Wk 10 - Neuro Func Flashcards
What are the 3 layers of the meninges?
Epidural Layer: Dura - thick and strong
- in the epidural space: fat and small vessels
Subdural layer: Arachnoid - connecting
- in the subdural space: not really a space
Subarachnoid layer: Pia - thin and hugs brain and spine
- in the subarachnoid space: CSF & major blood vessels
What is the purpose of the meninges?
secures and absorbs shock
What is effected if brainstem is damaged?
autonomic nervous sys
- breathing
- HR
- BP
- digestion
Intracranial pressure
pressure inside the cranial vault
Intracranial pressure is dependent on what factors/volumes?
- Brain
- CSF
- Blood
What are some examples of things that can change brain vol (one of the three components that regulate intracranial pressure)
- atrophy: changing w/ ageing, or health conditions
- tumor: takes up space
- surgery: removal of tumor
- health conditions: AD, stroke
- trauma
- infection
- alzheimers
What are some examples of things that can change blood flow vol (one of the three components that regulate intracranial pressure)
- stroke: clot or bleed
- deformity: AVM, aneurysm
- injury: SDH, SAH, epidural hemorrhage
- changes in hydration (too much/little)
What are some examples of things that can change CSF vol (one of the three components that regulate intracranial pressure)
- injury
- surgery (cause) - can cause leak, complication of epidural (break through dura - “dural tear”
- surgery (fix) - VP shunt to fix (hydrocephalus, EBP (epidural blood patch for dural tear)
What color is CSF?
clear, colorless
what can happen if CSF leaks? (basic)
headache
C3-5
Phrenic nerve - diaphragm
T4
nipple line
T10
belly button
L1-5
most common site of injury
if there is an injury what type of pain is it?
neuropathic
Radiculopathy
associated w/ nerve pinching causing neuropathic pain
PNS overview
Sensory Neurons - afferent
- somatic/visceral sensory ganglia
- cranial nerve ganglia
- Autonomic: PNS (far from spine)/SNS (close to spine)
Motor Neurons - efferent
Afferent
sensory goes to CNS
(sense pain)
Efferent
Motor goes away from CNS
(run away)
The PNS consists of
ganglion and nerves
Ganglion
nerve clusters coming out from spinal cord
Nerves extend to
extending to skin and all other organ, muscles, bones, etc.
Vision Issues
- cataracts
- glaucoma
- refractive errors
- diabetic retinopathy
- macula degeneration
Macular Degeneration
- leading cause of vision loss, affects >50yrs
- incurable
- loss of central vision
Cataracts
- everyone will develop it with age, gradually and without pain
- blurs all vision
Diabetic Retinopathy
- leading cause of vision loss <50yrs
- uncontrolled diabetes
- sever vision loss/blindness
Glaucoma
- second most common cause of vision loss >65
- visual field loss, decrease acuity, halo, or blindness
Refractive Errors
- Myopia - nearsighted
- Hyperopia - farsighted
- Presbyopia - difficulty reading small print
Hearing Issues
- Otosclerosis
- Otitis media
- Presbycusis
- Meniere’s Disease
- Cerumen Accumulation
- Conductive Hearing Loss
- Sensorineural Hearing Loss
- Central Auditory Processing Disorder
Conductive Hearing Loss
- inefficient sound waves outer to inner ear
- ear canal blockage - cold, allergy, infection
Central Auditory Processing Disorder
- auditory center damage (pathway to medulla)
- central cortex pathway damage
- TBI, tumor, heredity
Otitis Media
- eardrum and middle ear damage
- infection
- can lead to permanent hearing loss
Otosclerosis
- hereditary
- ossicle hardening
- causes tinnitus
Sensorineural Hearing Loss
- cochlea or nerve damage
- causes - excess noise, meds, virus
Cerumen Accumulation
- wax build-up that can harden
- common in elderly
Presbycusis
- low-pitched sounds are heard better
- Muffles hearing
- age related hearing loss
Meniere’s Disease
- inner ear disease
- fluid in the ear
- can cause tinnitus, hearing loss, vertigo
Tinnitus
ringing in the ear
Vertigo
dizziness
Xerostomia (causes/risks)
- dry mouth
- decreases saliva
- thicker mucus
Causes:
- medications
- cancer
- ageing
Risks:
- food aversions decreasing calorie intake
Olfaction
decreases with age due to reduces sensory neurons and bulb cells
affects sensitivity to odours and taste discrimination
Senses in Older Persons
decreased blood flow:
- decreased cardiac output
- decreased peripheral blood flow
changes to nervous sys
- decrease in nerve cells
- myelin sheath degeneration
- decreased neurotransmitters/conduction rate
nociception
pain - somatic/visceral
neuropathic
Pain Patho
- transduction where the pain starts
- transmission is how the pain reaches our brain
- perception is how our bodies define the pain
- modulation where we have our signals and response
Transduction
where the pain starts
Transmission
how the pain reaches our brain
Perception
how our bodies define the pain
Modulation
where we have our signals and response
other senses
- Kinesthetic: movement awareness
- Proprioception: position awareness
- Stereognosis: recognition of object texture and size
What to consider when assessing cognition?
- the 3Ds: dementia, delirium, depression
- culture, education, values, beliefs, and previous experience of client
Cognition Assessment Tools
- GCS
- MOCA
- AEIOUTIPS
- Neuro
- MMSE
- CAM/PRISME
- NIHSS
Changes with age that affect Neuro (sensations)
- peripheral neuropathy
- brain atrophy
- hardened disks/vertebrae overgrowth
Peripheral Neuropathy
happens when the nerves located outside the brain/spinal cord (peripheral nerves) damaged
Brain Atrophy
is the loss of brain cells (neurons) and their connections, leading to a decrease in brain vol/potentially impacting cognitive/motor func
Sensory Processing
how the brain receives, organizes, uses information from our senses (touch, movement, smell, taste, vision, and hearing) to respond appropriately to the environment
3Ds
- dementia
- delirium
- depression
GCS
Glasgow Coma Scale
CAM/PRISME
delirium scale
What is the following question testing (related to cognition)?
Can you tell me what brought you to the hospital?
Memory
What is the following question testing (related to cognition)?
Don’t count your chickens before they hatch!
Abstract Thinking
What is the following question testing (related to cognition)?
What do you think of when I ask about heart health?
Association
What is the following question testing (related to cognition)?
How are you going to manage with your broken foot at home?
Judgement
How can we help to keep our clients safe?
- appropriate stimuli: not too much, not too little
- family support: education on their family members condition (i.e. their safety needs, medications, etc.)
- environment: using ceiling lift, shower/toilet grab bar, personal belongings, is area cluttered (tripping hazards)?, well lit?
- medication review: reviewing of meds and side effects - getting pharmacist to see what patient really needs to be on
- use of assistive devices: PT/OT, walker etc., helping them understand how to use them, note they may not want to use the devices b/c it is perceived as for old people
Presbycusis
- difficulty discriminating some constants/hearing high-freq sounds
Reduced:
- hearing acuity
- speech intelligibility
- pitch discrimination
- hearing threshold
Presbyopia (reduced/increased effects)
difficulty reading due to lens stiffening
Reduced:
- visual field
- night vision
- accommodation
- depth perception
- colour discrimination
Increased:
- glare
CVA
Cerebral Vascular Accident
AKA Stroke
- TIA - temporary disruption of blood flow to part of brain
- Ischemic Stroke - thrombus/embolus
- Hemorrhagic Stroke - brain bleed
What is the main/most commons direct cause of stroke in Canada/worldwide?
Hypertension
TIA
temporary disruption of blood flow to part of brain, no permanent damage
mini stroke, symptoms resolve on their own w/out intervention (often w/in minutes)
1 in 3 people who have TIA’s will have a stroke
S/S and risk factors same as ischemic stroke
Most common cause of Ischemic Stroke?
Atherosclerosis
Ischemic Stroke
most common, caused by thrombus/embolus
Hemorrhagic Stroke
caused from bleed in the brain
CVA Risk Factors
- hypertension
- atherosclerosis
- smoking
- age >65yrs
- diabetes
- obesity
- atrial fib
Ichemia
reduced/restricted blood flow
Ischemic Stroke: Thrombotic
blood vessels in the brain
risk factors same as all arterial disease
- atherosclerotic plaque
- clot formation
the brain does not get enough O2
Ischemic Stroke: Embolic
moves to the blood vessels in the brain
atherosclerosis, smoking/ETOH, obesity, High LDL, HTN, atrial fib
less commonly can be cause by air, vegetation, amniotic
Less Common causes of Embolic Ischemic Stroke
Air - air bubbles getting into vascular sys
Vegetation - ie. oral infection from flossing, gets into cardiac valve, flicks off into brain
Amniotic - pregnancy - get amniotic fluid in the bloodstream
Treatment specific for Ischemic Stroke
- open up the blood vessels
- increase the odds of recovery
- don’t let it happen again
- Break up the clot: t-RA = recombinant tissue plasminogen activity (thrombolytic)
- Remove the clot: EVT (endovascular treatment) - thrombectomy
Ischemic Stroke can either be
Thrombotic (fixed clot)
Embolic (floating clot)
Preventions for Ischemic (to prevent further damage)
Prevent clots - do not thin the blood
Antiplatelets
- platelets will not stick as easily
- Meds: ASA, Plavix (Clopidogrel)
Anticoagulants
- Interfere w/ the coagulation cascade
- Meds: Heparin, Warfarin, Rivaroxaban, Apixaband
Hot Stroke
symptoms which are hyperacute and within 6hrs
stroke the occurs less than 6hrs ago
VAN+
Larger Vessel Occlusion
Types of Hemorrhagic Strokes
Intracerebral
Subarachnoid
Intracerebral Hemorrhage
bleeding into the brain tissue
S/S:
- headache
- nausea/vomiting
- changes to LOC
- seizure (ICP)
Causes:
- HTN
- trauma
- tumor
- infection
- medications
- AVM
Blood in the cranial vault means
increased intracranial pressure (ICP)
ICP
intracranial pressure
Subarachnoid Hemorrhage
bleeding into the subarachnoid space
S/S:
- worst headache ever (thunder clap)
- nuchal rigidity (stiff neck)
- Photophobia
- nausea/vomiting
Causes:
- AVM
- aneurysm
- trauma
- bleeding disorder
- medication
Thunder clap
worst headache ever
Nuchal Rigidity
stiff neck
Treatment specific for Hemorrhage
coiling
- prevents clots from forming, prevents entry of blood into weak space. via artery.
clipping
- to clip off broken area. via craniotomy.
both under general anesthetic
Nursing Process
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
What is Cushing’s Triad?
Symptoms
- low HR (bradycardia)
- irregular respirations
- widening pulse pressure
increased pressure can cause…
herniation
CVA Diagnostics
Looking at type and causes/risks
doing a CT - to find out what type of stroke
Lab work
- ECG
- INR (international normalized ratio - clotting factors)
- CBC - blood count
Identify Stroke Using
FAST VAN
FAST VAN
F - Face
A - Arm
S - Speech
T - Time
V - Vision
A - Aphasia
N - Neglect
NIHSS
stroke severity, monitor for changes
TOR-BSST
stroke swallowing assessment
AEIOU TIPS (for 101)
A: Alcohol/Acid Base Disorders/Ammonia/Arrhythmias
E: Epilepsy/Electrolyte Disorders;
I: Insulin
O: Overdose
U: Underdose/Uremia
T: Trauma/Tumor/Thermal Insult (Hypothermia)
I: Infection
P: Psychiatric/Poisoning
S: Stroke/Shock
What is the meaning of stupor and lucid
Stupor: state of near-unconsciousness or insensibility
Lucid: expressed clearly; easy to understand.
Neuro Assessment for Right Brain Stroke
- Emotional highs/lows
- Concentration/attention span
- Judgement/Impulsiveness
- Confusion/memory loss
» Agnosia - objects, faces, places, etc.
» Anomia – names of everyday objects - Vision
- Neglect left side
Neuro Assessment for Left Brain Stroke
- Cautious/Compulsive behaviours
- Apraxia (movement)
- Aphasia (more on next slide)
» Expressive aka Broca’s aphasia
» Receptive aka Wernicke’s aphasia - Dysarthria (slurring)
- Comprehension
- Neglect right side
Obtundation
isa state similar to lethargy in which the patient has
- a lessened interest in the environment
- slowed responses to stimulation
- tends to sleep more than normal with drowsiness in between sleep states.
Reticular Activating Sys
is found in the midbrain, pons, medulla and part of the thalamus.
It controls levels of wakefulness, enables people to pay attention to their environments and is involved in sleep patterns.
Stroke Immediate Complications
- Airway
- Increased Intracranial Pressure (ICP)
- Seizure
- Death (ex: brains stem stroke)
- Infection: UTI/Urosepsis, Pneumonia
Stroke Ongoing Complications
- nutrition
- communication
- motor function
- behaviour
- memory
Broca’s Area
Expressive (non-fluent) from frontal lobe stroke
- in the left hemisphere
- may still be able to sing!
- Comes from the opposite side of the body.
- May be able to understand but not respond.
- Difficulty in forming complete sentences or trouble in understanding sentences, or may experience both
Wernickes
Receptive (fluent) from temporal stroke
- central processing disorder.
- Characterized by the client using wrong or meaningless words that do not make sense.
Nursing Process - Assessment
Focus:
- collect
- organize
- validate
- document
eg. Martha, 86yrs,
Dx: Rt. CVA
Hx: HTN, Arthritis, COPD, Colon Ca.
Nursing Process - Diagnosis
Focus
- analyze
- identify good/bad
- formulate nursing diagnosis
The purpose is to identify client needs
Nursing Process - Planning
Focus
- prioritize
- formulate goals and expected outcomes
- select nursing interventions
- write care plan
Nursing Process - Implementation
Focus
- begin interventions
- supervise, delegate, communicate w/ team
- determine nursing assistance needed
- reassessing… always
Nursing Process - Evaluation
Focus
- collect data and compare
- connect nursing interventions
- draw conclusions
- continue, modify or terminate
Kinesthetic
movement awareness
Proprioception
position awareness
Stereognosis
recognition of object texture and size
