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NUR 202 Week 7 > Neuro Assessment & ICP > Flashcards

Neuro Assessment & ICP Flashcards

1
Q

Central Nervous System (CNS)

Comprised of the ___ and ___

A

brain; spinal cord

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2
Q

Peripheral Nervous System (PNS)

  • Cranial nerves (12 pairs)
  • Spinal nerves (31 pairs)
  • Autonomic nervous system [involuntary]
    > SNS & PNS
  • Somatic nervous system (voluntary)
A
  • Enteric nervous system of the GI tract
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3
Q

?

Are impulse-controlling cells that facilitate communication within the nervous system

Receive stimuli & transmit or conduct info in response to the stimuli

3 types of

A

Neurons

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4
Q

?

Are specialized cells that support & protect the neurons

Are up to 10x more common; provide support, nutrition, & protection

Have the ability to multiply, & this makes them a common source for tumor growth in the brain & spinal cord

A

Neuroglial cells

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5
Q

Neuroglial cells

  • Astrocytes
  • Ependymal cells
  • Microglia
  • Oligodendrocytes
A
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6
Q

?

Are located entirely in the CNS

Integrate incoming & outgoing msgs, process & store info, & “make decisions” about the body’s response to the stimuli

A

Interneurons

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7
Q

___ neurons

Transmit msgs from the brain back to the muscles or glands that respond, & are considered motor nerves

A

Efferent

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8
Q

___ neurons

Detect sensory stimuli from receptors such as sensory nerve endings & transmit them to the CNS

A

Afferent

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8
Q

___ neurons

Detect sensory stimuli from receptors such as sensory nerve endings & transmit them to the CNS

A

Afferent

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9
Q

Structure of a Synapse/Neurotransmitters

  • Acetylcholine
  • Norepinephrine
  • Dopamine
  • Serotonin
  • GABA (gamma-aminobutyric acid)
  • Glutamate
A

Central Nervous System

  • Cerebrum
  • Cerebellum
  • Medulla (brain stem)
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10
Q

?

Is the largest portion of the brain, covered by a thin layer of gray matter, the cerebral cortex

A

Cerebrum

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11
Q

The ___ ___ are located in the front area of the brain & are largely responsible for motor movement, mood, thoughts, & personality

A

frontal lobes

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12
Q

The Broca’s expressive speech area is within the frontal lobe

A
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13
Q

Located behind the frontal lobes, the ___ ___ control sensation & perception, such as temperature, taste, touch, & movement coming from the rest of the body; spatial relationships

A

parietal lobes

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14
Q

The ___ ___ are located on the sides of the brain level w/the ears, beneath the parietal lobes, & control sound recognition/hearing, and language/speech

The Wernicke’s receptive speech center is here

A

temporal lobes

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15
Q

The ___ ___, located at the back of the brain, is responsible for processing visual info

A

occipital lobes

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16
Q

These lobes are further divided into right and left hemispheres w/specific functions that are important when assessing neurological deficits

A

Most people are left hemisphere dominant, even in left-handed people

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17
Q

The brainstem is composed of the ___, ___, and ___

A

midbrain, pons, medulla

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18
Q

?

Is continuous w/the spinal cord & is located @ the level of & below the foramen magnum, the opening in the skull that allows the spinal cord to connect w/the brainstem

A

medulla oblongata

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19
Q

?

Rests above the medulla oblongata below & anterior to the midbrain, & relays all impulses between the brain & the spinal cord

A

Pons

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20
Q

?

Is located in the base of the brain or posterior fossa posterior to the medulla oblongata & pons

A

Cerebellum

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21
Q

?

Contains the nerve pathways between the cerebrum & the medulla oblongata

A

Midbrain

22
Q

?

Runs through all lvls of the brainstem & conduction of the motor & sensory tracts is relayed through the brainstem to the cerebellum & the cerebrum

Consists of the networks of neural cells that have these functions:
* Motor control & coordination & maintaining balance & posture during movement
* Resp & cardiac control
* Pain modulation by providing a route of passage for pain signals from the lower body
* Alertness & sleep by controlling some of the sensory stimuli that reach the cerebral cortex

A

Reticular formation

23
Q

?

Serves as relay center for sensory impulses to cerebral cortex

A

Thalamus

24
Q

?

In coordination w/the cerebellum, regulates movement by sending info back and forth through the thalamus to the cerebral cortex

Signals from are inhibitory whereas cerebellum signals are excitatory

A

Basal ganglia

25
Q

?

Is the main regulator for the ANS by sending signals to the brainstem, regulating among other things HR & BP

A

Hypothalamus

26
Q

?

Consists of the cingulate gyrus, hippocampus, & amygdala

Referred to as the “emotional brain”

A

Limbic system

27
Q

Blood from the deep internal & external veins, as well as CSF from the subarachnoid space, empty into these channels to be transported back to the heart via the internal jugular vein

A
28
Q

Blood flow in the brain: arterial circulation

  • Is supplied by the right & left internal carotid arteries & the right & left vertebral arteries
  • The internal carotid arteries & the vertebrobasiliar arteries join together via the posterior communicating artery @ the base of the brain to form the circle of Willis
A

Venous blood flow

  • Blood from the deep internal & external veins, as well as CSF from the subarachnoid space, empty into these channels to be transported back to the heart via the internal jugular vein
29
Q

Spinal cord

  • Made up of both gray matter & white matter
  • Pathway carries info to and from the brain & the body
  • Decussation (“crossover”)
  • contralateral (opposite)
  • ipsilateral (same)
A
  • Controls body movement
  • Regulates organ function
  • Process sensory info from the extremities, trunk, & internal organs
  • Transmits info to & from brain
30
Q

Protective Mechanisms

  • Cranium
  • Vertebrae
  • Meninges
  • Consist of the meningeal layers & spaces
  • Protect the brain & spinal cord
  • Outer layer is the __ __, which is a tough fibrous membrane that rests against the interior part of the skull
A

dura mater

31
Q

The 2nd layer of the meninges is the ___, which is a very thin layer w/a spiderweb appearance

The inner membrane is the ___ ___ which is the highly vascular membrane that lies in direct contact w/the brain

A

arachnoid

pia mater

32
Q

The epidural space is the potential space that exists between the inner dura mater layer & the arachnoid layer

The third space is the ___ ___, which is between the arachnoid membrane & the pia mater

A

subarachnoid space

33
Q
  • The meningeal layers cover the spinal cord, but also fold into the brain
  • One fold (falx cerebri) separates the right and left cerebral hemispheres
  • Another layer (tentorium cerebelli) separates the cerebrum from the cerebellum
A
  • CSF
    > Provides cushioning, protection, & nutrition
  • Blood-brain barrier
34
Q

Peripheral Nervous System: Spinal Cord

  • 31 pairs of spinal nerves
  • 8 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral
  • 1 coccygeal
A

Spinal nerves are mixed nerves as they transmit signals in both directions

35
Q

Peripheral Nervous System

  • Includes spinal nerves and cranial nerves

Autonomic (involuntary)
- sympathetic (“flight or fight”)
- parasympathetic (rest)

A

Somatic (voluntary)
- muscle movement

Enteric
- GI tract nervous system; controls the autonomous responses of the digestive process

36
Q

Cranial Nerves

  • Originate in the brain except for the olfactory & optic nerves
  • Transmit signals to receptors in the body
  • Identified by roman numerals
  • Named in order according to where they arise in the brain
A
37
Q

?

  • Opposes SNS
  • Decreases HR, RR, BP
  • Constricts pupils
  • Stimulates GI tract, GU system
A

Parasympathetic (or craniosacral)

38
Q

?

  • “fight-or-flight”
  • Increases HR, RR, BP
  • Dilates pupils
  • Inhibits GI tract, GU system
A

Sympathetic (or thoracolumbar)

39
Q

SNS

The neurotransmitter released @ the synapse site is typically ___, & the fibers that secrete it are adrenergic fibers

A

norepinephrine

40
Q

PNS

The neurotransmitter released @ the synapse site is ___

The nerve fibers that secrete it are called cholinergic fibers

A

acetylcholine

41
Q

Neuro Assessment

History
> Best provided by the pt

Physical assessment
> Levels of consciousness, cranial nerves, motor & sensory systems, cerebellar assessment & reflexes

A

Cognitive → Mini-Mental Status Exam; memory [remote (longterm), recall (recent), immediate (new)]

Motor/Cerebellar → Muscle mass, strength, tone, equality, balance, coordination, gait, posture

Cranial Nerve → Perform CN assessments; PERRLA, etc.

LOC → GCS

Sensory → Temp, pain, proprioception, cortical sensory

Reflexes → Reflex hammer: absent, weak, normal, stronger, hyperactive

42
Q

Glasgow Coma Scale (GCS)

The higher the #, the better the patient’s LOC

A

States of Consciousness

  • Alert
  • Lethargic
  • Obtunded
  • Stuporous
  • Comatose
43
Q

The single most important assessment is evaluation of level of consciousness (LOC) and mentation

A change in either is usually the first clue to a deteriorating condition

A
44
Q

Full consciousness

  • The pt is alert, attentive, & follows commands. If asleep, she responds promptly to external stimulation &, once awake, remains attentive

Coma

  • The pt does not respond
A

Lethargy

  • The pt is drowsy but awakens - although not fully - to stimulation. She will answer questions & follow commands, but will do so slowly & inattentively
45
Q

?

The pt arouses to vigorous & continuous stimulation; typically, a painful stimulus is req’d. She may moan briefly but does not follow commands. Her only response may be an attempt to withdraw from or remove the painful stimulus

A

Stupor

46
Q

?

The pt is difficult to arouse & needs constant stimulation in order to follow a simple command. She may respond verbally w/1 or 2 words, but will drift back to sleep between stimulation

A

Obtundation

47
Q

? posturing

Usually assoc w/brainstem dysfunction

A

Decerebrate

48
Q

? posturing

Results from damage to one or both corticospinal tracts

A

Decorticate

49
Q

VS & Increased Intracranial Pressure

Regulated in the brain & brainstem

  • HR
  • BP
  • Respirations

These VS changes are usually LATE SIGNS of increased ICP or neurological deterioration

A
50
Q

Normal ICP is ___-___

A

7-15

51
Q

Measurements greater than __-__ indicate increased ICP and require intervention

Sometimes pts w/IICP will demonstrate sx’s of changes in LOC, vomiting, headaches, & seizures

The CLASSIC signs of IICP are known as ____, which is characterized by an ____, ____, and ____

A

15-20

Cushing’s Triad

elevated BP w/a widening PP, bradycardia, irregular respirations

52
Q

Considerations for the Older Adult

  • Slowed body movements
  • Dec reaction time
  • Dec muscle strength & flexibility
  • Dec sense of touch, smell, temp, & pain sensations
  • Possible cognitive impairment such as confusion and/or memory loss - use caution to eval for other causes of cognitive issues such as infection
A

Diagnostic Testing

  • Radiographic procedures
  • CT, PET, MRI
  • Cerebral angiography (! shellfish/iodine allergy)
  • CT angiography
  • EEG
  • Evoked potential
  • LP
  • Myelography/myelogram
  • Brain biopsies
53
Q

LP

  • Insertion of spinal needle into the subarachnoid space (between the 3rd/4th or 4th/5th lumbar vertebrae)
  • Contraindicated in pts w/IICP
  • Position - fetal side-lyng, then FLAT after
A
  • Spinal HA possible from spinal tap
  • COMPLICATIONS -
    Brainstem herniation, infection, CSF leakage, & hematoma formation

NUR 202 Week 7 (5 decks)

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