Neurology Flashcards
Function of neurotransmitter adrenaline
fight or flight
Function of neurotransmitter noradrenaline
concentration
Function of neurotransmitter dopamine
pleasure
Function of neurotransmitter GABA
calming
Function of neurotransmitter acetylcholine
learning
Function of neurotransmitter serotonin
calming and sleep
Function of neurotransmitter histamine
immunity
CNS is made up of the
brains and spinal cord
the peripheral nervous system is made up of the
cranial and spinal nerves
occipital lobe of the brain
vision
temporal lobe of the brain is
memory, understanding language
parietal lobe of the brain
perception, math, spelling, logic
frontal lobe of the brain
thinking, planning, organizing, problem solving, emotions, behavioural control, personality
cerebellum of the brain
balance
medulla of the brain is responsible for
HR, BP, reflexes (swallowing, vomiting)
Broca’s area is
expressive language
Wernicke’s area is
receptive language
meninges
cover and coat nervous system to protect it
CSF is found in
brain and spinal cord
Peripheral nervous system includes two type of neurons ______ and ________
sensory/afferent and motor/efferent
voluntary nerves are called and example
somatic; ex) skeletal muscle
involuntary nerves are called and example
autonomic; ex) cardiac and smooth muscle, glands
autonomic breaks into _______ and _______
parasympathetic and sympathetic
the sympathetic nervous system does
fight or flight; dilates pupils, inhibit salivation, increase HR, dilate bronchi, inhibit peristalsis, glucose release, adrenaline and noradrenaline, inhibit bladder
the parasympathetic nervous system does
rest and digest; constrict pupils, stimulate salivation, decrease HR, construct bronchi, stimulate peristalsis, bile release, stimulate intestines, constrict bladder
cranial nerves send information from
peripheral to central nervous system
cranial nerve I
olfactory
cranial nerve II
optic
cranial nerve III
oculomotor (pupil constriction)
cranial nerve IV
trochlear (downward movement of eyes)
cranial nerve V
Trigeminal (jaw movement, sensation of face and neck)
cranial nerve VI
abducens (lateral movement of eyes)
cranial nerve VII
facial (facial movement, taste)
cranial nerve VIII
vestibulocochlear (hearing and balance)
cranial nerve IX
glossopharyngeal (swallowing, taste)
cranial nerve X
vagus (swallowing, speaking)
cranial nerve XI
spinal/accessory (flexing and rotation of head)
cranial nerve XII
hypoglossal (tongue movements)
C1
head and neck
C2/C3
diaphragm
C4
deltoids, biceps
C5
wrist extenders
C6/C7
triceps
C8
hand
T7
chest muscles
T8
abdominal muscles
L3
leg muscles
S3
bowel, bladder
S4
sexual functions
cerebral perfusion is
the blood flow to the. rain
to maintain adequate cerebral perfusion
BP needs to be high enough to send blood to the brain; MAP >60
ICP
pressure inside the still
5-15 is normal
________ works against the BP and pushing blood away from the brain
ICP
monroe-kellie hypothesis
as pressure in skull goes up it can only get so high before something else has to give
causes of ICP
cerebral edema, hemorrhage, tumor growth, excess CSF
increased ICP S&S
headache, vomiting
change in LOC, GCS decreasing, posturing, pupillary changes, changes in speech, cushing’s triad
cushing’s triad
increased systolic BP
decreased HR
altered respirations
herniation
too much pressure and and brain protrudes through skull
Decorticate posturing
abnormal flexion; arms pulled in towards centre, clenched fists, rigid muscles, damage in mid brain
decerebrate posturing
abnormal extension; arms and legs straight out, toes downward, neck and head arched back, rigid muscles, damage to deep brain structures (pons), GCS 2
hydrocephalus
increased accumulation of CSF, increases ICP
extra ventricular drain and important nursing consideration
acute, temporary fix; drain must always be in like with tragus of ear, if standing must clamp drain temporarily
VP shunt
drains extra CSF from brain to abdomen where it can then be excreted as urine
hemi means _______ of body
one side of body
para means _______ of body
only legs
quad means ______ of body
all four extremities
hyperkinesia
tremors
dyskinesias
spasms, involuntary movements
hypokinesia
bradykinesia, akinesia (absence)
ataxia
poor muscle control causes clumsy voluntary movements
dyspraxia
partial inability to perform purposeful or skilled motor acts
apraxia
complete inability to perform purposeful or skilled motor acts
seizures are not a disease but a symptom of
an underlying disorder
epilepsy
neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain
epilepsy is diagnosed when
no other reason can be found for having seizures
partial seizure
specific area of brain
generalized seizure
entire brain
simple seizure
no loss of consciousness
complex seizure
impaired consciousness ranging from confusion to non responsive
tonic/clonic
phases of tonic and clonic spasm
myoclonic
sudden, brief contractions of a muscle or group of muscles
atonic
muscles become limp, no tone
absence seizure
loss of consciousness, staring off into space
generalized seizures include
tonic clonic, myoclonic, atonic, absence
partial (focal) seizures include
complex and simple
general seizure treatment
fix the cause! anticonvulsant
during a seizure you need to
stay with client, note time, duration, and characteristics, remove harmful objects in clients area, cushion clients head, loosen restrictive clothing, assist client to side lying position if possible
seizure precautions at bedside
oxygen and suctioning equipment, side lying with pillow under head, padded rails, all four rails raised, bed in lowest position
benzodiazepines are
CNS depressant, slow everything down “lam” and “pam”
short acting benzodiazepines
midazolam
intermediate acting
alprazolam, clonazepam, lorazepam
long acting benzodiazepines
diazepam
phenytoin
anticonvulsant; needs to be at therapeutic level; blocks sustained high frequency repetitive firing of action potentials
TBI
alteration in brain function caused by an external source
in an open skull fracture the dura is
torn
in a closed skull fracture the dura is
intact
Basilar skull fraction shows these findings
Battle’s sign and raccoon eyes and cerebrospinal rhinorrhea
battle’s signs
bruising over mastoid process
raccoon eyes
periodical bruising
cerebrospinal rhinorrhea
test drainage for CSF, clear odor less fluid from nose. Two ways to identify: halo test and test for glucose (CSF will have glucose in it)
never put a ______________ in a pt with a basilar skull fracture
NG tube
epidural hematoma
above the dura; occurs because of arterial bleeds
epidural hematoma S&S
loss of consciousness followed by awake period of confusion and bad headache, then neuro will begin to decline, no longer PERRLA, decrease LOC, decrease GCS, posturing and then pt will begin to decline quickly due to arterial bleeds bleeding quickly
subdural hematoma
below the dura; low pressure, slow bleed, body will accommodate for these changes in increased ICP pressure (brain gradually gets pushed down), neuro status does not change dramatically
subdural hematome S&S
fall or injury awhile ago, family/friends/self notices they begin to act not like themselves
difference between epidural and subdural hematoma
epidural = arterial bleed = quick bleeding = quick neurological changes/decline
subdural = low pressure, slow bleed = symptoms slowly arise
subdural hematomas are likely to occur in
elderly (risk of falls), geriatric pts, and those on blood thinners
Spinal cord injury
damage to spinal cord causes permanent changes in strength, sensation, and other body functions below the site of injury
for SCI at and above T6 we need to closely monitor for
autonomic dysreflexia
fatal SCI include injury to cervical vertebrae
C1 and C2; b/c it affects diaphragm function -> resp distress -> resp failure and needing mechanical ventilation
the higher the SCI the more ___________ that is lost
function
autonomic dysreflexia is characterized by
sudden severe htn, bradycardia, headache, nasal stuffiness, flushing, sweating, blurred vision, anxiety
autonomic dysreflexia happens because
communication between bottom half and top half is lost
autonomic dysreflexia triggers
restrictive clothing, dehyrdration, pressure ulcers, anxiety, fecal impaction, full blader, broken bone, UTI, blister
autonomic dysreflexia tx
sit client up to help lower bp, antihypertensives, find cause and treat it
stroke / CVA
lack of oxygen to the brain that causes damage either due to a bleeding or a clot
hemorrhagic stroke
vessel ruptures and bleeds into the brain, blood accumulates leading to increased pressure on brain and increased ICP
ischemic stroke
blood flow to brain is blocked by a blood clot; either thrombotic or embolic; lack of blood -> lack of O2 to brain -> ischemia
thrombotic stroke
blood clot in an artery going to the brain; onset happens in a “stepwise” fashion
embolic stroke
clot that is formed elsewhere and travels the bloodstream, then clogs a blood vessel in or leading to the brain; sudden onset
Stroke S&S
dizziness, headache, loss of balance, blurry vision, unilateral facial drooping, arm or leg weakness/drift, speech difficulty (aphagia, dysphagia)
Ischemic stroke tx
ensure perfusion to brain (bring down bp), antithrombotics, percutaneous thrombectomy
tPA
clot buster; breaks up clot and restores blood flow; must be done quickly, door to tPA = 60min
hemorrhagic stroke tx
get bleeding under control, if caused by aneurysm coiling or clipping, craniotomy, EVD (drainage device)
Meningitis
inflammation of the spinal cord or brain; usually caused by a virus or bacteria
bacterial meningitis is _____________ compare to viral
more dangerous
meningitis S&S
nuchal rigidity (neck stiffness), photophobia, Kernig’s sign, Brudzinski’s sign, fever, headache, vomiting, flushed, fatigue, seizure
most concerning meningitis signs
nuchal rigidity and photophobia (pushing on cranial nerves)
Kernig’s sign
when client place supine and hip flexed knee cannot be extended completely due to extreme pain
Brudzinski’s sign
when pt supine passive flexion the neck causes involuntary flexion of knee and hips
why do Kernig’s sign and Brudzinski’s sign happen
pain is due inflammation of meninges
meningitis tx
steroids, analgesics, abx (only if bacterial), isolation precautions viral = standard bacterial = droplet
meningitis prevention
Hib vaccine
encephalitis and S&S
inflammation of brain tissue due to a viral infections, causes edema and necrosis, meninges are also inflamed
encephalitis tx
steroids to address inflammation, analgesics to address pain, and treating cause of infection
Multiple sclerosis
autoimmune disorder where body starts attacking myelin sheath causing CNS inflammation
Multiple sclerosis S&S
tingling and numbness, weakness, optic neuritis, dysdiadochokinesia (inability to perform rapid, alternating movements), ataxia, nystagmus (involuntary, rapid, repetitive eye movement), intentional tremor, scanning speech, hypotonia, epilepsy/seizures, spasticity (muscles, bladder)
MS treatment
no cure, corticosteroids (decreasing inflammation to slow progression), plasmapheresis
plasmapheresis
removal of some plasma that contains destructive antibodies and putting back in “clean” plasma with no antibodies
Guillain-Barre
antibody and cell mediated immunologic reaction precipitated by a viral or bacterial illness; immune system attacks nerves and de-myelinates peripheral nerves; causes ascending weakness and paralysis
Guillain-Barre S&S
recent illness/infection, weakness or tingling in lower extremities, increases in severity and moves up symmetrically, paralysis, absent reflexes, loss of muscle tone, respiratory distress (as severity increases), peaks in about 2 weeks, slow recovery
Guillain-Barre tx
gradually recover as antibodies clear, plasmapheresis, immunoglobulin therapy
neuropathy
weakness, numbness, and pain from nerve damage; has been an injury to a peripheral nerve; “pins and needles”
Botulism
botulinum toxin release by clostridium botulinum; found in soil and dust (can contaminate honey), inhibits acetylcholine release at junction between peripheral nerves and muscles causing life-threatening flaccid paralysis - paralysis is descending
botulism tx
antitoxin
botulism S&S
blurry vision, difficulty breathing, resp failure, symmetric descending flaccid paralysis
myasthenia gravis
antibodies in peripheral nervous system, communication between nerves and muscles destroyed, blocks acetylcholine making muscles very weak
Tensilon test
diagnose myasthenia gravis; boost of acetylcholine is given, will see improvement in S&S if it is myasthenia gravis and will see no change if it is not
difference between multiple sclerosis and myasthenia gravis
MS = autoimmune disorder in CENTRAL nervous system
Myasthenia gravis = autoimmune disorder in PERIPHERAL nervous system
myasthenia gravis S&S and tx
weak muscles, ptosis (drooping eyelid)
tx: cholinesterase inhibitors (improve communication between nerves and muscles), corticosteroids, immunosuppressants (stop body from making antibodies)
Parkinson’s Disease
progressive nervous system disorder, caused by degeneration of dopamine neurons
Parkinson’s S&S
tremors, rigidity, hypophonia, mask-like faces, akinesia, bradykinesia, dyskinesia, stooped posture, difficulty balancing, orthostatic hypotension
Parkinson’s Tx/Interventions
reduce fall risk, no cure, therapies (PT, OT, SLP), carbidopa-levodopa
carbidopa-levodopa action
increases dopamine in the brain to hopefully help tx symptoms of Parkinson’s - is NOT a cure but will help improve quality of life
