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Anatomy And Physiology > Applied Nervous System > Flashcards

Applied Nervous System Flashcards

1
Q

Sympathetic nervous system

A
  • triggers response of fight or flight
  • neurotransmitter adrenaline is released
  • adrenaline causes an increase in heart rate, vasoconstriction, increase in blood pressure, stimulation of glycogenolysis, peristalsis and gastric absorption cease, respiratory rate increases, bronchodilation and pupillary dilation
  • it is an instant response (stress response)
  • if the body is still under perceived threat the hypothalamus will release CRH which travels to the pituitary gland triggering ACTH. Cortisol is then released by the adrenal glands
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2
Q

Parasympathetic nervous system

A
  • controls smooth muscle and cardiac muscle, it also controls rest and digest
  • it controls glands that control hormone release to counteract fight or flight
  • it stimulates the release of acetylcholine which inhibits cortisol response thus returning the body to normal
  • SLUDD&raquo_space;> saliva, lacrimation, urination, digestion, defecation&raquo_space;> this is what the parasympathetic nervous system works on
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3
Q

Enteric nervous system

A
  • this is a branch of the autonomic nervous system (ANS) which operates completely separately to the sympathetic and parasympathetic nervous system
  • controls the gut and its functions
  • communicates through neurotransmitters such as dopamine, serotonin and acetylcholine&raquo_space;> these control blood flow into the stomach and bowels
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4
Q

Application to nursing practice

A
  • many diseases or conditions can cause injury or disruption to how the nervous system works
  • there are diseases such as Alzheimer’s, Parkinson’s, epilepsy or motor neurone disease that affect the central nervous system
  • there are diseases such as diabetes and Guillian-Barre that affect peripheral nervous system
  • this disruption of the nervous systems function is caused by traumatic injury or disease
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5
Q

Supporting patients with neurological injury

A
  • patients may present in any stage of neurological injury
  • neurological injuries/ conditions may occur at any stage of life
  • nurses will need to be aware of the conditions affecting their caseload
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6
Q

What is a CVA (stroke)?

A
  • interruption of blood supply to the brain, caused by a blockage or burst blood vessel cutting off the supply, causing damage to the brain
  • there are two types of CVA: ischaemic and Haemorrhagic
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7
Q

Ischaemic strokes

A
  • caused by an obstruction or blockage
  • this is the most common type of stroke
  • it is also known as a thrombo/embolic stroke
    Risk factors
    »> hypercholesterolemia
    »> hypertension
    »> atrial fibrillation
    »> ischaemic heart disease/angina
    »> peripheral vascular disease
    »> diabetes
    »> previous stroke
    »> smoking
    »> increased alcohol intake
    »> poor diet/obesity
    »> increased age
    »> oral contraceptive pill
    »> drug misuse
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8
Q

Haemorrhagic stroke

A
  • this is caused by a burst blood vessel
    Risk factors
    »> chronic hypertension
    »> amphetamine use
    »> amyloid angiopathy
    »> arteriole venous malformation
    »> inflammation of blood vessels
    »> bleeding disorders
    »> use of anticoagulants
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9
Q

Subdural haematoma

A
  • this also known as subdural haemorrhage is a type of haematoma, usually associated with traumatic brain injury&raquo_space;> in this blood gathers between the dura mater and the brain
  • usually resulting from tears in bridging veins which cross the subdural space
  • subdural haemorrhages may cause an increase in intracranial pressure, which can cause compression of and damage to the delicate brain tissue
  • subdural haematomas are often life threatening when acute
  • chronic subdural haemoatomas have a better prognosis if properly managed
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10
Q

Why perform a neurological assessment?

A

1) identify the presence of nervous system dysfunction
2) detect life threatening situations
3) establish a neurological baseline for a patient
4) compare data to previous assessments and determine the change in neurological ability and necessary interventions
5) determine effects of nervous system dysfunction on activities of daily living and independent functions
6) provide database upon which nursing interventions will be implemented

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11
Q

ACVPU score

A

Alert&raquo_space;> Confusion&raquo_space;> Voice&raquo_space;> Pain&raquo_space;> Unresponsive

  • basic assessment of neurological capacity
  • requires minimal training
  • able to identify deterioration
  • doesn’t have diagnostic capacity
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12
Q

Glasgow coma scale

A
  • evaluates three key categories of behaviour that closely reflect activity in the higher centres of the brain: eye opening, verbal response and motor response
  • these categories enable the MDT to determine whether the patient has cerebral dysfunction
  • within each category each level of response is attributed to a numerical value&raquo_space;> the lower the value the greater the neurological deterioration
  • 13+&raquo_space;> mild brain injury
  • 9-12&raquo_space;> moderate brain injury
  • 8>&raquo_space;> severe brain injury
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13
Q

Voice

A

Alert and orientated?
Full sentences or mumbled?
Able to form words?
Incomprehensible?
If unresponsive, raise voice?
Are they deaf? Right ear?

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14
Q

Motor

A

Obeys pain - neurologically intact
Localising pain - sensory and motor cortex intact
Flexion to pain - reduced sensory and motor processing
Abnormal flexion - blocked motor pathway between cortex ad brain stem
Extension to pain - blocked motor pathway in brainstem
None - gross neurological dysfunction

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15
Q

Central stimulus

A

Assess eye opening and motor response
Patient doesn’t obey commands
Trapezius squeeze - spinal accessory nerve
Grasp approximately 3cm of muscle and squeeze for <15 seconds

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16
Q

Pupillary response

A

Estimate size of pupil in mm - record on chart
Move torch from outer aspect towards uplift&raquo_space;> pupils should constrict
Repeat for other eye

17
Q

Limb assessment

A
  • evaluation of limbs provides nurses with detail of geographical distribution of dysfunction&raquo_space;> important when performing complete neurological assessment
  • different responsiveness in one limb indicates focal brain injury/damage
  • hemiplegia occur in limbs on the opposite side to the lesion&raquo_space;> due to crossing over of nerve fibres in the medulla
    How to test limbs
  • each limbs should be assessed separately&raquo_space;> patient must be awake
  • have patient flex and extend arms and legs against your hand
  • a peripheral stimulus needs to be applied if limbs dont move
    5 = full range of motion and full strength
    4 = full range of motion but less strength
    3 = can raise but not against resistance
    2 = can move but not lift
    1 = slight movement
18
Q

Vital signs&raquo_space;> temperature

A
  • regulation may be disrupted due to damaged hypothalamus
19
Q

Vital signs&raquo_space;> heart rate

A
  • ECG changes may occur in the acute stage following cerebral insult as a result of acetylcholine release
  • these include peaked P waves, prolonged QT intervals, heightened T waves, ST segment elevation or depression
  • bradycardia is present in later taxes of raised ICP or when there is an associated cervical spine injury
  • tachycardia is present in terminal stages of raised ICP
  • arrhythmias are seen in posterior fossa lesions of when there is blood in CSF
20
Q

Vital signs&raquo_space;> blood pressure

A
  • in a normal brain a fall in blood pressure doesn’t cause a drop in cerebral perfusion pressure since auto-regulation results in cerebral vasodilation to protect brain tissue
  • following cerebral injury auto-regulation may be impaired&raquo_space;> hypotension may lead to brain ischaemia
  • hypotension has been identified as a predominant factor in secondary brain injury is related to morbidity and mortality
  • hypotension is associated with a rising ICP and is a part of Cushing response&raquo_space;> rising BP with a widening pulse pressure, bradycardia and decreasing respirations
  • this is a ate response and may not appear in some patients and is invariably preceded by a drop in GCS
21
Q

Vital signs&raquo_space;> respirations

A
  • changes in the respiratory pattern are common following the cerebral insult and patients often require advanced respiratory support in the acute stage.
  • initially an acute rise in ICP will cause slowing of the respiratory rate indicating loss of all cerebral and cerebellar control of breathing with respiratory function at only brain stem level
  • as ICP continues to rise the rate becomes rapid and indicating that the brain stem is affected too
  • a decreased level of consciousness may compromise respiratory function therefore observe for potential airway problems
    Symptoms and signs of respiratory distress:
    »> irregular breathing pattern
    »> noisy respirations
    »> use of accessory muscles
    »> tachypnoea/dyspnoea/apnoea

Anatomy And Physiology (27 decks)

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