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NURSING 3 > Neuro week 1 > Flashcards

Neuro week 1 Flashcards

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1
Q

What does the central nervous system consist of?

A

Brain and spinal cord

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2
Q

What does the peripheral nervous system consist of?

A

cranial nerves and spinal nerves

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3
Q

Nervous system function

A

Control all motor, sensory, autonomic, cognitive and behavioral activities

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4
Q

What is the PNS further divided into?

A

somatic and autonomic

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5
Q

Synapse

A

gap between where the two neurons meet. Either the neuro is going to tell the next one to do something (excite) or stop (inhibit)

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6
Q

What does a neuron do?

A

Communicate messages/information from one neuron to the next or to the target cell. They either stimulate/terminate the activity of the target cell.

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7
Q

Catecholamine: when are they released?

A

in response to physical or emotional stress

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8
Q

What are examples of catecholamines?

A

Noradrenaline
Adrenaline (epinephrine)
Dopamine

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9
Q

What does adrenaline (epinephrine) do?

A

Hormone produced outside the brain, break down in communication, weakness and rapid fatigue of muscles under voluntary control.

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10
Q

Acetylcholine

A

major transmitter of the parasympathetic nervous system

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11
Q

Acetylcholine - source

A

Many areas of the brain; autonomic nervous system

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12
Q

Acetylcholine: action

A

Usually excitatory; parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerve) – voluntary muscle contraction, controls heartbeat, and stimulates hormones

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13
Q

Acetylcholine: example of dysfunction

A

↓ Leads to Myasthenia gravis

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14
Q

Serotonin: source

A

-Brainstem, hypothalamus, dorsal horn of the spinal cord

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15
Q

Serotonin: action

A

Inhibitory, helps control mood and sleep, inhibits pain pathways, regulation of appetite and temperature

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16
Q

Serotonin: example of dysfunction

A

↓ Leads to depression

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17
Q

Dopamine: source

A

Substantia nigra and basal ganglia

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18
Q

Dopamine: action

A

Usually inhibits, affects behavior (attention, emotions) and fine movement but can also be excitatory

  • Plays a role in behavior, learning, sleep, mood, focus, attention, immune health, pleasurable reward
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19
Q

Dopamine: example of dysfunction

A

↓ Leads to Parkinson disease (found in the basal ganglia. Hard for them to initiate movement and to smooth movement out)

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20
Q

Norepinephrine: what?

A

(major transmitter of the sympathetic nervous system) * fight or flight

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21
Q

NE: source

A

Brainstem, hypothalamus, postganglionic neurons of the sympathetic nervous system

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22
Q

NE: action

A

Usually excitatory; affects mood and overall activity

Seen rarely

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23
Q

Gamma-aminobutyric acid (GABA): source

A

Spinal cord, cerebellum, basal ganglia, some cortical areas

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24
Q

GABA: action

A

Inhibitory

*Mood modulator – Low levels lead to restlessness, anxiety and irritability

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25
Q

GABA: example of dysfunction

A

↓ Leads to seizures

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26
Q

Enkephalin, endorphin: source

A

Nerve terminals in the spine, brainstem, thalamus and hypothalamus, pituitary gland

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27
Q

Enkephalin, endorphin: action

A

Excitatory; pleasurable sensation, inhibits pain transmission

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28
Q

Enkephalin, endorphin: example of dysfunction

A

Poor pain control

If we do not have enough endorphins  lack of pain control

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29
Q

Cerebrum consists of what?

A 
2 hemispheres
Thalamus
hypothalamus
basal ganglia
connections for cranial nerve II and II
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30
Q

What does brainstem consist of?

A

midbrain
pons
medulla oblongata
connections for cranial nerves III through XII

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31
Q

Thalamus

A

relays information regulation of conscious and alertness

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32
Q

Hypothalamus job

A

Important for endocrine system

Regulates the pituitary secretion of hormones influencing metabolism, reproduction, stress response, and urine production

It works with the pituitary to maintain fluid balance

Emotional, Responses, aggressive and sexual behavior

Hunger, sleep/wake cycle, BP

Controls and regulates the autonomic nervous system and maintains temperature regulation by promoting vasoconstriction or vasodilatation.

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33
Q

Basal ganglia function

A

Controls fine motor movments

Planning and coordinating movements and posture

Inhibit unwanted muscular movement

Disorders results in exaggerated uncontrolled movements

Muscle rigidity

Athetosis

Chorea

Parkinson disease

Huntington disease

Spasmodic torticollis

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34
Q

Athetosis

A

Movement of a slow, squirming, writhing, twisting

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35
Q

Chorea

A

spasmodic, purposeless, irregular, uncoordinated motions of the trunk and extremities and facial grimacing

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36
Q

Brainstem function

A

autonomic function (involuntary), HR, breathing, swallowing

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37
Q

Midbrain, pons function overall

A

Motor and sensory pathways

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38
Q

Pons (portion of it) controls what?

A

HR, respiration and BP

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39
Q

Medulla oblongata: function

A

respiratory function

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40
Q

Cerebellum function

A 
Coordination and movement
Balance (postural) 
Awareness of body parts. 
Balance
Coordination
Timing
Damage results in loss of muscle tone, weakness, fatigue
Ataxia and incoordination
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41
Q

Frontal lobe

A

Largest lobe

The major functions are concentration, abstractthought, information storage or memory, and motor function.

The frontal lobe is responsible in large part for a person’s affect, judgment, personality, emotions, attitudes, and inhibitions, and contributes to the formation of thought processes.

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42
Q

Motor strip location

A

Location: frontal lobe

lies in the frontal lobe, anterior to the central sulcus

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43
Q

What does the motor strip do?

A

responsible for muscle movement

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44
Q

What are nursing consideration when working with a client who has damage to temporal lobe?

A

receptive speech issues, effected long term memory…reinforce teaching, chart to help them ID letters/objects to help them communicate what they want/need, pictures to remind family members, patience with them, giving them time to determine if they have aphasia or are confused, yes/no questions

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45
Q

What are nursing considerations when working with a client who has damage to their frontal lobe?

A

safety, fall risk, siderails (only 3 max.), etc.

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46
Q

Parietal lobe function

A

primary sensory cortex

This lobe analyzes sensory information such as pressure, vibration, pain, and temperature, and relays the interpretation of this information to the thalamus from the sensory cortex.

It is also essential to a person’s awareness of the body in space, as well as orientation in space and spatial relations.

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47
Q

Where is the parietal lobe?

A

posterior to the motor strip

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48
Q

Stereogenesis

A

ability to perceive an object using the sense of touch

processed in parietal lobe

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49
Q

What are nursing considerations when working with a client who has damage to parietal lobe?

A

walkers/assistive devices, communicate location of belongings/food, assistance while getting up, good lighting, correct temperature, nonverbal cues, remove tripping hazards)

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50
Q

Temporal lobe function

A

contain the auditory receptive areas

The interpretive area of the temporal lobe provides integration of visual and auditory areas and plays the most dominant role of any area of the cortex in thinking

Long-term memory recall is also associated with this lobe.

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51
Q

Where are the auditory and receptive areas located in the temporal lobe?

A

around temple regions

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52
Q

What is located in the posterior region of the temporal lobe

A

is the area responsible for receptive speech referred to asBroca’s area and Wernicke’s area.For most people, whether right- or left-handed, Broca’s area and Wernicke’s area. is in the left lobe

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53
Q

Occipital lobe function

A

primary visual cortex
visual reflexes
involuntary eye movements.

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54
Q

Nursing considerations when working with a client who has occipital lobe damage?

A

placing belongings/food close and describing where it is/placing belongings in their center field of vision

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55
Q

What are the structures that protect the brain?

A

Bones
Membranes
Fluid cushioning
Chemical (?)

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56
Q

Skull

A

Hard, protecting it from injury

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57
Q

What are meninges?

A

connective tissue covering the brain and spinal cord

Provides protection, support and nourishment

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58
Q

What are the 3 meningeal layers?

A

dura, arachnoid and pia

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59
Q

Dura

A

outermost meningeal layer, very tough, thick, inelastic, fibrous and gray

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60
Q

Epidural layer

A

potential space that lies outside the dura (meninge)

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61
Q

Arachnoid layer

A

– middle membrane, thin, delicate membrane – white due to no blood supply.

Has small finger-like projections (villi) which absorb CSF

62
Q

What happens when trauma occurs to the arachnoid layer?

A

When trauma occurs (trauma or hemorrhagic stroke) the villi become obstructed, and hydrocephalus can occur – also blocks the absorption of CSF leaving it to accumulate.

63
Q

Pia (meningeal layer)

A

thin, transparent, hugs the brain – very vascular

64
Q

Herniation

A

when the cranial cavity/brain tissue is being compressed or displaced downward.

65
Q

Normal neurological assessment

A 
Pain
Headaches/Migraines
Seizures
Dizziness and Vertigo
Visual Disturbances
Weakness
Abnormal Sensation

Family History
Social History

66
Q

Neuro assessment: assessing cerebral function

A

LOC = primary energy for the brain is glucose. Brain is dependent on blood flow for brain glucose. When blood sugars drop

Mental status - short/long term memory
Perception
Motor ability
Language ability

67
Q

agnosia

A

inability to interpret or recognize objects seen through the special senses

68
Q

Neuro assessment: physical assessment

A

Cerebral function
Cranial nerves
Motor system

69
Q

Neuro assessment: motor system

A 
strength
balance
coordination 
ataxia
Romberg test
grading deep tendon reflexes
sensory examination
70
Q

Ataxia

A

incoordination of voluntary muscle action (usually walking or reaching for objects)

71
Q

Romberg test

A

balance test – feet together, arms side, first with eyes open, then closed both for 20-30 seconds, slight swaying is normal, loss of balance is + test

72
Q

Deep tendon reflexes: grading

A

absence of reflexes is significant 0-4+ ( can be subjective) present, diminished, absent

73
Q

Deep tendon reflexes: clonus

A

hyperactive - sustained

74
Q

Deep tendon reflexes: superficial reflexes

A

include corneal, gag/swallow, upper/lower abdominal, plantar reflexes

75
Q

Corneal reflex

A

clean wisp of cotton lightly touching the outer corner of each eye on the sclera – if blink ok, can be unilateral or bilateral, need eye protection to prevent corneal damage

76
Q

Gag reflex

A

gently touching the back of the pharynx with a cotton tipped applicated. Must touch both sides of the uvula – swallowing precautions if no gag reflex

77
Q

Plantar (babinski) reflex

A

stroking the lateral side of the foot with a tongue blade – intact CNS = toes curl, not intact CNS = toes fan out

78
Q

Broca area function

A

control of muscles for speech production and ability to comprehend grammatical structure

79
Q

wernicke’s area

A

comprehension of speech sounds and language

80
Q

Diagnostic evaluation: Computed tomography scanning nursing considerations

A 
allergies (shellfish)
Fluids if receiving constrast
Preparation
Lie quietly
Kidney function
81
Q

PET: preparation

A

sensations
dizziness
lightheadedness
HA

no surar prior; typically NPO (no dextrose fluids)

82
Q

PET: contraindications

A

pregnancy and breastfeeding

83
Q

MRI: nursing considerations

A

Relaxation techniques
Magnetic field - NO nic patch
Monitor kidney function

84
Q

Cerebral angiography: nursing considerations

A

well hydrated - clear liquids
monitor injection site for hematoma
void prior to procedure

client will experience a brief feeling of warmth in face, behind eyes, jaw, teeth, tongue and lips with a metallic taste when contrast is injected

check pulses

monitor neuro s/s for at least 24 hours after

85
Q

EEG: nursing considerations

A

sleep deprived, taking away seizure medications

86
Q

Lumbar puncture: nursing considerations

A

Headache most common s/s after (May occur a few hours to several days after the procedures)

  • Bedrest after
  • Bifrontal or occipital (location HA)
  • Severe upon standing
87
Q

What is the lumbar puncture HA caused by?

A

CSF leakage at puncture site

88
Q

lumbar puncture management

A

bed red, analgesic, hydration, blood patch

89
Q

lumbar puncture complications

A 
Herniation
Abscess
Epidural hematoma
Meningitis 
Temporary voiding difficulties
90
Q

Blood brain barrier

A

Endothelial cells in the brain capillaries

All substances entering the brain must filter through these cells and astrocytes

91
Q

What can damage the BBB

A

Blood brain barrier can be altered by trauma, cerebral edema and cerebral hypoxemia

Implications for selection of medications to treat CNS disorders

92
Q

Spinal cord

A

Connection between the brain and the periphery

93
Q

Spinal cord - location

A

Extends from the foramen magnum at the base of the skull to the base of the first lumbar vertebrae

94
Q

what is passed the 2nd lumbar?

A

cauda equina (nerve roots)

95
Q

where is a lumbar puncture done?

A

L3-L4

96
Q

Circle of Willis

A

Collateral circulation
Arterial bifurcations - common site for aneurysm formation

where all vasculature meets in brain (bottom part)

97
Q

Describe the cerebral circulation

A

Brain does not store nutrients so it requires high blood flow

Blood flows against gravity

98
Q

Describe the arteries in the brain

A

Arteries - internal carotids - anterior circulation

Vertebral arteries (become the basilar artery) - then into the vertebrobasilar artery - supplying the posterior circulation of the brain

99
Q

Describe the veins of cerebral circulation

A

Veins - join larger veins - cross the subarachnoid space and empty into the dura sinuses (dura mater)

Empty into the internal jugular vein

100
Q

What nerves are located in the cerebral hemisphere?

A

Olfactory (I)

Optic (II)

101
Q

What nerves are located in the midbrain

A

Oculomotor (III)

Trochlear (IV)

102
Q

What nerves are located in the pons?

A

Trigeminal (V)
Abducens (VI)
Facial (VII)
Acoustic (VIII)

103
Q

What nerves are located in the Medulla?

A

Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII)
Spinal accessory (XI)

104
Q

Cranial nerve 1: name, type, dysfunction

A

Olfactory
Sensory
Dysfunction: inability to ID odor, termed anosmia

105
Q

Cranial nerve 2: name, type, dysfunction

A

optic
sensory
Dysfunction: decreased visual acuity and visual fields

106
Q

Cranial nerve 3: name, type, dysfunction

A

Oculomotor
Motor nerve

Dysfunction:
inability to move the eyes in the visual field described
Ptosis of affected eye
Nonreactive or dilated pupils

107
Q

Cranial nerve 4: name, type, dysfunction

A

Trochlear
Motor

Dysfunction: inability to look down and in

108
Q

Cranial nerve 5: name, type, dysfunction

A

Trigeminal
Mixed nerve type

Dysfunction:

  • Absence of corneal reflex
  • Diminished sensation to forehead, maxillary and mandibular region
  • Weakness of muscles responsible for chewing
109
Q

Cranial nerve 6: Name, type, dysfunction

A

Abducens
Motor

Dysfunction: inability to look laterally, double vision

110
Q

Cranial nerve 7: name, type, dysfunction

A

Facial
mixed nerve type

Dysfunction:

  • facial paralysis
  • Facial asymmetry, droop of mouth
  • Absent nasolabial fold
  • Decreased ability to taste
111
Q

Cranial nerve 8: name, type, dysfunction

A

Accoustic
sensory

dysfunction: decreased hearing in affected ear

112
Q

Cranial nerve 9: name, type, dysfunction

A

Glossopharyngeal
Mixed

Dysfunction: Dysphagia, Absence of gag reflex

113
Q

Cranial nerve 10: name, type, dysfunction

A

Vagus
mixed nerve type

Dysfunction: Hoarse or nasal quality to voice, Slurred speech

114
Q

Cranial nerve 11: name, type, dysfunction

A

Spinal accessory
motor nerve

dysfunction: inability to shrug shoulders

115
Q

Cranial nerve 12: name, type, dysfunction

A

Hypoglassal
Motor nerve

Dysfunction: tongue weakness

116
Q

Skull fracture: nursing considerations

A

Be alert for CSF leakage

  • Rhinorrhea (nose leak)
  • Otorrhea (ear leaking)
  • raccoon eyes
  • Battle’s signs
117
Q

What should the nurse keep in mind if there is a CSF leakage is suspected?

A

Do not insert anything into the orifice is it leaking from

118
Q

What are we concerned about when someone has a skull fracture or CSF leak?

A

Meningeal tear leading to meningitis

119
Q

What are telltale signs of of meningitis

A

High fever, stick neck, n/v, HA, sensitivity to light, seizure, sleepy

120
Q

What does CSF look like?

A

Should be clear and colorless

121
Q

How can CSF be tested?

A

Lumbar puncture

122
Q

What is normal for CSF? (what should be in it)

A

Less than 5 WBC in CSF,
50-80 glucose (minimal amount)
15-60 protein
Should NOT have RBC

123
Q

What kind of patients might present with a CSF leak?

A

trauma and surgery are two most common

124
Q

Causes of increase ICP

A 
Injury
Increased CSF
Bleeding
Hematoma
Hydrocephalus
Encephalopathy
Subarachnoid Hemorrhage
125
Q

What does CPP stand for?

A

Cerebral perfusion pressure

126
Q

How do we figure out CPP (cerebral perfusion pressure)

A

MAP - ICP

127
Q

Increased ICP: cranial vault

A

10% intravascular blood
80% brain tissue
10% CSF

an increase in any of these causes increased intracranial pressure

Brain tissue has limited ability to expand, compensation occurs by increasing absorption or decrease production of CSF or decreasing cerebral blood volume

128
Q

What should a nurse do with anyone with increased ICP?

A

increase HOB at least 30 degrees

129
Q

Signs and symptoms of ICP

A 
(MIND)
Mental status change
Irregular breathing
Nerve changes
Decerebrate/decorticate
(CRUSHED)
Cushing triad
Reflexes
Unconscious
Seizures
Headache
Emesis
Deterioration
130
Q

What are receiving sensory impulses

A

Thalamus integrates all sensory impulses except olfaction
Awareness of pain
Recognition of touch and temperature
Sense of movement and position
Ability to recognize size, shape and quality of objects
May be integrated at the spinal cord or relayed to the brain

131
Q

What is sensory loss

A

transection of spinal cord yields complete anesthesia below level of injury

132
Q

Motor and sensory functions include what

A

upper/lower motor neurons
coordination
receiving/sending sensory impulses
sensory loss

133
Q

Comparison of Lesions of the Upper Moto Neurons and Lower Motor Neurons

A

UPPER MOTOR NEURON LESIONS:

  • loss of voluntary control
  • increased muscle tone
  • muscle spasticity
  • no muscle atrophy
  • hyperactive and abnormal

LOWER MOTOR NEURON LESIONS:

  • loss of voluntary control
  • decreased muscle tone
  • flaccid muscle paralysis
  • muscle atrophy
  • absent or decreased reflexes
134
Q

Gero: structural changes

A

Brain weight decreases
Cerebral blood flow reduced
DTR decreased or absent
Stage IV sleep is reduced

135
Q

Gero: motor alterations

A

Flexed posture
Shuffling gait
Rigidity of movement
Reaction time decreased

136
Q

Gero: sensory alterations

A

Visual and hearing loss

Home environment modification

137
Q

Gero: temp regulation and pain perception

A

Need a warmer environment

Pain reaction decreased

138
Q

Gero: taste and small alterations

A

Decreased appetite
Decrease smell
Smoke, gas leaks, bad food

139
Q

Gero: tactile and visual alterations

A

Longer to recover moving from dark to light area

Difficulty identifying objects by touch

140
Q

Gero: mental status

A

Drug toxicity
Delirium
Vitamin B deficiency
Thyroid disease

141
Q

What are names of 6 primary brain tumors

A 
Gliomas
Meningiomas
Acoustic neuromas
Pituitary adenomas
angiomas
cerebral metasteses
142
Q

Primary brain tumors: risk factors

A 
Exposure to ionizing radiation and cancer
Cig
cell phone use
powerlines
genetic risk factors
143
Q

Primary brain tumors: clinical manifestations

A

Increased ICP – seizures, ,localized symptoms sensory loss, facial paralysis (HA, papilledema (edema of optic disk), visual changes, Personality changes, fatigue, vomiting, visual disturbances

144
Q

Primary brain tumors: assessment

A

check LOC, Emegent AIRWAY then metabolic eval – labs, structural

145
Q

Primary brain tumors: medical management

A

Surgical, Radiation, Pharm = chemo

146
Q

Primary brain tumor: nursing management

A

Monitor for increased ICP, neuro checks, VS

147
Q

Spinal cord tumors: metastatic Spinal Cord Tumors

A

– common cancer to spread – lung, breast and GI

148
Q

Spinal cord tumors: spinal cord compression

A

Medical Emergency = paralysis

Iv steroids (Dexamethasone)

149
Q

Spinal cord tumors: assessment

A

Sensory changes
Back pain
Sphincter dysfunction

150
Q

Spinal cord tumors: medical management

A

MRI diagnostic

151
Q

Spinal cord tumors: nursing management

A

Pre-op care
Post-op = changes in condition
Managing pain
Promote home and community based care

NURSING 3 (16 decks)

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