intracranial Flashcards
central nervous system
brain, spinal cord, contains relay neurons
peripheral nervous system
cranial nerves, spinal nerves, peripheral nerves, contain sensory neurons and motor neurons
cerebrum
main
portion of the brain-
contains 2
hemispheres and 4
lobes
diencephalon
assists
with endocrine
function – houses the
hypothalamus
brainstem
controls
basic body functions –
swallowing, heart rate,
breathing etc.
cerebellum
regulates muscle
activity and
coordination
frontal lobe
motor control, problem solving, brocas area - speech production
temporal lobe
auditory processing, hearing, language processing - wernickes area, memory and information retrieval
brainstem
breathing, heart rate, involuntary response
cerebellum
balance and coordination
occipital lobe
visual cortex- sight, visual reception, visual interpretation
parietal lobe
touch perception, body orientation and body discrimmination
expressive aphasia
Broca’s area
* Associated with the production
of speech.
* You may be able to
comprehend what’s being said
but be unable to speak fluently
(unable to find the right word)
* Impacts how words are strung
together to form complete
sentences.
* You might only be able to say
single words or very short
sentences
receptive aphasia
- Wernick’s Aphasia
- Associated with the
comprehension of speech - When you don’t realize that
what your saying is
nonsense or you’re using
the wrong words - Unable to understand the
meaning of words
autonomic nervous system,
sympathetic and parasympathetic nervous system
sympathetic nervous system
the bodies primary process to stimulate fight or flight (pupil dilation)
parasympathetic nervous system
rest and digest, feed and breed,
sympathetic actions
heart rate increases, airways dilate, sweat glands stimulate secretions, liver converts glycogen to glucose, digestive system decreases activity, uterus contacts, bladder relaxes
parasympathetic actions
pupils constrict, heart slows, breathing slows, airways constrict, liver releases bile, blood vessels constrict, digestive system activates, uterus relaxes, increased urinary output
collection of data
Past History
* Head injuries – even
minor head injuries
can produce deficits
* Hx of brain disorders?
– meningitis/
encephalitis (infection
of brain)
Family history –
may have genetic
disposition
* HTN
* CVA
* Epilepsy
Lifestyle
* Smoker- nicotine
constricts brain
vessels and
decreases blood flow
to the brain
* Pesticides- can alter
neuro status
neurological examinations
Mental status, cranial nerves, motor
and cerebellar systems, sensory
system, reflexes
order of physical exam
Gather equipment
Assess LOC, appearance and behavior
Test Cranial Nerves (includes pupil assessment)
Test movement of muscles, balance and coordination
Test sensation (tactile touch, temperature, pain)
Additional testing as needed (Brudzinski)
assess of the patient is conscious and oriented
- Awake and alert
- Responds to verbal – may grunt or moan
- Responds to pain – pinch / sternal rub
- Unresponsive
- Person – who are they?
- Place – where are they?
- Time – what is today? Usually first to go in older
adults - Documented as A & O x3 (alert and oriented x 3)
glasgow coma scale
Assesses patients with a
brain injury
May not be useful in
intubated or aphasic
patients (unable to assess
verbal)
Best score - 15
Score under 10 requires
emergency treatment
Score 8 or less=coma
general impression
gait, posture, behavior and affect, dress and grooming, facial expressions, speech, memory
motor and cerebellar systems
Assess size and condition of
muscles
Atrophy- muscle wasting
Assess strength and tone
Ask patient to squeeze hands
bilaterally and push down/pull
up feet against resistance.
Evaluate balance and gait
Observe patient
walking and
balance
romberg tests
Ask patient to stand with feet together,
hands at their sides and eyes closed
Swaying or moving feet apart is abnormal
finding
Positive Romberg test is an indication of
cerebellar ataxia (abnormal lack of
coordination)
Be sure to protect the patient from falling!
assessing sensory system
Assess light touch, pain, and temperature sensations.
May use a pen or paper clip to test sensation in hands / feet.
May use hot or cold pack to test temperature.
anesthesia
absence of touch
hypesthesia
decreased sensitivity to touch
test reflexes
Reflexes test the integrity of spinal cord
and the peripheral nervous system
Testing with a reflex hammer
Scaled on response from 0 – 5+
Conducted more often in advanced
health assessment
grading reflexes
0 = no response; always abnormal. 1+ = a slight but definitely present response; may or may not be normal. 2+ = a brisk response; normal. 3+ = a very brisk response; may or may not be normal.
what is a CVA
Stroke is when blood flow to the brain is
interrupted depriving the brain cells of oxygen.
Stroke is a medical emergency. Seek help
immediately because treatment is time limited.
Don’t wait for the symptoms to improve or
worsen. If you believe you are having a stroke—
or someone you know is having a stroke—call
911 immediately. Making the decision to call for
medical help can make the difference in
avoiding a lifelong disability
symptoms of a stroke
Sudden
numbness or
weakness of the
face, arm, or leg
(especially on
one side of the
body)
Sudden confusion,
trouble speaking,
or understanding
speech
Sudden trouble
seeing in one or
both eyes
Sudden trouble
walking, dizziness,
loss of balance or
coordination
Sudden severe
headache with no
known cause
risks for stroke
Hypertension Diabetes mellitus Heart disease
Smoking and
exposure to
second-hand
smoke
Age and gender
(older and
women)
Race (African
American)
Personal or family
history
Use of oral
contraceptives
(birth control)
Obesity Stress
teaching topics for stroke prevention
Quit smoking.
Control your cholesterol through diet, exercise,
and medicines, if needed.
Control high blood pressure through diet,
exercise, and medicines, if needed.
Control diabetes through diet, exercise, and
medicines, if needed.
Exercise at least 30 minutes a day.
FAST
FACE: Ask the person to
smile. Does one side of the
face droop?
ARMS: Ask the person to
raise both arms. Does one
arm drift downward?
SPEECH: Ask the person to
repeat a simple phrase. Is
speech slurred or strange?
TIME: If you observe any of
these signs, call 9-1-1
immediately.
kernigs sign
flexion of the leg while the hip is flexed
brudzinkis sign
flexion of the hips and knees in response to neck flexion
decorticate posturing
arms look like C’s, problems with cervical spine or cerebral hemisphere
decerebrate posturing
arms are outwards and look like e’s, damage to the pons or midbrain
abnormal muscle movement
Eye tics- brief, repetitive, coordinated movements
Tourette’s syndrome / amphetamines
Resting (static) tremors – only at rest, disappear with
voluntary movement – seen in Parkinson’s
Nystagmus – eyes make repetitive uncontrolled
movements
multiple sclerosis- immune disorder that causes
degeneration of brain
Brain tumor
Diabetic neuropathy
abnormal movements in older adults
Decreased taste and scent sensation.
There is a normal decrease in the older person’s
ability to hear.
There is a normal decrease in the older person’s
ability to see.
Older adults may experience tremors with intentional
movements.
* Some older clients may have reduced muscle mass from degeneration
of muscle fibers.
older adult considerations
Some older clients may normally have hand or head tremors
or dyskinesia (repetitive movements of the lips, jaw, or
tongue).
Some older clients may have a slow and uncertain gait. The
base may become wider and shorter, and the hips and knees
may be flexed for a bent-forward appearance.
For some older clients, rapid alternating movements are
difficult because of decreased reaction time and flexibility.
common pregnant client complaints
Pain or tingling feeling in the thigh
Carpal tunnel Syndrome
Leg Cramp
Dizziness and lightheadedness
newborn considerations
Have a knowledge of developmentally
appropriate relfexes- this may indicate an
underlying problem
Inappropriate response to stimuli suggest
CNS disorders/problem
Babinski response is a normal response
in children younger than 2years
babinski reflex
stroke the sole of foot - fans out toes and twists foot in, disappears at nine months to a year
blinking
flash of light or a puff of air - closes eyes - permanent
grasping
palms touched - grasps tightly - weakens at three months dissapears at one year
nystigmus
abnormal eye movement
accomodation
stare off at the penlight and bring the penlight closer to the face and should have the pupils constrict as you get closer
PERRLA
pupils equal round and reactive to light and accomodation
moro reflex
theres a sudden loud noise or sudden move and startles the baby so the baby throws the arms and legs out and then turns them towards the body.
disappears at 3-4 months
rooting reflex
when you stroke the side of the babies cheek and they move their towards that side of the face being stroked
disappears around 3-4 months
stepping reflex
infant is held up with the feet touching the ground in response the infant will step as if to walk
disappears around 3-4 months
sucking reflex
something is placed in the infants mouth and the infant sucks to it in response, this disappears around 3-4 months
swimming reflex
infants legs are placed in water and they begin to make swimming movements with their legs
disappears at 6-7 months
tonic reflex
placed on the back and they make fists with their hands and turns the head to the right.
disappears at 2 months
