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Clinical Nursing May Exam > Neurological system > Flashcards

Neurological system Flashcards

1
Q

describe normal cerebral activity

A

neurones transmit information through chemical and electrical signals
interneurons are inhibitory cells which regulate activity

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2
Q

what happens to cerebral activity causing seizures?

A

hypersynchronisation of neurones due to imbalance of inhibitory and excitatory input

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3
Q

define seizure

A

abnormal, uncontrollable, hypersynchronous electrical activation of large groups of neurones

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4
Q

list the types of seizures

A 
isolated
cluster
status epilepticus
partial/focal
generalised tonic clonic
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5
Q

what is an isolated seizure?

A

one seizure lasting less than 5 minutes

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6
Q

what is a cluster siezure?

A

2 or more seizures within 24 hours with complete recovery between

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7
Q

what is status epilepticus?

A

seizure lasting more than 5 minutes or 2 seizures without full recovery between

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8
Q

what are partial/focal seizures?

A

asymmetric seizures where one part of the brain affected

simple or complex

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9
Q

what is a simple seizure?

A

no change in mentation

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10
Q

what is a complex seizure?

A

changed mentation

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11
Q

list signs of partial/focal seizure

A

facial twitching
hypersalivation
changes in behaviour
maintained consciousness

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12
Q

what are generalised tonic clonic seizures?

A

bilateral cerebral hemisphere involvement

pre and post ictal phases

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13
Q

list signs of generalised tonic clonic seizures

A

autonomic signs
excreting
loss of consciousness

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14
Q

what is pre-ictal phase of seizures and what can be seen?

A

before seizure

behavioural changes, altered mentation, attention seeking

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15
Q

what is ictal phase of seizures and what can be seen?

A

seizure phase
unconsciousness
muscle contraction
excretion

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16
Q

what is post-ictal phase of seizures and what can be seen?

A

after seizure

abnormal neurological signs for minutes to days

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17
Q

list extracranial causes of seizures

A

toxins
portosystemic shunt causing toxin build up
hypoglycaemia
hypocalcaemia

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18
Q

list intracranial causes of seizures

A

tumour
inflammation
hydrocephalus
idiopathic epilepsy

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19
Q

what is seen with idiopathic epilepsy?

A

recurrent but not cluster seizures

normal inter-icteral neuro exams, metabolic investigations, MRI and CSF

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20
Q

how are seizures diagnosed?

A 
history
blood tests
MRI
CSF analysis
videos
monitoring
retinal exam and BP to rule out other causes
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21
Q

what is meant by seizure mimics?

A

disorders that look like seizures but aren’t

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22
Q

list seizure mimics

A 
narcolepsy
fly catching
movement disorder
syncope
3rd degree AV block
canine epileptoid cramping syndrome
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23
Q

what is narcolepsy?

A

inherited sleep wake disorder

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24
Q

what is seen in narcolepsy?

A

loss of muscle tone during episode

no autonomic signs

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25
what are signs of fly catching?
fly catching behaviour with normal mentation and no autonomic signs
26
what happens in movement disorders?
episodes of involuntary, spontaneous movement patient stays conscious normal between episodes
27
what causes syncope?
``` reduced oxygenation to the brain cardiac issues neurological issues hypoglycaemia hypocalcaemia ```
28
what causes seizure like activity from 3rd degree block?
prolonged hypoxic event
29
what is canine epileptoid cramping syndrome?
movement disorder | with normal consciousness, mentation
30
what is emergency management for seizures?
``` oxygen IV placed if possible diazepam assess circulation and temperature intubate as needed cool if hyperthermic mannitol if seizure over 15 minutes or cerebral oedema full blood tests ```
31
what is phone triage for seizure patients?
``` keep owner calm history of seizures toxin exposure head trauma length of seizure consciousness excretions travel when no longer seizing get contact number ```
32
what are considerations for seizure patients on ward?
``` quiet area dim lights as can be sensitive bottom kennel for access seizure plan on kennel with meds available limited traffic ```
33
how do you respond if patient seizes?
``` note time call clinician for help remove dangers dim lights reduce noise observe and monitor follow seizure plane ```
34
what do you do initially when owner brings in seizure patient?
``` reassure triage ABCs oxygen anticonvulsants if needed check temperature CRI and intubation as needed ```
35
what is the main aim when patient presents with seizure in an emergency?
stop the patient seizing
36
what are the aims or managing patients with recurrent seizures?
improve quality of life reduce frequency and severity manage side effects and cost educate owner
37
how can phenobarbital help manage seizures?
increases frequency of synaptic inhibition | reduces neuronal excitability
38
what are potential side effects of phenobarbital?
``` hepatotoxicity sedation PUPD polyphagia ataxia ```
39
how does potassium bromide help control seizures?
reduces neuronal excitability alongside other drugs or alone
40
list possible side effects for use of potassium bromide
``` gastric irritation nausea PUPD sedation pancreatitis ```
41
how does imepitoin help manage idiopathic epilepsy?
reduces electrical activity
42
what are potential side effects of imepitoin?
ataxia vomiting polyphagia
43
what are considerations for owners with pets who have seizures?
managed expectations situation and ability to care for pet finances as life time treatment needed home environment
44
how can nurses provide long term support to owners with pets with seizures?
consistency in who they see in follow ups follow up calls written communication support groups
45
what part of the body does NMD affect?
peripheral nervous system particularly motor neurones innervating skeletal muscle
46
what is polyradiculoneuritis?
immune mediated disease affecting myelin and axons causing axonopathy
47
how does polyradiculoneuritis present?
short strides progressing to tetraparesis dysphonia normal autononic functions such as eating and toileting varys between patients
48
how is polyradiculoneuritis diagnosed?
``` history physical exam neuro exam EMG nerve and muscle biopsy ```
49
how is polyradiculoneuritis treated?
recumbency care keep muscles moving to prevent contracture physio
50
define myasthenia gravis
disease of neuromuscular transmission affecting NMJ | juncionopathy
51
what causes myasthenia gravis?
congenital or immune mediated reduction in NMJ receptors | less functional receptors so muscles cant contract normally
52
describe presentation of myasthenia gravis
muscle weakness and fatigue, focal or generalised | regurgitation due to oesophageal weakness
53
how is myasthenia gravis diagnosed?
history presentation megaoesophagus edrophonium/tensilon test showing normal walking after medication
54
how is myasthenia gravis treated?
anticholinesterase therapy immunosuppressive corticosteroids intensive nursing manage aspiration pneumonia risk
55
define polymyositis
immune mediated inflammatory myopathy
56
what causes polymyositis?
idiopathy | clinical diseases
57
what are the two types of polymyositis?
focal affecting muscles of mastication | diffuse affecting multiple groups over the body across the body
58
describe presentation of polymyositis
``` exercise intolerance stiffened gait muscle weakness and atrophy dysphonia regurgitation ```
59
how is polymyositis diagnosed?
``` rule out other causes clinical history increased creatinine kinase electrodiagnostic testing muscle biopsy megaoesophagus ```
60
how is polymyositis treated?
immunosuppressive corticosteroids manage aspiration pneumonia risk prevent pressure sores from low muscle coverage
61
what is the effect of aspiration pneumonia?
pulmonary damage | inflammatory response
62
list signs of aspiration pneumonia
coughing tachypnoea crackles on auscultation
63
how is aspiration pneumonia managed?
``` prevention intense monitoring to catch early signs antibiotics IVFT oxygen respiratory physio turning patients to prevent fluid accumulation food balls from height to prevent inhaling ventilation in severe cases ```
64
how do pressure sores form?
increased pressure on bony prominences in recumbent patients
65
what is seen in type 1 pressure sore?
light pigmentation
66
what is seen in type 2 pressure sore?
broken skin
67
what is seen in type 3 pressure sore?
wound deep to fat
68
what is seen in type 4 pressure sore?
wound deep to muscle or bone | necrotic or infected
69
how can pressure sores be prevented?
``` thick bedding turning every 2-4 hours donut bandages vet bed physio close monitoring boots if cant lift feet ```
70
how are pressure sores treated?
debridement antibiotics prevention better
71
how does muscle contracture happen?
recumbency and immobilisation causes adaptive shortening of muscle and soft tissue
72
how is muscle contracture treated?
intensive physiotherapy
73
what are considerations when treating muscle contracture patients?
``` temperament client expectations disease process previous injuries other conditions ```
74
why is it important for nurses to understand spinal cord injury?
provide best care identify progression of disease correct monitoring support owners
75
describe the anatomy of spinal cord
extracranial part of CNS encased in spinal column
76
how are SCD patients assessed?
``` history physical exam neurological exam potential diagnosis diagnostic tests diagnosis prognosis treatment ```
77
when are neurological exams indicated in SCD patients?
seizures altered behaviour gait abnormality
78
why are neuro exams done in SCD patients?
identify if NS involved identify location of disease aid diagnosis and prognosis assess condition continually
79
what is assessed in neuro exams for SCD patients?
``` mentation gait posture cranial nerves proprioception spinal reflexes of limbs sensory evaluation of panniculus and deep pain palpation of head, spine and limbs ```
80
what are the tests for cranial nerves?
``` menace PLR gag palpebral vestibulocular reflexes ```
81
define panniculus
dense fatty tissue layer consisting of excess SC fat around lower abdomen
82
define neurolocalisation
determine part of spinal cord effected
83
where are upper motor neurones located?
between cerebral cortex and spinal cord
84
what is the role of upper motor neurones?
send signals to lower motor neurones
85
what are signs of upper motor neurone disease?
``` loss of motor function paresis normal to high reflex high muscle tone muscle atrophy ```
86
what is the role of lower motor neurones?
connect CNS to effector causing contraction
87
what are signs of lower motor neurone disease?
paresis low reflexes low muscle tone muscle atrophy
88
define ataxia
uncoordinated gait
89
define paresis/paretic
weakness, decreased voluntary movement
90
define paralysis/plegic
no voluntary movement
91
define mono-
one limb affected
92
define hemi-
both limbs on one side effected
93
define quadra/tetra-
all 4 limbs affected
94
what is one of the most common presentation for SCD?
gait abnormalities
95
how is gait assessed in SCD?
can they generate and make coordinated movement | walked up and down with or without support
96
what are examples of abnormal postures caused by SCD?
``` head tilt head turn neck ventroflexion curving of spine decerebrate rigidiy decerebellate rigidity wide stance ```
97
define scoliosis
sideways curve of spine
98
define lordosis
ventral deviation
99
define kyphosis
arched dorsally
100
what is decerebrate rigidity?
extension of all limbs, head, neck
101
what is decerebellate rigidity?
extension of thoracic limbs, head and neck
102
how are postural reactions tested?
proprioceptive repositioning visual placing- should reach out to table tactile placing- place paw on table with eyes covered hopping hemi walking wheelbarrowing
103
how are spinal reflexes tested in thoracic limbs?
withdrawal reflex of toes | tapping extensor carpi radialis and biceps brachii
104
how are spinal reflexes tested in pelvic limbs?
patella reflex cranial tibial and gastrocnemius reflex perineal reflex panniculus reflex to locate injury along cord
105
why is pain evaluation usually done last in SCD patients?
allows other tests to be done
106
what is the purpose of pain evaluation in SCD pateints?
test deep pain sensation
107
how are pain evaluations carried out in SCD patients?
pinching or pressure on digits of each limb and looking for reaction
108
list acute causes of spinal cord injury
IVDD trauma fracture lesion
109
list chronic causes of spinal cord injury
DDD degenerative myelopathy cervical stenotic myelopathy
110
what are other causes of spinal cord injury?
alanto-axial subluxation vertebral abnormalities neoplasia inflammatory disease
111
how is SCD diagnosed?
radiography MRI is gold standard cisternal or lumbar CSF tap
112
what is conservative treatment for SCD?
``` 6 weeks cage rest physio anti-inflammatories analgesia steroids ```
113
what are examples of surgical treatment of SCD?
hemilaminectomy ventral slot dorsal laminectomy spinal fixation
114
what is the likely bladder status of SCD patients?
incontinent
115
what are signs of UMN bladder?
hard to manually express so need catheter | intermittent squirting of urine
116
describe UMN bladder
increased urethral resistance detrusor and urethral sphincter can contract simultaneously uncontrollable bladder function urinary retention
117
describe LMN bladder
flaccid bladder causing continual filling without expression
118
what are signs of LMN bladder?
overflow incontinence | easy to manually express
119
state nursing considerations for SCD patients
``` long term care enrichment nutrition recumbency care physio excretion management hygiene ```
120
what is intercranial disease?
disease affecting the brain
121
what is contained in the skull?
80% brain 10% blood 10% CSF
122
why does the brain need constant supply of oxygen
high demand of oxygen and nutrients with little storage
123
what is normal ICP?
5-10mmHg
124
define ICP
pressure between skull and IC tissue
125
what is the effect of IC hypertension?
reduced CPP | reduced blood flow
126
how does ICP increase?
increase in IC volume without compensatory decrease
127
what is the effect of ICP increase without compensation?
MAP decreases and ICP increases so CPP decreases | CBF decreases
128
what is the cushings reflex?
rise in MAP and reflex bradycardia triggered by severe acute increase in ICP
129
list causes of ICD
``` trauma meningoencephalitis of unknown origin infection neoplasia toxins seizures hydrocephalus ```
130
what is alert mentation?
normal responses to surrounding
131
what is obtunded mentation?
less responsive but awake
132
what is stuporous mentation?
only responsive to noxious stimuli
133
define coma
unresponsive to all stimuli
134
what does pupil size indicate about neurological status?
poor prognosis if mid sized fixed pupils unresponsive to light or if goes from miotic to mydriatric
135
define miosis/miotic
constricted pupils
136
define mydriasis/mydriatic
dilated pupils
137
define anisocoria
asymmetrical pupils
138
list some clinical signs of ICD
``` ataxia blindness altered mentation seizures abnormal posturing non-responsive pupils coma nystagmus ```
139
how is GCS used not monitor neuro patients?
assessment of motor activity, brainstem reflex and consciousness scored 1-6 so total 3-18 with lower the score the worse prognosis
140
how is high ICP treated?
``` mannitol infusion hypertonic saline sedatives analgesia ventilation intensive nursing ```
141
how does mannitol infusion help treat increased ICP?
hyperosmolar so reduces cerebral oedema and increases CPP and CBF with rapid onset of effect
142
describe nursing management for ICD patients
``` recumbency care elevation of cranial body no jugular samples eye lube clean excretions from mouth monitor and reduce coughing nutrition anaesthetic monitoring ```
143
define hydrocephalus
excess accumulation of CSF in ventricular system
144
what causes hydrocephalus?
obstruction of CSF outflow decreased absorption of CSF increased production of CSF ``` congenital tumour inflammation haemorrhage infection ```
145
list clinical signs of hydrocephalus
``` behavioural changes loss of coordination visual deficits seizures depression enlarged dome shaped skull ```
146
how is hydrocephalus managed?
prednisolone, omeprazole to reduce CSF production | ventriculoperitoneal shunt to divert CSF
147
what is prognosis for hydrocephalus?
depends on cause and severity good if infectious cause treated guarded if tumour obstruction good with VP shunt
148
what is MUO?
meningoencephalitis of unknown origin | non-infectious inflammatory disorder of CNS
149
list the types of MUO
granulomatous necrotising necrotising leukoencephalitis
150
what are signalment of MUO?
small dogs females over 6 months
151
list signs of MUO
``` seizures muscle tremors blindness head tilt altered posture circling ```
152
how is MUO managed?
immunosuppressive drugs antiepileptics nursing
153
how is MUO diagnosed?
clinical exam bloods MRI of brain CSF analysis to see inflammation
154
what is the prognosis for MUO?
poor if seizures better if focal rather than multifocal lesions can relapse
155
what needs considering for neurology patients?
``` ambulation ability surgical or non-surgical continence temperament recumbency normal routine ```
156
describe how kennels are set up for neuro patients
thick bedding as bottom layer layered inco pads so dont need to change whole bed every time vet bed as top layer to wick urine pad sides for comfort and prevent injury
157
how is urination managed in neuro patients?
manual expression catheterisation prevent urine scalding check for UTI
158
how does urine scalding happen?
when left on skin causes soreness, erythema, scalding and skin breaking
159
how often do you express bladders?
6-8 hours minimum
160
how often should you empty bladder with intermittent catheter?
2x daily as risks trauma
161
how often are indwelling catheters emptied?
3-4x daily
162
how do you care for patients with faecal incontinence?
keep clean and remove quickly | monitor for sores
163
define decubital ulcer
open skin wound caused by continued pressure of skin on firm surface
164
why is it important to provide neuro patients with exercise?
aids mental wellbeing allows to exhibit normal behaviour mobilise joints and muscles
165
how do you aid paretic/plegic patients with exercise?
sling or harness cover hind paws keep back neutral
166
how do you aid tetraparetic/plegic patients with exercise?
chest harness and sling may need multiple people cover all paws
167
what are considerations for patients wounds following neuro surgery?
``` ventral slot needs care when walking hemilaminectomy has risk of seroma as more movement cold therapy analgesia anti inflammatories primapore for 72 hours prevent interference use harness ```
168
how can self mutilation occur in neuro patients?
paraesthesia when deep pain negative boredom stress
169
define paraesthesia
feeling of something wrong in limb
170
what is the purpose of physiotherapy?
keep joints and muscles mobile retrain correct movement in limbs promote recovery prevent complications
171
when can nurses do physio?
following plan and under guidance of physiotherapist
172
what conditions benefit from physiotherapy?
NM conditions SCD degenerative myelopathy
173
list benefits of pysio
``` pain management improved ROM reduce muscle contracture stimulate NS improve blood perfusion encourage relearning motor skills weight management ```
174
what is the role of nurses in physio?
carry out plans | monitor and record chnages
175
what are safety considerations for physiotherapy?
need to be clinically stable | nursing care plan in place for potential problems, interventions and evaluations
176
how should you handle neuro patients?
encourage natural movement keep spine in line TLC positive reinforcement
177
list types of physio
``` massage coupage passive ROM assisted exercise proprioceptive exercise NM electrical stimulation hydrotherapy laser therapy ```
178
what is the purpose of massage?
relax and aid circulation
179
describe how massages are performed?
effleurage- stroking towards heart petrissage- rolling, compressing of skin and muscles percussion- gentle tapping vibration- gently shaking limbs
180
what is coupage and when is it used?
respiratory therapy | recumbent or patients with pulmonary disease
181
what is the benefit of coupage?
loosen secretion and assist airway clearance
182
what is the purpose of passive ROM?
help joint mobilisation and stretching in normal ROM in flexion and extension
183
list examples of assisted exercises
``` standing walking sit to stand 3 legged standing weight shifting ```
184
list examples of proprioceptive exercises
standing wobble board uneven surfaces over poles weaving
185
list reasons for active exercises in physio
improve strength | promote independence
186
what is the process of active exercises?
actively carry out movement | repetition
187
list examples of active exercises
``` lead exercise figure 8s sitting and standing pole walking weight shifting hydrotherapy ```
188
how is hydrotherapy done?
underwater treadmill gradually reducing water height to increase strength used pool swimming
189
what is meant by e-stim?
NM electrical nerve stimulation to skeletal muscle percutaneously electrical muscle stimulation by needle electrodes
190
list benefits of e-stim
``` increase muscle strength and tone increase ROM pain control oedema reduction improve perfusion slow muscle atrophy ```
191
how are effective muscle contractions generated in e-stim?
clip hair clean and place conducting gel 1 electrode on motor point of muscle and other on belly check for contraction then do contraction cycles 10-20 minutes daily

Clinical Nursing May Exam (22 decks)

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