Neurological System Flashcards
cns
- the BRAIN & SPINAL CORD
- 12 pairs
pns
- ALL NERVE FIBERS that are OUTSIDE the brain & spinal cord
- 31 pairs
midbrain
the RELAY CENTER for our EYE & EAR REFLEXES
- relays between CEREBRUM & BRAIN STEM
pons
links the CEREBELLUM to the CEREBRUM
links the MIDBRAIN to the MEDULLA
- reflex actions
medulla
controls our RESPIRATORY, HR, fORCE & BP
cerebellum
- important for COORDINATION & maintaining EQUILIBRIUM & MUSCLE TONE
- important for our PRIMARY FUNCTIONS
what is the DIFFERENCE BETWEEN AFFERENT & EFFERENT IMPULSES?
afferent:
- sends impulses UP to the brain
efferent:
- sends impulses DOWN to the glands & muscles
describe the ANS
- has impulses from BOTH CRANIAL & SPINA:
- important for maintaining HOMEOSTASIS
what are the TWO COMPONENTS of the ANS?
SYMPATHETIC;
fight or flight response
PARASYMPATHETIC;
the rest and digest response
what to do before STARTING a NEURO ASSESSMENT?
- want to EXPLAIN the procedure
- instruct family members NOT to answer questions for the patient
**want a CLEAR BASELINE for the patient
what is the PURPOSE OF THE ASSESSMENT (6)?
we want to cover;
- LOC & MENTATION
- MOVEMENT
- SENSATION
- CEREBELLAR FUNCTION
- REFLEXES
- CRANIAL NERVES
how do we EVALUATE LOC & MENTATION?
- looking at the patient’s ORIENTATION & MEMORY
what does the PATIENT have to be orientated to?
- PERSON
- PLACE
- TIME
- SITUATION
lethargic
the PATIENT is DROWSY but is able to be awakened
- can have slow or inattentive answers
full consciousness
- ALERT
- ATTENTIVE
- follows commands
obtunded
the patient is DIFFICULT to AROUSE & needs CONSTANT STIMULATION
stuporous
patient needs VIGOROUS & CONTINUOUS STIMULATION in order to stay awake–often needing a PAINFUL STIMULUS
- can often MOAN briefly etc…
comatose
no response to any stimulation even if painful
- no movement or sounds made
what are the THREE RESPONSES we look for in the GLASGOW COMA SCALE? what are the ranges of points?
- EYE OPENING RESPONSE
- VERBAL RESPONSE
- MOTOR RESPONSE
out of 15 points!
anything lower than 8 can an indicate a SEVERE BRAIN INJURY
definition of AVPU
a - patient is AWAKE
v - patient responds to VERBAL STIMULATION
p - patient responds to PAINFUL STIMULATION
u - patient is COMPLETELY UNRESPONSIVE
how do we DIVIDE MEMORY?
- IMMEDIATE MEMORY
- SHORT-TERM MEMORY
- REMOTE MEMORY
immediate memory
- quick repetition of recent events
ex. testing three objects
short-term memory
- memory of something that occurred recently in the past few days
ex. holidays or breakfast for the day
remote memory
memory of the DISTANT PAST–looking at yers or decades
**typically is the LAST TO GO
definition of SYNCOPE
feeling faint
definition of VERTIGO
spinning type of sensation
definition of DISEQUILIBRIUM
feeling of unsteadiness
what do we use during a SENSORY EXAMINATION?
- use of different objects;
soft or dull test - use of cotton balls, paper clips or a reflex hammer
how do we test our MOTOR SKILLS?
- testing the CRANIAL NERVES
- want to utilize alternating movements within the extremities
how do we TEST FOR BALANCE?
use of the ROMBERG TEST
- want the patients to close their eyes for around 20 seconds and to stand still
**want to have arms ready in case they fall or sway
**swaying is relatively a normal sign
stereognosis
identification of a FAMILIAR OBJECT by TOUCH or MANIPULATION
definition of GRAPHESTHESIA
identification of letter or number being drawn on the palm of the hand
sensation
identification of the body area being touched
which DEEP TENDON REFLEXES do we test? (5)
- BICEPS
- BRACHIORADIALIS
- TRICEPS
- PATELLAR
- ACHILLES
what is the BABINSKI TEST?
- use of a reflex hammer to stimulate PLANTAR FLEXION OF THE FOOT
- stroking of the sole of the foot - J MOTION
- want to see; toes should CURL DOWN NOT UP **for anyone 2 years and up
ankle clonus
type of INVOLUNTARY REPETITIVE MUSCLE CONTRACTIONS when a spastic muscle is being stretched
- can see that REFLEXES are HYPERACTIVE
what are the CRANIAL NERVES (in order?
OLFACTORY (I)
OPTIC (II)
OCULOMOTOR (III)
TROCHLEAR (IV)
TRIGEMINAL (V)
ABDUCENS (VI)
FACIAL (VII)
ACOUSTIC (VIII)
GLOSSOPHARYNGEAL (IX)
VAGUS (X)
SPINAL ACCESSORY (XI)
HYPOGLOSSAL (XII)
how do we test CN I?
odor identification
how do we test CN II?
visual acuity/visual fields
how do we test CN III, IV, VI?
looking at the PUPILS, points of GAZE, and opening of the UPPER EYELIDS
how do we test CN V?
looking at the FACIAL MUSCLE STRENGTH, sharp vs. dull test
how do we test CN VII?
looking at FACIAL EXPRESSIONS and speech
how do we test CN VIII?
hearing screening
how do we test CN IX and X?
gag reflex & swallowing
how do we test CN XI?
looking at our TRAPEZIUS & STERNOCLEIDOMASTOID MUSCLES–want pt. to shrug
how do we test CN XII?
looking at the TONGUE and its movements
how can we test ACCURACY OF MOVEMENT?
the FINGER to NOSE TEST
the HEEL to SHIN TEST
how do we GRADE REFLEXES?
graded upon a 4 POINT SCALE
4 - very BRISK + CLONUS + INDICATIVE OF DISEASE
3 - BRISKER than AVG. + can indicate disease
2- average/normal
1 - DIMINISHED/LOW/needs reinforcement
0 - NO RESPONSE
definition of MENINGITIS
the INFLAMMATION of the BRAIN or SPINAL CORD
signs and symptoms of MENINGITIS
- fever, neck stiffness, headaches
- nausea or sleepiness
- use of BRUDZINKSKIS SIGN + KERNIGS SIGN
- use of LUMBAR PUNCTURE & NEURO EXAM
definition of CVA/STROKE
sudden INTERRUPTION of BLOOD SUPPLY to the part of the brain or RUPTURE of a BV–spilling blood into spaces around the brain cells
who is at RISK for CVA?
- hypertensive pts.
- DM pts.
- heart dx pts.
- smokers
- African American population
- high cholesterol
FAST
F - any facial drooping? want pt. to smile
A - any drifting of the arms? want pt. to raise both arms
S - any slurred/strange speech? want pt. to repeat a simple phrase
T - time is crucial! act fast
**can also see student WEAKNESS on ONE SIDE OF THE BODY
**trouble seeing in ONE OR BOTH EYES
**HEADACHES/DIZZINESS/trouble with walking
what is the difference between RIGHT and LEFT BRAIN DAMAGE?
RIGHT SIDE:
- have LEFT SIDE PARALYSIS
- have LEFT-SIDED NEFLECT
- tend to have more denial of issues & greater impulsive behavior
LEFT SIDE:
- have RIGHT SIDE PARALYSIS
- have impaired speech
- more slower performance & anxiety & depression
definition of PERIPHERAL NEUROPATHY
disorder of the PNS where there is MOTOR & SENSORY LOSS in distribution of one or more nerves
signs & symptoms of peripheral neuropathy
- HYPERALGENISA & ALLODYNIA
- numbness & tingling in hands or feet
- muscle weakness
decerebrate posture
arms & legs are STRAIGHT OUT
toes are DOWNWARD
head & neck are ARCHED BACKWARD
FLEXED WRISTS
decorticate posture
- stiff & bent arms
- arms and fists clenched
- flexion INWARD
- plantar flexion of feet
definition of PARKINSONS
type of SLOW PROGRESSIVE DEGENERATIVE NEUROLOGIC DISORDER wher motor function is affected with behavioral & cognitive issues
signs and symptoms of PARKINSONS
- slower movements
- stooped posture
- type of SHUFFLING WALK & reduced arm swinging
- tremors and difficulty of breathing
