Lec 5th Exam Flashcards
What is the primary functional unit of the nervous system?
Neurons
Neurons are responsible for generating and transmitting nerve impulses.
What are the three characteristics shared by neurons?
- Excitability
- Conductivity
- Influence
What does the central nervous system (CNS) consist of?
- Brain
- Spinal cord
- Cranial nerves I and II
What does the peripheral nervous system (PNS) consist of?
- Cranial nerves III to XII
- Spinal nerves
- Peripheral components of the autonomic nervous system (ANS)
What is the role of Schwann cells in the PNS?
Myelinate the nerve fibers
Schwann cells facilitate regeneration of injured nerve fibers in the PNS.
What is a synapse?
The structural and functional junction between two neurons.
What are neurotransmitters?
Chemicals that affect the transmission of impulses across the synaptic cleft.
What are excitatory neurotransmitters?
- Epinephrine
- Norepinephrine
- Glutamate
What are inhibitory neurotransmitters?
- Serotonin
- Gamma-aminobutyric acid (GABA)
- Dopamine
What is the major transmitter of the parasympathetic nervous system?
Acetylcholine
Fill in the blank: The brain’s blood supply arises from _______ and _______.
[internal carotid arteries] and [vertebral arteries]
What should be assessed when performing a neurologic examination?
- Emergency status
- Patient reliability
- History of present illness
What can neurologic problems lead to in terms of nutrition?
Poor nutrition due to issues with chewing, swallowing, or muscle coordination.
True or False: Neurologic disorders can affect a patient’s mobility and increase the risk for falls.
True
What does the cranial nerve assessment for the olfactory nerve involve?
Asking the client to smell and identify the smell of cologne with each nostril.
What is the normal response for the optic nerve assessment?
Client should be able to read with each eye and both eyes.
What does PERRLA stand for?
Pupil Equally Round and Reactive to Light and Accommodation
What is assessed in the trigeminal nerve assessment?
- Corneal reflex
- Light sensation
- Deep sensation
What is the normal response for the facial nerve assessment?
Client should perform facial expressions and distinguish different tastes without difficulty.
What is the expected response when assessing the vestibulocochlear nerve?
Client should hear the tickling of the watch in both ears.
What does the glossopharyngeal nerve assessment check for?
Ability to elicit gag reflex and swallow without difficulty.
What is the assessment for the vagus nerve?
Ask the patient to swallow and speak.
What should be documented after the assessment of the accessory nerve?
Client was able to shrug shoulders and turn head from one side to the other.
Fill in the blank: The hypoglossal nerve assessment involves asking the client to protrude their tongue at _______.
[midline]
What are the findings of a normal mental status assessment?
- Alert and oriented
- Orderly thought processes
- Appropriate mood and affect
What are the grades of reflexes in a normal assessment?
- 0 - No evidence of contraction
- 1+ - Decreased, but still present
- 2+ - Normal
- 3+ - Increased
True or False: Neurologic problems can affect a patient’s ability to perform daily living activities.
True
What is the normal muscle condition described?
Normal and symmetric muscle bulk, tone, and strength.
What is the significance of smooth performance of finger-nose, heel-shin movements?
Indicates intact motor coordination.
What does intact sensation to light touch, position sense, pinprick, heat, and cold indicate?
Indicates a functional sensory system.
What does a reflex grade of 0 indicate?
No evidence of contraction.
What does a reflex grade of 1+ indicate?
Decreased, but still present (hypo-reflexic).
What condition is associated with hyporeflexia?
Lower motor neuron deficit.
What does a reflex grade of 2+ indicate?
Normal reflex response.
What does a reflex grade of 3+ indicate?
Super-normal (hyper-reflexic).
What condition is often attributed to hyperreflexia?
Upper motor neuron lesions.
What does a reflex grade of 4+ indicate?
Clonus: Repetitive shortening of the muscle after a single stimulation.
What is dysphagia?
Difficulty in swallowing.
What is ophthalmoplegia?
Paralysis of eye muscles.
What does anisocoria refer to?
Inequality of pupil size.
What is diplopia?
Double vision.
What is homonymous hemianopsia?
Loss of vision in one side of visual field.
What does papilledema indicate?
Swelling of optic nerve head due to increased intracranial pressure.
What does altered consciousness signify?
Stuporous, mute, decreased response to verbal cues or pain.
What is anosognosia?
Inability to recognize bodily defect or disease.
What is apraxia?
Inability to perform learned movements despite having desire and physical ability.
What is ataxia?
Lack of coordination of movement.
What is dyskinesia?
Impairment of voluntary movement, resulting in fragmentary or incomplete movements.
What is hemiplegia?
Paralysis on one side of the body.
What is nystagmus?
Jerking or bobbing of eyes as they track a moving object.
What does decreased or absent motor response indicate?
Lower motor neuron lesions.
What is the extensor plantar response?
Toes pointing up with plantar stimulation.
What is analgesia?
Loss of pain sensation.
What is anesthesia?
Absence of sensation.
What is astereognosis?
Inability to recognize form of object by touch.
What does paresthesia refer to?
Abnormal sensation, such as numbness or tingling.
What is aphasia?
Loss of or impaired language faculty.
What is dysarthria?
Lack of coordination in articulating speech.
What is bladder dysfunction in an atonic condition?
Absence of muscle tone and contractility.
What is hypertonic bladder dysfunction?
Increased muscle tone, decreased capacity, reflex emptying.
What is paraplegia?
Paralysis of lower extremities.
What does skull radiography reveal?
Size and shape of skull bones, fractures, and bony defects.
What is the purpose of a CT scan?
Detect intracranial bleeding, space-occupying lesions, and cerebral edema.
What are pre-procedural interventions for a CT scan?
- Obtain informed consent
- Assess for allergies
- Instruct the client to lie still
- Initiate an IV line if prescribed
- Remove objects from the head
What is MRI used for?
Identify tissues, tumors, and vascular abnormalities.
What is a lumbar puncture?
Insertion of a spinal needle to obtain cerebrospinal fluid.
What is cerebral angiography used for?
Visualize cerebral arteries and assess for lesions.
What does pre-procedural intervention for electroencephalography involve?
Wash the client’s hair and inform about the procedure.
What is caloric testing used for?
Assess function of the vestibular portion of the eighth cranial nerve.
What is multiple sclerosis?
Chronic, progressive, noncontagious, degenerative disease of the CNS.
What are common symptoms of multiple sclerosis?
- Fatigue and weakness
- Ataxia and vertigo
- Tremors and spasticity
- Blurred vision and diplopia
What is Parkinson’s disease caused by?
Depletion of dopamine.
What are signs of Parkinson’s disease?
- Bradykinesia
- Akinesia
- Tremors at rest
- Rigidity
What is bradykinesia?
Abnormal slowness of movement and sluggishness of physical and mental responses
Define akinesia.
Absence or loss of voluntary movement
What is characterized by monotonous speech?
A symptom associated with certain neurological conditions
What happens to handwriting in certain neurological diseases?
It becomes progressively smaller
What are tremors in hands and fingers at rest often referred to as?
Pill rolling
What is the effect of fatigue on tremors?
Tremors increase when fatigued and decrease with purposeful activity or sleep
What is rigidity with jerky movements a symptom of?
Neurological disorders such as Parkinson’s disease
What does a blank facial expression indicate?
A masklike face common in certain neurological conditions
What are some common difficulties faced by patients with neurological conditions?
- Difficulty swallowing and speaking
- Loss of coordination and balance
What is a typical gait pattern for patients with certain neurological disorders?
Shuffling steps, stooped position, and propulsive gait
List some interventions for patients with neurological disorders.
- Assess neurological status
- Provide a high-calorie, high-protein, high-fiber soft diet
- Increase fluid intake to 2000 mL/day
- Promote independence with safety measures
What should be avoided when assisting patients with activities?
Rushing the client
What is the recommended footwear for clients with neurological conditions?
Low-heeled shoes
What should clients be instructed to do to initiate movement?
Rock back and forth
What type of medications are administered to increase dopamine levels in the CNS?
Antiparkinsonian medications
What foods should clients avoid when taking antiparkinsonian medications?
Foods high in vitamin B6
What is myasthenia gravis?
A neuromuscular disease characterized by considerable weakness and abnormal fatigue of voluntary muscles
What are the causes of myasthenia gravis?
- Insufficient secretion of acetylcholine
- Excessive secretion of cholinesterase
- Unresponsiveness of muscle fibers to acetylcholine
What are common assessment findings in myasthenia gravis?
- Weakness and fatigue
- Difficulty chewing and swallowing
- Ptosis
- Diplopia
What is the purpose of the edrophonium test?
To diagnose myasthenia gravis and differentiate between myasthenic crisis and cholinergic crisis
What indicates a positive result for myasthenia gravis during the edrophonium test?
Improvement in muscle strength after administration
What is a myasthenic crisis caused by?
- Rapid progression of the disease
- Inadequate medication
- Infection
- Fatigue
- Stress
What is a cholinergic crisis caused by?
Overmedication with anticholinesterase medications
What are the signs of increased intracranial pressure (ICP)?
- Headache
- Vomiting
- Change in alertness
- Cranial nerve dysfunction
What is Cushing’s triad?
Three primary signs indicating increased ICP: Increased Systolic BP, Decreased Pulse, Decreased Respiration
What are the types of strokes?
- Ischemic stroke
- Hemorrhagic stroke
- Transient Ischemic Attack
What does the Monro-Kellie hypothesis state?
The sum of volumes of brain, cerebrospinal fluid (CSF), and intracerebral blood is constant
What is the primary cause of stroke?
- Thrombosis
- Embolism
- Hemorrhage from vessel rupture
What are common risk factors for stroke?
- Atherosclerosis
- Hypertension
- Diabetes mellitus
- Obesity
What does the acronym BE FAST stand for in stroke assessment?
- Balance
- Eyes
- Face
- Arm
- Speech
- Time
What are the two types of aphasia?
- Expressive aphasia
- Receptive aphasia
What is the main characteristic of expressive aphasia?
The client understands but cannot communicate verbally
What is the main characteristic of receptive aphasia?
The client cannot understand spoken or written words
What are seizures?
An abnormal, sudden, excessive discharge of electrical activity within the brain
What is epilepsy?
A disorder characterized by chronic seizure activity
List some causes of seizures.
- Genetic factors
- Trauma
- Tumors
What is a Foley catheter used for?
To assist with urinary drainage as prescribed
It is commonly used in medical settings for patients who are unable to urinate naturally.
What is a seizure?
An abnormal, sudden, excessive discharge of electrical activity within the brain
Seizures can lead to altered awareness and involuntary movements.
Define epilepsy.
A disorder characterized by chronic seizure activity indicating brain or CNS irritation
It may have various underlying causes including genetic factors and infections.
What are some causes of seizures?
- Genetic factors
- Trauma
- Tumors
- Circulatory or metabolic disorders
- Toxicity
- Infections
What is status epilepticus?
A rapid succession of epileptic spasms without intervals of consciousness
It can lead to brain damage and is a medical emergency.
What are the phases of seizure activity?
- Prodromal
- Aural
- Ictal
- Postictal
What occurs during the prodromal phase of a seizure?
Mood or behavior changes that may precede a seizure by hours or days
What characterizes the ictal stage of a seizure?
Seizure activity, usually musculoskeletal
What is the postictal stage?
A period of confusion, somnolence, and irritability that occurs after the seizure
List the types of generalized seizures.
- Tonic-clonic
- Absence
- Myoclonic
- Atonic or akinetic (drop attacks)
What are simple partial seizures?
Seizures that do not involve a loss of consciousness
What is a key assessment aspect during a seizure?
Documenting the time and duration of the seizure
What should be monitored during the postictal state?
Behavior such as state of consciousness, motor ability, and speech ability
What are seizure precautions?
- Side rails up
- Side lying position
- Seizure pads against the side rails
- Pillow under head
- Suction available
- Bed in low position
- Curtain for privacy
What is the most common cause of spinal cord injury?
Motor vehicle accidents
Define complete transection of the spinal cord.
The spinal cord is severed completely, resulting in total loss of sensation, movement, and reflex activity below the level of injury
What is central cord syndrome?
A condition where loss of motor function is more pronounced in the upper extremities with varying degrees of sensation remaining intact
What is anterior cord syndrome?
A syndrome caused by damage to the anterior portion of the spinal cord, leading to loss of motor function, pain, and temperature sensation below the level of injury
What are the complications related to spinal cord injuries?
- Respiratory failure
- Autonomic dysreflexia
- Spinal shock
- Further cord damage
- Death
What are the early signs of increased ICP?
- Slight change in vital signs
- Slight change in level of consciousness
What is a closed head injury?
An injury resulting from blunt trauma, often more serious due to the risk of increased intracranial pressure (ICP)
What are the late signs of increased ICP?
- Significant decrease in level of consciousness
- Bradycardia
- Alteration in pupil size and reactivity
- Coma
What is the primary goal in managing a spinal cord injury?
To prevent further damage and loss of neurological function
What interventions are critical during hospitalization for spinal cord injury?
- Assess respiratory status
- Monitor for cardiac dysrhythmias
- Assess motor and sensory status
- Maintain skin integrity
What is the significance of the C4 vertebra?
It provides major innervation to the diaphragm via the phrenic nerve, and injury above this level causes respiratory difficulty
What is the management strategy for a client with a cervical fracture?
Place the client immediately in skeletal traction to immobilize the cervical spine
What is the purpose of using an incentive spirometer in spinal cord injury patients?
To encourage deep breathing and prevent respiratory complications
What is the function of the conus medullaris?
It is the terminal part of the spinal cord, and damage here can lead to bowel and bladder areflexia
What is the typical presentation of Brown-Séquard syndrome?
Loss of motor function and deep touch sensations on the same side as the injury and loss of pain and temperature sensations on the opposite side
What are the manifestations of head injury?
Depend on the type of injury and the amount of increased ICP
What is an open head injury?
Injury involving a fracture of the skull or penetration of the skull by an object
What should be done to minimize ICP in head injury patients?
Position the client with the head maintained midline to avoid jugular vein compression
What should be initiated during the acute phase of an injury to assess consciousness levels?
Seizure precautions
Important for monitoring neurological status.
What does NPO stand for in medical care?
Nothing by mouth
Indicates that a patient should not consume food or drink.
What should be monitored to avoid increasing cerebral edema?
Prescribed intravenous fluids
Important to prevent complications related to fluid overload.
What might alterations in fluid or electrolyte indicate?
Injury to the hypothalamus or posterior pituitary
These alterations can lead to serious complications.
What indicates a possible leakage of cerebrospinal fluid (CSF)?
Nose or ear drainage
This requires immediate medical evaluation.
What should be administered if hyperthermia occurs?
Tepid sponge baths or hypothermia blanket
Helps to reduce elevated body temperature.
Why should suctioning through the nares be avoided?
Risk of catheter entering the brain through a fracture
This can lead to severe infections.
What medications may be prescribed for headache and seizures?
Acetaminophen (Tylenol) and anticonvulsants
Antibiotics may be needed for lacerations.
What might be prescribed to reduce cerebral edema?
Corticosteroid or osmotic diuretic
These medications help manage swelling in the brain.
What are signs of brainstem involvement?
Deep, rapid, or gasping respirations; wide fluctuations in pulse; sluggish pupils
Requires immediate notification to healthcare provider.
What is a fracture?
A break in the continuity of the bone
Can result from trauma, twisting, or bone decalcification.
What are common assessment findings for fractures?
Pain, deformity, edema, ecchymosis, muscle spasm
Loss of function and crepitation may also be present.
What is the initial care for a fracture?
Assess injury, immobilize extremity, cover wounds, elevate, apply cold
Transport to emergency department if necessary.
What is closed reduction?
Manual alignment of bone fragments followed by immobilization
Used to restore proper alignment of fractured bones.
What is open reduction in fracture treatment?
Surgical insertion of internal fixation devices
Helps maintain bone alignment during healing.
What type of traction is used to stabilize a fractured femur?
Russell skin traction
Provides a double pull using a knee sling.
What is balanced suspension traction?
Used with skin or skeletal traction to approximate fractures
Counterforce is provided by something other than the child.
What is 90-degree-90-degree traction?
Support of the lower leg by a boot cast or calf sling
Allows for 90-degree flexion of the femur.
What must be monitored in traction therapy?
Correct weight, free hanging of weights, neurovascular status
Ensures proper healing and prevents complications.
What complications of immobilization should be monitored?
Constipation, skin breakdown, lung congestion
Renal complications and disuse syndrome are also concerns.
What type of play should be provided for children undergoing treatment?
Therapeutic and diversional play
Helps in emotional and physical recovery.
