Nervous System Flashcards
What is apraxia?
the inability to perform purposive movements, although there is no sensory or motor impairment; it affects ADLs
Why do diabetics have decreased vision?
because there is gradual deterioration of the retinal vessels
How do you perform a Rinne’s test?
The stem of the vibrating tuning fork is held against the mastoid bone until the child indicates that she can no longer hear the sound. Then the tuning form is moved in from of the auditor canal.
Pts with pituitary dwarfism will appear _______
younger than chronologically aged
Corneal abrasion occurs when __________
pt is unable to close eye voluntarily; when facial nerve (cranial nerve VII) is affected, the lacrimal gland will no longer supply secretions that protect the eye.
A great way to assess the neurosensory cerebellar functioning is to ________
have pt stand with eyes closed and observe for swaying. Coordination is governed by cerebellum.
_________can occur in a person who has been paralyzed from a spinal cord injury.
Clonic jerks in the foot
What is chorea?
involuntary dancing or writhing (twisting) of the limbs or facial muscles
What is Huntington’s chorea?
chorea in the upper and lower extremities; it results from atrophy of parts of the brain
Rupture lumbar disc (lumbar lesion) can cause the following:
- Paresthesia in the affected leg
- Pain
- Muscle weakness
- Atrophy in the lower extremities
What is tardive dyskinesia?
neurological syndrome marked by involuntary movements of the face and jaw
Cranial nerve I - Olfactory
Sense of smell
When do you do a sense of smell test?
- it pt reports loss of smell
- head trauma
- pt has abnormal mental status
- when intra-cranial lesions is suspected
What does noxious mean?
harmful
What is anosmia?
loss of smell
Unilateral loss of smell in the absence of nasal disease is __________
neurogenic anosmia
Cranial nerve 2
Optic
What is papilledema?
swelling of the optic nerve caused by ICP; often due to a tumor in the brain pressing on the optic nerve, blindness may result
Cranial nerve 3, 4 and 6
Oculomotor, trochlear and abducens nerves
Cranial nerves 3, 4 and 6 all control ________
eye movements opening of eyelid constriction of pupil focusing proprioception (awareness of posture & changes in equilibrium
Palpebra pertains to _________
eyelid
Palpebra fissures are __________
equal in width
How do you check extra-ocular movements?
you use cardinal position of gaze
If a pt has nystagmus, you check for the _________.
severity
Ptosis (drooping) of the eyes occurs with ________ (3 things)
- myasthenia gravis
- dysfunction of cranial nerve 3
- Horner Syndrome
What is myasthenia gravis?
an auto immune disease in which antibodies attack the neuromuscular junctions and bind ACh receptors together in clusters
Horner syndrome occurs from __________
lesion that interrupts the sympathetic innervations of the head
Horner syndrome is characterized by (5 things)
- unilateral papillary constriction
- sagging eyelid
- withdrawal of the eye into the orbit
- flushing of the skin
- lack of facial perspiration
Cranial nerve 5 - Trigeminal (has three divisions)
- Ophthalmic division (controls sensory of upper face
- Maxillary (controls sensory of lower face)
- Mandibular (controls sensory of lower face with mastication)
How can the muscles of mastication be assessed?
with palpation of the temporal muscle and masseter muscles
Cranial nerve 7
facial
Cranial nerve 8
Acoustic (hearing acuity test is done)
Cranial nerve 9 and 10
Glossopharyngeal and vagus nerves
Cranial nerve 11
Spinal accessory
Cranial nerve 12
Hypoglossal (tongue movement of speech and food manipulation)
What is fasciculation?
involuntary contraction of twitching
A late sign of brainstem damage is?
decerebrate posturing
A fixed dilated pupil represents ________
a neurological emergency
__________is effective in maintaining blood levels to alleviate the pain associated with cancer.
Around the clock administration of analgesics
Hallucinations are _______perceptions.
sensory
5 things to know about myelogram:
- ask if pt is allergic to contrast
- encourage fluids before and after test
- pt must be NPO for 4 - 6 hrs
- elevate head to 30 degrees for 24 hours
- bed rest may be maintained for as long as 24 hours
5 things to know about viral conjunctivitis:
- extreme tearing
- redness
- foreign body
- highly contagious
- child should be restricted from school until symptoms have resolved, 3 to 7 days
___________ is a sign of deterioration in pt’s condition. This should be reported.
Withdrawing from pain
__________ helps reduce frequency and degree of phantom pain.
Activity
What is an oculogyric crisis?
a spasm of involuntary deviation and fixation of the eyeballs
With Bell’s palsy (cranial nerve 7), the face must be protected from cold drafts because of ________
trigeminal hyperesthesia
6 things to know about Bell’s palsy:
- pt should place an eye shield over the affected eye at bedtime
- use of artificial tears is useful
- should use heat on affected side to promote blood flow
- Isometric exercises are helpful during recovery process
- pt may have steroid and analgesic therapy.
- it is not permanent
What is trigeminal neuralgia (cranial nerve 5)?
a painful disease marked by brief attacks of lightning-like stabs
What meds can be given for trigeminal neuralgia?
Carbamazepine (Tegretol), an anticonvulant
What 2 things can be done to treat trigeminal neuralgia:
- pt may need to be injected with alcohol to the nerve, to destroy the nerve
- pt may need surgery to decrease pressure on the nerve from blood vessels
Patient with trigeminal neuralgia should be taught to use _______ on face to prevent trigger.
Tepid (lukewarm) water
Pts with trigeminal neuralgia should eat _________ to prevent stimuli to the area.
soft and warm foods
What is acoustic neuroma?
a neuroma (tumor) of the 8th cranial nerve
What is Guillain-Barre Syndrome?
A condition in which the immune system attacks the nerves.
4 things to know about Guillain-Barre Syndrome:
- pt will be given steroid therapy
- pt will be given aggressive respiratory care
- pt will be given physical therapy
- pt will be given eye care
3 things Guillain-Barre Syndrome may cause:
- respiratory failure
- flaccid paralysis
- urinary retention
What is oculocephalic reflex?
the deviation of a person’s eyes to the opposite side when the head is rapidly rotated; normal for neonates, sign of coma for adults
How can you avoid eliciting the gag response?
depress the tongue slightly off center
Why are cotton applicators not safe for the inner ear?
they can force earwax further in blocking the canal
Why should a toddler not blow with one nostril closed?
because it can push foreign material into the Eustachian tube and damage the inner canal.
When a side of the body is paralyzed from a CVA, what is the most common injury?
Shoulder dislocation
What is the most common side effect of spinal anesthesia?
hypotension; hydrate patient to avoid hypotension
Multiple sclerosis causes: (5 things)
- Alteration in innervations of the bladder
- Decreased sensitivity to pain
- Decreased temperature perception
- Hyperreflexia of extremities
- Decreased concentration
3 things that ginkgo does:
- it is an anti platelet agent
- it is a CNS stimulant given for dementia syndromes
- it increases the risk of bleeding when given with NSAIDs.
________ and _________ are pain distracters.
Anxiety and fatigue
What is meniere’s disease?
a syndrome that causes hearing loss, tinnitus, vertigo and may lead to deafness
How can Meniere’s disease be controlled?
It requires a low sodium diet (2000 mg/day) to decrease fluid retention. Nurse needs to assess pt’s diet.
Meniere’s disease is associated with cranial nerve _______.
8
What medications are used for Meniere’s disease?
Meclizine (Antivert), antihistamines and antiemetics.
What else should be avoided with Meniere’s disease?
alcohol, nicotine and caffeine
What is parkinson’s disease?
a degeneration of the CNS that produces movement disorders and changes in cognition and mood.
Pts with parkinson’s disease should avoid __________
flexion of the neck and shoulders. Sleep on firm mattress without a pillow to prevent flexion of the spine.
A warming tray is for a pt with parkinson’s disease because _______
it keeps the foot hot, safe and appealing during the slow eating process due to slowed body movements, tremors and difficulty chewing and swallowing.
Patients with parkinson’s disease have problems with communication, primarily related to _________
speaking in a way that others can hear and understand
Same muscles are used for speaking and __________
swallowing
Parkinson’s disease is an irreversible disease that leads to _________
permanent physical limitations.
2 symptoms of parkinson’s disease:
- muscle tone and rigidity
2. propulsive gait (a walk with a forward momentum)
A pt at stage 4 parkinson’s disease means __________
that the pt is immobile
Pts with parkinson’s disease should do _________
ROM exercises to all extremities four times a day
What to avoid after detached retina repair (3 things):
- jarring movements of the head, because is will increase ICP
- first week avoid rapid eye movement; reading and writing
- stooping and straining
If gas or oil is used to reattach the retina, pt should sleep in what position?
abdomen with affected eye down for several days
Why is gas or oil used to reattach the retina?
a gas bubble, silicone oil or perfluorocarbon and liquids may be infected into the vitreous cavity to help push the sensory retina up.
After a retina attachement pt may ___________
- see flashes of light
- have blurred or “sooty” vision
- loss of vision, may see floaters
What is autonomic dysreflexia?
a state in which a pt with spinal cord injury at T7 or above experiences a life threatening uninhibited sympathetic response of the nervous system to noxious stimulus
Symptoms of autonomic dysreflexia (4 things):
- pounding headache
- profuse sweating
- nasal congestion
- hypertension
Autonomic dysreflexia is precipitated by __________
full bladder or bowel
What is the Glasgow coma scale?
a quantitative tool that is useful in testing consciousness in aging persons
Glasgow coma scale give a numerical value of (3 things):
- pt’s response in eye opening
- pt’s best verbal response
- pt’s best motor response
A score of 15 in the Glasgow coma scale represents _______
a fully alert and normal pt
A score of 7 or less in the Glasgow coma scale represents _________
pt is in a coma
For a pt with severe head injury/severe brain damage the glasgow score is ________
For a pt with moderate head injury, the glasgow score is
between 9 - 12
For a pt with mild head injury the glasgow score is
between 13 - 15
If a pt’s pupil is 2mm dilated and the other is 8 mm dilated, this is a sign of __________
a head injury and it demonstrates ICP and direct result from pressure on the affected oculomotor nerve
An unequal and dilated pupils indicates __________
brainstem damage
After a minor head injury, pt should have no________
strenuous activity for the next 48 hours
After a minor head injury, pt may have (3 things):
- dizziness for 24 hours
- complaints of nausea
- headaches, but not intense
After a minor head injury, pt should not (5 things):
- be vomiting; if vomiting occurs notify physician
- have blurred vision
- have no drainage from ear or nose
- slurred speech
- weakness
A decreased level of consciousness indicates ________
intracranial bleeding
1 things to know about a lumbar puncture:
- vital signs must be obtained; change in vital signs can indicate ICP
What position should a pt be in after a lumbar puncture?
remain supine position for 8 hours to prevent a headache and the leaking of CSF at the puncture site
__________ is a common side effect of the lumbar puncture.
Headache
During a lumbar puncture a child must be ________, to prevent trauma to the child during the procedure.
restraint
Early signs of ICP (4 things):
- Confusion
- Restlessness
- Papillary changes
- Alteres LOC
Nursing care for a pt that has ICP includes:
minimizing ICP; its are sensitive to sudden stimuli such as touching, jarring, loud noise and bright lights, which can all increase ICP
ICP can adversely affect _________
the cough and gag reflex and increase the possibility of aspiration
__________ and _________ can mask symptoms of ICP
drugs and alcohol
How should a pt be positioned if they have ICP?
pt’s head should not flex or rotate. Elevate the head of the bed to 30 degrees, pts neck should be in the midline position to increase venous return
If a pt has ICP, the nurse should avoid _________
frequent suctioning
________ and _____________ indicates an increase in ICP.
an increase in systolic pressure and a widening pulse pressure
Injuries at level T1 -T6 results in ___________
decrease respiratory reserve; pt should be fully dependent in self care and in wheelchair
___________ is a common problem in paraplegics.
UTI
____________ should be kept away from pts that have seizures.
a padded tongue blade
___________ decreases the chance of a seizure occurring.
Darkening a room
__________ stops seizures activity.
Diazepam (Valium)
If a pt has a seizure, the nurse should (4 things):
- protect the pt from injury
- provide oxygen
- establish an IV access
- loosen restrictive clothing
It is a good to make a seizure chart to identify seizure triggers, such as: (9 things)
- alcohol
- stress
- caffeine
- constipation
- loud noise
- music
- flickering lights
- prolonged reading
- drugs
Increase in seizure may occur during _________
menses
__________ and __________ checks the pt’s ability to swallow.
Glossopharyngeal and vagus nerves
If a pt has a concussion, there is nothing wrong with ________
waking up the pt from sleeping every 3 hours and orient them x3
_________ should never be given to a pt that has experienced a concussion.
Aspirin
_________ and ________ is encouraged if a pt has experienced a concussion.
resting and eating lightly
If a pt had a concussion, 6 symptoms require immediate attention:
- blurred vision
- double vision
- difficulty walking
- weakness
- numbness
- clumsiness
If a pt suffered a concussion, the pt should not be involved in any ___________
strenuous activities for at least 2 days
4 symptoms of Amyotrophic lateral sclerosis (ALS):
- difficulty swallowing and my aspirate
- fatigue while talking, tongue atrophy and weakness in the hands and arms
- fasciculation (twitching) of the face
- Does not cause changes in mental state
If a pt has amyotrophic lateral sclerosis, a pt retains control of _________ and ________.
bowel and bladder
Meningitis is caused by ____________ and __________
Haemophillus influenza and Neisseria meningitidis
Pt must be placed in what kind of precaution (for 24 hours) whether or not meningitis diagnosis is confirmed or not?
droplet
When can isolation be stopped for a pt with meningitis?
24 hours after the start of antibiotic therapy
