor neuron to peripheral motor nerve.

127
Q

How to collect objective data from reflexes

A

Limb should be relaxed
Compare right to left
4 point scale:
- +2 normal
- 0 absent
- +4 hyper

Health Assessment (7 decks)

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