Unit 2 Module 2: Neurology Flashcards
Pathological changes with a stroke t/f: cellular injury and death
true
status epilepticus: hyper or hypo tension
hypotension
Parkinson’s symptom related to dysphagia
difficulty swallowing (drooling)
What are the three components in the Monro-Kellie hypothesis?
blood volume, cerebral spinal fluid, brain tissue
Cog wheel rigidity
Hesitation before clicking forward into the next position
t/f: neuritic plaques are outside the neuron
true
What are non-clot causes of embolic strokes?
fat embolism, air embolism, foreign body
myoclonus
brief muscle twitching (often happens while falling asleep)
neuropsychiatric disorders with Parkinson’s
mood changes, dementia, hallucinations
Hypoxic or ischemic: stroke
hypoxic
What are small vessel local occlusion strokes?
lacunar strokes
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.
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.
Where is dopamine made?
substantia nigra of basal ganglia
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.
Parkinson’s symptom related to lack of facial expression
mask-like face
Pathological changes with a stroke t/f: local alkalosis
false. anaerobic metabolism –> lactic acidosis
Dementia or delirium: consistent behavior at home and at the hospital
dementia
atonic
loose muscle control
status epilepticus: acidosis or alkalosis
acidosis
respiratory acidosis initially, and metabolic acidosis with prolonged seizing
bradykinesia
slow moving – difficulty getting started moving, stopping, shuffling gate
tonic
muscles become tense or rigid
Pathological changes with a stroke t/f: elevated lymphocytes
false: inflammatory cells and cytokine release
What does BE FAST stand for?
Balance
Eyes
Face
Arms
Speech
Time
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?
no
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
