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N1180 > Neuro > Flashcards

Neuro Flashcards

1
Q

What is a Dermatome?

A
  • an area of skin that is mainly supplied by afferent nerve fibres from the dorsal root of any spinal nerve

*afferent nerve fibres - carry info from sensory receptors to CNS**

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2
Q

What is Paraesthesia?

A

“Pins and needles” sensation related to an injury

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3
Q

Presyncope VS. Syncope

A

Presyncope: sensation of almost fainting

Syncope: fainting

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4
Q

What is Diplopia?

A

Double Vision

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5
Q

What is Tinnitus?

A

Ringing in the Ear

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6
Q

Risk Factors Affecting the Neuro System

A

1) any risk factor that affects the cardiovascular system also puts the brain at an increased risk (esp risk for stroke)

Who is most Susceptible to Strokes?
- depends on risk factors

2) Risk factors we do Not control:
- age
- gender
- family history
- untreated heart disease
- atrial fibrillation

3) Risk Factors we DO Control
- smoking
- alcohol consumption
- controlling blood pressure
- lowering/managing cholesterol
- staying active
- improving diet
- controlling blood sugar

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7
Q

Signs of a Stroke:

A

B - balance; there is a sudden loss of balance

E - eyes; there is a sudden loss of vision

F - face; does the persons face look uneven/droop

A - arm; does 1 arm drift down

S - speech; is their speech strange (do they slurr words)

T - time; every 1 second, brain cells die

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8
Q

What are the 2 division of the Nervous System:

A

1) Central Nervous System
2) Peripheral Nervous System

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9
Q

What does the CNS consist of:

A

1) Brain
2) Spinal Cord

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10
Q

What are the divisions of the Parasympathetic Nervous System?

A

1) Sensory/ Afferent (to CNS)
- from sensory input → the brain

2) Motor/Efferent
- from brain → whatever it is controlling (ie. organs, muscles)

  1. Somatic Nervous System
    - conscious mind is involved (ie. deliberate action)
  2. Autonomic Nervous System
    - activity is automatic

1) Sympathetic Division - fight or flight (emergency resonse)
(ie. actions that help to escape danger)

2) Parasympathetic Division - rest and digest (maintenace)
(ie. digestion of food)

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11
Q

What are Cranial Nerves?

A
  • Pairs of nerves that connect our brain to different parts of our head, neck, and trunk
    (nerves originating from brain/brain stem)
  • each cranial nerve is present on both sides of the body
  • there are 12: each names for structure and function
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12
Q

Cranial Nerve II

A

Optic; Sensory
- responsible for vision

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13
Q

Cranial Nerve III

A

Oculomotor; Motor
- eye movement and pupil reflex

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14
Q

Cranial Nerve VII (7)

A

Facial; Sensory + Motor
- face movement and taste

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15
Q

Cranial Nerve IX (9)

A

Glossopharyngeal; Sensory + Motor
- throat sensation, taste, swallowing

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16
Q

Cranial Nerve X (10)

A

Vagus; Sensory + Motor
- movement, sensation, and abdominal organs

17
Q

What are Spinal Nerves?

A
  • come from the spinal cord and serve the rest of the body
  • there are 31 pairs of spinal nerves:
    8 Cervical
    12 Thoracic
    5 Lumbar
    5 Sacral
    1 Coccygeal
  • each pair innervates a specific region of the body
    (innervation to regions = dermatomes)
18
Q

What is a spinal cord injury?

A
  • damage to any part of the spinal cord or nerves at the end of the spinal canal
  • causes permanent changes in strength, sensation, and other body functions
  • injury to the spinal cord affects function at and below the site of trauma
    (ex. patient with an injury at T6 has arm movement/sensation, but no leg movement/sensation)
19
Q

What should be the 1st thing you ask when doing an assessment? (Presenting Complaint)

A
  • Ask what the reason for presenting was

Common neurological presenting complaints:
- headaches
- seizures
- presyncope/ syncope
- muscular symptoms; weakness, tremor, spasm
- peripheral sensory symptoms - numbness, paraesthesia
- visual changes - blurring, diplopia
- Hearing changes - hearing loss, tinnitus
- Vertigo
- instability/loss of balance

20
Q

Q’s to ask following a single episode of a: seizure, headache, pre-syncope/syncope (to narrow down diagnosis)

A

Before episode: palpitations, light-headedness, visual changes

During Episode: length of episode, loss of consciousness, tongue biting, eye movement

After Episode: focal limb weakness, confusion, fatigue

21
Q

Patterns of Events Over time

A
  • if it has happened before, try to understand history of the episodes
  • when was the 1st event, when was the most recent event, what is the frequency, are they normal between events?
22
Q

Circumstances

A
  • ask what brings on the episodes
  • ex. changes in position, trauma, whether they happen at day/night, was patient indoors/outdoors
23
Q

Past Medical and Family History

A
  • ask of patient has been diagnosed with medical condition
  • ask if any relatives have neurological disorders

If so, ask about these conditions:
- ischemic stroke (brain tissue death)
- hemmorage stroke (brain bleed)
- epilepsy
- migraines
- brain injury/tumour
- concussion
- alzheimers
- parkinsons
- nerve injury
- congenital diorders (ie. spina bifida)

24
Q

Social History

A
  • ask about a patients social situation
    ex. where do they work, living situation, mobility, ability to perform ADL’s, diet, exercise
25
Q

Substance History

A

ASK about:
1) Smoking history
- how many yrs patient smokes, how many smoked per day, and how long since quitting

2) Alcohol intake
- how many drinks patient has per week, type of drinks

3) Recreational drug use
- any intravenous drug use

26
Q

What are the 6 Components of a Neuro Assessment?

A

1) Vital Signs
2) Level of Consciousness using Glasgow Coma Scale
3) Cranial Nerves (2,3,7,9,10)
4) Speech
5) Strength Testing
6) Cerebellar Function

27
Q

What do Vital Signs tell us about Neuro status?

A

Intracranial Pressures causes the following vital signs:
- ↓ pulse
- ↓ respirations
- ↓ oxygen saturation level
- ↑ blood pressure
- widening pulse pressure

Clinical Signs that indicate
↑ ICP include:
- headache
- altered loss of consciousness
- altered cognition (including confusion)
- vomiting (without nausea)
- changes in vision
- changes to pupillary response
- unresponsiveness
- seizure activity

28
Q

What does the Glasgow Coma Scale tell us about neuro assessment?

A
  • an assessment for a patient with impaired consciousness by evluating behavioural responses in 3 areas:
    1) eye opening
    2) verbal response
    3) motor response

Each category is added
- best score = 15
minimum score (death) = 3

29
Q

Eye Opening Response

A

Spontaneously - 4
To speech - 3
To pain - 2
No response - 1

30
Q

Verbal Response

A

Oriented to person, place, time - 5
Confused - 4
Inappropriate words - 3
Incomprehensible Sounds - 2
No response - 1

31
Q

Motor Response

A

Obeys commands - 6
Moves to pain - 5
Flexion withdrawal from pain - 4
Abnormal flexion - 3
Abnormal Extension - 2
No response - 1

32
Q

CN II + CN III - Pupillary Response

A

CN II - senses the incoming light

CN III - controls muscles that restrict

Direct Light Reflex: behaviour of pupil when shining light
Consensual Light Reflex: behaviour of pupil when light is not shining

How to perform:
- hold light over right eye and assess pupil constriction (do same to left)
- hold right over RIGHT eye and assess pupil constriction of LEFT eye) same to other side)

33
Q

CN 7

A
  • responsible for facial movement

Can be tested by making patient perform facial movements:
1. Raise eyebrows
2. Frown
3. Eye clenching (close tight)
4. Show teeth
5. Smiling
6. Puffing cheeks out

** assess symmetry of the movements**

  • sensory component of facial nerve is responsible for taste in anterior 2/3 of tongue (we do not assess this)
34
Q

CN 9 + CN 10

A
  • assessing patients ability to swallow

How:
- depress tongue and note pharyngeal movement as they say “ahhh” (uvula raises)

  • sensory component of glossopharyngeal nerve is responsive for taste in posterior 1/3 of tongue which is NOT assessed
35
Q

What does Speech tell us about neuro status?

A
  • tells us if patient has aphasia
    Aphasia: acquired neurological language disorder resulting from injury to the brain (left hemisphere usually) that effects speech functioning

Aphasia involves impairment in 4 areas:
1) spoken language
2) written language
3) spoken comprehension
4) reading comprehension

36
Q

What are the 2 types of aphasia:

A

1) Expressive Aphasia (Brocas)
- affects Broca’s area of brain (frontal lobe)
- patients understand language BUT can not express/form words

How to assess:
- ask patient to identify and describe purpose of 3 objects

2) Receptive Aphasia (Wernicks)
- affects Wernicks area of brain (temporal lobe)
- patients have poor comprehension, but speech is fine

How to assess:
- ask patient 3 random actions to do without cues
ex. Point to ceiling, Touch your nose, ask a question

37
Q

Testing strength

A
  • ask patient to lift each limb off bed (to see how they manage against gravity)
  • ask patient to counter your pressure to determine how they manage against resistance
  • compare each side
38
Q

What is Proprioception?

A

Proprioception (kinethesia) - the body’s ability to sense it location, movements, and actions
- the reason we are able to move freely without consciously thinking about our environment’s
- nurses assess for proprioception by testing cerebellar function

39
Q

Cerebellar Function Tests

A

1) Gait
- ask patient to walk in straight line
- Tandem walking: ask patient to walk forward by placing 1 heel directly in front of the other toe
Ataxia - wide-based, unsteady, and staggering gait (typical of cerebellar disorder)

2) Finger to nose test
- tell patient to extend arm and touch tip of nose (repeat)
Dysmetria: if unable to put finger on tip of nose precisely
Intention Tremor: hand tremor that increases as hands moves toward nose
- dysmetria and tremor are sigs of cerebellar dysfunction

3) Finger to finger test
- patient holds finger at full reach and alternately touches noses and your finger (repeat)
- move your finger to determine accuracy and smoothness of movement

4) Rapid Alternative Movements
- place 1 hand over the other and flip top hand back and forth as quick as possible
- observe accuracy, speed, smoothness
Dysdiadochokinesia - inability to do this

5) Heel to shine Test
- place heel on opposite patella and slide heel down shin and back up to knee
Dysmetria: unable to control the movement accurately

6) Pronator Drift
- patient closes eyes and outstretches arms with palms facing up and holds for 20 seconds
Positive Pronator Drift: arm begins to drift downwards
- a sign of upper motor neuron disease (ie. stroke)

7) Romberg Test
- stand with feet together and arms at sides for 20 seconds while closing eyes
- observe for swaying or inability to maintain position with eyes closed

N1180 (13 decks)

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