Neuro Adults Flashcards by Maximino Malave

How much glucose is used by the brain?

80%

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Controls mobility, sensation, cognition, many involuntary processes.

Nervous system key function

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Brain (cerebrum, cerebellum, brain stem)
Spinal Cord are part of what?

Central Nervous System (CNS)

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Basic units of the nervous system.
* Trasmit impulses or “messages”.

Neurons

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(afferents neurons): Control sensation and send messages from PNS to the CNS.

Sensory neurons

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(efferent neurons): Control mobility and send messages from the CNS to PNS

Motor neurons

Afferent Approaches the CNS, Efferent Exits the CNS

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Regulated by centers in the spinal cord, brainstem, and hypothalamus

Autonomic Nervous System

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farsightedness; light rays focus behind the retina

hyperopia

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If ____ is present in adult then is abnormal.

Babinski

Babinski is for babies

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Alert, Verbal stimuli, Painful stimuli, Unresponsive

A V P U

Levels of consiousness

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Dropping eyelid

Ptosis

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Produces images of actual organ functioning. The patient is injected with a radioctive (nuclear) substance that emits positively charged particles.

Positron Emisson Tomography (PET)

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Side effects of ____ may include dizziness, lightheadedness, headache

Side effects of PET

Expected

Relaxation exercises may reduce anxiety

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Three dimentional imaging technique that uses radionuclides and instruments to detect single photons.

Useful in detecting abnormally perfused areas of the brain, find stroke.

Pregnancy and breast-feeding are contraindications

Single-Photon Emission Computed Tomography (SPECT)

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X-ray study of the cerebral circulation with a contrast agent injected into a selected artery

Inserted into the femoral artery in the groin.

Mark peripheral pulses.

Cerebral Angiography

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Check patient’s blood urea nitrogen (BUN) and creatine to ensure the kidneys will be able to excrete the contrast agent before what test?

Void immediatle before the test.

Cerebral Angiography

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Complications of ____ are altered LOC, weakness of one side of the body, motor or sensory deficits, and speech disturbances.

Cerebral Angiography

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Care after ____ check bleeding, hematomas, peripheral pulses, color of extremity, increase fluids.

Keep extremity straight.

Cerebral angiography

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X-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture.

Myelography

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Keep head of bed 30 to 45 degrees. Remain in bed 4 to 24 hours in recommended position.

Myelography

Nursing Intervensions

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Used to identify seizures, sleep disorders, and other conditions. Electrodes placed on the scalp to record electrical activity in the brain.

Electroencephalogram (EEG)

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Instruct patient to wash hair prior to procedure, arrive sleep deprived, avoid stimulants or sedative medications prior to procedure. No NPO needed.

Electroencephalogram (EEG)

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Obtained by inserting needle electrodes into the skeletal muscles changes in the electrical potential of the muscles.

Muscle can be sore.

Electromyography

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Cerebral Spinal Fluid (CSF) sample is taken from the spinal canal for analysis.

Lumbar Puncture

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Used to diagnose meningitis, subarachnoid hemorrhage, neurological disorders. | Usually done between L3/L4 or L4/L5

Lumbar puncture

* Have patient empty bladder. * Position patient on their side in a fetal position, or streched over a table (**so back is arched**)

Lumbar puncture Pre Procedure

* Instruct patient to lay flat for several hours and Increase fluid intake. * Monitor for CSF leak, which can cause a severe headache (**epidural blood patch** may be necessary)

Lumbar Puncture Post Procedure

What part of the brain contains the motor cortex and **Broca's area** (speech function)?

Frontal Lobe

What part of the brain contains the **sensory cortex**?

Parietal Lobe

What part of the brain contains **the visual cortex**?

Occipital Lobe

What part of the brain contains the auditory cortex and **Wernicke's area** (comprehension of verbal/written language)?

Temporal Lobe

Key functions: Controls motor, cognitive, sensory function.

Cerebrum

What's the expected color of CSF?

Clear, colorless, no blood, no bacteria

Involuntary movement of the eyeball

nystagmus

refractive error due to an irregularity in the curvature of the cornea. | (can't drive at night, fireworks)

Astigmatism

Normal vison

Emmetropia

What's the normal intraocular pressure (IOP)?

Less than 21 mm Hg

Composed of a series of progressively smaller rows of letter; the person is asked to read the lowest line possible

Snellen chart

CN III, IV and VI control?

Movement and pupil size

Defined as having central visual acuity of 20/40 or worse in the better eye with the best possible correction

Vision Impairment

Describes visual impairment that requires the **use of devices** and strategies to perform visual tasks.

Low vision

Best possible corrected central visual acuity that can range from **20/400 to no light perception.**

Blindness

Condition of impaired vision and is defined as **having central visual acuity of 20/200** or worse in the better eye with the best possible correction or whose widest visual field diameter is 20 degrees or less.

Legal Blindness

Function: Maintains homeostasis through innervation of smooth muscle, cardiac muscle, and glands.

Autonomic Nervous System (ANS)

"Fight or flight" Effects: Increase cardiac output, vasoconstriction (Increase BP), broncodilation, pupil dilation, Slow secretion/peristalsis | Opposite of Parasympathetic Nervous System

Sympathetic Nervous System

"Rest and digest" Effects: Decrease cardiac output, vasodilation (decrease BP), bronchoconstriction, pupil constriction, increased secretions/peristalsis | Opposite of Sympathetic Nervous System

Parasympathetic Nervous System

Eye disorder that results in **Increase Intraocular Pressure (IOP)**

Glaucoma

**Called the "silent thief of sight"** because most patient are unaware that they have the disease until they experienced visual changes and vision loss. ## Footnote May experience blurred vision or "halos" around lights, possible eye discomfort and headache.

Glaucoma

Patho: Most common. Aqueous humor overproduction or obstruction of outflow results in a **gradual increase of IOP.**

Open Angle Glaucoma

Patho: Less common. Forward displacement of the iris closes the angle between the iris and sclera completely, resulting in **sudden increase of IOP**

Closed Angle Glaucoma

Risk factors: Familial, Over Age 40, Diabetes, Hypertension, History of Ocular problem.

Glaucoma

S/S: **Lose of peripheral vision**, mild aching in the eyes, headache.

Open Angle Glaucoma

S/S: **Severe eye pain**, severe headache, n/v, blurred vision, halos around lights, reddened sclera.

Closed Angle Glaucoma

Pupil dilation

Mydriasis

In ________ for glaucoma, a laser beam is applied to the inner surface of the trabecular meshwork to open the intratrabecular spaces and widen the canal of Schlemm, promoting outflow of aqueous humor and decreasing IOP

laser trabeculoplasty

lens opacity or cloudiness that impairs vision | can progress to blindness

Cataracts

What are cataracts three most common types?

congenital, traumatic, senile | The most common risk factor being **age**

# Clinical Manifestation * Painless blurry vision * Reduced visual acuity * Sensitivity to glare * Color shift

Cataracts

Surgery is the only temporary cure is peformed on an outpatient basis with local anesthesia | Avoid bending the head below the waist.

Cataract

# Complications of surgery Hemorrhage in eye, infection, rupture of posterior capsule, toxic syndrome

Cataracts Surgery Complications

Separation of the retinal pigment epthelium from the neurosensory layer

Retinal Detachment

# Clinical manifestations * Sensation of shade or curtain coming across vision field * Cobwebs, bright flashing lights, sudden onset of increased floaters * **Requires immediate surgical intervention**

Retina Detachment

Deterioation of the macula, resulting in central loss of vision. | Two types: dry and wet

Macular Degeneration

Dry: Macula get thinner with age and tiny clumps of protein (**drusen**) grow. | More common, slower onset

Macular Degeneration

Wet: Abnormal blood vessels grow under the retina and leak blood/fluid, causing scarring of the macula. | Less common, faster onset

Macular Degeneration

results from an external ear disorder, such as impacted cerumen, or a middle ear disorder, such as otitis media or otosclerosis

Conductive hearing loss

involves damage to the cochlea or vestibulocochlear nerve.

Sensorineural hearing loss

Patients with ________ loss have conductive loss and sensorineural loss, resulting from dysfunction of air and bone conduction

Mixed hearing loss

# Early symptoms * Tinnitus: perception of sound; often "ringing in the ear" * Speech deterioration * Increase inability to hear in a group * Turning the volume on the TV

Hearing Impaired

* Removal may be by irrigation, suction, or instrumentation * Gentle irrigation should be used with lowest pressure, directing stream behind the obstruction.

Cerumen Impaction

abnormality in inner ear fluid balance caused by a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct

Ménière’s disease

# Clinical Manisfestation * Vertigo, * tinnitus, * feeling of pressure or fullness | Risk factor: Fall risk

Ménière’s disease

# Treatment Low sodium diet: 1,000-1,500 mg/day Meclizine (med) Surgical management to eliminate attacks of vertigo Tranquilizer, antimetics may be used

Ménière’s disease

episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) that result from sudden excessive discharge from cerebral neurons

Seizures

# What type of seizure present with these symptoms? Motor *Nonmotor *Awareness *Aware *Impaired awareness *Unknown awareness

Focal | One hemisfire

# What type of seizure present with these symptoms? Motor *Absence

Generalized

# What type of seizure present with these symptoms? Motor *Nonmotor *Awareness *Aware *Impaired awareness *Unknown awareness *Unclassified

Unknown

# Causes of what include these related diseases? Allergies Brain tumor Cerebrovascular disease CNS infections Drug and alcohol withdrawal Fever (childhood) Head injury Hypertension Hypoxemia of any cause, including vascular insufficiency Metabolic and toxic conditions (e.g., kidney injury, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure)

Seizures

# Nursing care during what? Provide privacy, and protect the patient from curious onlookers. (The patient who has an aura may have time to seek a safe, private place.) *Ease the patient to the floor, if possible. *Protect the head with a pad to prevent injury (from striking a hard surface). *Loosen constrictive clothing and remove eyeglasses. *Push aside any furniture that may injure the patient during the seizure. *If the patient is in bed, remove pillows and raise side rails. *Do not attempt to pry open jaws that are clenched in a spasm or attempt to insert anything in the mouth during a seizure. Broken teeth and injury to the lips and tongue may result from such an action. *Do not attempt to restrain the patient during the seizure, because muscular contractions are strong and restraint can produce injury. *If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions.

Seizure

# Nursing care after what? Keep the patient on one side to prevent aspiration. Make sure the airway is patent. *On awakening, reorient the patient to the environment. *If the patient is confused or wandering, guide the patient gently to a bed or chair. *If the patient becomes agitated after a seizure (postictal), stay a distance away, but close enough to prevent injury until the patient is fully aware.

Seizure

# What test is this? Hold vibrating fork on the mastoid bone, then in front of the ear canal

Rinne test

# What test is this? Hold vibrating fork on top of the patient's head, compare hearing on the right vs. left side. | Expected: Patient can hear equally in both ears

Weber test