Nervous System Flashcards
What part of the nervous system is composed of the brain and spinal cord?
Central nervous system (CNS)
What part of the nervous system is composed of the cranial nerves, spinal nerves, and autonomic nervous system?
Peripheral nervous system
Basic unit of the nervous system
Neuron — transmits impulses
Sensory neurons control sensation and are _________ meaning they transmit messages from the PNS to CNS
Afferent
Motor neurons control mobility and are _________ meaning they transmit messages from the CNS to the PNS
Efferent
Fatty substance that surrounds and insulates the axon in a neuron and promotes faster transmission of impulses
Myelin sheath
Largest part of the brain that controls motor, cognitive, and sensory function
Cerebrum (2 hemispheres — R and L)
Structure that connects the L and R hemispheres of the cerebrum
Corpus callosum
The left hemisphere controls the _____ side of the body, while the right hemisphere controls the _____ side of the body
Right; Left
Outer layer of the cerebrum composed of gray matter
Cerebral cortex
The motor cortex is found in the _________ lobe of the brain
Frontal
Which lobe of the brain controls memory, speech and language, personality, and decision-making
Frontal
_________ area is located in the frontal lobe and is essential for speech function
Broca’s
The sensory cortex is found within the _________ lobe of the brain
Parietal
The _________ lobe of the brain is essential for interpreting signal related to things such as touch, position, pain, temperature
Parietal
The visual cortex is found within the _________ lobe of the brain
Occipital
The _________ lobe of the brain is essential for visual processing and interpretation
Occipital
The auditory cortex is found within the _________ lobe of the brain
Temporal
The _________ lobe of the brain is essential for hearing and recognizing language
Temporal
_________ area is found within the temporal lobe of the brain and is essential for the comprehension of verbal and written language
Wernicke’s
Structure located at the back of the brain beneath the occipital and temporal lobes essential for coordinating muscle movements and maintaining posture and balance
Cerebellum
Structure of the brain essential for regulating autonomic functions such as breathing, HR, and digestion
Brainstem
The spinal cord terminates around ___ or ___
L1; L2
Membrane the surrounds the brain and the spinal cord
Meninges
What are the three layers of the meninges
Dura mater, arachnoid mater, pia mater
Space between the skull/vertebrae and the dura mater
Epidural space
Space between the dura mater and the arachnoid mater
Subdural space
Space between the arachnoid mater and pia mater
Subarachnoid space
Cerebral spinal fluid (CSF) circulates in the _________ space
Subarachnoid
_____ helps to surround and cushion the CNS and provides nutrients and eliminates waste products from the nervous system
CSF
The _________ nervous helps to maintain homeostasis in the body by innervating smooth muscle, cardiac muscle, and several glands
Autonomic
Components of the autonomic nervous system
Sympathetic and parasympathetic nervous systems
The _________ nervous system is responsible for controlling the body’s fight or flight response
Sympathetic
The nerves of the sympathetic nervous system originate between ___ and ___ in the spinal cord
T1; L2
Effects of the SNS
Increased CO, vasoconstriction and increased BP, bronchodilation, pupil dilation, decreased secretions and peristalsis
The _________ system controls the body’s rest and digest response
Parasympathetic (PSNS)
Nerves associated with the PSNS originate between ___ and ___ in the spinal cord
S2; S4
Effect of the PSNS
Decreased CO, vasodilation and decreased BP, bronchoconstriction, pupil constriction, increased secretions and peristalsis
Diagnostic that allows for visualization of the cerebral blood vessels to check for blockages and other abnormalities; catheter is typically inserted at femoral artery at the groin and is threaded up through the blood vessels to the brain
Cerebral angiogram
Cerebral angiogram pre-procedure nursing care
Ensure patient has been NPO for 4-6 hrs, assess for allergy to contrast dye, assess kidney function, assess and mark pulses distal to insertion site
Cerebral angiogram post-procedure nursing care
Check insertion site for bleeding, advise patient to keep leg straight, perform neurovascular assessment distal to insertion site (pulses, cap refill, temp, color), encourage patient to increase fluid intake
Diagnostic used to identify seizures, sleep disorders, and encephalopathy; electrodes are placed on patient’s scalp and electrical activity of brain is recorded
Electroencephalogram (EEG)
EEG pre-procedure nursing care
Have patient wash hair so electrodes stick to scalp, educate patient to arrive sleep-deprived (easier to diagnose epilepsy), advise patient to avoid stimulants or sedative medications, NPO is NOT required (anesthesia not used)
EEG intra-procedure nursing care
Educate patient that hyperventilation or strobe lighting may be used to increase likelihood of seizure activity
Invasive procedure where device is inserted into cranial cavity to measure ICP
Intracranial pressure (ICP) monitoring
ICP monitoring is done in the OR and carries a major risk for
Infection
Indications for ICP monitoring
Glasgow coma scale <8
Normal ICP
10-15 mmHg
S/S of increased ICP
Initially: restlessness, irritability, headache
Progression: decreased LOC, pupil abnormalities, abnormal breathing patterns (Cheyne-stokes, BOS), abnormal posture (decerebrate, decorticate)
Diagnostic by which cerebral spinal sample is obtained from spinal canal and is analyzed for suspected meningitis, subarachnoid hemorrhage, and other neurological disorders
Lumbar puncture
Lumbar puncture pre-procedure nursing care
Have patient empty their bladder, position patient on side in fetal position OR sit up and leaned over a table (either way, patient’s back should be arched)
Lumbar puncture post-procedure nursing care
Instruct patient to lie flat for several hours and increase fluid intake, monitor for signs of CSF leak (severe headache!)
MRI pre-procedure nursing care
Assess for history of claustrophobic (administer anti-anxiety if needed), instruct patient to remove all jewelry, assess for contraindications such as metal implants (artificial joints, pacemaker), provide patient with earplugs
S/S of migraine headaches
Unilateral throbbing head pain, N/V, photophobia (light sensitivity), phonophobia (sensitivity to noise), aura
Treatment for mild and moderate migraines headaches
Mild: NSAIDs
Moderate: ergotamine, sumatriptan
Migraine headache patient education
Lay in dark, quiet environment, avoid triggers
S/S of cluster headaches
Severe unilateral NON-throbbing head pain typically around orbital region, nasal congestion, facial sweating, droopy eyelid and excess tearing, agitation and pacing
Cluster headache treatment
Ergotamine, sumatriptan, oxygen therapy, corticosteroids, verapamil
Seizure risk factors
Fever, cerebral edema, infections like meningitis, fluid and electrolyte imbalances (hyponatremia), drug or alcohol withdrawal)
Seizure characterized by three phases: tonic episode (stiffening of muscles and loss of consciousness), clonic episode (1-2 min or rhythmic jerking of extremities), postictal phase (confusion, sleepiness, agitation)
Tonic-clonic (grand-mal)
Seizure characterized by loss of consciousness for a few seconds, resembles day-dreaming. Other symptoms include picking at clothes, lip smacking, and eye fluttering
Absence seizure
Seizure characterized by brief jerking of the extremities (usually no loss of consciousness)
Myoclonic seizure
Seizure characterized by loss of muscle tone (often results in falling if patient is standing)
Atonic seizure
Examples of medications used to treat seizures
Valproic acid, carbamazepine, phenytoin
Seizure nursing care
If patient is standing or sitting, lower them to the floor or bed and turn them to their side. Loosen restrictive clothing, do NOT place anything in their mouth or restrain the patient, note the onset and duration of seizure
Post-seizure nursing care
Assess vital signs and neuro status, reorient patient, implement seizure precautions if not already done, determine possible triggers
Life-threatening complication of seizures characterized by prolonged seizure lasting more than 5 minutes or the failure to regain consciousness between seizures
Status epilepticus
Status epiplepticus risk factors
CNS infection, head trauma, drug withdrawal or toxicity
Status epilepticus treatment
Antiepileptics (Phenytoin), Benzos (lorazepam), anesthetics (propofol), barbiturates (phenobarbital)
Status epilepticus nursing care
Maintain patent airway and administer O2 as prescribed (PRIORITY!), administer appropriate medications, assist with intubation
Meningitis risk factors
Crowded conditions (dorms, prisons), immunosuppression, travel exposure
Meningitis prevention
Infants: HIB, PCV vaccination
Teens: meningitis vaccine (A & B) BEFORE college
S/S of meningitis
Headache, fever, N/V, nuchal rigidity (neck stiffness), photophobia, positive brudzinski sign (severe pain resulting in flexion of knees and hips when attempting to push head toward chest) and positive kernig sign (severe pain when attempting to straighten knee from flexed position), altered mental status, tachycardia, seizures
Meningitis diagnosis
Lumbar puncture, CSF analysis
CSF analysis findings for BACTERIAL meningitis
Cloudy, decreased glucose, increased protein and WBCC, positive gram stain
CSF analysis findings for VIRAL meningitis
Clear, normal glucose, slight increase in protein and WBCC, negative gram stain
Meningitis treatment
Antibiotics (for bacterial), analgesics, anticonvulsants
Meningitis nursing care
Implement DROPLET precautions (remain on droplet for first 24 hr with antibiotic therapy), implement seizure precautions, monitor neurological status, provide quiet room with dim lights, minimize ICP (maintain HOB at 30 degrees, maintain head at midline, minimize suctioning)
Parkinson’s disease is characterized by _________ dopamine and _________ acetylcholine
Decreased; increased
S/S of Parkinson’s disease
Muscle rigidity, tremor, slow shuffling gait, postural instability (risk for falls), akinesia, bradykinesia, mask-like expression, drooling, Dysphagia (risk for aspiration pneumonia)
Parkinson’s disease treatment
Levodopa-carbidopa (increases dopamine), Benztropine (decreases acetylcholine)
Parkinson’s disease nursing care
Monitor swallowing and food intake, thicken liquids, sit patient upright, advise patient to tuck chin while swallowing, keep suction equipment at bedside, encourage ROM exercises, assist with ADLs, implement fall precautions
A gradual, irreversible form of dementia that causes memory problems, judgement issues, and changes in personality
Alzheimer’s
Alzheimer’s patho
Formation of beta-amyloid deposits and neurofibrillary tangles in brain causing impaired communication between neurons and brain
Alzheimer’s risk factors
Older age, family hx, cardiovascular disease
Stage 1 (mild) symptoms of Alzheimer’s
Forgetfulness, short-term memory loss, mild cognitive impairment
Stage 2 (moderate) symptoms of Alzheimer’s
Disorientation, agitation, wandering, incontinence, ADL assistance may be necessary
Stage 3 (severe) symptoms of Alzheimer’s
Bedridden, lose ability to talk, control movement, and swallow
Definitive diagnosis of Alzheimer’s
Occurs after death through examination of brain tissue
Alzheimer’s treatment
No cure; Donepezil (improves cognition), antipsychotics, antidepressants, anti-anxiety
Alzheimer’s nursing care
Maintain structured environment, provide short directions and repetition and reorientation as needed, avoid overstimulation, use single-day calendar, maintain routine toileting schedule
Alzheimer’s home safety measures
Remove scatter rugs, install door locks out of sight and reach to prevent wandering, provide good lighting especially over stairs, tape edges of stairs, remove clutter
A progressive brain disorder that causes uncontrolled movement, emotional problems, and dementia
Huntington’s disease
Huntington’s is an _________ _________ genetic disorder
Autosomal dominant
S/S of Huntington’s
Chorea (abnormal or excessive involuntary movements), cognitive issues such as dementia, memory loss, and poor impulse control, and psychiatric issues such as depression, mania, and personality changes
Huntington’s treatment
No cure; manage symptoms with psychotropic agents and tetrabenazine (decreases symptoms of chorea)
A _________ spinal cord injury results in the loss of all nerve function below the level of the injury
Complete
_________ spinal cord injuries allow for some function below the level of the injury
Incomplete
S/S of spinal cord injury
Loss of motor function, loss of sensation, loss of reflexes, loss of bowel or bladder function
A spinal cord injury below the level of ___ causes paraplegia (paralysis or paresis/weakness) of the lower extremities
T1
A spinal cord injury to the __________ region causes quadriplegia resulting in paralysis or paresis of all four extremities
Cervical
A spinal cord injury to the _________ motor neurons results in hypertonia (spastic muscle tone and spastic neurogenic bladder)
Upper (above L1 or L2)
A spinal cord injury to the _________ motor neurons results in hypotonia (flaccid muscle tone and flaccid neurogenic bladder)
Lower (below L1 or L2)
Spinal cord injury nursing care
Stabilize the spine, maintain patent airway, monitor for complications such as hemorrhage, neurogenic shock, and autonomic dysreflexia
A patient who has had a spinal cord injury at the level of ___ or above is at risk for respiratory dysfunction
C4
Nursing care for patients with halo traction device (common in patients with spinal cord injury to cervical region)
Move patient as a unit, do NOT apply pressure to rods, ensure there is a wrench or screwdriver attached to the vest for removal of vest in the event of an emergency
Neurogenic shock typically occurs with a spinal cord injury above
T6
Key symptoms of neurogenic shock
Hypotension, bradycardia, flushed and warm skin
Treatment of neurogenic shock
IV fluids, vasopressors, atropine
Life-threatening hypertension following a spinal cord injury triggered by stimuli below the level of injury such as distended bladder
Autonomic dysreflexia
S/S of autonomic dysreflexia
Extreme hypertension, severe headache, blurred vision, diaphoresis
Autonomic dysreflexia nursing care
Sit the patient upright (PRIORITY!), notify provider, loosen restrictive clothing, address underlying cause (check catheter tubing for kinks, manually disimpact patient if d/t fecal impaction), administer Antihypertensives and closely monitor BP
An autoimmune disorder that affects the central nervous system and causes damage to the myelin sheath and underlying nerves resulting in inflammation and formation of scar tissue or plaques
Multiple sclerosis (MS)
T or F: MS is characterized by periods of relapse and remission
True
MS risk factors
Women, ages 20-40
S/S of MS
Vision issues such as diplopia and nystagmus, muscle spasticity and/or weakness, balance issues, bowel and bladder dysfunction, fatigue, cognitive changes such as difficulty concentration, emotional changes such as depression or anxiety, pain, Dysphagia
MS diagnosis
MRI, lumbar puncture and CSF analysis (elevated protein)
MS treatment
Immunosuppressants (corticosteroids), interferon beta, anti-inflammatories, muscle relaxants
MS patient education
Avoid triggers (temp extremes, stress, fatigue, illness)
Neurodegenerative disease that causes gradual deterioration of upper and lower motor neurons resulting in loss of voluntary movement and muscle control. Patients will eventually lose their ability to speak, eat, move, and breathe.
Amyotrophic Lateral Sclerosis (ALS)
S/S of ALS
Muscle weakness and atrophy, muscle cramps and twitching, Dysphagia, respiratory paralysis (between 3-5 years of diagnosis)
ALS treatment
No cure; riluzole (helps slow deterioration of motor neurons)
ALS nursing care
Maintain patent airway (PRIORITY!), monitor for pneumonia and respiratory failure (ventilator will eventually be necessary)
Autoimmune disorder that affects the peripheral nervous system causing sudden onset of weakness and paralysis
Guillain-Barre Syndrome (GBS)
GBS risk factors
Previous viral infections such as influenza or pneumonia
S/S of GBS
Tingling in hands and feet, symmetric weakness (both sides), decreased DTRs, paralysis; symptoms usually occur at the feet and move up the body
GBS treatment
Plasmapharesis (filters blood, removes antibodies attacking nerves), IV immunoglobulin
GBS nursing care
Maintain patent airway, monitor for aspiration, pneumonia, and respiratory failure
Autoimmune disorder that causes severe muscle weakness and is characterized by period of exacerbation and remission. This disorder results from antibodies blocking and destroying acetylcholine receptors at the neuromuscular junction
Myasthenia Gravis (MG)
S/S of MG
Muscle weakness that is worse with exercise and improved with rest, diplopia, Dysphagia, SOB, thymus hyperplasia (enlarged thymus gland), drooping eyelids (ptosis)**
Interpretation of edrophonium/Tensilon test for diagnosis of MG and differentiation between MG and cholinergic crisis
Edrophonium is a cholinergic agent that increases levels of acetylcholine
MG: if administration of edrophonium improves patient condition, then they have MG
Cholinergic crisis: if administration of edrophonium worsens patient condition, then patient is experiencing a cholinergic crisis; administer atropine!
MG treatment
Cholinergic agents such as Neostigmine and pyridostigmine, immunosuppressants such as prednisone, Plasmapharesis, thymectomy
MG nursing care
Maintain patent airway, assist with ambulation, encourage rest periods, provide patient with frequent, small high-calorie meals, monitor for aspiration and choking, administer eye drops and tape eyes shut at night to prevent drying and irritation
Ruptured arteries and aneurysms in the brain can cause a _________ stroke
Hemorrhagic
_________ strokes are caused by a blood clot
Ischemic
Stroke risk factors
Smoking, HTN, DM, afib, hyperlipidemia, previous TIA
Temporary blockage of blood flow to the brain
Transient ischemic attack (TIA)
S/S of stroke
Unilateral limb weakness, facial drooping, slurred speech, dizziness, visual disturbances
A stroke on the _____ side of the brain can cause expressive aphasia meaning that the patient will have the inability to speak or understand language and difficulty with reading or writing
Left
A stroke on the left side of the body will cause _____-sided weakness or paralysis
Right
A stroke on the _____ side of the brain can cause poor judgement and impulse control and overestimation of abilities
Right
A right sided stroke leads to _____-sided weakness or paralysis
Left
Treatment for ischemic stroke
Thrombolytics such as alteplase (tPA) within 3 hours of onset of symptoms**, anticoagulants and antiplatelets
Treatment for hemorrhagic stroke
Antihypertensives agents
Stroke nursing care
Implement fall precautions, assess swallowing ability and gag reflex before eating anything, advise patient to tuck chin against chest to facilitate swallowing, reposition patient frequently, advise patient to use scanning technique in order to see everything (if the patient has homonymous hemianopsia)
S/S of TBI
Related to an increase in ICP: decreased LOC, Cushing’s triad, confusion, headache, pupil abnormalities, N/V, seizures, abnormal posturing
Cushing’s triad
Systolic hypertension (widened pulse pressure), bradycardia, irregular breathing
TBI treatment
Mannitol, hypertonic saline, pentobarbital (induces coma and decreases metabolic demands), anticonvulsants, opioid analgesics
TBI nursing care
Stabilize patient’s cervical spine, maintain patent airway, monitor vitals and LOC, take measures to decreases ICP (hyperventilation, avoid suction, HOB at 30 degrees or more, ensure head stays midline). If patient is conscious and alert, advise them to avoid coughing, blowing nose, and extreme flexion or extension of neck
Complication of TBI characterized by downward movement of brain tissue that occurs due to cerebral edema
Brain herniation
S/S of brain herniation
Fixed/dilated pupils, decreased LOC, abnormal respirations, abnormal posturing
Arterial bleeding between the skull and dura mater
Epidural hematoma
Venous bleeding between the dura mater and arachnoid mater
Subdural hematoma
The accumulation of blood within the brain tissue
Intracerebral hemorrhaging
Lens opacity that impairs vision
Cataracts
What is the number one risk factors for cataracts
Aging
S/S of cataracts
Gradual, painless loss of vision, blurry vision, diplopia, white or graying of pupil, absent red reflex
Post-cataract surgery patient education
Number of eye drops will be used (antibiotic, steroid, NSAID) several times a day, advise patient to wear dark sunglasses when outside, avoid activities that can increase IOP (bending at waist, sneezing, coughing, blowing nose, lifting over 10lb, straining with bowel movements), educate patient that best vision occurs around 4-6 weeks
_____-angle glaucoma is more common and is caused by aqueous humor overproduction or a decrease in outflow resulting in a gradual increase in IOP
Open
_________-angle glaucoma is caused by forward displacement of the iris obstructing the angle between the iris and the cornea resulting in complete blockage of aqueous humor outflow and rapid increase in IOP
Closed
Glaucoma risk factors
Aging, genetics, diabetes, hypertension
S/S of open-angle glaucoma
Loss of peripheral vision**, mild aching in eyes, headache
S/S of closed-angle glaucoma
Severe eye pain, N/V, blurred vision, halos around lights, reddened sclera
Normal intraocular pressure (IOP)
10-21 mmHg
Glaucoma treatment
Mannitol, eye drops (timolol, Acetazolamide, brimonidine, travaprost; this will decrease aqueous humor production or improving outflow)
Deterioration of the macula (part of the retina) resulting in loss of central vision
Macular degeneration
Type of macular degeneration that is more common and is causes by clumps of protein called drusen that grow under the macula and cause the macula to become thinner and dry out
Dry
Type of macular degeneration in which abnormal blood vessels grow under retina and leak blood or fluid into macula causing scarring. This type has a faster onset
Wet
Macular degeneration patient education
Smoking cessation, wear sunglasses, follow-up care with provider, home modifications for safety d/t loss of central vision
Macular degeneration treatment
No cure; photodynamic therapy for wet macular degeneration
Separation of the retina from the underlying epithelium d/t build-up of vitreous humor behind retina
Retinal detachment
Retinal detachment risk factors
Aging, injury, family hx, previous intraocular surgery, ocular tumors
S/S of retinal detachment
Floaters, flashing lights, sudden painless sensation of current being drawn over visual field
Retinal detachment treatment
Emergency surgery to repair detached retina
Inner ear disorder that causes issues with hearing and balance
Ménière’s disease
What are the three key symptoms of Ménière’s disease?
Tinnitus, unilateral sensorineural hearing loss, vertigo
Ménière’s disease risk factors
Genetics, infection, ototoxic medications
Ménière’s disease treatment
Supportive: antihistamines, anticholinergics, diuretics, antiemetics
Labyrinthectomy (educate patient that this will result in complete hearing loss on affected side!)**
Ménière’s disease patient education
Avoid caffeine, smoking, and alcohol; restrict salt intake, distribute fluid intake evenly throughout the day
