nrsg 126 weeks 10 & 11 Flashcards
1
Q
what are the three meninges?
A
Innermost: Pia
Middle: Arachnoid mater
Outermost: Dura mater
2
Q
List the structures and spaces around the brain
A
- Bone
- Epidural space
- dura mater
- Subdural space
- Arachnoid mater
- Subarachnoid space
- Pia mater
- Brain
3
Q
What is the function of the meninges?
A
To secure the brain and absorb shock
4
Q
Describe the epidural space
A
contains fat and small blood vessels
5
Q
Which meninge layer is very thick and strong?
A
The dura mater
6
Q
Which ‘space’ contains the CSF & major blood vessels?
A
Subarachnoid space
7
Q
Describe the pia mater layer
A
Thin, hugs the brain and spine
8
Q
Which meninge layer is made of connecting spider-like structures?
A
Arachnoid mater
9
Q
What ‘space’ is not really much of a space at all?
A
Subdural space
10
Q
How many lobes does the cerebral cortex have? List them.
A
4 lobes. Frontal, parietal, temporal, and occipital.
11
Q
Which lobe is responsible for motor fxn, motivation, moods (aggression), and smell?
A
The frontal lobe.
Memory trick: most of these start with ‘M’, so think frontal = frontlines = moms are on the frontlines = M for mom
12
Q
Which lobe is responsible for reception & evaluation of sensory info?
A
The parietal lobe.
Memory trick: P for parietal, P for Private investigator. PIs recept info and evaluate it
13
Q
Which lobe is responsible for smell, hearing, memory, & abstract thought?
A
The temporal lobe.
Memory trick: idk yet
14
Q
Which lobe fxns for visual processing?
A
The occipital lobe
15
Q
Left side of brain fxns?
A
Controls right side of body
Speak
Read
Write
Listen
Grammar
Number skills
Analyzing
Logic
Reasoning
Time sense
16
Q
Right side of brain fxns?
A
Control left side of body
Organize info
Abstract meaning
Context
Spatial recognition
Visual info
Face recognition
Intuition
Emotion
Imagination
Music/art awareness
17
Q
What three factors is Intercranial Pressure dependent on?
A
1) Brain 2) CSF 3) Blood
18
Q
What is the normal or expected percentages that the brain, CSF, and blood take up in ICP?
A
Brain = 80%
Blood = 10%
CSF = 10%
19
Q
List some factors that could affect the brain, either increasing or decreasing ICP
A
- stroke
- TBI
- Infection
- Trauma
- Atrophy
- Bleeding
- Tumor
- Health conditions
20
Q
List some factors that could affect the CSF, either increasing or decreasing ICP
A
- Injury
- Surgery - can cause Dural tear
- Surgery - VP shunt, EBP
- CSF leak
21
Q
List some factors that could affect the blood, either increasing or decreasing ICP
A
- stroke
- sever over/de - hydration
- deformity - AVM, aneurysm
- injury - SDH, SAH, epidural bleed
22
Q
Why do brain bleeds go unnoticed in older adults?
A
Because the older adult brain shrinks, there is more space for a bleed to occur without the tell-tale signs
23
Q
Are sensory neurons in the PNS afferent or efferent?
A
Afferent
24
Q
Motor neurons in PNS are afferent or efferent?
A
Efferent
25
Is grey matter made up of neuron bodies or axons?
Grey matter = neuron body
White matter = axon
26
What connects CNS to PNS?
Dermatomes
27
What is the order of stimulus transduction?
Reception of stim (afferent)
Perception (based on quality and nature)
Reaction (efferent)
28
The leading cause of vision loss that is incurable. A central loss of vision.
Macular Degeneration
29
A condition that blurs all vision, causes no pain, and is inevitable to all.
Cataracts
30
The leading cause of vision loss under 50. Usually due to uncontrolled diabetes.
Retinopathy
31
The second most common cause for vision loss under 65 years. A loss of the visual field (outside)
Glaucoma
32
Changes in the shape of the eye that causes either:
Myopia - ___________
__________ - Far sightedness
Near sightedness
Hyperopia
33
Change in hearing that results in insufficient sound entering the inner ear. Can be caused be cold, blockages, or allergy.
Conductive Hearing Loss
34
This form of hearing loss can be caused be damage to the auditory center or central cortex of the brain (e.g. TBI, Tumors, Hereditary).
Central Processing Disorder
35
Can be caused by damage to the eardrum/middle ear or infection.
Otitis Media
36
Otosclerosis is from... and can cause...
Hardening of the ossicles...tinnitus
37
Damage to the cochlea or nerves from excess noise, virus, or medication can cause this type of hearing loss.
Sensorineural Hearing Loss
38
What is Cerumen
Ear wax
39
Hearing loss resulting in muffles hearing, age related, and makes low pitched sounds easier to hear than high pitched.
Presbycusis
40
An inner ear disease that causes fluid in ears. Can cause tinnitus and vertigo
Meniere's Disease
41
Causes to xerostomia and risk factors?
Causes: meds, cancer, aging
Risk factors: food aversion, decreased calorie intake
42
Why does olfaction decrease with age?
decreased amount of sensory neurons and bulb cells
43
Decreased blood flow and changes to the nervous system lead to what in the older adult?
Decreased sensation.
Explanation:
Decreased blood flow = decreased CO & peripheral blood flow
Changes to NS = fewer nerve cells, myelin degeneration, fewer neurotransmitters, decreased conduction rate
44
What are a few functions of the Kidneys
Maintain F/E Balance
BP control
Drug Metabolism
Filter Waste and Drugs
Bone health and EPO Functions
45
What are some common neuro deficits?
Peripheral neuropathy
Cerebral atrophy
Sensory processing disorders (more common in kids)
46
What is the recognition of object texture and size?
Stereognosis
47
What do the 3 Ds stand for?
Depression, dementia, delirium
48
Age Related Changes to Urinary System
Nephrons < in fxn = GFR will also <
Hardening of the vessels impacts perfusion = < fxn
< bladder strength
Harder and less elastic bladder (> risk for UTI)
49
What assessment tools are used for dementia?
MMSE and MOCA
50
How does the body know when to pee?
Sensory nerves in the BRAINSTEM detect the fullness of the bladder
The forebrain controls voluntary voiding
51
What assessment tools are used for delirium?
CAM+ PRISME
52
What happens if the urinary system fxn is impaired?
Increased Ca++ retention overall < bone health
> renin = contributes to HTN (affecting RAAS)
F/E imbalance
53
What assessment tools are used for depression?
Geriatric depression scale
54
If someone just had a fall, what FOCUSED assessment tools should you use? (be more specific than HTT as it is not focused)
Neurological record and GCS
55
What are the three components of the GCS? also what are the scores in each?
Eye opening, best verbal response, best motor response.
E4V5M6 = max 15
56
Define the following prefixes in relation to urine:
Poly -
Olig -
Hemat -
Dys -
An -
Bacterimia
Noct -
Lots of urine
Little urine
Blood in urine
Hard time peeing
No pee
Bacteria in pee
Getting up 2-3+ times at night to pee
57
What assessment tool is used for stroke?
FAST VAN
58
Factors impacting urination
Stress/anxiety
Cultural views on privacy and respect
Fluid Balance
Diagnosis
Meds
Surgery
Stroke
59
What does AEIOUTIPS stand for?
Possible causes for change in LOC
A: alcohol/acid base disorders, arrhythmia
E: epilepsy/electrolyte disorders
I: insulin
O: overdose
U: underdose/uremia
T: trauma, tumor, thermal insult (hypothermia)
I: infection
P: psychiatric/poisoning
S: stroke/shock
60
Common Alterations in GU
UTI
Incontinence
Nocturia
Urine retention
Diversion of urine to external source (catheters)
Renal Failure
61
Why are individuals with vaginas more likely to have a UTI
Short ureter
Closer proximity to the butt
Pregnancy increases [ ] of sugars, proteins, hormones in pee
(Estrogen helps produce an acidic environment for antimicrobial)
62
Other risks that > UTI
Immobility
Incontinence
Weakening of the pelvic floor
Diabetes
63
ADULT s/s of a UTI
Dysuria/Nocturia
Urgency and frequency of elimination
Hematuria
Cloudy & smelly pee
Pyelonephritis
Tender costovertebral angle
64
OLDER ADULTS s/s of a UTI
Changes in LOC
Confusion
Delirium
Agitation
Falls
65
What are the question styles used in a neuro assessment?
Abstract thinking, association, memory, judgement, knowledge
66
What ways can we diagnose a UTI
Urinalysis
Culture and Sensitivity
Bladder scans
Renal Ultrasounds
Cystoscopy (invasive)
67
What ways can we treat a UTI
Fluids to > GFR
Abx to treat bacteria
68
How can we prevent UTI
Hydration
Mobility
Diet
Hygiene
69
What does CVA stand for and what are the three types?
Cerebral vascular accident (AKA stroke)
* TIA
* Ischemic (blockage)
* Hemorrhagic (rupture)
70
Risk factors to a CVA
***HTN***
atherosclerosis
>65yrs
A-Fib
Diabetes
Smoking
Obesity
71
What is a TIA?
Transient ischemic stroke
** Temporary Artery Block**
* 1/3 people who have TIAs will have a stroke
* S/S & risk factors
72
What does FAST VAN stand for?
Face: drooping?
Arms: weakness?
Speech: slurred?
Time: <6hrs or woke w/ symptoms
Vision: gaze?
Aphasia: naming difficulties?
Neglect: ignoring side of body?
73
What organs are part of the GI system
Mouth (teeth, tonsils, salivary glands, lips, epiglottis)
Esophagus
Stomach
74
What are the Double G enzymes of the GI system?
Gastrin and Ghrelin
75
what does it mean if someone is VAN+?
VAN+ indicates a large vessel occlusion
76
What type of stroke is the most common?
ischemic stroke
77
What are the two kinds of stroke that an ischemic stroke can be?
thrombotic or embolic
78
What type of ischemic stroke is caused by a clot that originates in the blood vessels in the brain?
A thrombotic ischemic stroke occurs/originates from a clot directly in the brain vessels.
The problem is the brain doesn't get enough oxygen.
79
what ischemic stroke starts with a clot somewhere in the body that then travels to the brain?
An embolic stroke.
80
what are some general treatment options for an ischemic stroke?
* open up blood vessels
* dont let it happen again
81
What is the purpose of t-PA (recombinant tissue plasminogen activator)?
**Breakup the clot**(thrombolytic)
Opens occluded arteries to improve perfusion. Ideally done within 3 hrs of symptoms, but up to 6 hrs is acceptable.
82
What is the purpose of an EVT (endovascular treatment)?
**Remove the clot**
(thrombectomy)
ideally done within 6hrs of symptoms
There is a higher risk for intracerebral bleed with this operation
83
What are the two types of hemorrhagic stroke?
intracerebral or subarachnoid
84
What type of hemorrhagic stroke is caused by a bleed into the brain tissue?
Intracerebral.
increases the ICP.
S/S: headache, N/V, changes in LOC, seizure
85
What type of hemorrhagic stroke is caused by a bleed not in the brain tissue?
Subarachnoid hemorrhage (SAH).
S/S: WOSRT headache of life, stiff neck, photophobia, N/V
86
What is the #1 SIGN of increased ICP?
What is the #1 Symptom of increased ICP?
Sign: changes in LOC
Symptom: headache
87
What are the two options to treat a hemorrhagic stroke?
Coiling or clipping
88
The act of clipping off a broken area of an artery is what form of treatment for hemorrhagic stroke?
Clipping
89
The act of preventing entry of blood into a weak space (preventing clot formation) via an artery is what form of treatment for a hemorrhagic stroke?
Coiling
90
What are some diagnostic tools that are used for diagnosing a stroke?
* CT
* Lab work
- CBC count (RBC WBC)
- ECG (heart's electrical activity)
- INR (international normalization ratio: clotting factors)
91
What are the steps of the nursing process?
ADPIE
Assessment
Diagnosis
Planning
Implementation
Evaluation
92
What is obtundation
state similar to lethargy when pt has decreased interests in the environment, slow stimulation response, and sleeps more but is drowsy between sleep periods.
93
What is the term that describes 'near-unconsciousness/insensibility?
Stupor
94
What is lucid?
someone who is expressed easily and clear to understand
95
What sided stroke would cause problems in these areas of intellect?
* emotional highs/lows
* judgement/ impulsiveness
* vision
* neglect of left side
* confusion/ mem loss
* attention span
* agnosia & anomia
Right brain.
96
What sided stroke would cause problems in these areas?
* cautious/ compulsive behaviours
* aphasia
* dysarthria
* comprehension
* apraxia
* neglect right side
left brain.
97
What is the term used to describe slurring of speech?
dysarthria
98
what is apraxia
trouble with movement after a stroke
99
what are the two types of aphasia? Describe both.
Broca's (expressive, frontal lobe stoke) and Wernicke's (receptive, temporal lobe stroke)
100
What are some IMMEDIATE complications of stroke that would need intervention?
Airway
Increased ICP
Seizure
Death (brain stem CVA)
Infection (UTI, pneumonia)
101
What are some ONGOING complications of stroke?
Nutrition
Communication
Motor function
Behaviour
Memory
102
What are the functions of Gastrin
Stimulates secretion of HCl from parietal cells
Promotes gastric motility
Promotes pepsinogen release from chief cells
Relaxes pyloric sphincter
103
What are the three parts of the Small Intestine?
Duodenum
Jejunum
Ileum
104
What enzymes are secreted in the Duodenum?
Secretin - stimulates bicarb secretion
CCK - stimulates more amylase, lipase, and protease
105
What is mainly absorbed in the Jejunum?
Carbs and Protein
106
What does the Ileum absorb?
Absorbs water, vitamins, bile, ions, fats
107
The large Intestine primarily absorbs?
Water, Na+, Cl-
108
What is the best angle for promoting pooping?
35 degrees
109
What are the two events that stimulates defecation?
Distension and relaxation of internal sphincter
External sphincter relaxing and abdominal muscles pushing
110
What is the Valsalva Maneuver and why is it important to be cautious of?
The Valsalva Maneuver is when you bear down and increase the pressure within the abdominal cavity to forcefully defecate.
- increased Intra-abdominal pressure can cause tachy-brady-cardiac arrest
111
What are examples of age related changes to the GI system?
< production of saliva
< motility
Degeneration of gastric mucosa
Decreased absorption of B12, folic acid, Ca++, Fe+++
112
Factors influencing defecation?
Fibre intake
Fluid balance
Physical activity
Privacy
113
Infectious diseases that impair GI system
Norovirus - gastroenteritis causing cramps, diarrhea, vomiting
C. Diff - colitis (inflammation of colon), diarrhea, contact+ precautions
Rotavirus - foodborne illness, diarrhea, fever
114
Inflammatory bowel disorder can cause what s/s and how can it be treated?
Pain, fever, vomiting, diarrhea
Corticosteroids, immunosuppressants
