Week 7 Flashcards
What structures are involved in the CNS and PNS?
What is the basic functional unit?
CNS - brain and spinal cord
PNS - cranial and spinal nerves
Basic function unit is the neuron
What are the 5 common deep tendon reflexes?
Biceps
Triceps
Patella
Achilles
Plantar
What are the functions of neurons?
To communicate messages
Neuron - neuron
Neuron - target tissue
Potentiate a specific action
Terminate a specific action
Modulate a specific action
Excite a target cell
Inhibit a target cell
What are the 3 layers and functions of the meninges?
Dura mater (outside) Arachnoid mater (middle) Pia mater (inside)
The meninges protect the CNS
Blood supply to skull and hemispheres
Space for CSF production and flow
What is the blood-brain barrier and what is its function?
Barrier formed by endothelial cells of the brains capillaries, forming continuous tight junctions.
It’s function is to make the CNS inaccessible to many substances circulating the blood plasma. Has implications in treatment and medication selection for CNS disorders.
What is a dermatome?
Area of skin with sensory nerves from a single dorsal root of a spinal nerve.
What is the function of the autonomic nervous system (ANS)?
Regulates activities of internal organs to maintain and restore internal homeostasis.
How is the ANS regulated?
Regulated by centres in the spinal cord, brainstem and hypothalamus
What systems does the ANS contain?
Sympathetic - fight or flight; main neurotransmitter is noradrenaline
Parasympathetic - controls visceral functions
What are some common cerebrovascular disorders?
Stroke Aneurism Haemorrhage Trauma Tumour
What are some common neurological disorders?
Alzheimer's Epilepsy MS Parkinson's Motor Neuron Disease Huntington's chorea
What are the risk factors for a CVA (stroke)?
Age Ethnicity Obesity Diabetes Alcohol and drug use Atrial fibrillation Smoking Family history Hypertension Genetics
Regarding stroke, what are some modifiable risk factors?
Smoking
Obesity
Diet
Drug use
What are three common causes of stroke?
Thrombus formation
Embolus formation
Haemorrhage
What are the 3 types of ischaemic stroke?
Thrombotic - clot
Embolic - clot moves from heart to brain
Thrombo-embolic - clot from plague lodges in vessel
What are the 2 types of haemorrhage stroke?
Intracerebral - blood vessel bursts inside brain
Subarachnoid - blood vessel bursts outside the brain
What is a TIA?
Transient ischaemic attack
‘mini’ stroke
Temporary disturbance in blood flow
What are the symptoms of a subarachnoid haemorrhage?
Neck/sudden severe back pain
Nausea
Intense migraine-like headache
Weakness
What is the recovery rate for a subarachnoid haemorrhage?
One third good recovery
One third disability
One third death
What does treatment for subarachnoid haemorrhage focus on?
Stopping the bleeding
Restoring blood flow
Relieving pressure on the brain
Preventing vasospasm
Manifestation of a stroke - what is FAST?
Face - has the mouth dropped?
Arms - can the person lift both arms?
Speech - is speech slurred, does the person understand you?
Time - time is critical, emergency help immediately
What are the manifestations of a stroke?
Sudden weakness or paralysis of face, arm or leg
Dysarthria
Aphasia
Unilateral vision loss
Sudden confusion
Sudden trouble walking
Sudden headache
What is epilepsy?
What is the pathophysiology?
What are the types and clinical manifestations?
Chronic disorder of the brain characterised by recurring seizures.
Continuous firing of impulses after cell task is finished, causing erratic performance of body parts controlled by errant neurons.
Partial seizure - no loss of consciousness
Complex partial - episode not remembered
Generalised (grand-mal; tonic clonic) - unconsciousness
Describe a partial seizure.
Focal
Affects only part of the brain
Experience unusual sights, sounds, odour, tastes
Dizziness
No loss of consciousness
Describe a complex partial seizure.
Motionless or moves automatically
Responds inappropriately to time and place
Extreme emotions
Episode not remembered
Describe a generalised seizure
Both hemispheres of brain cause whole body to react
Intense contraction and relaxation of muscles
Epileptic cry
Incontinence of urine and faeces
Unconsciousness
Patient drowsy and confused, will sleep postictal
What is the nursing care of a person having a seizure?
DRABCDE
MET
Provide privacy
Bring patient to the floor if possible
Protect head from injury
Loosen constrictive clothing
Remove risks such as furniture that may cause injury
Remove pillows and raise bed rails if facility permits
What is the nursing care for a person post seizure?
DRABCD
Recovery position
Patent airway
Reorientate patient
Calm patient
Vital signs
Document in notes
What is the Monroe-Kellie doctrine?
Sum of volumes of brain, CSF and intracranial blood is constant.
An increase in one should cause a decrease in one or both of the others. Compensation occurs until the body snowballs into ischaemia and oedema.
What is Cushing’s Triad?
Manifestation of acute elevation of ICP
Indicated imminent brain hernia ruin
Increased BP
Decreased HR
Apnoea
What is decorticate posturing?
Flexor posture - arms like ‘c’s
Indicates problems with cervical spinal tract or cerebral hemisphere
What is decerebrate posturing?
Extensor posture
Arms like ‘e’s
Indicates problems with midbrain and pons
What are the signs of elevated ICP?
Decreased LOC Decreased motor function Cushing's Triad Pupil changes Headache Seizures Vomiting Weakness Abnormal posturing Abnormal speech
What is the medical management of a seizure?
Pharmacological intervention
Surgical intervention
What is post-stroke nursing management of a haemorrhage stroke?
Control and monitor BP Medication HOB 30 degrees Hourly NVO initially Monitor EVD output daily VTE prophylaxis - teds, heparin Analgesia Mouth care Hygiene Catheter care
Rehab/palliative care
What is the nursing care for a patient with MS?
Preventing injury
Promote physical mobility
Improve and promote self-care abilities
Enhance bladder and bowel control
For patients with cognitive impairments it is more effective to communicate using one step rather than two step questioning and/or instructions. Explain the difference and give examples.
A way of communicating with those with cognitive impairment, by clear succinct instructions or questions. One main point at a time;
One step process preferred:
- pick up pen
- now write your name
“We need to order your lunch for tomorrow; do you feel like chicken? (yes/no)
How about beef? (yes/no)
Would you prefer a sandwich?” (yes/no)
Two step process:
*pick up the pen and write your name
Multi-step question:
*we need to order your lunch for tomorrow. Do you feel like chicken, beef or a sandwich?
Describe the trajectory if signs and symptoms of rising intracranial pressure are missed and there is a failure to act?
Failure to act on elevated ICP - higher risk of mortality and permanent neurological impairment.
Delayed treatment - worsening of tissue hypoxia within the brain. Further increases oedema and injury.
Changes in ICP and BP may alter blood volume as a result of dilation or constriction of cerebral blood vessels. This causes further pressure.
Compression of optic nerve due to oedema results in impaired pupillary responses.
Causes pressure gradients between cranial vault compartments and shift of brain structures.
Changes in BP, pulse and respiratory pattern are usually late signs of raised ICP in clinical practice. These are related to brain stem distortion, hernias ion or ischaemia.
Describe how you would assess neurological functioning using the acronym AVPU?
The AVPU scale is a system easily applied to initially assess a patients neurological status. It can measure and record a patients responsiveness, indicating their level of consciousness. Following this initial assessment, a formal assessment of the GCS is performed.
A = Alert: is the patient alert and responsive? V = Verbal: does the patient respond to verbal commands? P = Pain: does the patient respond to painful stimulus? U = Unconscious: with no response to any of the above, the patient is considered unconscious.
Falls and the consequences in the elderly population are becoming increasingly common. What interventions would you put in place to minimise the risk for an elderly patient in hospital?
Falls risk assessment and plan Mini-mental state exam Nom-slip socks Aids and equipment nearby - hearing aids, walking frames/sticks, glasses, urinal bottle Call bell within reach Bed lowered to the ground Supervised mobilisation Nurse near nursing station PCA/HAS guard if confused (1:1 special) Medication review and minimise agents known to cause falls - antidepressants, diuretics, sedatives, antihistamines
Define Alzheimer’s Disease and describe the common manifestations
Progressive mental deterioration that can occur in middle or old age due to generalised degeneration of the brain.
It is the commonest cause of premature senility.
Define Multiple Sclerosis and describe the common manifestations
Progressive disease involving damage to the myelin sheaths of nerve cells in the brain and spinal cord.
Symptoms may include numbness, impairment of speech and of muscular coordination, blurred vision and severe fatigue.
Define Parkinson’s Disease and describe the common manifestations
Progressive degenerative disorder of the CNS mainly affecting the motor system.
Also known as idiopathic or primary Parkinsonism, hypokinetic rigid syndrome (HRS) or paralysis agitans
Define Motor Neuron Disease and describe the common manifestations
Progressive disease involving degeneration of the motor neurons and wasting of the muscles
Define Huntington’s Chorea and describe the common manifestations
Genetic neurodegenerative disorder that affects muscle coordination and leads to mental decline and behavioural symptoms.
Symptoms usually appear when a person is in their 40s.
Behavioural problems are thought to be a combination of events, including damage to the brain as the disease progresses and the understandable frustration and depression that people feel when challenged by chronic illness.
Define Epilepsy/seizures and describe the common manifestations
“Chronic disorder of the brain characterised by recurring seizures” (WHO, 2012).
Neurons carry messages by discharging electrochemical energy. Normal function impulses occur in bursts when the cell has a task to perform. Epilepsy continued firing of impulses after cell task is finished, causing erratic performance of body parts controlled by errant neurons. This results in dysfunction which ranges from mild to severe and incapacitating seizures which often cause unconsciousness. Causes are varied but categorised as idiopathic (unknown) and acquired.
