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Med Surg > Neuro > Flashcards

Neuro Flashcards

1
Q

12 cranial nerves

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Touch
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
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2
Q

Fx Olfactory nerve

A

Smell

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3
Q

Fx Optic nerve

A

See

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4
Q

Fx occulolotor

A

Adjust pupil, eye lens, move eyelids, rotate eye balls

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5
Q

Fx trochlear

A

Move eyeballs

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6
Q

Fx trigeminal

A

Chew, feel face and mouth

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7
Q

Fx Abducens

A

Move eyeballs

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8
Q

Fx Facial

A

Facial expressions, tears, sensations in tongue

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9
Q

Fx vestibulocochlear

A

Hearing and balance

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10
Q

Fx Glossopharyngeal

A

Saliva, swallow, taste

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11
Q

Fx vagus

A

Control of peripheral nervous system (PNS)

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12
Q

Fx accessory nerve

A

Move neck & shoulders, swallow

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13
Q

Types of stroke (include subtype)

A

Ischemic
Hemorrhagic
-intracerebral (more common)
-subarachnoid (bleed between pia mater and arachnoid mater)

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14
Q

Types of intracerebral hemorrhage

A
  1. Intraparenchymal: Just brain tissue
  2. Intraventricular: extends into ventricle
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15
Q

4 Lobes of cerebral cortex

A

Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe

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16
Q

Fx of frontal lobe

A

Movement
Executive fx

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17
Q

Fx of parietal lobe

A

Sensory info

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18
Q

Fx of temporal lobe

A

Hearing
Smell
Memory
Facial recognition
Visual recognition of language

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19
Q

Fx of occipital lobe

A

Vision

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20
Q

Fx of cerebellum

A

Muscle coordination
Balance

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21
Q

Fx of Brain stem

A

Vital fx
-heart rate
-blood pressure
-breathing
-GI fx
-consciousness

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22
Q

Arteries that supply brain with blood

A

-internal carotid artery
-vertebral arteries (combine to form basilar artery)

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23
Q

Causes of ischemic stroke

A

-hypertension
-arteriovenous malformations
-vasculitis
-vascular tumors
-cerebral amyloid angiopathy

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24
Q

How hypertension causes stroke

A

-Hyaline arteriolosclerosis: stiff and brittle, more likely to rupture
-micro aneurysm: found on small arteries

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25
Q

Hemorrhagic Conversion

A

Bleeding into dead tissue

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26
Q

Stroke in anterior or middle cerebral artery symptoms

A

Numbness & muscle weakness

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27
Q

Stroke affecting Broca’s area (usually in left frontal lobe)

A

Slurred speech

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28
Q

Stroke affecting Wernicke’s area (usually in left temporal lobe)

A

Difficulty understanding speech

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29
Q

Effects of posterior cerebral artery stroke

A

Can affect vision

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30
Q

Imaging diagnosis of stroke

A

CT scan, MRI, and also angiography (with contrast to see where blood pooling in brain)

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31
Q

Medical treatment of intracerebral hemorrhage

A

-Drugs: control hypertension, relieve intracranial pressure

-surgery: craniotomy (relieve pressure if bled near surface of skull by removing part of skull;
Stereotactic Aspiration: aspirate off blood to relieve pressure

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32
Q

Signs of Parkinson’s

A
  1. Resting tremors
  2. Rigidity
  3. Bradykinesia
  4. Postural instability
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33
Q

Excitatory neurotransmitters

A

Epinephrine
Norepinephrine
Glutamate

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34
Q

Inhibitory neurotransmitters

A

Serotonin
GABA
dopamine

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35
Q

Two parts of Autonomic Nervous System (ANS)

A

Sympathetic
Parasympathetic
Have opposing fx

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36
Q

6 Parts of neuro assessment

A
  1. Mental status
  2. Cranial nerves
  3. Mobility &motor Fx
  4. Deep tendon reflexes
  5. Sensory Fx
  6. Cerebellar Fx ( fine motor)
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37
Q

ABCD TIA assessment

A

Age 60 or older
BP 140/90 or higher
Clinical features like one sided weakness
Duration

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38
Q

TIA tx

A

-Can be at home
-increase perfusion to brain by removing plaque
-carotid angioplasty w/stent
-anti platelet drugs to prevent stroke
-control BP and DM w/ meds, lifestyle

39
Q

Features of ischemic thrombotic stroke

A

Onset-gradual
Factors- HTN, atherosclerosis
Deficits- headache, speech, visual, confusion
Characteristics- awake, CSF normal, no seizure
Duration- gradual over weeks or months with deficits present

40
Q

Features of ischemic embolic stroke

A

Onset- sudden
Factors- cardiac disease
Deficits- worst at onset, paralysis, expressive aphasia
Characteristics- awake, CSF normal, no seizure
Duration- usually rapid improvement

41
Q

Features of hemorrhagic stroke

A

Onset is sudden
Factors- HTN, vessel d/o, genetic
Deficits- focal deficits, severe, frequent
Characteristics- lethargy/stupor/coma, bloody CSF, usually seizures
Duration- varies, possible permanent neuro deficits

42
Q

Manifestations of hemorrhagic stroke

A

Neuro deficits
Headache
Nausea/vomiting
Decreased levels of consciousness
HTN

43
Q

History for stroke

A

First priority is get pt to stroke center
Onset, progression of sx
Medical hx: head trauma, DM, HTN, heart disease, anemia, obesity
Medication, Rx, OTC, herbal, illicit
Lifestyle: smoking, diet, exercise, travel/ leisure

44
Q

Stroke: neuro assessment

A

Focused: LOC, cognition, mobility, sensory perception
Balance, gait, communication, vision
Cranial nerves, photophobia
R/out hypoglycemia, hypoxia
Headache in hemorrhage, “ worst in my life”
NIHSS- NIHS stroke scale
Eligibility for fibrinolytics

45
Q

Stroke in right cerebral hemisphere

A

-Unaware of deficits, impulsive, poor judgment
-left sided paralysis
-Left sided neglect
-spatial/perceptual deficit
-deny / minimize problems
-impulsive with rapid performance, short attention span
-impaired judgment
-impaired concept of time

46
Q

Stroke in left cerebral hemisphere

A

-Problems with speech, language aphasias, analytical thinking
-right sided paralysis
-impaired right/left discrimination
-aware of deficits so anxious, depressed
-slow performance, cautious
-impaired language and math comprehension

47
Q

Embolic stroke features

A

Heart murmur,
atrial fibrillation
BP 180/110 - 200/120

48
Q

Hemoglobin range

A

12-18

49
Q

Hematocrit range

A

37-52%

50
Q

aPTT range

A

30-40 seconds

51
Q

INR

A

No anticoagulant 0.8-1.1
Afib, DVT, &PE 2-3

52
Q

PT range

A

11-12.5 seconds

53
Q

HgA1C

A

4 - 5.7%

54
Q

tPA use

A

-reestablishes blood flow through blocked arteries
-must be started within 3 - 4 1/2 hours of signs of stroke

55
Q

tPA screening

A

Must be
-under 80
-no hx of stroke and DM
-active bleeding
-NIHSSS score must be under 25
-imaging shows less than 1/3 brain tissue damaged
- dosage 0.9 mg/kg, 90 mg/hr with first 10% given in first minute
- verify dose, do not push med, vs every 10-15 min, if high BP give antihypertensive (labetolol)
-no tubes until stable 24 hours
-follow up CT

56
Q

Endovascular therapy

A

-Small stent placed in artery,
-clot catches on stent’s mesh, both removed
-assess neuro and cardiovascular status

57
Q

Post stroke meds (7 types)

A

-Antiplatelet: aspirin, clopidogrel
-anticoagulant if cardiac like afib
-low molecular weight heparin
-stool softener to prevent strain
-analgesic
-anti anxiety
-statins

58
Q

Signs of hemorrhagic stroke

A
  1. LOC
  2. Behavior changes: restless, irritated, confused
  3. Headache, nausea, vomiting, aphasia, change in speech
  4. Ataxia
  5. Seizures
  6. Late sign: constricted pupils
  7. Very late sign: Cushing’s triad (severe HTN, widened pulse pressure, decreased HR), posturing
59
Q

Actions for Hemorrhagic stroke

A
60
Q

Hemorrhagic stroke meds

A

Calcium channel blockers

61
Q

Intervention for right sided stroke

A
62
Q

Intervention for left sided stroke

A
63
Q

Migraine assessment

A
64
Q

Med for Moderate to severe headaches

A
65
Q

Migraine management meds

A
66
Q

4 phases of seizures

A
  1. Prodromal phase
  2. Aural phase
  3. Ictal phase
  4. Postictal phase
67
Q

Tonic clonic seizure characteristics

A
68
Q

Tonic seizure characteristics

A

Loss of muscle tone for about 30 sec

69
Q

Clonic seizure characteristics

A

Contraction, relaxation, for several min.

70
Q

Myoclonic seizure characteristics

A

Jerking/stiffening extremities for a few seconds

71
Q

Atonic seizure characteristics

A

Sudden loss of muscle tone, postictal confusion, may fall

72
Q

Complex partial seizure characterized

A

LOC, 1-3 min, unaware during, amnesia after

73
Q

Simple partial seizure characterized

A

Conscious during, has aura or deja vu, unusual sensations, unilateral movements

74
Q

Refractory status epilepticus (RSE)

A

Seizures continue despite first and second line therapy

75
Q

Seizures: imaging

A
76
Q

Drugs for generalized tonic clonic and focal onset seizures

A
77
Q

Drugs for generalized onset nonmotor and myoclonic seizures

A
78
Q

Parkinson disease incidence and prevalence

A

Affects up to 1 mil Americans
Incidence increases with age
4% diagnosed before 50 yo
Men 1.5x more likely than women

79
Q

Risk factors for PD (primary)

A

Genetic 15%
Well water
Pesticides
Herbicides
Industrial chemicals
Metals
Wood pulp mills
Rural residence
TBI

80
Q

Secondary / atypical PD

A

Drug induced (antipsychotics)
Brain tumors

81
Q

PD nonmotor sx

A
  1. Depression
  2. Anxiety
  3. Apathy
  4. Fatigue
  5. Pain
  6. Urinary retention
  7. Constipation
  8. ED
  9. Memory changes
  10. Sleep disturbances
82
Q

PD complications

A
  1. Dysphasia can lead to malnutrition or aspiration
  2. Pneumonia, UTIs, skin breakdown
  3. Orthostatic hypotension
  4. High fall risk
83
Q

Huntington

A
  1. Hereditary: autosomal dominance
  2. Caused by alterations in dopamine, GABA, glutamate from basal ganglia
  3. Sx onset 30-50
  4. Gradual decline 15 years; progressive dementia, uncontrolled rapid jerky movements
84
Q

PD labs and imaging

A
85
Q

Levodopa / carbidopa

A
  • levodopa crosses blood brain barrier where it is converted to dopamine in basal ganglia
    -carbidopa inhibits enzyme that breaks levodopa down before it crosses blood brain barrier
  • give on time to avoid PD sx; with meals to aid absorption
    -side effects are orthostatic hypotension, drowsiness, psychotic episodes
86
Q

Entacapone

A

Blocks COMT, thus prolonging effect of levodopa

87
Q

Selegiline

A

Increase dopamine, reducing s/s of PD
Must avoid tyramine foods (cured), alcohol

88
Q

Rivastigmine or donepezil

A

Treat dementia

89
Q

Amantadine

A

Antiviral with anti PD effects given early in disease

90
Q

PD hypo mobility

A

Occurs within 3-5 yrs
Off episodes (dose wearing off)
Combination of carbidopa, levodopa, and entacapone
Apomorphine: must be with antiemetic

91
Q

Surgical management of PD

A

Deep Brain Stimulation (DBS)
Stereotactic pallidotomy
Fetal tissue transplant

92
Q

Donepezil or rivastigmine nursing implications

A

Can decrease HR, monitor for dizziness, avoid if cardiac disease, take in evenings, titrate any dosage change

93
Q

Memantine

A

Side effects: dizziness, headache, confusion, constipation
Can be given with donepezil
Indicated for advanced AD

Med Surg (4 decks)

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