NURS 264 Exam 5 Flashcards
How Many muscles attach to the eye?
Six muscles attach eyeball to its orbit and direct eye
to points of a person’s interest
➢ Give eye both straight and rotary movement
➢ Each muscle is coordinated, or yoked, with one in other eye
ensuring that when two eyes move, their axes always remain
parallel, called conjugate movement
* Four straight, or rectus, muscles are superior, inferior, lateral,
and medial rectus muscles
* Two slanting, or oblique, muscles are superior and inferior
muscles
What are the cranial nerves that move the eye?
Cranial nerve VI: abducens nerve, innervates lateral rectus
muscle, which abducts eye
➢ Cranial nerve IV: trochlear nerve, innervates superior oblique
muscle
➢ Cranial nerve III: oculomotor nerve, innervates all the rest:
the superior, inferior, and medial rectus and the inferior
oblique muscles
What nerve is the pupil stimulated by?
Cranial nerve III
What is the Macula and where is it located?
Macula: located on temporal side of fundus
➢ Slightly darker pigmented region surrounding
fovea centralis, area of sharpest and keenest
vision
➢ Receives and transduces light from center of
visual field
16
What happens to the lens as we age?
it flattens throughout life
What is cataracts?
Lens opacity resulting from a clumping of proteins in the lens
What is diabetic retinopathy?
- Oxidative damage and inflammation of the retina leading to blindness
What field of vision has the lowest degree?
upward with 50
What is the Hirschberg test?
Another word for corneal light reflex test
What does PERRLA stand for?
- Pupils equal, round, reactive to light, and accommodation.
What happens to the pupils in older adults?
They begin to shrink.
What is ptosis?
Drooping upper eyelid
Dacryocystitis and Hordeolum What is it?
Dacryocystitis - inflammation of lacrimal sac Hordeolum – stye; staph infection of hair follicle
Chalazion and Blepharitis What are they?
Blepharitis - inflammation of eyelids Chalazion - infection, cyst on lid (nontender & movable)
Argyll Robertson pupil and Tonic/Adie’s pupil What are they?
Argyll Robertson pupil – no reaction to - Light
Tonic pupil, Adie’s pupil – sluggish reaction to light & accommodation
Subconjunctival hemorrhage What is it?
Subconjunctival hemorrhage – red patch on sclera; usually not serious
Iritis, circumcorneal redness (What is it?)
Iritis, circumcorneal redness – redness around iris; pupil irregular r/t swelling of iris →immediate referral
Hyphema (What is it?)
Hyphema
➢ Blood in anterior chamber; serios result of herpes zoster
➢ Also occurs with trauma (fist or baseball to eye)
Hypopyon (What is it?)
Hypopyon
➢ Layer of WBC in anterior chamber
➢ Pain, red eye, decreased vision
What nerve is responsible for hearing?
Cranial nerve VIII
Conductive hearing loss What is it?
Conductive hearing loss: mechanical dysfunction of external or middle ear
➢ Partial loss because a person can hear if sound amplitude is
increased enough to reach normal nerve elements in inner ear
➢ May be caused by impacted cerumen, foreign bodies, a perforated
TM, pus or serum in middle ear, and otosclerosis
Otosclerosis What is it?
Otosclerosis
➢ Common cause of conductive hearing loss in young adults between ages of 20 and 40
➢ Gradual hardening that causes footplate of stapes to become fixed in oval window
* Impeding transmission of sound and causing progressive deafness
Presbycusis What is it?
Presbycusis: type of hearing loss that occurs
with aging, even in people living in quiet
environment
➢ Gradual sensorineural loss caused by nerve
degeneration in inner ear or auditory nerve
➢ Documented in 2/3 of the population over age 70
What is Otis Media (OM)
- Obstruction of the Eustachian tube or passage of nasopharyngeal secretions into middle ear
What is the Weber test?
Putting the fork onto of head
- Conductive loss = more sound in worse ear
- Sensorineural loss = more sound in better
What degree should the ear be of vertical in children?
10 degrees
How should hearing be assessed in 3-8 month olds?
- Response or quieting to sounds
What are mental disorders?
Mental disorder
Clinically significant behavioral emotional or cognitive syndrome that is associated with significant distress or disability involving social, occupational, or key activities
What are organic disorders?
Organic disorders
Due to brain disease of known specific organic cause (e.g., delirium, dementia, alcohol and drug intoxication, and withdrawal)
Psychiatric mental illnesses What are they?
Psychiatric mental illnesses
Organic etiology has not yet been established (e.g., anxiety disorder or schizophrenia)
Mental status assessment documents a dysfunction and determines how that dysfunction affects self-care in everyday life.
What are the 4 main headings of a mental status assessment?
Four main headings of mental status assessment: A-B-C-T
Appearance
Behavior
Cognition
Thought processes
When is a full mental status examination necessary?
Initial screening
- Suggests an anxiety disorder or depression
Behavioral changes
- Memory loss, inappropriate social interaction
Brain lesions
- Trauma, tumor, cerebrovascular accident, or stroke
Aphasia
- Impairment of language ability secondary to brain damage
Symptoms of psychiatric mental illness
- Especially with acute onset
Aphasia (What is it?)
Aphasia: loss of ability to speak or write coherently or to understand speech or writing due to a cerebrovascular accident
What test is used to assess depression?
PHQ-9
- Series of 9 questions requiring adding column totals that relate to frequency of occurrence of symptoms
- Higher the score, the greater the likelihood of functional impairment or clinical diagnosis.
Mini-Mental State Exam (MMSE) What is it?
Mini-Mental State Exam (MMSE)
- Concentrates only on cognitive functioning
- Standard set of 11 questions requires only 5 to 10 minutes to administer.
Useful for both initial and serial measurement
- Detect dementia and delirium and to differentiate these from psychiatric mental illness.
- Normal mental status average 27; scores between 24 and 30 indicate no cognitive impairment
Montreal Cognitive Assessment (MoCA) What is it?
Montreal Cognitive Assessment (MoCA)
- Examines more cognitive domains, more sensitive to mild cognitive impairment
- Visuo-constructive ability, language function, memory, auditory attention, conceptual thinking, working memory, calculations, speech/language
- Ten minutes to administer
- Total score of 30 with a score of greater to or equal than 26 considered normal
Denver II screening test What is it?
Denver II screening test gives a chance to interact directly with child to assess mental status.
- For child from birth to 6 years of age, Denver II helps identify those who may be slow to develop in behavioral, language, cognitive, and psychosocial areas.
How many nerves is the nervous system made up of?
Includes 12 pairs of cranial nerves, 31 pairs of spinal nerves, and all their branches
What does the wernicke’s and Broca’s area control?
Wernicke’s: controls understanding of language
Broca’s: controls speech
Thalamus (What does it do?)
Main relay station where sensory pathways of spinal cord, cerebellum, and brainstem form synapses - Important for emotion and creativity
Basal Ganglia (What does it do?)
- Gray matter that form subcortical associated motor system
Hypothalamus (What does it do?)
- Major respiratory centre with basic function control and coordination
What part of the spinal cord interprets sensations?
- The dorsal column
What is cranial nerve I?
- Olfactory nerve (sense of smell)
What is cranial nerve II?
- Optic nerve (Sight)
What is cranial nerve III, IV, and VI?
- Oculomotor: Pupil dilation
- Trochlear: Positions of gaze
- Abducens: Alignment of eyes
What is cranial nerve V?
- Trigeminal nerve: movement of the jaw and touch of skin in the area
What is cranial nerve VII?
- Sense in the face along with motor function
What is cranial nerve VIII
- Acoustic nerve: Ability to hear
What is Cranial nerve IX and X?
Tongue movement and sense of taste
What is cranial nerve XI?
- Sternomastoid movement (Motor)
What is cranial nerve XII?
- Protrusion of tongue (anterior aspect of tongue movement)
Graphesthesia What is it?
Graphesthesia: ability to “read” a number by having it traced on skin
Extinction (What is it?)
Extinction: simultaneously touch both sides of body at same point; normally both sensations are felt
Stereognosis (What is it?)
Stereognosis: test the person’s ability to recognize objects by feeling their forms, sizes, and weights
What is the grading scale for tendon reflexes?
4 = very brisk, hyperactive with clonus, indicative of disease
3 = brisker than average, may indicate disease
2 = Average, normal
1 = diminished, low normal, or occurs with reinforcement
0 = no response
What is the Rooting reflex?
Rooting Reflex: brush the infant’s cheek near mouth; note whether infant turns head toward that side and opens mouth
- Appears at birth; disappears at 3 to 4 months
Dyskinesias What is it?
Dyskinesias: repetitive stereotyped movements in jaw, lips, or tongue may accompany senile tremors; no associated rigidity present
F.A.S.T. plan—American Stroke Association What does it stand for?
F = Face drooping
A = Arm weakness
S = Speech difficulty
T = Time to call 9-1-1
What are causes of Hemorrhagic strokes?
Acute rupture & bleeding
Congenital malformations
Disturbed coagulation cascade
Tumor
Cocaine abuse
What are causes of Ischemic strokes?
Sudden interruption of blood flow
Thrombotic
Embolic
Opisthotonos What is it?
Opisthotonos
Prolonged arching of back, with head and heels bent backward; indicates meningeal irritation
