Beth - Week 1 - Exam 1 Flashcards
(79 cards)
1
Q
what are the functions of the frontal lobe?
A
- emotional state
- problem solving
- broca judgement
- *impulsive, emotional**
2
Q
what are the functions of the occipital lobe?
A
visual disturbances
3
Q
what are the functions of the parietal lobes?
A
- sensory
- spatial orientation
- concept formation
4
Q
what are the functions of the temporal lobe?
A
- auditory
- spoken memories
- wernicke
- *speak, write, understand**
5
Q
what is the first sign that something is wrong neurologically?
A
LOC changes
6
Q
what are the levels of progression for changes in LOC?
A
consciousness confusion or unusual agitation lethargy or drowsy obtunded stupor deep coma
7
Q
what is AVPU and what does it stand for?
A
It's a quick neuro assessment tool. • A-The Patient is Awake • V-The Patient Responds to Verbal • P-The Patient Responds to Painful • U-The Patient is Completely unconscious
8
Q
what are s/sx of a confused/combative patient?
A
restlesss, confused, agitated, combative, argumentative (covering confusion)
9
Q
what should we look for in a confused pt?
A
the source of confusion → take VS → call MD (could need O2)
10
Q
what is in the general part of the long neuro assessment?
A
- Vital Signs
- Current Health (sepsis?)
- Past History (diabetic? ↓ BG → confusion)
- Meds (opoids, benzos, hypnotics, sedatives, blood pressure meds, beta blockers)
11
Q
what is in the cerebral part of the long neuro assessment?
A
- LOC
- Memory
- Intellectual performance (problem w/ learning)
- Judgement and Insight (Thinking is logical; “what is this?” “a pen vs for writing”)
- Language and communication (appropriate)
- Mood and affect (cussing → talk to family; tearful, crying → frontal lobe damage)
- Cranial nerves (function)
12
Q
what cranial nerves are in the cerebrum?
A
only CN 1 and 2
13
Q
what CN are in the brain stem?
A
CN 3 - 12
14
Q
what are the cranial nerves?
A
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
15
Q
what is cranial nerve 1? what are it’s characteristics?
A
olfactory - sense of smell
- sensory nerve
16
Q
what is cranial nerve 2? how is it assessed?
A
optic - sense of vision, visual acuity, and vision fields
- “how many fingers … “
- sensory
17
Q
what is cranial nerve 3?
A
oculomotor - eyelid control, accommodations (reflex to light), direct/consensual, conjugate and disconjugate, and blurred
- mixed nerve
18
Q
what cranial nerves are assessed together, and what are the possible assessment findings?
A
- assess III, IV, VI together
- anisocoria: normal, unequal
- nystagmus
- hippus: rapid constrict, dilate
- ptosis: drooping eyelid
19
Q
what are cranial nerves IV and VI? what is assessed?
A
- Trochlear and Abducens
- assess the “6 cardinal fields of gaze”
20
Q
what is cranial nerve V? what does it assess?
A
- Trigeminal - mixed nerve
- motor: place hands on cheeks and clench jaw
- sensory: eyes closed; touch face @ least 3 times
21
Q
what is cranial nerve VII? how do we assess?
A
Facial - mixed nerve
- assess by having pt smile big, puff out cheeks, squeeze eyes closed
22
Q
what is cranial nerve VIII? how is it assessed? what should we be aware of?
A
Acoustic/Vestibulocochlear - sensory nerve
- whisper test, Rinnes test, tuning fork
- *hearing deficit**
23
Q
what is cranial nerve IX? how is it assessed?
A
Glossopharyngeal - mixed nerve
- back of tongue, taste, gag and swallow
24
Q
what is cranial nerve X? how is it assessed?
A
Vagus - mixed nerve
- gag/cough “say ahh”
25
what is cranial nerve XI? how is it assessed?
Accessory (spinal) - motor nerve
| - shoulder shrug, place pressure on mandible
26
T/F CN 9 - 11 are assessed together
TRUE
27
what is cranial nerve 12 and how is it assessed?
hypoglossal - motor nerve
| - tongue out, side to side
28
long neuro assessment: how is balance tested?
- Romberg test (feet together, eyes closed)
| - hopping
29
long neuro assessment: how is upper extremity coordination tested?
- rapid movement (hands on lap)
- fine motor test (nose to finger - make sure they don't need visual aid)
- finger coordination (fingers to thumb)
30
long neuro assessment: how is lower extremity coordination tested?
by having the patient lie down and have one heel steady from knee to foot
31
long neuro assessment: what senses do we test?
all of them: sight, smell, hearing, taste, touch
32
long neuro assessment: how do we test the senses for touch?
- superficial tactile (cotton ball to foot)
- superficial pain (pinprick to foot)
- vibration (tuning fork)
- position sense of joint (pushing toes up or down and telling what position its in)
33
long neuro assessment: what are 3 other ways to test the senses?
- stereognosis
- two point discrimination
- graphesthesis
34
what is stereognosis?
holding a well known object; eyes closed; trying to figure out what it is
35
what is two point discrimination?
having a two pronged item; eyes closed; pressing either one or two prongs on the pt's hand and have them say which it is.
36
what is graphesthesis?
making numbers and letters on the pt's hand; eyes closed; they tell you what is spelled`
37
long neuro assessment: how is motor function tested?
dorsiflexion/planter flexion (push/pulls)
| deep tendon reflexes
38
what are the 7 deep tendon reflexes?
- tricep
- bicep
- brachioradial
- patellar
- achilles
- ankle tonus
- babinski
39
when is a babinski used and what does a positive babinski look like/mean?
used on semicomatose/comatose pts
- if big toe goes up, may mean trouble
- indicative of severe damage to the CNS
40
long neuro assessment: what are cheyne-stokes respirations?
breathing really fast followed by periods of apnea
| - indicates the brain is at the very end
41
what are limitations to a neuro assessment?
- LOC
- attitude (teens → kick parents out)
- physical weakness
- inability to follow directions
- culture/language barrier
- immobility
42
what are the categories for the GCS?
- eye opening
- motor response
- verbal response
43
what is Glasgow Coma Scale?
a tool to measure LOC and ID the severity of a neurological injury of a patient with altered alertness
44
what are the point values for GCS
3 - 15
3 being the worst
15 being the best
45
what are neuro changes that occur with aging? (9)
- sleep patterns
- balance
- movement
- memory loss
- reaction time
- learning slower
- temp regulation
- feeling pain
- vision
46
what are neuro changes that occur with aging? (9)
- sleep patterns
- balance
- movement
- memory loss
- reaction time
- learning slower
- temp regulation
- feeling pain
- vision
47
how does aging affect the cranial nerve function? (1-10)
I → ↓ sense of smell
II → reduced ability to differentiate color; farsighted
III, IV, VI → reduced upward gaze; slow accommodaton
V → ↓ corneal reflex
VII → diminished taste
VIII → high frequency hearing loss
IX, X → reduced gag reflex
48
why do we run diagnostics for a neuro assessment?
- to ID location and severity of the injury so that interventions can be started timely
- to confirm brain death
49
what 8 diagnostic tests are performed for neuro?
- Lumbar Puncture (LP)
- Myelogram
- Cerebral Angiogram (good brain blood flow)
- Evoked Potential
- Transcranial Doppler (TCD) (some people thick skulls/no windows → brain has brain flow)
- Computed Tomography Scanning (CT)
- Magnetic Resonance Imaging (MRI) (MRA)
- Electroencephalography (EEG)
50
what 8 diagnostic tests are performed for neuro?
- Lumbar Puncture (LP)
- Myelogram
- Cerebral Angiogram (good brain blood flow)
- Evoked Potential
- Transcranial Doppler (TCD) (some people thick skulls/no windows → brain has brain flow)
- Computed Tomography Scanning (CT)
- Magnetic Resonance Imaging (MRI) (MRA)
- Electroencephalography (EEG)
51
why and how is an MRI done?
- hydrogen atoms excited→ scanner measures oscillations
| - better for anatomical info.,bone, tissue, soft structures
52
what are the NI associated with MRIs?
- metal? Pt. and You (magnetic field)
- Pacermaker
- Tattoos with red ink/metal flex
- noisy--ear plugs
- claustrophobic/ sedation?
- MRA pt needs an Saline lock
53
why and how is a CT done?
- radiographic images--”slices”
| - assess bone, fluid collections, tissue
54
what are NIs associated with CTs?
- invasive vs non-invasive? Consent?
- immobile during test
- claustrophobia?--“I’m nervous in small/confined places
55
why and how is a cerebral angiogram done?
- contrast study--threading the cath up the femoral artery
| - patency, narrowing, occlusions, aneurysms, tumors, alterations in bld. flow
56
EXAM: why and how is a EEG (electroencephalogram) done?
• ID Electrical/Seizure Activity
- at rest
- hyperventilation
- phobic stimulation
- Sleep (currently done at the patient bedside)
• Brain Death Evaluation
- no opioids, stimulants, or sedation (could potentially change test)
57
what are the NI for an EEG?
- no stimulants
- Keep patient calm
- anti-convulsants?
58
EXAM: why do we do lumbar punctures?
- obtain CSF
- measure ICP
- diagnostic for SAH or Epidural bleed (if already suspected it's contraindicated)
59
where is the lumbar punctured inserted?
'L3-4 or L4-5
| - needle tip must be in the subarachnoid space
60
what are the NIs for a lumbar puncture?
- Consent
- Bladder (empty)
- Positioning (left side/legs up)
- Specimens to the Lab (normal/abnormal)
- Stat finger stick with puncture?????
- Check injection site
61
what are the NIs for a lumbar puncture?
- Consent
- Bladder (empty)
- Positioning (lateral recumbent position - left side/legs up)
- Specimens to the Lab (normal/abnormal)
- Stat finger stick with puncture?????
- Check injection site
62
what if you ID CSF leak from site?
- blood patch may be used
| - 10 - 20 cc of pts own blood injected into epidural space to "plug"
63
what is the teaching for lumbar punctures?
- ice pack
- bed rest at home
- hydrate
- no ASA or NSAIDS
- no straining
64
what is myelography/myelogram and what is its purpose?
• Fluoroscopy imaging examination that uses a spinal needle placed in the spinal canal
- injection of contrast material in the space
around the spinal cord and nerve roots
• Purpose
- View of the subarachnoid space
- Spinal Canal
65
what is myelography/myelogram and what is its purpose?
• Fluoroscopy imaging examination that uses a spinal needle placed in the spinal canal
- injection of contrast material in the space
around the spinal cord and nerve roots
• Purpose
- View of the subarachnoid space
- Spinal Canal
66
why and how is a myelogram done?
• Provides a very detailed image of the spinal cord, nerve roots, subarachnoid space, and spinal column
• If any abnormalities are found CT is done
to define anatomy and findings
67
what are the NIs for myelogram?
```
• Pre and Post
• Obtain consent and allergies
• General
- Post procedure
- hydration IV or oral
- VS
- pain level
- lie flat if HA otherwise 30-45 degrees
```
68
what are the NIs for cerebral angiogram? preprocedure vs postprocedure
```
• pre-procedure
- Obtain consent/allergies
- Check orders for NPO
- IV for hydration
• post-procedure
- neuro deficits
- Assess puncture site for hematoma/bleeding
- VS
- Distal pulses
```
69
why and how is a transcranial doppler done?
- Ultrasound
| - Flow velocity of blood through the vessels; ID vasospasms
70
what are the NIs for a transcranial doppler?
- noninvasive (done by a tech)
| - plan to hold still for 30-60 min
71
what is the goal of the TCD test?
- confirm cerebral blood flow
| - ordered on pts looking brain dead → looking for spasms
72
why and how is evoked potential done?
- assesses neuron transmission through sensory pathways (integrity of the pathway)
- senses central/cortical activity via electrodes in response to peripheral stimulation
- can be used before/during/after surgery
73
what are the NIs for evoked potential?
- no interference - peace and quiet
| - 30 - 45 min (time management)
74
why and how is positron emission tomography (PET) done?
- radiographic images-shows organ function
| - Metabolic changes in the brain
75
what are the NIs for a PET scan?
- Consent
- immobile during test
- Relaxation techniques
- Possible sensations (dizzy, HA, light-headed)
76
for a healthy brain, what does the cerebellum control?
balance and coordination
77
if the cerebellum is injuried, what occurs?
- difficulty coordinating fine movements
- difficulty walking
- tremors
- dizziness
- slurred speech
78
for a healthy brain, what does the brainstem control?
breathing, heart rate, alertness/consciousness
79
if the brainstem is injuried, what occurs?
changes in breathing
difficulty swallowing food/water
problems with balance and movement
dizziness and nausea.
