Unit 2 Module 2: Neurology Flashcards by Chris Letts

Pathological changes with a stroke t/f: cellular injury and death

true

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status epilepticus: hyper or hypo tension

hypotension

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Parkinson’s symptom related to dysphagia

difficulty swallowing (drooling)

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What are the three components in the Monro-Kellie hypothesis?

blood volume, cerebral spinal fluid, brain tissue

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Cog wheel rigidity

Hesitation before clicking forward into the next position

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t/f: neuritic plaques are outside the neuron

true

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What are non-clot causes of embolic strokes?

fat embolism, air embolism, foreign body

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myoclonus

brief muscle twitching (often happens while falling asleep)

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neuropsychiatric disorders with Parkinson’s

mood changes, dementia, hallucinations

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Hypoxic or ischemic: stroke

hypoxic

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What are small vessel local occlusion strokes?

lacunar strokes

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Which component of Alzheimer’s pathology has the greatest significance?

abnormal tau proteins

The presence of abnormal tau is where the focus is. There is a great statement by one of the researchers. Amyloid plaque pulls the trigger and tau protein is the bullet in the gun.

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When increased intracranial pressure occurs in the brain, what is the relationship between ICP and arterial pressure?

ICP= arterial pressure

this impacts blood flow and the exchange of oxygen. This first starts to happen in stage 3.

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Where is dopamine made?

substantia nigra of basal ganglia

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t/f: All Alzheimer’s disease is hereditary

false

Early onset Alzheimer’s disease (diagnosed before the age of 50) has an inheritable genetic component, but this has not been found in all individuals with Alzheimer’s disease.

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Parkinson’s symptom related to lack of facial expression

mask-like face

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Pathological changes with a stroke t/f: local alkalosis

false. anaerobic metabolism –> lactic acidosis

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Dementia or delirium: consistent behavior at home and at the hospital

dementia

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atonic

loose muscle control

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status epilepticus: acidosis or alkalosis

acidosis

respiratory acidosis initially, and metabolic acidosis with prolonged seizing

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bradykinesia

slow moving – difficulty getting started moving, stopping, shuffling gate

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tonic

muscles become tense or rigid

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Pathological changes with a stroke t/f: elevated lymphocytes

false: inflammatory cells and cytokine release

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What does BE FAST stand for?

Balance
Eyes

Face
Arms
Speech
Time

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Do stroke symptoms present ipsilaterally or contralaterally?

contralaterally

What dysrhythymia causes 25% of all strokes

a-fib

status epilepticus: compartment syndrome or rhabdomyolysis

rhabdo --> kidney failure

hemineglect

inability to react to stimuli on affected side

Pathological changes with a stroke t/f: antioxidant effects

false: free radicals and toxic metabolites

What is a CVA

death of brain tissue

What is a difficulty expressing or understanding speech

aphasia

What is difficulty articulating words (physically)

dysarthria

What is a key environmental factor in Parkinson's development?

insecticides

Hemorrhagic strokes are [more/less] common and have [better/worse] prognosis

Hemorrhagic strokes are [less] common and have [worse] prognosis

Parkinson's autonomic dysfunction symptoms

loss of blinking, excessive sweating, drooling, orthostatic blood pressure

Pathological changes with a stroke t/f: neuron instability

true

What does CVA stand for

cerebral vascular accident

Dementia or delirium: insidious onset

dementia

t/f: acetylcholine and dopamine reinforce each other

false: they balance each other out

status epilepticus: hyper or hypo glycemia

hypoglycemia

Michael J. Fox is typical of Parkinson's presentation in that

he is male (2x more common than female)

Pathological changes with a stroke t/f: necrotic core with surrounding penumbra

true ``` necrotic core with surrounding penumbra anaerobic metabolism--> lactic acidosis neuron instability Na/K pump malfunction (no ATP)--> cellular swelling--> cerebral edema (can cause increased ICP) inflammatory cells and cytokine release cellular injury and death free radicals and toxic metabolites release of glutamate ```

Michael J. Fox is atypical of Parkinson's presentation in that

he was 29 at dx (typically 60-70 years at dx)

What does the tau protein contribute to?

neurofibrillary tangles

Pathological changes with a stroke t/f: release of lysine

false: release of glutamate

What is the body positioning in decorticate posturing?

internal rotation, protecting chest

Pathological changes with a stroke t/f: Na/K pump malfunction

true: Na/K pump malfunction (no ATP)--> cellular swelling--> cerebral edema (can cause increased ICP)

dementia or delirium: Family notices that the patient is becoming more and more forgetful. He went to the grocery store and got lost coming home

dementia

How long is a status epilepticus?

5+ minutes, or repeated seizures over 30 minutes

Initially after a brain attack (CVA), a client’s pupils are equal and reactive to light. Later the nurse assesses that the right pupil is reacting more slowly than the left and the systolic blood pressure is beginning to increase. The nurse concludes that these signs are suggestive of

Increasing intracranial pressure

In the Southeastern U.S., we are more prone to...

strokes (stroke belt) potentially linked to fried fish

Is Alzheimer's disease a normal part of aging?

dementia or delirium: Patient becomes confused after being admitted to the hospital for hip surgery after falling at home.

delirium

hemiplegia

unilateral paralysis

What is beta amyloid protein

primary component of neuritic plaques

What are the elements of Cushing's triad

Increased blood pressure (but wide gap between systolic and diastolic) Decreased pulse Irregular respiratory pattern

What is normal intracranial pressure?

0-15 mmHg

What is the most common type of stroke?

thrombotic

What are the two types of ischemic stroke?

Thrombotic (blood clot) and embolic (blood clot from elsewhere)

Typical Parkinson's posture and gait

stooped, reduced arm swing, shuffling gait

What is the role of acetylcholine?

important for memory formation. 90% below normal in advanced Alzheimer's

Does a brain with cerebral atrophy look plump or shriveled

shriveled

dementia or delirium: This problem is non-curable and will eventually result in the patient being bed-bound and requiring total care.

dementia

A patient knows a seizure is coming from a gustatory, visual, or auditory forewarning.

aura Auras are actually partial seizures that proceed a generalized tonic clonic seizure. I always ask seizure patients if they have an aura, to help alert me when I am caring for them.

How are seizures grouped?

- motor or non-motor - aware or impaired awareness - origination area in the brain

t/f: Almost all Downs syndrome folks above 45 develop Alzheimer's

true

CVA risk factors

``` Hypertension Heart disease Atrial fibrillation Dyslipidemia Diabetes mellitus Oral contraceptives, hormone replacement therapy, illegal drugs like cocaine Smoking, excessive alcohol use Migraines ```

After an automobile accident a client who is unconscious and exhibiting decerebrate posturing is brought to the emergency department. When assessing the client, what does the nurse expect to observe?

hyperextension of both the upper and lower extremities

A client is having a brain attack (CVA) is brought to the emergency department. The vital signs are P 78, R 16, BP 120/80. Notify the practitioner with which vital changes?

Lower pulse, widened pulse pressure

hemianopia

half of vision is blocked

What does a bulging fontanel signify in children

increased intracranial pressure

A [x] is an acute focal neurological deficit from an interruption of blood flow in a cerebral vessel due to thrombi or emboli or bleeding into the brain.

stroke cva cerebral vascular accident

Parkinson's TRAP

Tremor Rigidity Akinesia (or bradykinesia) Postural instability

t/f: neurofibrillary tangles are outside the neuron

false - inside from disrupted arrangement of tubules

clonic

jerking

How much of our resting cardiac output goes to the brain?

1/6

hemiparesis

unilateral weakness

dementia or delirium: The patient was fine last week and now is hallucinating and seeing bugs crawling on the walls.

delirium

t/f: delirium and dementia are mutually exclusive

false

The nurse is caring for a client with increased intracranial pressure. Which of the following assessment findings should the nurse report immediately? [headache, nausea, absence of pupillary response, fever]

absence of pupillary response Absence of pupillary response is always an abnormal finding and in someone with suspected IICP, this should be reported immediately. Vomiting tends to happen early, but it is usually not accompanied by nausea and tends to be projectile in nature.

t/f A person who has a seizure disorder always has convulsions

false People with convulsions have seizures, but not all seizures have motor activity like convulsions.

Parkinson's is a [serotonin/dopamine] depletion

dopamine