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NUR203 Questions From Powerpoints & SDLP > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What structures are involved in the CNS and PNS?

What is the basic functional unit?

A

CNS - brain and spinal cord

PNS - cranial and spinal nerves

Basic function unit is the neuron

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2
Q

What are the 5 common deep tendon reflexes?

A

Biceps

Triceps

Patella

Achilles

Plantar

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3
Q

What are the functions of neurons?

A

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

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4
Q

What are the 3 layers and functions of the meninges?

A 
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

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5
Q

What is the blood-brain barrier and what is its function?

A

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.

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6
Q

What is a dermatome?

A

Area of skin with sensory nerves from a single dorsal root of a spinal nerve.

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7
Q

What is the function of the autonomic nervous system (ANS)?

A

Regulates activities of internal organs to maintain and restore internal homeostasis.

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8
Q

How is the ANS regulated?

A

Regulated by centres in the spinal cord, brainstem and hypothalamus

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9
Q

What systems does the ANS contain?

A

Sympathetic - fight or flight; main neurotransmitter is noradrenaline

Parasympathetic - controls visceral functions

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10
Q

What are some common cerebrovascular disorders?

A 
Stroke
Aneurism
Haemorrhage
Trauma
Tumour
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11
Q

What are some common neurological disorders?

A 
Alzheimer's 
Epilepsy
MS
Parkinson's
Motor Neuron Disease
Huntington's chorea
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12
Q

What are the risk factors for a CVA (stroke)?

A 
Age
Ethnicity
Obesity
Diabetes
Alcohol and drug use
Atrial fibrillation
Smoking
Family history
Hypertension
Genetics
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13
Q

Regarding stroke, what are some modifiable risk factors?

A

Smoking
Obesity
Diet
Drug use

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14
Q

What are three common causes of stroke?

A

Thrombus formation
Embolus formation
Haemorrhage

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15
Q

What are the 3 types of ischaemic stroke?

A

Thrombotic - clot

Embolic - clot moves from heart to brain

Thrombo-embolic - clot from plague lodges in vessel

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16
Q

What are the 2 types of haemorrhage stroke?

A

Intracerebral - blood vessel bursts inside brain

Subarachnoid - blood vessel bursts outside the brain

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17
Q

What is a TIA?

A

Transient ischaemic attack

‘mini’ stroke

Temporary disturbance in blood flow

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18
Q

What are the symptoms of a subarachnoid haemorrhage?

A

Neck/sudden severe back pain

Nausea

Intense migraine-like headache

Weakness

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19
Q

What is the recovery rate for a subarachnoid haemorrhage?

A

One third good recovery

One third disability

One third death

20
Q

What does treatment for subarachnoid haemorrhage focus on?

A

Stopping the bleeding

Restoring blood flow

Relieving pressure on the brain

Preventing vasospasm

21
Q

Manifestation of a stroke - what is FAST?

A

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

22
Q

What are the manifestations of a stroke?

A

Sudden weakness or paralysis of face, arm or leg

Dysarthria

Aphasia

Unilateral vision loss

Sudden confusion

Sudden trouble walking

Sudden headache

23
Q

What is epilepsy?

What is the pathophysiology?

What are the types and clinical manifestations?

A

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

24
Q

Describe a partial seizure.

A

Focal

Affects only part of the brain

Experience unusual sights, sounds, odour, tastes

Dizziness

No loss of consciousness

25
Q

Describe a complex partial seizure.

A

Motionless or moves automatically

Responds inappropriately to time and place

Extreme emotions

Episode not remembered

26
Q

Describe a generalised seizure

A

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

27
Q

What is the nursing care of a person having a seizure?

A

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

28
Q

What is the nursing care for a person post seizure?

A

DRABCD

Recovery position

Patent airway

Reorientate patient

Calm patient

Vital signs

Document in notes

29
Q

What is the Monroe-Kellie doctrine?

A

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.

30
Q

What is Cushing’s Triad?

A

Manifestation of acute elevation of ICP

Indicated imminent brain hernia ruin

Increased BP
Decreased HR
Apnoea

31
Q

What is decorticate posturing?

A

Flexor posture - arms like ‘c’s

Indicates problems with cervical spinal tract or cerebral hemisphere

32
Q

What is decerebrate posturing?

A

Extensor posture

Arms like ‘e’s

Indicates problems with midbrain and pons

33
Q

What are the signs of elevated ICP?

A 
Decreased LOC
Decreased motor function
Cushing's Triad
Pupil changes 
Headache 
Seizures
Vomiting 
Weakness
Abnormal posturing 
Abnormal speech
34
Q

What is the medical management of a seizure?

A

Pharmacological intervention

Surgical intervention

35
Q

What is post-stroke nursing management of a haemorrhage stroke?

A 
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

36
Q

What is the nursing care for a patient with MS?

A

Preventing injury

Promote physical mobility

Improve and promote self-care abilities

Enhance bladder and bowel control

37
Q

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

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?

38
Q

Describe the trajectory if signs and symptoms of rising intracranial pressure are missed and there is a failure to act?

A

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.

39
Q

Describe how you would assess neurological functioning using the acronym AVPU?

A

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.
40
Q

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?

A 
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
41
Q

Define Alzheimer’s Disease and describe the common manifestations

A

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.

42
Q

Define Multiple Sclerosis and describe the common manifestations

A

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.

43
Q

Define Parkinson’s Disease and describe the common manifestations

A

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

44
Q

Define Motor Neuron Disease and describe the common manifestations

A

Progressive disease involving degeneration of the motor neurons and wasting of the muscles

45
Q

Define Huntington’s Chorea and describe the common manifestations

A

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.

46
Q

Define Epilepsy/seizures and describe the common manifestations

A

“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.

NUR203 Questions From Powerpoints & SDLP (7 decks)

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