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N110 Exam #3 > Neurosensory > Flashcards

Neurosensory Flashcards

1
Q

Alert

A

Follows commands in a timely fashion

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2
Q

Lethargic

A

Appears drowsy, easily drifts off to sleep

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3
Q

Stuporous

A

Requires vigorous stimulation before responding

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4
Q

Comatose

A

Doesn’t respond to verbal or painful stimuli

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5
Q

Obtunded

A

Having diminished arousal and awareness, often as the result of intoxication, metabolic illness, infection, or neurological catastrophe

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6
Q

Semi-Comatose

A

State of drowsiness and inaction, in which more than ordinary stimulation may be required to evoke a response.

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7
Q

Syncope

A

A brief loss of consciousness caused by inadequate blood flow to the brain

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8
Q

Nystagmus

A

Involuntary, rapid, rhythmic movement (horizontal, vertical, rotatory, or mixed, i.e., of two types) of the eyeball

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9
Q

Flaccid

A

Weak, lax, or soft; applied especially to muscles

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10
Q

Dysphagia

A

Difficulty swallowing

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11
Q

Expressive Aphasia

A

Cannot communicate through speech, writing, or signs

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12
Q

Receptive Aphasia

A

Cannot receive or interpret verbal/non-verbal messages

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13
Q

Paresthesias/Neuropathy

A

An abnormal prickly, burning, or tingling sensation caused by nerve injury/Any disease of the nerves

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14
Q

4 Components of the Neurosensory Experience and the role of the Reticular Activating System

A

Reception, Perception/RAS, Arousal Mechanism, Responding to Sensations

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15
Q
  1. Reception
A

Process of receiving stimuli from nerve endings in the skin and inside the body

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16
Q

Reception:

Receptors convert stimuli to a ____ ______ and then transmits them along ____ ____ to the _____.

A

Nerve impulse; sensory neurons; Central Nervous System

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17
Q

Adaptation

A

Receptors responses to stimuli decline over time

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18
Q

Sensory Receptors: Mechanoreceptors

A

Skin and hair; detect touch, pressure, and vibrations

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19
Q

Sensory Receptors: Hair

A
  • Hearing
  • Cochlea= sound waves
  • Vestibular Apparatus= acceleration of body and position of head
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20
Q

Sensory Receptors: Thermoreceptors

A

Skin; detect temperature

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21
Q

Sensory Receptors: Proprioceptors

A

Skin, muscles, tendons, ligaments, joint capsules; coordinate input and allow us to sense body position in space (proprioception)

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22
Q

Sensory Receptors: Photoreceptors

A

Retina; detect visible light

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23
Q

Sensory Receptors: Chemoreceptors

A

Taste buds; detect taste

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24
Q

Sensory Receptors: Olfactory receptors

A

Epithelium of nasal cavity; detect smell

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25
Q
  1. Perception
A

Ability to interpret impulses and give meaning to stimuli
• after impulses are sent to the CNS, they are then relayed to specialized locations in the brain where perception and awareness of the stimuli occurs

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26
Q

Perception requires functioning of the:

A

Sensory receptors, reticular activating system (RAS), neural pathways, and the brain

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27
Q

Factors that affect Perception of a stimulus

A
  • Location (of receptors and pathway activated)
  • Number (of receptors activated)
  • Frequency (of action potentials generated [vary according to intensity of stimulus])
  • Changes (in location, number, and frequency)
  • Past experiences, knowledge, attitude, etc.
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28
Q

Reticular Activating System

A

Controls consciousness and alertness
• Neurons in the RAS make connections between the thalamus, spinal cord, cerebral cortex, and cerebellum –> relay visual, auditory, and other stimuli –> keep us alert, awake, and observant
• Anesthesia, opioids, sedatives, and other drugs depress the RAS along with dark rooms and quiet environments
• Regulates sleep

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29
Q
  1. Arousal Mechanism
A

see RAS

• Brain can adapt to constant stimuli, so to maintain arousal, variation in stimuli is required

30
Q
  1. Responding to Sensation
A 
• Brain sends impulses along motor pathways--> evokes response
• Response to a stimulus is based on:
Intensity
Contrast
Adaptation
Previous Experience
31
Q

Stimulus Response: Intensity

A

Excites more receptors –> stronger response

i.e. Bright light= shielding, squinting vs. dim light= little response

32
Q

Stimulus Response: Contrast

A

Being outside in freezing cold windy weather and then entering a garage that blocks the wind, or then entering a room with a fireplace thats burring hot

33
Q

Stimulus Response: Adaptation

A

Becoming accustomed to a stimuli, “tuning it out”

34
Q

Stimulus Response: Previous Experience

A

•Affects ongoing responses to same stimulus in future

ex. Patient scrunching eyes before an injection (memory of a prior negative experience)

35
Q

Factors that Affect Neurosensory Function: Developmental

A

Adults/Older Adults: Older adults have slower reflexes and delayed response to stimuli; structural changes in the eye and ear; sensory decline can cause depression, hallucinations, social isolation, withdrawal, etc.

36
Q

Sensory Changes with Aging: Vision

A
  • Decreased peripheral vision and tear production
  • Vitreous humor thins (floaters appear)
  • Lens discolors and is opaque/pupil shrinks= less light= limited vision
  • Lens is less flexible/cannot focus on near objects
  • Ciliary body contracts/lens thickens= lost visual acuity, decreased accommodation to distance and sudden changes in illumination/decreased night vision
37
Q

Sensory Changes with Aging: Hearing

A
  • Cerumen dries/solidifies= hearing loss
  • Scarring
  • Presbycusis (loss of high-frequency sounds) and decreased speech discrimination
38
Q

Sensory Changes with Aging: Taste

A
  • Taste buds atrophy and lessen= less tasting ability (esp. sweet)
  • Drier mouth can alter taste
39
Q

Sensory Changes with Aging: Smell

A

• Atrophy/loss of olfactory neurons= decreased ability to perceive smell (can also alter sense of taste)

40
Q

Factors Affecting Neurosensory Functioning: Culture

A

Affects the nature, type, and amount of interaction and stimulation a person is comfortable with

41
Q

Factors Affecting Neurosensory Functioning: Illness and Medications

A
  • Illness: Neurologic diseases (i.e. MS) delay transmission of nerve impulses; Circulation impairment (i.e. atherosclerosis) affects sensory receptors/brain –> alter perception and response; Diseases can affect specific sensory organs (diabetic retinopathy=blindness)
  • Medications: Aspirin and Lasix (furosemide) can become ototoxic and damage the auditory nerve; CNS depressants (opioids and sedatives) blunt perception/reception of stimuli
42
Q

Factors Affecting Neurosensory Functioning: Stress

A

Stress= stimulation (i.e. running a marathon); can be too much stimulation and lead to sensory overload

43
Q

Factors Affecting Neurosensory Functioning: Lifestyle and Personality

A

Clients are at risk for sensory alterations if previous level of stimuli doesn’t match current level; Loss of a partner, change in environment, and health problems can all lead to a change in stimuli

44
Q

Assessment of a patient for Neurosensory Deficits: Nursing History

A

Usual and current mental status, prior sensory problems, use of sensory aides

45
Q

Assessment of a patient for Neurosensory Deficits: Physical Assessment

A

6 senses (hearing, sight, touch, taste, smell, balance)

46
Q

Assessment of a Patient for Neurosensory Deficits Info

A

Factors affecting, mental status, level of consciousness, recent changes, use of sensory aides, client’s environment, support network, and focused examination

47
Q

Assessment: Level of Consciousness (LOC)

A
  • Arousal and orientation
  • Auditory stimuli (verbal communication or noise); Tactile stimuli (touch); Painful stimuli
  • Alert, Lethargic, Stuporous, Comatose
48
Q

Assessment: Orientation Status

A
  • Time (year, date, time of day)
  • Place (surroundings)
  • Person (recognition of familiar people/self-identity)•
49
Q

Assessment: Mental Status and Cognitive Function

A

Includes: behavior, appearance, response to stimuli, speech, memory, communication, and judgement
Observe for: clarity of thought, concentration, ability to perform abstract reasoning, appropriate material, and memory

50
Q

Assessment: Mental Status and Cognitive Function

A
  • Includes: behavior, appearance, response to stimuli, speech, memory, communication, and judgement
  • Observe for: clarity of thought, concentration, ability to perform abstract reasoning, appropriate material, and memory
51
Q

Assessment: Sensory Function

A
  • Applying pressure to various parts of the body with patient’s eyes closed
  • Usually upper/lower extremities (start with most peripheral i.e. foot–> leg)
52
Q

Assessment: Pupillary Reaction/Accommodation

A
  • Reaction: eye reaction, equality, speed

* Accommodation: pupil location and size

53
Q

Sensory Deprivation

A

RAS depression caused by a lack of meaningful stimuli

54
Q

Situations that cause Sensory Deprivation

A

Impaired sensory reception, impaired ability to transmit/process impulses, non stimulating environment, different cultures, restricted mobility, sensory deficits

55
Q

Assessment: Client’s Environment/Support Network

A
  • Compare patient’s usual personality and lifestyle to current environment; Assess effects of environment on sensory deficits (worsen/help compensate)
  • Assume chores, provide comfort, increase stimulation and decrease sensory deprivation, reorient and calm confused persons from sensory alterations
56
Q

Assessment: Pupillary Reaction/Accommodation

A
  • Reaction: eye reaction, equality, speed

* Accommodation: pupil location and size

57
Q

Sensory Deprivation: Definition and Signs

A
  • RAS depression caused by a lack of meaningful stimuli

* Depression, delusional, hallucinations, preoccupied with somatic complaints

58
Q

Sensory Overload

A
  • External/internal stimuli exceeds higher level than what a person’s sensory system can effectively process
  • Muscle tension, cant concentrate, disoriented, anxiety, decreased performance, restlessness
59
Q

People at Risk for Sensory Overload

A
  • Physical problems that stimulate CNS (hyperthyroidism)
  • Medications/substances that stimulate CNS (caffeine, weight-loss pills)
  • Neurological/Pyschiatric disorders–> cannot adapt to stimuli increase
  • Hospitalized patients experience physical discomfort, anxiety, separation from family, unfamiliar environment
60
Q

Nursing Interventions for Sensory Deprivation

A 
*Provide stimulation; help patient perceive/interpret stimuli*
• Visual/Auditory/Tactile stimulation
• Media (inappropriate media--> sensory deprivation)
• Social interaction 
• Minimizing anxiety and confusion
• Facilitate communication
• Collaboration
• Self-stimulation
• Pet Therapy
61
Q

Sensory Deprivation: Causes and Effects of Visual Impairment

A 
(CAROtMdRGSTDCNSMV)
• Cataracts
• Age-Related
• Orbital trauma
• Macular degeneration
• Retinopathy (diabetic, hypertensive)
• Glaucoma
• Stroke
• Trauma/disease of eye
• CNS disorders
• Microvascular problems
*Affects ADL and limits mobility/interaction
62
Q

Sensory Deprivation: Causes and Effects of Hearing Impairment

A 
Injury/trauma to:
• structures of the ear
• nerves
• brain
*Creates safety hazards through decreased communication ability, social interaction, understanding
63
Q

Nursing Interventions for Sensory Overload

A
  • Control auditory/visual/olfactory stimuli
  • Good TV/radio use
  • Minimize stress
  • Promote sleep
64
Q

Sensory Deprivation: Causes and Effects of Hearing Impairment

A 
Injury/trauma to:
• structures of the ear
• nerves
• brain
*Creates safety hazards through decreased communication ability, social interaction, understanding
65
Q

Sensory Deprivation: Nursing Interventions for Visual Impairments

A 
Client with sight:
• Clean eyeglasses
• Soft/diffuse light, sunglasses when outside
• Large print
Client with severely limited sight:
• Uncluttered environment
• Self-care items within reach
• Make staff aware
• Offer arm on preferred side when walking 
• Books on tape or braille
• Bed in low position
66
Q

Sensory Deprivation: Nursing Interventions for Hearing Impairments

A
  • Promote auditory functioning (hearing aides, cerumen impaction, captions)
  • Improve communication (written instructions)
  • Safety (@ home: blinking lights; @ hospital: limit background noise, call bell in reach)
67
Q

Sensory Deprivation: Causes and Effects of Confusion

A

Interferes with ability to interpret stimuli
• Delirium: acute, reversible, caused by meds and physiologic (hypoxia, metabolic disorders, infections, sensory alterations) CHANGES IN LOC
• Dementia: chronic, progressive, caused by physical changes in brain NO CHANGES IN LOC

68
Q

Sensory Deprivation: Nursing Interventions for Confusion

A
  • Promote orientation
  • Simple communication
  • Reduce anxiety
  • Safety
  • Continuity of care
69
Q

Sensory Deprivation: Nursing Interventions for Unresponsive/Unconscious

A
  • Involve/teach patient’s support network
  • Incorporate touch
  • Safety (bed in low, side rails up when not at bedside, eye care if eyes not closed, oral care)
70
Q

Seizure

A

• Abrupt onset of disturbances in electrical activity in the brain; Neurons fire abnormally
• Rhythmic jerking, decreased LOC or loss of consciousness
*Incidence highest amongst:
-younger than 10 and older than 65
-males

71
Q

Safety Precautions for Seizures

A
  • Pad head, foot, and side rails of bed
  • Keep side rails up when not at bedside
  • Suctioning at bedside
  • Suction after to prevent aspiration
  • Dont open mouth or insert depressor/hand

N110 Exam #3 (6 decks)

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