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NURS122 > Neuro > Flashcards

Neuro Flashcards

1
Q

function of cerebellum

A

balance & coordination
coordinate muscle movements

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2
Q

what “3 functions” is cerebellum responsible for

A

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

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3
Q

what is a part of the brainstem

A

midbrain, pons, medulla

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4
Q

function of midbrain

A

relays visual & hearing information

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5
Q

function of pons

A

unconsiousness regulation such as sleep wake cycle

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6
Q

function of medulla

A
  • regulate breathing, heart rhythms/contraction force, BP, swallowing
  • non-vital: involuntary sneezing/coughing, chewing, swallowing, salivating, yawning, tears
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7
Q

Left vs. Right brain hemisphere function

A

Left for Logic: speech, comprehension, arithmetic, writing
Right: creativity, spatial ability, artistic/musical

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8
Q

right brain stroke could affect what

A
  • confused with date, time, place
  • left side neglect
  • denial about limitations
  • impulsive, short attention span
    vision issues, quick & inquisitive behavior
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9
Q

left brain stroke could affect what

A
  • agraphia, aphasia
  • aware of limitations
  • impaired math skills
  • depression/anger
  • cautious
  • no deficit in memory
    speech/language issues, slow & cautious behavior
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10
Q

function of cingulate gyrus

A

above the corpus callosum (connects the brain)
for regulating emotions and pain, behavioral response to stimuli (predicting and avoiding negative consequences)

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11
Q

frontal lobe functions

A

motor control
problem solving
concentration
planning & organizing
speech production (Broca’s area - left frontal lobe)

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12
Q

temporal lobe functions

A

auditory processing/interpret smell
language comprehension (Wernicke’s area)
memory/info retrieval

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13
Q

damage to temporal lobe leads to

A

visual changes
forgetting memories
balance issues
hallucinations

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14
Q

parietal lobe functions

A

think “PIRANHA” is biting making your hand sensitive
touch perception - interpret touch, pain, temp, taste
body orientation/sensory discrimination

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15
Q

occipital lobe functions

A

sight, visual reception and interpretation

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16
Q

what does the limbic system include & its function

A

amygdala, hippocampus, thalamus, hypothalamus, basal ganglia, cingulate gyrus
function: process & regulate emotions, formation and retrieval of memories

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17
Q

function of basal ganglia & what happens when it’s damaged

A

functions: fine motor activity, learning, emotion (addiction, reward, habits)
damage leads to issues controlling speech, movement, and posture

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18
Q

function of thalamus

A

relays all sensory info except for smell to cerebral cortex (outer parts of brain)
maintain reticular activating system (RAS)

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19
Q

neurohypophysis means what

A

posterior pituitary gland

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20
Q

function of hypothalamus

A
  • ANS switchboard
  • sympathetic & parasympathetic regulation
  • maintains homeostasis - sleep, body temp, thirst, appetite, behavior
  • sends signal to neurohypophysis to secrete ADH & oxycotin
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21
Q

what is ADH & oxycotin

A

ADH (vasopressin): holds more fluid
Oxycotin: uterine contractions during birth & milk injection for breastfeeding

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22
Q

reticular activating system (RAS) function

A
  • nerves & connections in superior brainstem
  • modulate attention & arousal
  • regulate wakefulness, arousal, sleep
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23
Q

what does middle and posterior cerebral arteries nourish

A

middle: frontal, parietal, superior temporal
posterior: occipital, inferior temporal

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24
Q

what arteries makeup the circle of willis

A

L&R internal carotid and vertebral arteries

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25
Q

what can not pass the blood brain barrier

A

large proteins, ionized molecules, polarized molecules, water-soluble molecules - BBB helps maintain homeostasis

lipid solubles such as barbituates can pass

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26
Q

under what conditions can break the BBB

A
  • HTN
  • not fully developed at birth
  • hyperosmolality (high conc)
  • exposure to microwaves, radiation
  • infections
  • trauma, injuries, inflammation, ischemia, pressure
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27
Q

neuro changes in elderly

A
  • 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
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28
Q

changes in visual in elderly

A

lens stiffen and lose water changes ability to focus
smaller pupils means less light reaches retina

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29
Q

Orientation ask in order

A

time -> place -> person

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30
Q

4 word recall: new learning test

A

4 words in 10 mins, 3 words in 30 mins typically
impaired in depression, anxiety, Alzheimer’s

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31
Q

judgement test

A

“what are your plans for the future”

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32
Q

what part of the brain damage leads to neurologic anosmia

A

loss of smell due to damage to frontal lobe olfactory bulb or anterior temporal lobe

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33
Q

testing the olfactory nerve 1

A

close one nare and sniff, use diff smell for each nare

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34
Q

testing the oculomotor nerve 3

A

light reflex and eye moving up

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35
Q

testing the trochlear & abducens 4,6 nerves

A

eye turn directions

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36
Q

testing trigeminal nerve 5

A

cotton ball on face
palpate jaws/temples while pt clenches teeth

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37
Q

testing facial nerve 7

A

frown, close eyes, lift eyebrows, puff cheeks
taste

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38
Q

testing glossopharyngeal/vagus nerves 9 & 10

A

ahh
yawn

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39
Q

testing accessory nerve 11

A

rotate head, shrug

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40
Q

testing hypoglossal nerve 12

A

tongue control
“l, t, d, n” sounds

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41
Q

testing motor response and 0-5 scale

A
  • 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

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42
Q

how to do sternal rub on an unconscious patient

A

rub sternum with closed fist’s knuckle
more accurate than peripheral stimulation

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43
Q

what to check for lumbar puncture

A

CSF should be clear
milky white indicates infection - meningitis, encephalitis

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44
Q

lumbar puncture procedure

A

L3 - L5 into subarachnoid space
empty bladder
lateral recumbent position w/ knees flexed
aseptic technique, encourage fluids, neuro checks

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45
Q

normal intracranial pressure mmHg

A

5 - 15mmHg
more than 20 is abnormal and raise head of bed

46
Q

tonic-clonic (grand mal) seizure

A

stiffness than muscle jerk
scream, loss of bowel/bladder control
no memory, muscle weakness, headache

47
Q

absence (petit mal) seizure

A

rapid blinking/staring into space

48
Q

clonic seizure

A

rhythmic jerk

49
Q

atonic seizure

A

sudden loss of muscle strength

50
Q

myoclonic seizure

A

short jerks shorter than clonic seizures

51
Q

what type of pts should be placed on seizure precautions

A
  • 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
52
Q

3 phases of seizures

A

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

53
Q

nursing intervention post ictal phase

A
  • assess LOC, neuro status, PERRLA, motor strength, sensation
  • document cause of seizure
54
Q

what is status epilepticus

A

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

55
Q

how does seizure affect metabolic activity, O2

A

increased metabolic activity where the brain uses up more glucose

decreased O2

56
Q

anticipated drugs for seizures

A
  • phenobarbital
  • phenytoin
  • benzodiazepines: diazepam, lorazepam

SL (lorazepam)Ativan, (midazolam)Midaz, IV Diazepam/IV Ativan (first line), IV phenytoin

57
Q

dysarthria

A

slowed or slurred speech that’s difficult to understand

58
Q

S/S of TIA

A
  • 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
59
Q

Labs and tests post and treatment for TIA

A
  • 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)
60
Q

Diagnostics and treatment tests/imaging etc.

A
  • 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
61
Q

what does CVA or brain attack mean

A

sudden death of brain cells in localized area due to lack of blood flow

62
Q

2 main types of CVA

A

ischemia
hemorrhagic

63
Q

2 types of ischemia stroke

A

thrombotic (blood clot)
embolic (blood clot from heart or large arteries of upper chest & neck)

64
Q

top 2 causes of ischemia stroke

A

atherosclerosis
A.fib

65
Q

changes in vitals due to ischemic stroke

A
  • elevated BP (give fluids)
  • hyperglycemia
  • elevated ICP
66
Q

2 types of hemorrhagic stroke

A
  • intracerebral: sudden blood burst in brain
  • subarachnoid: between brain and tissues covering brain where cerebrospinal fluid circulates that supposed to protect brain & cushion
67
Q

S/S of intracerebral vs. hemorrhagic stroke

A

intracerebral: headache, weakness, confusion, paralysis in one side, N&V, focal deficits
subarachnoid: coma, paralysis, death

68
Q

2 main causes of hemorrhagic stroke

A
  • weakened vessel that ruptures
  • head trauma
69
Q

2 main causes of weakened vessels that ruptures leading to hemorrhagic stroke

A

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

70
Q

what does BE FAST stands for

A

B: balance
E: eyes

F: face
A: arms
S: speech
T: time

71
Q

how long do you have to give anticoagulants to a stroke pt

A

3-4 hrs

72
Q

which anticoagulants are given to stroke pts

A

warfarin
dabigatrin
rixaroxiban
apixaban
enoxaparin

73
Q

Broca’s area damage leads to

A

expressive aphasia
speech is capable but content wrong

74
Q

Wernicke’s area damage leads to

A

receptive aphasia
sound/speech meaning not understood

75
Q

agnosia

A

can’t process sensory info; can’t identify
typically due to left sided stroke

76
Q

agraphia

A

inability to write

77
Q

apraxia

A

can’t do voluntary muscle movements even with muscles intact
typically damage to cortex

78
Q

dysarthria

A

difficulty speaking due to muscle issues
speech hard to understand and slurred

79
Q

aphasia

A

inability to understand or verbalize speech

80
Q

hemianopsia

A

decreased vision with blindness in 1/2 field
damage to left affects right side etc.

81
Q

homonymous hemianopsia

A

loss of 1/2 visual field in both sides

82
Q

neglect syndrome

A

hemispatial neglect: normal vision but neglects one side

83
Q

where does brain damage occur typically leads to neglect syndrome

A

right parietal lobe damage

84
Q

what is tPA used for and when can you give/not give

A

only for ischemic CVA and within 3 hours

85
Q

bladder training for post stroke pts

A

adequate fluids
toilet q2hrs
watch for signs of restlessness

86
Q

partial (focal) seizure: simple & complex

A

simple: fully conscious w/ jerks
complex: impaired or full LOC with lip smacking, biting, picking - staring off

87
Q

cause of a seizure

A

abnormal electrical activity or chemical changes
- altered ions: Na, K, Ca
- altered release of neurotransmitters

88
Q

treatment for status epilepticus

A

IV or rectal benzodiazepine, lorazepam, or diazepam

89
Q

Triggers for seizures

A
  • sleep deprivation
  • stress
  • stimulants
  • sugar or sodium low
  • strobe lights
90
Q

preparations for EEG

A

“egg head”
- no caffeine 10-24hrs
- no sleep
- no seizure meds
- can eat prior to test

91
Q

phenytoin adverse effects & signs of toxicity

A

suicidal ideation
skin rash (stevens johnson syndrome)

toxic s/s
- ataxia
- hand tremor
- slurred speech

92
Q

nursing teaching for phenytoin

A
  • no oral contraceptives, or warfarin
  • take folic acid (vit. B9, Ca, vit D)
  • don’t stop abruptly
93
Q

expected side effects phenytoin

A
  • bradycardia, hypotension
  • gingival hyperplasia - bleed -> good dental & soft toothbrush
94
Q

nurse teaching for levetiracetam (Keppra)

A

watch for drowsiness and fatigue when taking
has similar side effects as phenytoin

95
Q

1 risk for stroke

A

HTN over 140 systolic
BP needs to be dropped slowly

96
Q

dress which side first for stroke pts

A

dress weaker side first

97
Q

transfer which side for stroke pts

A

transfer strong side 1st

98
Q

feeding post stroke pts

A
  • NPO until swallow screen
  • “flex neck” chin to neck
  • avoid sedation before meals
  • puree diet first
99
Q

higher NIH stroke scale score means

A

0-42
21-42 is severe stroke symptoms

100
Q

contraindications for tPA

A
  • severe uncontrolled HTN above 185/110
  • recent MI within past 3 months
  • not for heparin in past 48hrs typically w/ elevated aPTT
101
Q

tPA is also known as

A

alteplase

102
Q

GFR

A

90-120

103
Q

albumin

A

3.4 - 5.4

104
Q

what is considered epilepsy

A
  • at least 2 unprovoked seizures occurring greater than 24hours apart
105
Q

treatment for epilepsy

A
  • antiseizure meds
  • surgery for partial epilepsy
  • corpus callosotomy
  • implanted devices
  • ketogenic diet
106
Q

common meds for epilepsy

A
  • benzodiazepines (Ativan, Midaz)
  • AEDs (valproic acid, gabapentin, clonazepam, vigabatrin, Keppra)
  • phenytoin (Dilantin)
  • phenobarbital
107
Q

what’s ketogenic diet

A
  • very high fat, low carbs
    fat converts to ketones
    2-10yrs
  • fasting - CBGs (capillary bg), dehydration, N&V, urine dips
108
Q

recognizing a seizure

A
  • stiffening, jerking
  • facial expression change
  • tachycardia, elevated BP
  • ocular deviation
  • impaired responsiveness
109
Q

S/S of increased ICP

A
  • 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

110
Q

subjective signs of meningitis

A
  • painful headache
  • nuchal rigidity (stiff neck)
  • photophobia
111
Q

objective signs of meningitis

A
  • fever
  • N&V
  • ALOC
  • hyperactive deep tendon reflexes
  • tachycardia
  • seizures
  • restlessness, irritability
112
Q

complications with meningitis

A
  • increased ICP - elevate bed, avoid cough/sneeze
  • too much ADH (SIADH) - limit water intake
  • septic emboli

NURS122 (28 decks)

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