Nervous System Flashcards

Question

Ataxia

Answer 1

Poor muscle control causes clumsy voluntary movements

Answer 2

Partial inability to preform purposeful or skilled motor acts

Answer 3

Complete inability to preform purposeful or skilled motor acts

Answer 4

Difficulty swallowing

Answer 5

Inability to swallow

Answer 6

Pupil constriction

Answer 7

Downward movement of eyes

Answer 8

Jaw movement, sensation of face and neck

Answer 9

Lateral movement of eyes

Answer 10

Facial movement, taste on anterior 2/3 of tongue

Answer 11

Hearing and balance

Answer 12

Swallowing, taste on posterior 1/3 tongue

Answer 13

Swallowing, speaking

Answer 14

Flexion and rotation of head

Answer 15

Tongue movements

Answer 16

Eye response 1-4 Verbal response 1-5 Motor response 1-6 Less then eight = intubate

Answer 17

Damage to the midbrain * Arms shape like C's * Arms pulled in towards center Clenched fists

Answer 18

Damage to deep brain structure pons * Extension of hands outwards * Arms and legs straight out * Toes pointed downwards * Neck and head arched back

Answer 19

What · Blood flow to the brain · Blood pressure in the body is what sends blood up to the brain · We MUST have a high enough BP to get blood to the brain..... ○ or it will not have oxygen! ○ and brain cells will start to die! MAP > 60! (for adults)

Answer 20

What ○ The pressure inside of the skull ○ Normal = 5-15 ○ Monro-Kellie hypothesis ○ The skull is a rigid container filled with: blood, brain, and CSF. If one of those three increases, another must decrease. ○ Works against BP.... pushing blood away from the brain! ○ High ICP = Less blood to the brain Increased Intracranial Pressure Side Effects ○ Headache ○ Vomiting ○ Inc systolic BP ○ Dec HR ○ Speech slurred ○ Decerebrate & decorticate Causes ○ Cerebral edema ○ Hemorrhage ○ Tumor growth ○ Excess CSF

Answer 21

What * Protrusion of an organ through a natural opening in a covering, muscle, or bone * There is SO much pressure, that the brain tissue pushes through the skull

Answer 22

What * Increased accumulation of cerebrospinal fluid * Increases ICP Causes * Tumor * Hemorrhage * Infection Congenital

Answer 23

What ○ Seizures are not a disease in themselves ○ They are a symptom of an underlying disorder § Increased ICP § Infection in the brain § Injury to the brain § Drug abuse § Hyper- or hypoglycemia § Hyponatremia § Medications Epilepsy § “A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.” § No other underlying disorder Treatment § Anticonvulsants § Rapid acting - lorazepam § Long acting - phenytoin * Very important to monitor for therapeutic levels * Never stop taking suddenly (can cause a seizure) Nursing Considerations * Stay with client * Note time, duration, characteristics of seizure * Remove harmful objects in clients area * Cushing clients head * Looser restrictive clothing * Assis client to side-lying position Seizure Precautions * Oxygen & suction equipment * Side-lying position with pillow under head * Padded side rails * All 4 side rails raised * Bed in lowest position

Answer 24

Phases of tonic (muscle stiffening/rigidity) and clonic (rhythmic jerking) spasm, immediate loss of consciousness

Answer 25

Sudden, brief, shock-like contractions of a muscle/group of muscles in extremities

Answer 26

Abrupt loss of muscle tone for a few seconds, then confusion, can result in falls/injury

Answer 27

Loss of consciousness, staring off into space

Answer 28

Impaired consciousness ranging from confusion to syncope and/or non-responsiveness

Answer 29

No loss of consciousness, may experience twitching, sensory changes, or autonomic symptoms

Answer 30

What * Alteration in brain function caused by an external source Fractures * Open * Closed Bleeds * Epidural * Subdural * Intracerebral Contusion * Coup Contrecoup

Answer 31

What * Open fracture → torn dura * Closed fracture → dura is intact Basilar skull fracture * Battle’s sign → Bruising over the mastoid process * Raccoon eyes → Periorbital bruising Cerebrospinal rhinorrhea * Test drainage for CSF ○ Halo test ○ Glucose NEVER INSERT A NG TUBE IN A CLIENT WITH A BASILAR SKULL FRACTURE

Answer 32

What * Damage to the spinal cord causes permanent changes in strength, sensation, and other body functions below the site of the injury * Symptoms depend on location of the injury * The higher the injury - the more function that is lost Injuries at and above T6: * Monitor for autonomic dysreflexia

Answer 33

Syndrome characterized by * Sudden severe hypertension * Bradycardia * Headache * Nasal stuffiness * Flushing * Sweating * Blurred vision * Anxiety Triggers * Dehydration * Anxiety * Fecal impaction * Full bladder * Blister * UTI * Pressure ulcer * Broken bone * Restrictive clothing Treatment * Sit the client up to lower their BP * Antihypertensives ○ Hydralazine * Find the cause and treat ○ Full bladder? Catheter ○ Constipated? Remove impaction ○ Pressure injury? Reposition ○ Painful stimuli? Remove stimuli ○ Cold room? Change the temperature

Answer 34

What is a stroke? * “A disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts” * There is a lack of oxygen to the brain and that causes damage! Lack of oxygen can be * Hemorrhagic * Ischemic ○ Embolic ○ Thrombotic Hemorrhagic stroke * A vessel ruptures and bleeds into the brain * As the blood accumulates, there is increased pressure on the brain * The rupture can be caused by a weakened vessel, such as in an aneurysm * “Worst headache of my life” Ischemic stroke * Blood flow to the brain is blocked by a blood clot ○ Thrombotic - a blood clot (thrombus) in an artery going to the brain. Onset in a stepwise fashion. ○ Embolic - a clot that’s formed elsewhere (usually in the heart or neck arteries), travels in the bloodstream, and clogs a blood vessel in or leading to the brain. Sudden onset! * There is a loss of blood circulating to this area of the brain * The lack of blood leads to a lack of oxygen, causing ischemia and damage Assessment * Warning signs: ○ Balance § Dizzy → loss of balance ○ Eyes § Blurry vision § Abnormal pupil response § Hemianopia ○ Facial droop § Unilateral ○ Arms § Arm drift or weakness ○ Speech § Aphasia § Dysphagia § Altered LOC/Confusion

Answer 35

What * Inflammation of the spinal cord or brain * Usually caused by a virus or bacteria ○ Rarely caused by fungi or parasites * Bacterial Meningitis is more dangerous compared to viral Assessment * Nuchal rigidity * Photophobia * Kernig’s sign * Brudzinski’s sign Kernig’s Sign With the client placed supine and the hip flexed, the knee cannot be completely extended due to pain. Brudzinski’s Sign With the client placed supine, passive flexion of the neck causes involuntary flexion of the knee and hips. Treatment * Steroids * Analgesics * Antibiotics - only if bacterial!! * Isolation precautions ○ Viral - standard ○ Bacterial - Droplet § Considered a Medical Emergency § Bacterial meningitis is VERY contagious * Prevention ○ Hib vaccine § Those who are immunized have protection against Hib meningitis ○ Meningococcal conjugate or MenACWY vaccines ○ Recommended for anyone living in close proximity to others

Answer 36

What * Inflammation of the brain tissue * Due to a viral infection ○ HSV most common * Causes edema and necrosis * Meninges are also inflamed

Answer 37

What * Autoimmune disorder * CNS inflammation * Damages and degrades the myelin sheath surrounding neurons ○ Demyelination Signs and Symptoms * Tingling & numbness * Weakness * Optic neuritis * Dysdiadochokinesia: inability to preform rapid, alternating movements * Ataxia: poor muscle control * Nystagmus: involuntary, rapid, repetitive eye movement * Intentional tremor * Scanning speech * Hypotonia: dec muscle tone * Epilepsy, seizures * Spasticity (muscle, bladder) Interventions * No cure * Corticosteroids ○ Decrease inflammation Plasmapheresis

Answer 38

What * Antibody and cell mediated immunologic reaction precipitated by a viral or bacterial illness * Immune system switches to attacking the nerves and de-myelinates peripheral nerves * Causes ascending weakness and paralysis * If ascends to the diaphragm can cause respiratory arrest Assessment Findings * Recent illness or infection ○ Ask about a GI bug.... Campylobacter jejuni is responsible for many GBS cases! * Weakness or tingling in the lower extremities * Increases in severity and moves up symmetrically * As severity increases ○ Paralysis ○ Absent reflexes ○ Loss of muscle tone ○ Respiratory distress - requires intubation or trach * Peaks in about 2 weeks * Slow recovery Treatment * Client will gradually recover as antibodies clear * Plasmapheresis ○ Filter blood and remove antibodies attacking the nerves ○ Helps symptoms * Immunoglobulin therapy Stops the antibodies that are attacking the myelin sheath

Answer 39

What * “Weakness, numbness, and pain from nerve damage” * There has been injury to the peripheral nerve ○ Injuries ○ Infections ○ Toxin exposure ○ Diabetes * Pain is often described as “pins and needles”, numbness, or weakness

Answer 40

What * Botulinum toxin released by Clostridium botulinum ○ Found in soil and dust ○ Can contaminate honey § Children under 1 year old should never have honey * Inhibits acetylcholine release at the junction between peripheral nerves and muscles * This causes life-threatening flaccid paralysis Treatment * Antitoxin Assessment Findings * Blurry vision * Difficulty breathing * Respiratory failure * Symmetric, descending flaccid paralysis

Answer 41

What * Autoimmune disorder * Communication between nerves and muscles destroyed Diagnosis * Tensilon Test Assessment * Weak muscles * Ptosis * Drooping eyelid Interventions * Cholinesterase inhibitors * Corticosteroids Immunosuppressants

Answer 42

What * Progressive nervous system disorder * Caused by degeneration of dopamine neurons Assessment findings * Tremor ○ Usually starts on one side * Rigidity * Hypophonia * Mask-like faces * Akinesia: loss or impairment in power of voluntary movement ○ Bradykinesia ○ Dyskinesia * Stooped posture * Difficulty balancing * Orthostatic hypotension Symptoms * Tremor * Rigidity * Akinesia: absence of movement * Ataxia: Poor muscle control Interventions * Fall risk * No cure * Therapy ○ PT ○ OT ○ SLP * Carbidopa-levodopa Increase dopamine in the brain