Neuro

Question 1

What is a Dermatome?

Answer 1

• 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**

Question 2

What is Paraesthesia?

Answer 2

“Pins and needles” sensation related to an injury

Question 3

Presyncope VS. Syncope

Answer 3

Presyncope: sensation of almost fainting

Syncope: fainting

Question 4

What is Diplopia?

Answer 4

Double Vision

Question 5

What is Tinnitus?

Answer 5

Ringing in the Ear

Question 6

Risk Factors Affecting the Neuro System

Answer 6

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

Question 7

Signs of a Stroke:

Answer 7

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

Question 8

What are the 2 division of the Nervous System:

Answer 8

1) Central Nervous System
2) Peripheral Nervous System

Question 9

What does the CNS consist of:

Answer 9

1) Brain
2) Spinal Cord

Question 10

What are the divisions of the Parasympathetic Nervous System?

Answer 10

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)

Question 11

What are Cranial Nerves?

Answer 11

• 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

Question 12

Cranial Nerve II

Answer 12

Optic; Sensory
- responsible for vision

Question 13

Cranial Nerve III

Answer 13

Oculomotor; Motor
- eye movement and pupil reflex

Question 14

Cranial Nerve VII (7)

Answer 14

Facial; Sensory + Motor
- face movement and taste

Question 15

Cranial Nerve IX (9)

Answer 15

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

Question 16

Cranial Nerve X (10)

Answer 16

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

Question 17

What are Spinal Nerves?

Answer 17

• 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)

Question 18

What is a spinal cord injury?

Answer 18

• 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)

Question 19

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

Answer 19

• 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

Question 20

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

Answer 20

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

Question 21

Patterns of Events Over time

Answer 21

• 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?

Question 22

Circumstances

Answer 22

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

Question 23

Past Medical and Family History

Answer 23

• 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)

Question 24

Social History

Answer 24

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

Question 25

Substance History

Answer 25

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

Question 26

What are the 6 Components of a Neuro Assessment?

Answer 26

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

Question 27

What do Vital Signs tell us about Neuro status?

Answer 27

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

Question 28

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

Answer 28

- 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

Question 29

Eye Opening Response

Answer 29

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

Question 30

Verbal Response

Answer 30

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

Question 31

Motor Response

Answer 31

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

Question 32

CN II + CN III - Pupillary Response

Answer 32

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)

Question 33

CN 7

Answer 33

- 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)

Question 34

CN 9 + CN 10

Answer 34

- 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

Question 35

What does Speech tell us about neuro status?

Answer 35

- 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

Question 36

What are the 2 types of aphasia:

Answer 36

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

Question 37

Testing strength

Answer 37

- 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

Question 38

What is Proprioception?

Answer 38

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

Question 39

Cerebellar Function Tests

Answer 39

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