NEUROLOGY Flashcards
1
Q
Catecholamines
A
Epi/Norepinephrine…released during sympathetic
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)
3
Q
NG vs TPN
A
NG/Pegs are used for when they gut does work, TPN for when gut does not
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
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
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.
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
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
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
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
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
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
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
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
15
Q
ICP Meds
A
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
