Neuro Flashcards
function of cerebellum
balance & coordination
coordinate muscle movements
what “3 functions” is cerebellum responsible for
ABC
A: agility - control direction of body rapidly
B: balance - maintain equilibrium
C: coordination - smoothness of activity in combination of muscles with appropriate intensity & timing
what is a part of the brainstem
midbrain, pons, medulla
function of midbrain
relays visual & hearing information
function of pons
unconsiousness regulation such as sleep wake cycle
function of medulla
- regulate breathing, heart rhythms/contraction force, BP, swallowing
- non-vital: involuntary sneezing/coughing, chewing, swallowing, salivating, yawning, tears
Left vs. Right brain hemisphere function
Left for Logic: speech, comprehension, arithmetic, writing
Right: creativity, spatial ability, artistic/musical
right brain stroke could affect what
- confused with date, time, place
- left side neglect
- denial about limitations
- impulsive, short attention span
vision issues, quick & inquisitive behavior
left brain stroke could affect what
- agraphia, aphasia
- aware of limitations
- impaired math skills
- depression/anger
- cautious
- no deficit in memory
speech/language issues, slow & cautious behavior
function of cingulate gyrus
above the corpus callosum (connects the brain)
for regulating emotions and pain, behavioral response to stimuli (predicting and avoiding negative consequences)
frontal lobe functions
motor control
problem solving
concentration
planning & organizing
speech production (Broca’s area - left frontal lobe)
temporal lobe functions
auditory processing/interpret smell
language comprehension (Wernicke’s area)
memory/info retrieval
damage to temporal lobe leads to
visual changes
forgetting memories
balance issues
hallucinations
parietal lobe functions
think “PIRANHA” is biting making your hand sensitive
touch perception - interpret touch, pain, temp, taste
body orientation/sensory discrimination
occipital lobe functions
sight, visual reception and interpretation
what does the limbic system include & its function
amygdala, hippocampus, thalamus, hypothalamus, basal ganglia, cingulate gyrus
function: process & regulate emotions, formation and retrieval of memories
function of basal ganglia & what happens when it’s damaged
functions: fine motor activity, learning, emotion (addiction, reward, habits)
damage leads to issues controlling speech, movement, and posture
function of thalamus
relays all sensory info except for smell to cerebral cortex (outer parts of brain)
maintain reticular activating system (RAS)
neurohypophysis means what
posterior pituitary gland
function of hypothalamus
- ANS switchboard
- sympathetic & parasympathetic regulation
- maintains homeostasis - sleep, body temp, thirst, appetite, behavior
- sends signal to neurohypophysis to secrete ADH & oxycotin
what is ADH & oxycotin
ADH (vasopressin): holds more fluid
Oxycotin: uterine contractions during birth & milk injection for breastfeeding
reticular activating system (RAS) function
- nerves & connections in superior brainstem
- modulate attention & arousal
- regulate wakefulness, arousal, sleep
what does middle and posterior cerebral arteries nourish
middle: frontal, parietal, superior temporal
posterior: occipital, inferior temporal
what arteries makeup the circle of willis
L&R internal carotid and vertebral arteries
what can not pass the blood brain barrier
large proteins, ionized molecules, polarized molecules, water-soluble molecules - BBB helps maintain homeostasis
lipid solubles such as barbituates can pass
under what conditions can break the BBB
- HTN
- not fully developed at birth
- hyperosmolality (high conc)
- exposure to microwaves, radiation
- infections
- trauma, injuries, inflammation, ischemia, pressure
neuro changes in elderly
- decreased cerebral flow, decreased brain metabolism
- changes in temp
- decreased motor response reflexes
- change in taste buds
- nerve cells send msgs slower
- build up of waste & nerves breakdown (fatty brown pigment lipofuscin build up)
- brain can lose up to 10% weight
changes in visual in elderly
lens stiffen and lose water changes ability to focus
smaller pupils means less light reaches retina
Orientation ask in order
time -> place -> person
4 word recall: new learning test
4 words in 10 mins, 3 words in 30 mins typically
impaired in depression, anxiety, Alzheimer’s
judgement test
“what are your plans for the future”
what part of the brain damage leads to neurologic anosmia
loss of smell due to damage to frontal lobe olfactory bulb or anterior temporal lobe
testing the olfactory nerve 1
close one nare and sniff, use diff smell for each nare
testing the oculomotor nerve 3
light reflex and eye moving up
testing the trochlear & abducens 4,6 nerves
eye turn directions
testing trigeminal nerve 5
cotton ball on face
palpate jaws/temples while pt clenches teeth
testing facial nerve 7
frown, close eyes, lift eyebrows, puff cheeks
taste
testing glossopharyngeal/vagus nerves 9 & 10
ahh
yawn
testing accessory nerve 11
rotate head, shrug
testing hypoglossal nerve 12
tongue control
“l, t, d, n” sounds
testing motor response and 0-5 scale
- pronator drift
- balance/coordination
- pushing/pulling against resistance
0 - no movement
1 - slight movement
2 - can move but not lift
3 - raise but not against resistance
4 - full ROM, less than normal strength
5 - full ROM, full strength
how to do sternal rub on an unconscious patient
rub sternum with closed fist’s knuckle
more accurate than peripheral stimulation
what to check for lumbar puncture
CSF should be clear
milky white indicates infection - meningitis, encephalitis
lumbar puncture procedure
L3 - L5 into subarachnoid space
empty bladder
lateral recumbent position w/ knees flexed
aseptic technique, encourage fluids, neuro checks
normal intracranial pressure mmHg
5 - 15mmHg
more than 20 is abnormal and raise head of bed
tonic-clonic (grand mal) seizure
stiffness than muscle jerk
scream, loss of bowel/bladder control
no memory, muscle weakness, headache
absence (petit mal) seizure
rapid blinking/staring into space
clonic seizure
rhythmic jerk
atonic seizure
sudden loss of muscle strength
myoclonic seizure
short jerks shorter than clonic seizures
what type of pts should be placed on seizure precautions
- high fever
- hyper/hypoglycemia
- hypoxemia
- massive sleep deprivation
- meningitis, encephalitis, infections
- drug withdrawal: alcohol, benzodiazepines
- brain tumor
- drug use: cocaine
- maternal drug use
- brain injury
- stroke
3 phases of seizures
1) prodromal (aural): feelings, sensations, change in behavior hours or days before seizure [aura counts as part of seizure]
2) Ictal: 1st symptom to end of seizure
3) postictal phase: recovery period
nursing intervention post ictal phase
- assess LOC, neuro status, PERRLA, motor strength, sensation
- document cause of seizure
what is status epilepticus
seizures longer than 5 mins or having more than 1 seizure within 5 mins
may lead to hyperpyrexia (high fever) , into coma, permanent brain damage or death
how does seizure affect metabolic activity, O2
increased metabolic activity where the brain uses up more glucose
decreased O2
anticipated drugs for seizures
- phenobarbital
- phenytoin
- benzodiazepines: diazepam, lorazepam
SL (lorazepam)Ativan, (midazolam)Midaz, IV Diazepam/IV Ativan (first line), IV phenytoin
dysarthria
slowed or slurred speech that’s difficult to understand
S/S of TIA
- temp loss of vision / double vision
- tinnitus, vertigo, dizziness
- loss of balance
- dysarthria
- dysphagia
- unilateral/bilateral weakness of face, arm, or leg
- hypertension
- hyperglycemia
- increased ICP
Labs and tests post and treatment for TIA
- head CT -> carotid doppler ultrasound
- magnetic resonance angiography (MRA), computed tomography angiography (CTA)
- treatment: endarterectomy (plaque removal), angioplasty with or without stent, oral antiplatelets (aspirin, plavix (clopidogrel), coumadin if afib, ticlopidine hydrochloride, aggrenox)
Diagnostics and treatment tests/imaging etc.
- blood glucose (high glucose can worsen severity)
- CT scan, EKG
- carotid doppler
- coagulation studies - PT, aPTT, INR
- TEE (transesophageal echocardiogram)
- carotid endarterectomy to remove plaque in carotid arteries
what does CVA or brain attack mean
sudden death of brain cells in localized area due to lack of blood flow
2 main types of CVA
ischemia
hemorrhagic
2 types of ischemia stroke
thrombotic (blood clot)
embolic (blood clot from heart or large arteries of upper chest & neck)
top 2 causes of ischemia stroke
atherosclerosis
A.fib
changes in vitals due to ischemic stroke
- elevated BP (give fluids)
- hyperglycemia
- elevated ICP
2 types of hemorrhagic stroke
- intracerebral: sudden blood burst in brain
- subarachnoid: between brain and tissues covering brain where cerebrospinal fluid circulates that supposed to protect brain & cushion
S/S of intracerebral vs. hemorrhagic stroke
intracerebral: headache, weakness, confusion, paralysis in one side, N&V, focal deficits
subarachnoid: coma, paralysis, death
2 main causes of hemorrhagic stroke
- weakened vessel that ruptures
- head trauma
2 main causes of weakened vessels that ruptures leading to hemorrhagic stroke
1) aneurysms: ballooning of weakened region of blood vessel that rupture
2) arteriovenous malformation (AVM): cluster of abnormally formed blood vessels and any could rupture
what does BE FAST stands for
B: balance
E: eyes
F: face
A: arms
S: speech
T: time
how long do you have to give anticoagulants to a stroke pt
3-4 hrs
which anticoagulants are given to stroke pts
warfarin
dabigatrin
rixaroxiban
apixaban
enoxaparin
Broca’s area damage leads to
expressive aphasia
speech is capable but content wrong
Wernicke’s area damage leads to
receptive aphasia
sound/speech meaning not understood
agnosia
can’t process sensory info; can’t identify
typically due to left sided stroke
agraphia
inability to write
apraxia
can’t do voluntary muscle movements even with muscles intact
typically damage to cortex
dysarthria
difficulty speaking due to muscle issues
speech hard to understand and slurred
aphasia
inability to understand or verbalize speech
hemianopsia
decreased vision with blindness in 1/2 field
damage to left affects right side etc.
homonymous hemianopsia
loss of 1/2 visual field in both sides
neglect syndrome
hemispatial neglect: normal vision but neglects one side
where does brain damage occur typically leads to neglect syndrome
right parietal lobe damage
what is tPA used for and when can you give/not give
only for ischemic CVA and within 3 hours
bladder training for post stroke pts
adequate fluids
toilet q2hrs
watch for signs of restlessness
partial (focal) seizure: simple & complex
simple: fully conscious w/ jerks
complex: impaired or full LOC with lip smacking, biting, picking - staring off
cause of a seizure
abnormal electrical activity or chemical changes
- altered ions: Na, K, Ca
- altered release of neurotransmitters
treatment for status epilepticus
IV or rectal benzodiazepine, lorazepam, or diazepam
Triggers for seizures
- sleep deprivation
- stress
- stimulants
- sugar or sodium low
- strobe lights
preparations for EEG
“egg head”
- no caffeine 10-24hrs
- no sleep
- no seizure meds
- can eat prior to test
phenytoin adverse effects & signs of toxicity
suicidal ideation
skin rash (stevens johnson syndrome)
toxic s/s
- ataxia
- hand tremor
- slurred speech
nursing teaching for phenytoin
- no oral contraceptives, or warfarin
- take folic acid (vit. B9, Ca, vit D)
- don’t stop abruptly
expected side effects phenytoin
- bradycardia, hypotension
- gingival hyperplasia - bleed -> good dental & soft toothbrush
nurse teaching for levetiracetam (Keppra)
watch for drowsiness and fatigue when taking
has similar side effects as phenytoin
1 risk for stroke
HTN over 140 systolic
BP needs to be dropped slowly
dress which side first for stroke pts
dress weaker side first
transfer which side for stroke pts
transfer strong side 1st
feeding post stroke pts
- NPO until swallow screen
- “flex neck” chin to neck
- avoid sedation before meals
- puree diet first
higher NIH stroke scale score means
0-42
21-42 is severe stroke symptoms
contraindications for tPA
- severe uncontrolled HTN above 185/110
- recent MI within past 3 months
- not for heparin in past 48hrs typically w/ elevated aPTT
tPA is also known as
alteplase
GFR
90-120
albumin
3.4 - 5.4
what is considered epilepsy
- at least 2 unprovoked seizures occurring greater than 24hours apart
treatment for epilepsy
- antiseizure meds
- surgery for partial epilepsy
- corpus callosotomy
- implanted devices
- ketogenic diet
common meds for epilepsy
- benzodiazepines (Ativan, Midaz)
- AEDs (valproic acid, gabapentin, clonazepam, vigabatrin, Keppra)
- phenytoin (Dilantin)
- phenobarbital
what’s ketogenic diet
- very high fat, low carbs
fat converts to ketones
2-10yrs - fasting - CBGs (capillary bg), dehydration, N&V, urine dips
recognizing a seizure
- stiffening, jerking
- facial expression change
- tachycardia, elevated BP
- ocular deviation
- impaired responsiveness
S/S of increased ICP
- change in LOC
- double vision, DILATED pupils/unequal
- positive Babinski reflex
- headache, vomiting WITHOUT nausea
- weakness or hemiplegia from altered motor fxn
late signs:
- irregular breathing (Cheyne stokes)
- unconscious
- cushings triad (increase systolic BP, decreased HR/RR
subjective signs of meningitis
- painful headache
- nuchal rigidity (stiff neck)
- photophobia
objective signs of meningitis
- fever
- N&V
- ALOC
- hyperactive deep tendon reflexes
- tachycardia
- seizures
- restlessness, irritability
complications with meningitis
- increased ICP - elevate bed, avoid cough/sneeze
- too much ADH (SIADH) - limit water intake
- septic emboli
