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Clinical Nursing May Exam > Neurological system > Flashcards

Neurological system Flashcards

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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
Q

what are signs of fly catching?

A

fly catching behaviour with normal mentation and no autonomic signs

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26
Q

what happens in movement disorders?

A

episodes of involuntary, spontaneous movement
patient stays conscious
normal between episodes

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27
Q

what causes syncope?

A 
reduced oxygenation to the brain
cardiac issues
neurological issues
hypoglycaemia
hypocalcaemia
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28
Q

what causes seizure like activity from 3rd degree block?

A

prolonged hypoxic event

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29
Q

what is canine epileptoid cramping syndrome?

A

movement disorder

with normal consciousness, mentation

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30
Q

what is emergency management for seizures?

A 
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
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31
Q

what is phone triage for seizure patients?

A 
keep owner calm
history of seizures
toxin exposure
head trauma
length of seizure 
consciousness
excretions
travel when no longer seizing
get contact number
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32
Q

what are considerations for seizure patients on ward?

A 
quiet area
dim lights as can be sensitive
bottom kennel for access
seizure plan on kennel with meds available
limited traffic
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33
Q

how do you respond if patient seizes?

A 
note time
call clinician for help
remove dangers
dim lights
reduce noise
observe and monitor
follow seizure plane
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34
Q

what do you do initially when owner brings in seizure patient?

A 
reassure
triage
ABCs
oxygen
anticonvulsants if needed
check temperature
CRI and intubation as needed
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35
Q

what is the main aim when patient presents with seizure in an emergency?

A

stop the patient seizing

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36
Q

what are the aims or managing patients with recurrent seizures?

A

improve quality of life
reduce frequency and severity
manage side effects and cost
educate owner

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37
Q

how can phenobarbital help manage seizures?

A

increases frequency of synaptic inhibition

reduces neuronal excitability

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38
Q

what are potential side effects of phenobarbital?

A 
hepatotoxicity
sedation
PUPD
polyphagia
ataxia
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39
Q

how does potassium bromide help control seizures?

A

reduces neuronal excitability alongside other drugs or alone

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40
Q

list possible side effects for use of potassium bromide

A 
gastric irritation
nausea
PUPD
sedation
pancreatitis
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41
Q

how does imepitoin help manage idiopathic epilepsy?

A

reduces electrical activity

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42
Q

what are potential side effects of imepitoin?

A

ataxia
vomiting
polyphagia

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43
Q

what are considerations for owners with pets who have seizures?

A

managed expectations
situation and ability to care for pet
finances as life time treatment needed
home environment

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44
Q

how can nurses provide long term support to owners with pets with seizures?

A

consistency in who they see in follow ups
follow up calls
written communication
support groups

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45
Q

what part of the body does NMD affect?

A

peripheral nervous system particularly motor neurones innervating skeletal muscle

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46
Q

what is polyradiculoneuritis?

A

immune mediated disease affecting myelin and axons causing axonopathy

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47
Q

how does polyradiculoneuritis present?

A

short strides progressing to tetraparesis
dysphonia
normal autononic functions such as eating and toileting
varys between patients

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48
Q

how is polyradiculoneuritis diagnosed?

A 
history
physical exam
neuro exam
EMG 
nerve and muscle biopsy
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49
Q

how is polyradiculoneuritis treated?

A

recumbency care
keep muscles moving to prevent contracture
physio

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50
Q

define myasthenia gravis

A

disease of neuromuscular transmission affecting NMJ

juncionopathy

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51
Q

what causes myasthenia gravis?

A

congenital or immune mediated reduction in NMJ receptors

less functional receptors so muscles cant contract normally

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52
Q

describe presentation of myasthenia gravis

A

muscle weakness and fatigue, focal or generalised

regurgitation due to oesophageal weakness

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53
Q

how is myasthenia gravis diagnosed?

A

history
presentation
megaoesophagus
edrophonium/tensilon test showing normal walking after medication

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54
Q

how is myasthenia gravis treated?

A

anticholinesterase therapy
immunosuppressive corticosteroids
intensive nursing
manage aspiration pneumonia risk

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55
Q

define polymyositis

A

immune mediated inflammatory myopathy

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56
Q

what causes polymyositis?

A

idiopathy

clinical diseases

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57
Q

what are the two types of polymyositis?

A

focal affecting muscles of mastication

diffuse affecting multiple groups over the body across the body

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58
Q

describe presentation of polymyositis

A 
exercise intolerance
stiffened gait
muscle weakness and atrophy
dysphonia
regurgitation
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59
Q

how is polymyositis diagnosed?

A 
rule out other causes
clinical history
increased creatinine kinase
electrodiagnostic testing
muscle biopsy
megaoesophagus
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60
Q

how is polymyositis treated?

A

immunosuppressive corticosteroids
manage aspiration pneumonia risk
prevent pressure sores from low muscle coverage

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61
Q

what is the effect of aspiration pneumonia?

A

pulmonary damage

inflammatory response

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62
Q

list signs of aspiration pneumonia

A

coughing
tachypnoea
crackles on auscultation

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63
Q

how is aspiration pneumonia managed?

A 
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
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64
Q

how do pressure sores form?

A

increased pressure on bony prominences in recumbent patients

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65
Q

what is seen in type 1 pressure sore?

A

light pigmentation

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66
Q

what is seen in type 2 pressure sore?

A

broken skin

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67
Q

what is seen in type 3 pressure sore?

A

wound deep to fat

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68
Q

what is seen in type 4 pressure sore?

A

wound deep to muscle or bone

necrotic or infected

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69
Q

how can pressure sores be prevented?

A 
thick bedding
turning every 2-4 hours
donut bandages
vet bed
physio
close monitoring
boots if cant lift feet
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70
Q

how are pressure sores treated?

A

debridement
antibiotics
prevention better

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71
Q

how does muscle contracture happen?

A

recumbency and immobilisation causes adaptive shortening of muscle and soft tissue

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72
Q

how is muscle contracture treated?

A

intensive physiotherapy

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73
Q

what are considerations when treating muscle contracture patients?

A 
temperament
client expectations 
disease process
previous injuries
other conditions
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74
Q

why is it important for nurses to understand spinal cord injury?

A

provide best care
identify progression of disease
correct monitoring
support owners

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75
Q

describe the anatomy of spinal cord

A

extracranial part of CNS encased in spinal column

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76
Q

how are SCD patients assessed?

A 
history
physical exam
neurological exam
potential diagnosis
diagnostic tests
diagnosis
prognosis
treatment
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77
Q

when are neurological exams indicated in SCD patients?

A

seizures
altered behaviour
gait abnormality

78
Q

why are neuro exams done in SCD patients?

A

identify if NS involved
identify location of disease
aid diagnosis and prognosis
assess condition continually

79
Q

what is assessed in neuro exams for SCD patients?

A 
mentation 
gait
posture
cranial nerves
proprioception
spinal reflexes of limbs
sensory evaluation of panniculus and deep pain
palpation of head, spine and limbs
80
Q

what are the tests for cranial nerves?

A 
menace
PLR
gag
palpebral 
vestibulocular reflexes
81
Q

define panniculus

A

dense fatty tissue layer consisting of excess SC fat around lower abdomen

82
Q

define neurolocalisation

A

determine part of spinal cord effected

83
Q

where are upper motor neurones located?

A

between cerebral cortex and spinal cord

84
Q

what is the role of upper motor neurones?

A

send signals to lower motor neurones

85
Q

what are signs of upper motor neurone disease?

A 
loss of motor function 
paresis
normal to high reflex
high muscle tone
muscle atrophy
86
Q

what is the role of lower motor neurones?

A

connect CNS to effector causing contraction

87
Q

what are signs of lower motor neurone disease?

A

paresis
low reflexes
low muscle tone
muscle atrophy

88
Q

define ataxia

A

uncoordinated gait

89
Q

define paresis/paretic

A

weakness, decreased voluntary movement

90
Q

define paralysis/plegic

A

no voluntary movement

91
Q

define mono-

A

one limb affected

92
Q

define hemi-

A

both limbs on one side effected

93
Q

define quadra/tetra-

A

all 4 limbs affected

94
Q

what is one of the most common presentation for SCD?

A

gait abnormalities

95
Q

how is gait assessed in SCD?

A

can they generate and make coordinated movement

walked up and down with or without support

96
Q

what are examples of abnormal postures caused by SCD?

A 
head tilt
head turn
neck ventroflexion
curving of spine
decerebrate rigidiy
decerebellate rigidity
wide stance
97
Q

define scoliosis

A

sideways curve of spine

98
Q

define lordosis

A

ventral deviation

99
Q

define kyphosis

A

arched dorsally

100
Q

what is decerebrate rigidity?

A

extension of all limbs, head, neck

101
Q

what is decerebellate rigidity?

A

extension of thoracic limbs, head and neck

102
Q

how are postural reactions tested?

A

proprioceptive repositioning
visual placing- should reach out to table
tactile placing- place paw on table with eyes covered
hopping
hemi walking
wheelbarrowing

103
Q

how are spinal reflexes tested in thoracic limbs?

A

withdrawal reflex of toes

tapping extensor carpi radialis and biceps brachii

104
Q

how are spinal reflexes tested in pelvic limbs?

A

patella reflex
cranial tibial and gastrocnemius reflex
perineal reflex
panniculus reflex to locate injury along cord

105
Q

why is pain evaluation usually done last in SCD patients?

A

allows other tests to be done

106
Q

what is the purpose of pain evaluation in SCD pateints?

A

test deep pain sensation

107
Q

how are pain evaluations carried out in SCD patients?

A

pinching or pressure on digits of each limb and looking for reaction

108
Q

list acute causes of spinal cord injury

A

IVDD
trauma
fracture
lesion

109
Q

list chronic causes of spinal cord injury

A

DDD
degenerative myelopathy
cervical stenotic myelopathy

110
Q

what are other causes of spinal cord injury?

A

alanto-axial subluxation
vertebral abnormalities
neoplasia
inflammatory disease

111
Q

how is SCD diagnosed?

A

radiography
MRI is gold standard
cisternal or lumbar CSF tap

112
Q

what is conservative treatment for SCD?

A 
6 weeks cage rest
physio
anti-inflammatories
analgesia
steroids
113
Q

what are examples of surgical treatment of SCD?

A

hemilaminectomy
ventral slot
dorsal laminectomy
spinal fixation

114
Q

what is the likely bladder status of SCD patients?

A

incontinent

115
Q

what are signs of UMN bladder?

A

hard to manually express so need catheter

intermittent squirting of urine

116
Q

describe UMN bladder

A

increased urethral resistance
detrusor and urethral sphincter can contract simultaneously
uncontrollable bladder function
urinary retention

117
Q

describe LMN bladder

A

flaccid bladder causing continual filling without expression

118
Q

what are signs of LMN bladder?

A

overflow incontinence

easy to manually express

119
Q

state nursing considerations for SCD patients

A 
long term care
enrichment
nutrition
recumbency care
physio
excretion management
hygiene
120
Q

what is intercranial disease?

A

disease affecting the brain

121
Q

what is contained in the skull?

A

80% brain
10% blood
10% CSF

122
Q

why does the brain need constant supply of oxygen

A

high demand of oxygen and nutrients with little storage

123
Q

what is normal ICP?

A

5-10mmHg

124
Q

define ICP

A

pressure between skull and IC tissue

125
Q

what is the effect of IC hypertension?

A

reduced CPP

reduced blood flow

126
Q

how does ICP increase?

A

increase in IC volume without compensatory decrease

127
Q

what is the effect of ICP increase without compensation?

A

MAP decreases and ICP increases so CPP decreases

CBF decreases

128
Q

what is the cushings reflex?

A

rise in MAP and reflex bradycardia triggered by severe acute increase in ICP

129
Q

list causes of ICD

A 
trauma
meningoencephalitis of unknown origin
infection 
neoplasia
toxins
seizures
hydrocephalus
130
Q

what is alert mentation?

A

normal responses to surrounding

131
Q

what is obtunded mentation?

A

less responsive but awake

132
Q

what is stuporous mentation?

A

only responsive to noxious stimuli

133
Q

define coma

A

unresponsive to all stimuli

134
Q

what does pupil size indicate about neurological status?

A

poor prognosis if mid sized fixed pupils unresponsive to light or if goes from miotic to mydriatric

135
Q

define miosis/miotic

A

constricted pupils

136
Q

define mydriasis/mydriatic

A

dilated pupils

137
Q

define anisocoria

A

asymmetrical pupils

138
Q

list some clinical signs of ICD

A 
ataxia
blindness
altered mentation
seizures
abnormal posturing
non-responsive pupils
coma
nystagmus
139
Q

how is GCS used not monitor neuro patients?

A

assessment of motor activity, brainstem reflex and consciousness scored 1-6 so total 3-18 with lower the score the worse prognosis

140
Q

how is high ICP treated?

A 
mannitol infusion
hypertonic saline
sedatives
analgesia
ventilation
intensive nursing
141
Q

how does mannitol infusion help treat increased ICP?

A

hyperosmolar so reduces cerebral oedema and increases CPP and CBF with rapid onset of effect

142
Q

describe nursing management for ICD patients

A 
recumbency care
elevation of cranial body 
no jugular samples
eye lube
clean excretions from mouth
monitor and reduce coughing
nutrition
anaesthetic monitoring
143
Q

define hydrocephalus

A

excess accumulation of CSF in ventricular system

144
Q

what causes hydrocephalus?

A

obstruction of CSF outflow
decreased absorption of CSF
increased production of CSF

congenital
tumour
inflammation
haemorrhage
infection
145
Q

list clinical signs of hydrocephalus

A 
behavioural changes
loss of coordination 
visual deficits
seizures
depression
enlarged dome shaped skull
146
Q

how is hydrocephalus managed?

A

prednisolone, omeprazole to reduce CSF production

ventriculoperitoneal shunt to divert CSF

147
Q

what is prognosis for hydrocephalus?

A

depends on cause and severity
good if infectious cause treated
guarded if tumour obstruction
good with VP shunt

148
Q

what is MUO?

A

meningoencephalitis of unknown origin

non-infectious inflammatory disorder of CNS

149
Q

list the types of MUO

A

granulomatous
necrotising
necrotising leukoencephalitis

150
Q

what are signalment of MUO?

A

small dogs
females
over 6 months

151
Q

list signs of MUO

A 
seizures
muscle tremors
blindness
head tilt
altered posture
circling
152
Q

how is MUO managed?

A

immunosuppressive drugs
antiepileptics
nursing

153
Q

how is MUO diagnosed?

A

clinical exam
bloods
MRI of brain
CSF analysis to see inflammation

154
Q

what is the prognosis for MUO?

A

poor if seizures
better if focal rather than multifocal lesions
can relapse

155
Q

what needs considering for neurology patients?

A 
ambulation ability
surgical or non-surgical
continence
temperament
recumbency
normal routine
156
Q

describe how kennels are set up for neuro patients

A

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
Q

how is urination managed in neuro patients?

A

manual expression
catheterisation
prevent urine scalding
check for UTI

158
Q

how does urine scalding happen?

A

when left on skin causes soreness, erythema, scalding and skin breaking

159
Q

how often do you express bladders?

A

6-8 hours minimum

160
Q

how often should you empty bladder with intermittent catheter?

A

2x daily as risks trauma

161
Q

how often are indwelling catheters emptied?

A

3-4x daily

162
Q

how do you care for patients with faecal incontinence?

A

keep clean and remove quickly

monitor for sores

163
Q

define decubital ulcer

A

open skin wound caused by continued pressure of skin on firm surface

164
Q

why is it important to provide neuro patients with exercise?

A

aids mental wellbeing
allows to exhibit normal behaviour
mobilise joints and muscles

165
Q

how do you aid paretic/plegic patients with exercise?

A

sling or harness
cover hind paws
keep back neutral

166
Q

how do you aid tetraparetic/plegic patients with exercise?

A

chest harness and sling
may need multiple people
cover all paws

167
Q

what are considerations for patients wounds following neuro surgery?

A 
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
Q

how can self mutilation occur in neuro patients?

A

paraesthesia when deep pain negative
boredom
stress

169
Q

define paraesthesia

A

feeling of something wrong in limb

170
Q

what is the purpose of physiotherapy?

A

keep joints and muscles mobile
retrain correct movement in limbs
promote recovery
prevent complications

171
Q

when can nurses do physio?

A

following plan and under guidance of physiotherapist

172
Q

what conditions benefit from physiotherapy?

A

NM conditions
SCD
degenerative myelopathy

173
Q

list benefits of pysio

A 
pain management
improved ROM
reduce muscle contracture
stimulate NS
improve blood perfusion 
encourage relearning motor skills
weight management
174
Q

what is the role of nurses in physio?

A

carry out plans

monitor and record chnages

175
Q

what are safety considerations for physiotherapy?

A

need to be clinically stable

nursing care plan in place for potential problems, interventions and evaluations

176
Q

how should you handle neuro patients?

A

encourage natural movement
keep spine in line
TLC
positive reinforcement

177
Q

list types of physio

A 
massage
coupage
passive ROM 
assisted exercise
proprioceptive exercise
NM electrical stimulation
hydrotherapy
laser therapy
178
Q

what is the purpose of massage?

A

relax and aid circulation

179
Q

describe how massages are performed?

A

effleurage- stroking towards heart
petrissage- rolling, compressing of skin and muscles
percussion- gentle tapping
vibration- gently shaking limbs

180
Q

what is coupage and when is it used?

A

respiratory therapy

recumbent or patients with pulmonary disease

181
Q

what is the benefit of coupage?

A

loosen secretion and assist airway clearance

182
Q

what is the purpose of passive ROM?

A

help joint mobilisation and stretching in normal ROM in flexion and extension

183
Q

list examples of assisted exercises

A 
standing
walking
sit to stand
3 legged standing
weight shifting
184
Q

list examples of proprioceptive exercises

A

standing
wobble board
uneven surfaces
over poles weaving

185
Q

list reasons for active exercises in physio

A

improve strength

promote independence

186
Q

what is the process of active exercises?

A

actively carry out movement

repetition

187
Q

list examples of active exercises

A 
lead exercise
figure 8s 
sitting and standing
pole walking
weight shifting
hydrotherapy
188
Q

how is hydrotherapy done?

A

underwater treadmill gradually reducing water height to increase strength used
pool swimming

189
Q

what is meant by e-stim?

A

NM electrical nerve stimulation to skeletal muscle percutaneously
electrical muscle stimulation by needle electrodes

190
Q

list benefits of e-stim

A 
increase muscle strength and tone
increase ROM
pain control
oedema reduction
improve perfusion
slow muscle atrophy
191
Q

how are effective muscle contractions generated in e-stim?

A

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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