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NEURO LEVEL III > NEUROLOGY > Flashcards

NEUROLOGY Flashcards

1
Q

Catecholamines

A

Epi/Norepinephrine…released during sympathetic

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2
Q

brain divisions

A
  • Cerebrum: L/R hemispheres divided by corpus callosum
  • cerebellum: balance will be off in PT if damage is here
  • brainstem: midbrain, pons, medulla (V.S. BP, HR..L side injury would show on R side b/c of cortex cross to opposite side)
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3
Q

NG vs TPN

A

NG/Pegs are used for when they gut does work, TPN for when gut does not

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4
Q

Divisions of the Brain: Lobes

A
  • parietal: L-sided stroke causes apashia; sensory part of brain, intelligence, reading
  • temporal: has temporal artery which if struck, can be fatal
  • frontal: develops fully in mid-20s, judgement/critical thinking, wernicke’s (slurred speech) from alcoholism happens here
  • occipital: back of the head, visual interpretation, color, focus/motion
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5
Q

Tentorium

A
  • fold of dura mater that separates cerebrum and cerebellum)
  • supra (top): cerebral lobes, diencephalon, basal ganglia
  • infra: cerebellum, brainstem, damage here is very very bad
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6
Q

Brain Injuries

A
  • hematoma: meningeal artery trauma causes space expansion (extra/epidural)
  • Trauma below the dura causes a subdural hemorrhage or hematoma, Bleeding below the arachnoid is subarachnoid, Bleeding below the pia is intraceberal (HTN PTs)
  • SAH is more dangerous than SDH because with SDH, surgery can fix it.
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7
Q

Communication Issues

A
  • aphasia: difficulty speaking
  • agraphia: difficulty writing
  • Expressive aphasia- knows what they want to say but cant
  • Receptive aphasia- inability to understand written or spoken word..temporal
  • global aphasia- both expressive & receptive
  • Agraphia- inability to express ones self in writing
  • Alexia- inability to undertand written word ..Occipital
  • Dysarthria- slurred or indistict speech r/t motor problem
  • Ataxia- poor balance, staggering gait- cerbellar lesion
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8
Q

Broca’s vs. Wernicke’s

A
  • Broca: L hemisphere, speech produced/articulation, ideas made, expressive language
  • wernicke’s: posterior superior temporal lobe, critical language, written/spoken language processing, affected by ETOH use…receptive language
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9
Q

Diencephalon

A
  • thalamus: pain awareness, sleep cycle
  • hypothalamus: temp control, water metabolism, L side insult–PT fearful/scared..expressive aphasia
    r side insult–TBI, Tumor, PT imsulsive/spontaneous/noncompliant, may not recognize L side of body
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10
Q

Pituitary (hypophysis)

A
  • hormone-secreting gland responding to hypothalamus
  • anterior: somatotropin, TSH,FSH, LH, prolactin, ACTH, GH, Melatonin
  • posterior: Oxytocin & ADH.. allow us to hold water
  • pituitary insult=DI (D. insipidus
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11
Q

brain stem

A
  • midbrain: reflexes, sound, eye coordination
  • pons: 2 respiratory centers work with medulla
  • medulla: BP, HR, resps, cough/sneeze/swallow/ gag
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12
Q

spine

A
  • 31 pairs of nerves, spine ends at L2 ..spinal tap done L3-L4
  • done for epidurals, culture/sensitivity, med admin. …PT should be hunched over or on L side, needle is very big
  • give fluids, lay flat 2-8 for headache avoidance
  • watch for “halo”–reddish CSF on dressing, can also come out of orifices (nose, eyes, etc) means CSF leak brain issue/trauma/ICP..glucose testing will determine this
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13
Q

12 cranial nerves

A

I Olfactory- smell
II Optic- sight
III Oculomotor-eyeball movement/ pupil constriction
IV Trochlear- eyeball movement
V Trigeminal- sensation face, neck, scalp / chewing
VI Abducens - side to side eyeball movement
VII Facial - taste, facial contraction, secretion saliva
VIII Vestibulocochlear-hearing, equilibrium
IX Glossopharyngeal- taste, swallow, vital reflexes
X Vagus-Vital reflexes, speaking, decrease HR,
peristalsis, digestive secretions
XI Accessory- neck and shoulder contraction, speaking
XII Hypoglossal- tongue movement

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14
Q

neuro assessment

A
  • Key Indicator of Neurological Impairment is LOC
  • Know Baseline
  • frequency??
  • get V.S.
  • check pupils’ light response
  • check extremity grasp/sensation in extremities
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15
Q

ICP Meds

A
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16
Q

Motor Strength test

A
  • Avoid only Hand Grasp - as patient “to let go”
  • Upper Extremities– Pronator Drift Test
  • Assess Lower Extremities
  • Palmar drift—Extend hands with palms up(with weakness palms turn & may drop.)..LOWER EXTREMITIES– hold legs out 10sec . Watch for dropping.
17
Q

posturing

A
  • Decerebrate – extension, damage to brain stem, wrist prone, fingers flexed, plantar flexed feet
  • Decorticate- flexion, impairment of cerebral function, abbducted arms, elbows flexed, fingers/wrists flexed
18
Q

Pupillary assessment

A
  • Observe pupil size at rest (1mm-9mm)
  • 15% of population have anisocoria
  • Congenital defect, eye trauma, drugs (miotics and mydriatics) and ANS may cause unequal pupils
  • Observe pupils response to direct light and consensual
  • Assess Accommodation
  • Observe for nystagmus–rapid eye moving
19
Q

ICP

A
  • usually from head injury/trauma, brain tumor
  • hemorrhaging and swelling cause brain to press up against skull (protruding) =Increased ICP
  • Brain can swell down into foramen magnum (skull hole by brainstem) which can cause pressure, resulting in death
  • irritability, restlessness main S/S of I.I.C.P.
  • Cushing’s triad..LATE SIGN: deep, weird resps. (cheyne-stokes), widened pressure pulse, bradycardia
  • give Keppra, dilantin (phenytoin), keep suction PRN..can cause worsen I.I.C.P., aggressive sneezing/coughing/Valsava/stimulation/hypoxia/hypercapnia can worse I.C.P.
  • give dexamethasone (cortico), mannitol, anticonvulsants (Dilantin)
20
Q

ICP Monitoring

A
  • Placed in cerebral parenchyma, or subdural or subarachnoid space–in ICU
  • if PT is bolted, they are paralyzed from meds so rectal tube and foley will be inserted
  • S/S–increased pupils, systolic may elevate (brady)
  • get V.S. no DR order needed
21
Q

I.C.P. Prevention

A
  • HOB elevated 30 degrees
  • Do not flex neck- keep head and neck midline
  • Antiemetic: Zofran (ondansetron)
  • Stool softeners
  • Suction prn
  • Quiet environment
  • Avoid hip flexion
  • Provide rest between activities
22
Q

I.C.P. Treatment

A
  • Maintain SBP > 90
  • Avoid Hypotonic solutions
  • Hyperventilation (controversy)
  • CNS depressants (benzos, barbituates) help seizures
  • Steroids
  • Osmotic diuretics (Mannitol)
  • Anticonvulsants
  • CPP = MAP - ICP Cpp cerebral blood flow to brain
  • D5 W(dextrose), .45% (Saline)
  • **never do spinal tap on IICP PT DUE TI RISK OF BRAIN HERNIATION **
23
Q

Lab Values

A
  • WBC: 5,000-10,000
  • Hgb: 12-18
  • Hct: 35-45
  • platelet: 150-450,000
  • PT: 10-13 SECONDS
  • INR: 0.8-1 second, 2-3 on warfarin
  • aPTT– 25-35 seconds
  • K+: 3.5-5
  • Na+: 135-145
24
Q

More Lab Values

A
  • Ca: 8-10.5
  • creatinine: 0.6-1.2
  • BUN: 8-21
  • glucose: 100 or less
  • A1C: Diabetes—8 or less, non-5.7 or less
  • cholesterol: 200
  • paCO2: 45-35
  • HCO3: 22-26
25
Q

CT scan/MRI

A
  • CT: performed without contrast FIRST/with contrast, BUN/creatinine
  • MRI: performed without contrast FIRST/with contrast, No metal, NPO 4H if abd. or pelvic
  • pre-medicate PT with tylenol and benadryl
26
Q

Cerebral arteriogram

A
  • pre-op: Explain Test
    NPO, VS, Allergy, Prep Area, Baseline N/V Assessment
  • post-op: Bed Rest, Encourage Fluids, Observe site frequently, VS, N/V Assessment
  • baseline helps find any issues post-op…they should come out the same way they went in
27
Q

prevention positions

A
  • used for: Pressure injuries, Compromised respiratory status, Contractures / Foot drop, Nerve Damage, Prevent Paresthesia

foot drop—achilles heel shortens, use splints to prevent

28
Q

Neuro PT Management

A
  • Maintain Airway, Elevate HOB, Encourage deep breathing, IPPB– lung expansion, done by Resp. Therapy, Repositioning, Suctioning, Communication
29
Q

Bowel/Bladder retraining

A
  • bladder: Offer bedpan q 2 , Run Water, Crede~ Bladder, Limit fluids at HS, Clamp Foley,SCHEDULE
    Cath for residual
  • bowel: Increase Fluids, Increase Activity, Increase roughage and fiber, Stool Softeners, Enema

its better to eat fruit than drink it because fruit skins are very nutritious

30
Q

Evoked Potential

A
  • the recording of electrical activity in a specific nerve pathway as the pathway is stimulated
  • The length of time for a stimulus to travel from its source to the brain is recorded
  • Visual EP
  • Auditory EP
  • Somatosensor

NEURO LEVEL III (3 decks)

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