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Term 5 MSIII > Neuro > Flashcards

Neuro Flashcards

1
Q

Neuro function: Controls _____, _______, ______, cognition and behavioral activities.

A

Motor; sensory; autonomic

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2
Q

Neuro Function: Links motor and _______ pathways. Monitors body posturing. responds to _______/______ environment. Maintains homeostasis.

A

sensory; internal/external;

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3
Q

Neuro Function: Directs all psychological, ______, and physical activities via ______ and electrical messages.

A

biological; chemical

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4
Q

Neuro Function: What are the 5 chemicals in the brain?

A
  1. Acetacholine 2. serotonin 3. dopamine 4. GABA 5. Endorphins
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5
Q

Function: What are the two systems involved in the brain function?

A
  1. Central nervous system (CNS)- brain and spinal cord 2. Peripheral nervous system (PNS- cranial nerves, spinal nerves
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6
Q

Neuro Function: The PNS is divided into two systems, what are they?

A
  1. Autonomic- involuntary 2. Somatic- voluntary
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7
Q

Autonomic Nervous system: ________ is the major center for regulation. Maintains and restores internal ________.

A

Hypothalamus; homeostasis

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8
Q

Autonomic Nervous system: What internal organs are regulated by the ANS?

A

lungs, blood vessels, digestive organs, and glands

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9
Q

Autonomic Nervous system: The ANS is divided into two systems, what are they?

A
  1. Sympathetic- “fight or flight” 2. Parasympathetic- controls visceral functions, in noxstress situations parasympathetic rules.
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10
Q

Assessment: Clinical manifestations They can be subtle or intense, fluctuating or permanent, inconvenient or devastating. What are 6 manifestations?

A
  1. pain 2. seizures 3. dizziness 4. visual disturbances-acuity 5. weakness 6. abnormal sensations- numbness, tingly
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11
Q

Physical examination: Cerebral function 1. mental status 2. intellectual functioning 3. thought content 4. emotional status 5. perception 6. motor/ language abilities

A
  1. are they coherent? 4. do they have mood swings? 5. can the patient properly identify and name things (agnosia-inability to name objects) 6. do they have the ability to speak?
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12
Q

Physical examination: Motor system 1. muscle strength 2. balance and coordination 3. reflexes

A
  1. is it weak or stronger on one side? 2. Romberg test- Ask the patient to stand with feet together and then close his or her eyes. If the patient is able to maintain balance with the eyes open but sways or falls with the eyes closed (i.e., a positive Romberg test) 3. Chart 0-4: normal-2, brisk-3, quick-4
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13
Q

Physical examination: Sensory Collections of _______ data. Most deficits are peripheral ___________. Tests- tactile sensation, _________ pain, vibration, position sense.

A

subjective; neuropathies; superficial

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14
Q

Physical examination: sensory 1. motor ability 2. language ability 3. impact on life 4. gerontology

A
  1. ask how it affects their life 4. structural changes, motor alterations, sensory alterations, temperature and pain perception, taste/smell alterations, tactile/visual alterations, mental status
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15
Q

Dermatomes: Spinal nerves

8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

A
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16
Q

Seizures:

Disorder taht involve periodic disturbances in the brains _________ activity, resulting in some degree of temporary brain _________.

A

electrical; dysfunction

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17
Q

Seizures:

_________, uncontrolled electrical discharge of ______ in the brain that interrupt normal function

A

paroxysmal; neurons

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18
Q

Seizures:

May be associated with loss of consciousness, excess _________, or loss of _____/________, disturbed behavior, mood, sensation, and _______.

A

movement; tone/movement; perception

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19
Q

Seizures:

Most seizures are sudden and ______. Often the symptom of underlying condition-systemic or _______ disturbances are not considered to be _______ if seizures leave after condition clears.

A

transient; metabolic; epilepsy

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20
Q

Seizures: Etiology

  1. high fever
  2. brain infections
  3. metabolic disorder- DM
  4. inadequate brain oxygenation- hypoxia
  5. structural damage- trauma
A
  1. fluid accumulation
  2. toxic drugs/ substance
  3. withdrawal
  4. ceratin drugs
  5. Heart problems
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21
Q

Seizure Disorders:

Partial seizures begin in 1 part of the brain. Name the 2 types of partial seizures:

A
  1. simple partial
  2. complex partial
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22
Q

Seizure disorders: Generalized Seizures

Involve electrical discharges in whole brain.

Name the 6 types of gerneralized seizures:

A
  1. tonic-clonic
  2. tonic
  3. clonic
  4. absence- petite-mal
  5. atonic
  6. myoclonic
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23
Q

Generalized: Tonic-clonic

Name the phases of a Tonic-clonic seizure

A
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24
Q

Generalized: Tonic phase

Name the 5 occurances during this phase

A
  1. neuronal hyperexcitation
  2. loss of consciousness
  3. apnea
  4. dilated pupils
  5. duration 15-60 seconds
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25
Q

Generalized: Clonic Phase

Name the 4 occurances during this phase

A
  1. inhibitory neurons interrupt seizure discharge
  2. hyperventilation
  3. rhythmic jerking of extremities
  4. duration- 60-90 seconds
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26
Q

Generalized: Postictal Phase

Name the 8 possible occurances during this phase:

What is Todd’s paralysis?

A
  1. deep sleep
  2. muscle soreness
  3. headache
  4. amnesia
  5. visual disturbances
  6. dysphagia
  7. aphagia
  8. duration varies

Todd’s paralysis: temporary motro deficit of ARM or LEG that can last u to 24 hours.

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27
Q

Recovery position:

Take at least 10 seconds to study image.

A

What is the recovery position?

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28
Q

EEG for diagnosis of Seizures:

What are important things to know about EEGs being done before and after?

A

Deprive patient of sleep for 24hrs. Labs for electrolytes, anemia, heart problems and DM. CT and MRI may be done to look for structural problems

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29
Q

Seizures: Nursing management during and after

What are 3 things to prevent injury?

What are other nursing management responsibilities?

A
  1. side-lying position
  2. suction available
  3. bed in low position, padded siderails up

*if possible loosen clothing

Support and documentation are other nursing management responsibilities.

*patient is at risk for respiratory distress have O2 available

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30
Q

Seizure Nursing observation and documentation

  1. circumstances prior to seizure
  2. Occurrence of an Aura
  3. First obvious sign of seizure
  4. types of movements
  5. area of body involved
  6. eyes- pupil size, open/closed, turned to one side?
A
  1. Presence of automatisms
  2. incontinence
  3. paralysis/wekness of extremities pose-24hrs
  4. inability to speak post
  5. movements at end
  6. sleeps afterward, cognitive staus after
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31
Q

Epilepsy:

Condition in which a patient has spontaneous unproveoked recurring ______ caused by a chronic underlying condition. Eitiology attributed to a group of abnormal ______ (seizure focus) that undergo spontaneous firing- possibly due to ______(gliosis).

*there is new evidnece that other cells may be the problem

A

seizures; neurons; scarring

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32
Q

Epilepsy:

Incidence rate (new onset) high in ___ year of life, _______ in childhood & teens, plateuing in _______ ____, and sharp _____ in elderly.

A

1st; declining; middle age; rise

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33
Q

Epilepsy:

Previously a stigma but acceptable now. What is primary and secondary?

What are the causes?

A

primary- idiopathic

secondary- cause is known and the epilepsy is a syptom of another underlying cause

Causes:

idiopathic- genetic/gevelopmental defect

acquired- hypoxemia

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34
Q

Epilepsy: Medical management

Individualized due to the varied forms of the condition. Management is aimed at _______ and _________ of seizures

A

prevention; management

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35
Q

Epilepsy: Medical management

What testing will be done for epilepsy?

A
  1. EEG
  2. CT
  3. MRI
  4. SPECT
  5. Tox screen
  6. Genetics
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36
Q

Epilepsy: Medical management

Pharmacologic Therapy

There are many available. Start with _____ med with ________ dose. Monitor ______

A

single; increasing; levels

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37
Q

Epilepsy: Medical management

Pharmacologic Therapy

May need to switch med if ot working. When ____ or with _____ change/stress may need dose adjustment.

A

sick; weight

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38
Q

Epilepsy: Medical management

Pharmacologic Therapy

Sudden _______ can cause frequent seizures or ______ _______

A

withdrawal; status epilepticus

39
Q

Epilepsy: Medical management

Pharmacologic Therapy

Name 3 side effects of phramacologic therapy

A
  1. idiosyncratic/allergic
  2. acute toxicity
  3. chronic toxicity

* seizure meds should be taken on an empty stomach, levels should be monitored. No alcohol, and other medications being used must be addressed by MD for interactions

40
Q

Epilepsy: Nursing Management

What are the 4 nursing managements and PC of epilepsy?

A
  1. preventing injury
  2. reducing fear- educate
  3. improving coping- decrease stress, get enough sleep
  4. monitoring and managing potential complications- injury

PC: Status epilepticus and toxicity

41
Q

Epilepsy: Monitor drug levels

Subtherpaeutic and toxic: breakthrough seizures. What are 4 adverse effects?

A
  1. lethargy
  2. nystagmus- involuntary movement of the eyes
  3. ataxia- loss of control of bodily movement
  4. dysarthria- difficult or unclear articulation of speech that is otherwise linguistically normal
42
Q

Epilepsy: monitor drug levels

What are food and drug interactions?

A
  1. delayed absorption
  2. potentiated
  3. inactivated
43
Q

Epilepsy: KEtogenic diet

4:1 ____ to _____ and carbohydrates

may be useful in ______

Difficulty with compliance.

A

fats; protein; children

44
Q

Epilepsy: Surgery

Extensive preoperative testing to determine eloquent areas. What are 3 considerations?

A
  1. medically intractable epilepsy
  2. feasibility of surgery
  3. likelihood of success.

*risk to benefit

45
Q

Epilepsy: Vagal nerve stimulator

The vagusnerve lies between the carotid and the jugular vein.(It’s the only cranial nerve that is more easily accessible.)The electrodes are wrapped around the left vagus nerve.

A

Where does the vagusnerve lie? and how does the vagal nerve stimulator work?

46
Q

Status Epilepticus:

Series of generalized seizures:

  1. Clinical/electrical- After how long is it considered status epilepticus?
  2. Medical emergency- when does it become an emergency?
  3. what are the precipitating factors?
A
  1. >15-30 minutes
  2. (1) heavy metabolic load (2). respiration interruption and even arrest at peak, producing hypoxia (3). can lead to anoxia, cerebral edema, possible irreversible brain damage and death
  3. drug withdrawal, fever, infection
47
Q

Status epilepticus: Medical management:

Stop seizures to promote adequate cerbral oxygenation. What are 3 things done for medical management?

A
  1. Airway- ET tube, O2
  2. Meds IV
  3. Monitor: EEG, VS, labs including electrolytes, glucose, med levels.
48
Q

Staticus Epilepticus: PCs

  1. aspiration
  2. Wernicke’s encephalopathy
  3. neurological deterioration, continuation of SE
  4. dehydration
  5. fever
  6. hypermetabolism
A
  1. disability
  2. metabolic
  3. ARF-acute repiratory failure
  4. autonomic dysfunction
  5. cerebral edema
  6. systemic complications
  7. death
49
Q

Parkinson’s Disease:

Slow progressice disabling neurologic moving disorder with GRADUAL onset.

  1. Tremor when muscles are at rest
  2. Rigidity with impaired movement
  3. bradykinesia
  4. shuffling gate
  5. pin rolling
  6. psych changes- depression
  7. mask like bland expression
A
  1. micrographic- sm handwritting
  2. monotone- soft and quick
  3. GI/GU issues

12 Aphasia (later)- inability to speak

  1. apraxia (later)-inability to perform particular purposive actions
  2. agnosia (later)- inability to interpret sensations and hence to recognize things
50
Q

Parkinson’s Disease:

Patho: decreased _______; it cannot pass from one _______ ______ at an adequate pace.

A

dopamine; nerve ending

51
Q

Parkinson’s Disease: Etiology

Part of the _____ _____ degenerate, reducing the production of ______ and the number of connections between nerve cells and the basal ganglia.

A

basal ganglia; dopamine;

52
Q

Parkinson’s Disease: Etiology

Basal ganglia cannot smooth out the movements, leading to _____, ______ and slowed reduced movement

A

tremor; incoordination; movement

53
Q

Parkinson’s Disease: Etiology

Mostly idiopathic but some _______. Mostly in men in their ____. Hard to pinpoint start time. Not noticed at first. S/S increase with ____/_____

A

secondary; 50’s; stress/fatigue

54
Q

Parkinson’s Disease: Etiology

Variation in the ____ can make the person more at risk but _____ does not play a role. Exposure to ______. There is some thought that this could be _________ in nature.

A

genes; genetics; toxins; autoimmune

55
Q

Parkinson’s Disease: Diagnostics

Bases on __/__. Difficult because aging can cause some of the same _______

A

S/S; symptoms

56
Q

Parkinson’s Disease: Diagnostics

Give significant dose of ________-________, if improved then positive for ___________

A

carbidopa-levodopa

Parkinsons

*S/E: Hallucinations & compulsive behaviors

57
Q

Parkinson’s Disease: Diagnostics

___ & _____ can be done to rule out any stuctural disorders.

A

CT, MRI

58
Q

Parkinson’s Disease: Diagnostics

_____ _____ to evalute levodopa uptake and conversion

A

PET scan

59
Q

Parkinsons: Medical Management

No cure, ______ symptoms and keep function is the goal, care __________

A

controlling, individualized

*goal: improved ADLs

60
Q

Parkinsons: Medical Management

Meds, Dopamine precursor - ________ ________,

______ ___________

A

carbidopa-levodopa, beta blockers

*30 - 1 hr before eating to help with dysphagia

61
Q

Parkinsons: Medical Management

Name 3 Surgeries that can be done for Parkinsons.

A

Palidotomy, stimullation, stem cell implants

*watch B/P

62
Q

Parkinson’s: Nursing

As the nurse what are 6 things to enhance?

A
  1. Mobility-wide stance
  2. maintain self care independence- use velcro instead of buttons
  3. adequate bowel elimination- increase fiber
  4. Maintain nutrition- increase calorie diet
  5. effective communication- listen carefully, be patient
  6. develop positive coping

*#1 educate on drugs; report S/E

63
Q

Degenerative Disorders:

Name the 8 degenerative disorders.

A
  1. Parkinson’s Disease
  2. Huntington’s disease
  3. Alzheimer’s Disease
  4. Amyotrophic lateral Sclerosis
  5. Muscular Dystrophies
  6. Degenerative disk disease
  7. Herniation of a cervical intervertebral disk
  8. Post-Polio syndrome
64
Q

Multiple Sclerosis

Study image for 10 seconds

A

What covers the nerves?

65
Q

Multiple Sclerosis:

Autoimmune activity results in _________ of nerve sheath. Scarring is the result leading to slowing and blockage of the electrical impulses that control _______ coordination, strength, sensation and vision.

A

demyelization; muscle

66
Q

Multiple Sclerosis:

Mostly in women age __-__.

Name at least 3 causes.

A

20-40;

  1. Genetic susceptibility
  2. Possibly viral- herpes
  3. Risk factors
67
Q

Multiple Sclerosis:

What are the patterns of MS?

What is an early sign in diagnosis?

A
  1. Relapsing remitting clearly defined flare-ups
  2. Primary progressive- gradual decline
  3. Secondary progressive- second step of relapsing remitting
  4. Pregressive relapsing-primary progressive with sudden worsening.

*starts in the eyes. early as 16 years or late as 60

68
Q

Multiple Sclerosis:

What are 4 important clinical manifestations?

A
  1. Numbness/weakness in limbs usually one side or bottom half of body.

  1. Loss of vision- partial or complete
  2. double vision/blurring
  3. Tingling or pain in parts of body
69
Q

Multiple sclerosis:

What other clinical manifestations for MS?

A
  1. electric shock sensation that occurs with certain head movements
  2. fatigue, ataxia
  3. dizziness
  4. Muscle stiffness and SPASTICITY
  5. slurred speech, dysphagia
  6. paralysis problems with elimination and sexual function
  7. mental changes
70
Q

Multiple Sclerosis:

Who can develop MS?

A

DM1, thyroid problems, IBS, Smokers

71
Q

Multiple sclerosis: Management

There is no cure. What individualized diagnostics would be done?

A
  1. pulmonary function
  2. spinal tap- increase WBCs in spinal fluid
  3. MRI
  4. Electrical studies
72
Q

Multiple Sclerosis: Medications

What type of medications would be given for MS?

A
  1. virus fighters
  2. immuno suppressors/ Steroids
  3. Muscle relaxants: BACLOFEN, CYCLOBENZAPINE
  4. Drugs to decrease relapse
  5. pain meds
  6. meds to rectify sexual, bowel and bladder problems
73
Q

Multiple Sclerosis:

What are the treatments for MS?

A
  1. Plasmaphoresis: gets rid of antibodies
  2. Physical Therapy: keep them moving or stretching
  3. Counseling

*Stem cells can also be used

74
Q

Multiple Sclerosis: Nursing

As the nurse what interventions should you do?

A
  1. encourage rest, exercise, AVOID HEAT, and a well balanced diet (increased protein, increased carbs, decrease gluten, decrease fat)
  2. enhance bladder/bowel control, sexual function-suppository or catheter
  3. improve cognitive and sensory funtion
  4. promote selfl-care

*increase fluids, keep cool, check CBG

75
Q

Myasthenia Gravis:

A _____ in the normal communication between muscle and _____.

A

Breakdown; nerves

76
Q

Myasthenia Gravis:

_________ disorder that impairs the passing of signals at the neural junction. Antibodies attack the ______ ____

A

Autoimmune; receptor sites

77
Q

Myasthenia Gravis:Etiology

Name 4 causes of MG.

Name 3 triggers.

A

Causes: 1. blockage and/or destruction of the receptor site for the Ach pathway

  1. Thymus tumor- 15% of people with MG, possible thyroid
  2. a different antibody ausing a defferent autoimmune problem
  3. can be genetic

Triggers: 1. fatigue eyes closing

  1. stress
  2. meds
78
Q

Myasthenia Gravis: Clinical Manifestations

Muscle weakness escalating with continues use. They will be strongest in the AM.

Name 8 clinical manifestations.

A
  1. initially ocular- PTOSIS (cant open eyes), double vision
  2. facial and throat weakness
  3. expression impaired
  4. speech impaired and voice fades
  5. chewing and swallowing impaired
  6. neck, shoulders and hips affected more than distal area
  7. Generalized weakness to include respiratory
  8. no effect on sensation or reflexes.
79
Q

Myasthenia Gravis: diagnostics

What would each of the following diagnostic tests include?

  1. Routine physical examination
  2. Tensilon test
  3. blood testing
  4. ice bad
  5. nerve testing
  6. scans
  7. pulmonary test
A
  1. Routine physical examination- reflexes, strength, tone, touch/sight senses, coordination and balance, weakness improves with rest
  2. Tensilon test- administer to see increased strength
  3. blood testing- for antibodies
  4. ice bag- to see if eyes open when applied
  5. nerve testing- function of nerves
  6. scans - for tumors
  7. pulmonary test- to find out function of pulmonary
80
Q

Myasthenia Gravis: Therapies

What 6 therapies would be used with MG?

A
  1. Anticholinesterase
  2. Steroids
  3. Immunosuppressants
  4. Plasmaphoresis
  5. IV immunoglobin G
  6. Thymectomy
81
Q

Myasthenia Gravis: Complications

What complications can occur in an MG crisis?

A
  1. Acute exacerbation of the disease with weakness in the chest muscle
  2. patient will probably need ventilation
  3. blood filtering to get rid of some of the antibodies
  4. aspiration
  5. all respiratory Problems
82
Q

Myasthenia Gravis: Self care

Plan ahead and ______ routine for energy conservation. Learn about ___________.

A

adjust; medications

83
Q

Myasthenia Gravis: Self care

Recognition and ________ of PCs. ______ precautions at home.

A

prevention; safety

84
Q

Myasthenia Gravis: Self Care

______ devices when possible. Eye patches for ______ ______.

A

electric; double vision

85
Q

Guillain Barre’Syndrome:

A
  • This will occur bottom up
  • weakness that is progressive
  • 30% may not recover
  • leads to paralysis
  • At bedside: trach set, EKG, O2, ventilator
86
Q

Guillain Barre’Syndrome:

Autoimmune attack destroys nerve ____. Acute, rapid, segmental __________ of peripheral nerves and some cranial nerves. ___________ happens in recovery

A

myelin; demyelization; remeylization

87
Q

Guillain Barre’Syndrome: Etiology

Exact cause is unknown. It is usually preceded by what 4 immune system stimulation?

A
  1. infectious illness
  2. respiratory infection
  3. stomach flu
  4. immunizations
88
Q

Guillain Barre’Syndrome: Clinical manifestations

Begins with ________ and muscle weakness of lower extremities and progresses upwards. May affect ______ & intercostal muscle.

A

hyporeflexia; diaphragm

89
Q

Guillain Barre’Syndrome: Clinical Manifestations

Cranial nerves that are affected are _____, vagus, & glossopharangeal. Bulbar paralysis such as facial weakness and _______

A

optic; dysphagia

90
Q

Guillain Barre’Syndrome: Clinical manifestations

Autonomic dysfuntion includes: orthostatic hypotension, abnormal ____ responses, bowel and bladder dysfunction, and BP fluctuations and irregular _________. Pain and _______

A

vagal; heartbeat; pain and numbness

91
Q

Guillain Barre’Syndrome: Diagnostics

Patient history and ______ _____.

Spinal tap- fluid has _____ protein levels after 7-10 days.

Elctromyography (EMG) and other nerve ______ testing.

A

Clinical signs; elevated; conduction

92
Q

Guillain Barre’Syndrome: Management

  • ICU care possibly on vent, IVIG, _________.
  • Prevention of PC due to _______.
  • Physical therapy
  • Adaptive devises
  • Meds to handle BP /_______
  • Deal with fear, ______– Communication
  • Adequate nutrition
A

plasmaphoresis; immobility; tachycardia; anxiety

93
Q

Guillain Barre’Syndrome: PCs

Name the two main PCs.

A
  1. respiratory distress and arrest
  2. dysphagia- aspiration, nutritional adequacy, urinary retension

Term 5 MSIII (5 decks)

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