Module 11: Neurological System Flashcards
1
Q
The nervous system is like the ___ of the body
A
Switchboard operator of the body (it processes, filters, and automatically/voluntarily routes messages)
2
Q
3 Major Functioning Units of the Nervous System
A
- Spinal Cord Level
- Brain Stem and Subcortical Level
- Cortical Level
3
Q
What is the spinal cord level
A
the lowest functional level of NS
controls automatic motor responses (reflexes)
4
Q
What is the brain stem and subcortical level
A
controls BP, respiration, equilibrium, and primitive emotions
5
Q
What is the cortical level
A
Responsible for cognition
6
Q
Central nervous system
A
brain and spinal cord
network of coordination and control of the body
7
Q
Peripheral nervous system
A
cranial nerves, spinal nerves, ANS (SNS+PNS)
motor and sensory nerves and ganglia outside the CNS which carries information to and from the CNS
8
Q
How many pairs of cranial nerves are there
A
12
9
Q
How many pairs of spinal nerves are there
A
31
10
Q
Spinal nerves are ___ nerves
A
somatic (they innervate voluntary muscles)
11
Q
Why do we avoid palpating or taking carotid pulse in non-emergency situations?
A
to not trigger baroreceptors in the brain
12
Q
How much blood supply does the brain get
A
15 to 20% of the total cardiac output goes to the brain
13
Q
What brings blood to the brain
A
The Basilar Artery
It is made from the 2 internal carotid arteries and 2 vertebral arteries joining together
14
Q
3 Major Units of the Brain
A
Cerebrum
Cerebellum
Brainstem
15
Q
Cerebrum
A
2 Hemispheres divided into lobes
16
Q
Gray Matter of the Cerebrum
A
Outer layer (of the cerebral cortex)
made up of cell bodies
Controls higher mental function, general movement, visceral functions, perception, behavior, and integrates these functions
17
Q
White Matter of the Cerebrum
A
Nerve fibers and myelin (heavily myelinated)
Bulk of it is in the inside of the cerebrum
18
Q
Disorders associated with White Matter
A
Multiple Sclerosis
CMV
Encephalitis
Folate or Vit-B12 Deficiency
Vasculitis
PKU (Phenylketoneuria)
19
Q
Frontal Lobe
A
Lobe of cerebrum
Responsible as a motor cortex, and for voluntary skeletal movement and fine repetitive motor movements and eye movements
Has impact on intellect and emotion and higher order processing
Brocas Area and Motor Cortex in this lobe
20
Q
Parietal Lobe
A
Lobe of cerebrum for processing sensory data
Assists in interpretation of tactile, visual, olfactory, gustatory, and auditory sensations; recognition of body parts and position; and acts as a communicator between sensory and motor areas of the brain
Somatosensory cortex here
21
Q
Occipital Lobe
A
Primary vision center lobe of the cerebrum
provides interpretation of visual data and gives the ability to read and understand
Visual cortex here
22
Q
Temporal lobe
A
Perception and interpretation of sounds along with determination of source, integration of taste/smell/balance/reception/interpretation of speech
Wernickes Area and Auditory cortex here
Works with the cerebellum to control balance
23
Q
Broca’s Area
A
Area of frontal lobe responsible as the motor area of speech
If broca’s aphasia occurs here they cannot speak correctly
24
Q
Wernicke’s Area
A
Area of the temporal lobe responsible for reception and comprehension of language/speech
If there is damage here the person can speak, but speaks nonsensically
25
Cerebellum
1. Works with motor cortex for integration of voluntary movement
2. processes sensory info from eyes, ears, touch receptors
3. Works with vestibular system for reflexive control of muscle tone, equilibrium, and posture to produce steady and precise movements (BALANCE)
26
The cerebellums main functions are ___ and ___
balance and coordination
27
Potential Causes of Cerebellum Disorders and Symptoms?
Causes: Congenital issues, hereditary ataxia, acquired conditions
Symptoms: vary but typically include ataxia
28
Ataxia
impaired muscle coordination
29
Brainstem
pathway between spine and brain
controls many involuntary movements (like cardiac and resp)
Nuclei here have 12 cranial nerves
Has a reticular formation running through it, and is mostly made of 3 main parts
30
3 Main Parts of the Brainstem
Midbrain
Pons
Medulla Oblongata
31
What does the reticular formation do
Contains a network of fibers for muscle stimulation
32
Main functions of the brainstem
Counteract gravitational forces
Regulate cardiac and resp systems
Maintain consciousness
33
Medulla Oblongata
Contains CN IX -XII
Controls respiration, circulation, vasomotor activities, houses the respiratory center.
Controls reflexes like: swallowing, coughing, vomiting, sneezing, hiccupping
34
Pons
Contains CN V-VIII
Regulates respiration, houses a portion of the respiratory center, controls voluntary muscle action
35
Midbrain
Contains CN III and IV
Reflex center for eye and head movement
Auditory Relay pathway
36
Diencephalon
Includes the hypothalamus, thalamus, and pituitary glands
Contains CN I and II
It relays info between the cerebrum, cerebellum, pons, and medulla (all sensory impulses except olfactory)
Also responsible for consciousness, perception of sensation, and abstract feelings
37
What sense does the thalamus/Diencephalon NOT relay?
Olfactory (scent)
38
Purpose of the Thalamus
perception of pain
temperature control
39
Purpose of Epithalamus
A pineal body for sexual development and behavior
40
Purpose of Hypothalamus
Major processing center of stimuli for the ANS
Maintains TEMPERATURE control, H2O metabolism, body fluid osmolarity, feeding behavior, neuroendocrine activity
41
Purpose of Pituitary Gland
HORMONAL GROWTH CONTROL
lactation
VASOCONCSTRICTION
metabolism
42
Severe Brainstem injuries can lead to ...
Decerebrate and Decorticate Posturing
43
Decerebrate Posture
arms and legs extended
toes pointed downward
head and neck arched backwards
muscles rigid
Usually indicates severe brainstem damage
44
Decorticate Posture
arms flexed
clenched fists
extended legs held straight out
Arms bent inward toward the body with wrists and fingers bent and held to chest
muscles rigid
45
What is more ominous, decerebrate or decorticate posturing?
Both are dangerous, but Decerebrate is more ominous (since its association with brainstem injury)
46
Spinal Cord Length
40 to 50 cm
47
What constitutes the spinal cord?
Fibers grouped into 2 tracts that run carrying sensory (afferent), motor (efferent), and automatic impulses between brain and body
there are 31 spinal nerves covered in myelinated white matter making ascending and descending tracts with gray matter nerve cell bodies
48
How are the gray matter cell bodies organized in the spinal cord?
In a butterfly shape for the anterior and posterior horns
49
Ascending Tract
carries SENSORY (Afferent) data to the brain
mediates and facilitates sensation like complex discrimination to touch, pressure, vibration, joint positions, and two point discrimination
50
Descending Tract
Carries MOTOR (Efferent) impulses from the brain to the body
Impulses conveyed to various muscle groups by inhibiting or exciting spinal activity
51
Sympathetic System is ___ or ___
Fight or Flight
52
Parasympathetic System is ___,___,___
Feed breed rest
53
ANS
Autonomic NS which controls body functions not directly monitored
54
Somatic NS
Deliberate actions / voluntary muscle movement
55
CN I
Olfactory Nerve
Sense of Smell
56
CN II
Optic Nerve (NOT Peripheral NS!)
Vision
57
CN III
Oculomotor Nerve
Upward, downward, medial eye movement, lid elevation, pupil constriction
58
CN IV
Trochlear Nerve
Eye movements downward and medial
59
CN V
Trigeminal Nerve
Somatic Sensation of face, mouth, cornea
Muscles of Mastication
60
CN VI
Abducens Nerve
Eye movements laterally
61
CN VII
Facial Nerve
Controls facial expression muscles and anterior taste of tongue
Salivation, scalp, facial movement, lacrimation
62
CN VIII
Acoustic Nerve
Cochlear hearing (and balance)
63
CN IX
Glosso-pharyngeal nerve
External ear, taste posterior 1/3, carotid reflexes, sinus, baro and chemoreceptors
Gag reflex, swallow reflex, salivation
64
CN X
Vagus Nerve
external ear, pharynx, swallow, pronation, bronchoconstriction, gastric secretion, peristalsis
65
CN XI
Accessory Nerve
Swallow, pharyngeal muscles, head turn, shoulders rise
66
CN XII
Hypoglossal nerve
tongue movements
67
What type of nerve is CN I
S
68
What type of nerve is CN II
S
69
What type of nerve is CN III
M
70
What type of nerve is CN IV
M
71
What type of nerve is CN V
S and M
72
What type of nerve is CN VI
M
73
What type of nerve is CN VII
S and M
74
What type of nerve is CN VIII
S
75
What type of nerve is CN IX
S and M
76
What type of nerve is CN X
S and M
77
What type of nerve is CN XI
M
78
What type of nerve is CN XII
M
79
The weber and rinne tests are important for which cranial nerve
CN VIII
80
The 5 Sense are controlled by which Cranial Nerves
I - olfactory
II - Optic
III - Oculomotor
IV - Trochlear
VI - Abducens
All responsible for smell, vision, pupillary constriction, extraocular movement
81
What cranial nerves control taste?
VII - Facial
IX - Glossopharyngeal
82
What cranial nerve controls hearing?
VIII - Acoustic
83
What cranial nerve controls sensory innervation to face, teeth, tongue, eyes?
V - Trigeminal
84
What things does the neurologic assessment accomplish?
1. Level of functioning, emotional, mental capacity, and functioning are determined
2. Monitors/Detects changes and to assess nervous system dysfunctions
3. Evaluates motor, sensory, autonomic, cognitive, and behavioral elements
85
The most complex nursing assessment of the physical examination is the ...
neurologic assessment
86
Any abnormal neurologic symptoms should be assessed using ...
COLDSPA
87
during neurologic and musculoskeletal exams there is a stress on ...
safety!
88
Pertinent Symptoms and information that need further assessment in the neurologic health history?
```
Dizziness
Numbness and tingling
loss of feeling
changes in sensation
mood changes
surgeries
difficulty or changes in speech/swallowing
hearing
memory
balance and coordination
head, back, neck injuries and accidents
seizure history
headaches
syncope
drug and ETOH use
chemical exposures
changes in sleep schedules
activity level
medications
changes in ADLS
```
89
Sequence of techniques in neurologic exam?
Inspection --> Palpation
Auscultation and Percussion not necessarily needed
90
When performing a neurologic physical exam, it is important to go ___ and ___
cephalocaudally and bilaterally
91
The neurologic exam does not look only at motor, but also ___
sensory
92
What things should be looked for during inspection via general survey and approach for a neurologic exam?
General appearance - is it appropriate, gait, posture, awareness, manner of grooming and dress
Get patients perception of things
Are they comfortable
Allow older patients longer response times
93
Patient Perceptions in the physical neurologic assessment is considered ___ data
objective
94
Spastic Hemiparesis
Gait where affected leg is stiff and extended
foot drags and toes scrape
Affected arm is flexed and adducted with no swing
95
Ataxia
uncoordinated uncontrolled falling occurs in gait
96
Parkinsonian Gait
stooped, rigid, short shuffling steps with difficulty starting and stopping
97
Glasgow Coma Scale
gold standard scale for Level of consciousness
has 4 levels but does not assess verbal response
98
4 Levels of the Glasgow Coma Scale
1. Awake and Alert - Follows commands
2. Lethargic - drowsy/tap awake
3. Stuporous - Shake or shout to wake
4. comatose - does not respond to verbal cues or pain stimuli
99
What aspects of mental status are important to look at during a neurologic examination?
Behavior/Mood/Affect
Emotional state
does their mood change
non verbal cues they give
speech characteristics
thought processes and cognitive function
assessment of orientation, attention, and memory
their use of language
100
Orientation Status
Test of awareness of person, place, and time for a patient
EX: *individualize to the specific person
Person - what is your name? address? who is examiner?
Place - tell me where you are?
Time - what day, month, year, season, president, etc
101
How should you go about assessing memory?
Put it into the general conversation, do not just quiz them usually
102
Memory is part of ___ function
cerebral
103
If recollection of past is easier than present what tests should be done?
Immediate Memory Tests:
1. Repeat numbers backward and forward
2. Recent Memory - Dietary recall
3. Remote Memory - past occupations and birth place
104
What is intellectual functioning?
Ability to define proverbs, learn a new item, perform computation, possess the ability to read, and have insight and judgment into situations
105
What plays a large roll in intellectual functioning?
Age and Culture
106
What is the Mini Mental Status Exam for Elders?
A judgment of mental status that assesses: (ORRAcL)
1. Orientation
2. Registration
3. Attention and Calculation
4. Recall
5. .Language
107
What can mental status changes indicate?
Early indications of change to neurological status which could be difficult or subtle to detect:
May begin slowly with forgetfulness, memory loss, inability to concentrate or process info quickly
Could rapidly proceed to unconsciousness
108
Causes for Mental Status Changes?
```
Neurological Issues
Fluid and Electrolyte Imbalance
Hypoxia
Poor perfusion
Nutritional Deficiencies
Infections
Renal and Liver Disease
Hyper/Hypothermia
Trauma
Medications/Toxins
Drug/ETOH Abuse
```
109
What is the order of information to go by when doing the neurologic exam?
Patient Perceptions > What you see > What family says is occurring
110
Proprioception
Ability to maintain posture, balance, and coordination
Done via the posterior columns of the spinal cord carrying stimuli and fibers for touch and integrating with the cerebellum
111
Functions of the Cerebellum
Works with vestibular sense to correct movement
Balance and coordination
Integrates muscle contractions for posture
112
If some non-neuro condition can cause motor issues..
do not assume the problem is from an issue of cerebellar function
113
Ways to Test Cerebellar Function
Finger to nose (helps display upper extremity movement)
Finger Nose and Finger Movements
Rapidly Alternative Movements: Thumb to 4 fingers as rapidly as possible, or slapping thighs with palms alternating with the back of hands (note speed and accuracy)
Heel to Shin Standing
Romberg Test
Tandem/Tip Toe Walking
114
How to test somatic sensation function?
1. Sensation (Dermatomes, Major Peripheral nerves, forehead, cheek, hand, foot)
2. Light Touch (wisp of cotton on diff. areas)
3. Pain and Temp (sharp, dull, hot, cold)
4. Vibration (tuning fork on bone prominence - ask localization stop and start)
*** always check bilaterally
115
Anesthesia
Lack of sensation
116
Hyperthesia
Very sensitive
117
Hypothesia
decreased sensation/ dull sensation
118
Paresthesia
Tingling sensation
119
Dermatomes
Sensory areas of the body where peripheral nerves are
It is a relationship between spinal nerves and skin sensation and each of the roots provides sensation to a predictable area of the skin (but there is a lot of overlap)
120
With sensory function it is important to also check for ___ sensitivity and ___ discrimination
position sensitivity and tactile discrimination
121
Stereognosis
Can they make out the form/what is in their hand when eyes are closed
122
Graphesthesia
If you write something with your finger on their palm or back can they tell what you wrote
123
Two Point Discrimination
What is the point that they can discriminate two different sensations
124
Deep Tendon Reflexes (DTR)
Reflexes that reroute info to cause the movement from the spinal level while also sending info to the brain
125
What are the main DTR?
```
Biceps
Brachioradialis
Achilles
Triceps
Patellar
Plantar
```
126
How is DTR rated?
on a scale of 0 to 4 with +2 being normal
The strength is then also rated on 0 to 5 with 5 being normal strength
127
Important Primitive Reflexes that should only be seen in newborns and infants
```
Sucking
Rooting
Moro (Startle)
Babinski
Blabellar
Palmar/Grasp
Plantar
Tonic Neck
```
128
Rooting Reflex
baby will auto turn toward stimulus and make sucking/rooting motions when mouth or cheek is touched
129
Sucking Reflex
when top of mouth is touched the baby will auto start sucking
130
Moro reflex
Startle Reflex
In a response to sudden loss of support the baby will spread out their arms then pull them in and likely begin to cry
131
Babinski Reflex
sole of foot being firmly stroked on an infant will cause the toes to fan out
132
Glabellar Reflex
Tap patient on forehead, and if extinction does not occur and they continue to blink after a while that is an abnormal response
133
Palmar/Grasp Reflex
put finger in babies hand, they should grasp around it
134
Plantar Reflex
In adults, the stroking of the foot should cause this flexion inward of toes rather than a babinski response
135
Tonic Neck
Fencing Reflex
When head is turned to one side, babies arm on ipsilateral side will extend while contralateral arm will bend at elbow
136
Important Superficial reflexes
Abdominal
Anal
Corneal
Cremasteric
137
Abdominal reflex
4 Strokes toward the umbilicus should elicit abdominal contraction
138
Anal Reflex
Anal Wink
Reflexive anal contraction to stimulus to the skin around the anus
139
Corneal Reflex
Reflexive blinking from stimulation of the cornea (by touch or foreign body)
Touch the cornea with cotton in a coma patient usually
140
Cremasteric Reflex
Only in males
if inner thigh is stroked, the cremaster muscle will pull up on the ipsilateral testicle
141
When a patient states they have headaches what should you analyze?
COLDSPA (pain)
Acute or chronic
localized or generalized
142
90% of headaches are ...
benign, caused by muscle contraction and or vascular issue (migraine or cluster)
143
10% of headaches are...
a serious medical issue
144
Dizziness
a "fainting sensation"
145
Vertigo
Sensation that everything is "spinning"
can be accompanied with nausea, vomiting, nystagmus
146
Syncope
temporary loss of consciousness
"black out" / "had a spell"
147
Paresthesia
Numbness or tingling
148
Symptoms of dizziness, vertigo, syncope, or paresthesia can be ...
benign OR serious (like in an impending CVA) so investigate thoroughly
149
Possible causes for dizziness, paresthesia, syncope, and vertigo?
diabetes
neurological issues
metabolic issues
cardiovascular issues
renal issues
inflammatory diseases
toxins
150
Disorders of the CNS
Multiple Sclerosis
Generalized Seizure Disorder
Meningitis
Lyme Disease
Space occupying lesions
Cerebral palsy
Normal pressure hydrocephalus
Spina bifida
Amyotrophic lateral sclerosis
151
Disorders of PNS (peripheral)
Myasthenia Gravis
Trigeminal neuralgia (tic douloureux)
Bells Palsy
Gullain barre Syndrome (GBS)
Peripheral Neuropathy
152
Multiple Sclerosis
immune destruction of myelin sheathing
153
Generalized Seizure Disorder
Systemic disease, head trauma, toxins, stroke, or hypoxic syndromes cause this
S/S: disturbances in consciousness, behavior, sensation, autonomic functioning, urinary and fecal incontinence
154
Meningitis
Inflammation, bacterial or viral, of the fluid and membranes surrounding the brain and spinal cord (can cause stiff neck and headache)
Kernig and brudzinski signs indicate this
155
Lyme Disease
caused by ticks
Has 3 Stages:
1. bulls Eye rash
2. Neuro and cardio symptoms (facial palsy, swollen knees, etc)
3. Arthritis and worsening neuro s/s
156
What can help cure lyme disease?
Antibiotics
157
Space Occupying Lesion
Primary or metastatic
S/S depend on the location
158
Cerebral palsy
non progressive issue with anoxia or hypoxia
permanent movement disorders starting in childhood
159
Normal Pressure Hydrocephalus
Corrected by V-P Shunt
liquid gathering in skull/brain
160
Spina Bifida
Neural tube defect (incomplete dev of brain, spinal cord, or protective coverings) causing spinal parts to come out of the back
161
Amyotrophic Lateral Sclerosis
Form of muscular dystrophy
Weakness muscles and is progressive
ALS/Lou Gehrigs Disease
162
CVA
Cerebrovascular Accident
Brain attack or stroke - sudden focal neurologic deficit resulting from impaired circulation to/within the brain
163
Causes of CVA
associated with cario disease
thrombosis
embolism
hemorrhaging causing circulation impairment
164
Most common site of CVA?
distribution of the anterior circulation of the brain
165
Warning Signs of Stroke
Sudden weakness, numbness, facial/arms/leg paralysis (especially on one side)
Sudden vision trouble in one or both eyes, diplopia, monocular blindness
Sudden confusion, dysarthria, aphasia
Sudden severe headache without apparent reason
Sudden trouble walking, dizziness, loss of balance, or falling without reason, loss of coordination
166
Dysarthria
difficulty speaking
167
Aphasia
Difficulty understanding speech
168
F.A.S.T
Acronym for stroke risk - stands for:
Face (have them smile, does one side droop)
Arms (raise both arms, is their drifting downward of one)
Speech (can they repeat simple phrase without strangeness or slurring)
Time (if you see a sign call 911 immediately)
169
Parkinson's Disease
Slowly progressing degenerative disorder of dopamine NTs in the brain resulting in poor communication in the neuronal system
170
Causes of Parkinson's Disease
questionable genetic links
environmental components
can be viral, vascular, or toxic in origin
171
S/S of Parkinson's Disease
Tremors at rest
fatigue
masked facial expression
parkinson's shuffling gait / propulsive gait
muscle rigidity
"pill rolling" - like something is between their fingers
behavioral changes and dementia
commonly causes stiffness or slowing of movement
coordination, movement, and balance issues
172
Alzheimer's disease
destruction of brain cells progressively leading to decline in memory and mental functions
Insidious and Neurologic
173
Most common cause of demetia is ...
alzheimers disease
174
What are causes for Alzheimer's disease?
combo of genetics lifestyle, and environment alongside the major risk of increasing age
BUT this is not a normal aging process
175
Alzheimer's Onset?
Late more common than early onset
Early onset occurs between 30-60 with less than 10% of all alzheimers being early and usually due to genetics
176
Myasthenia Gravis
Peripheral NS disorder
chronic, autoimmune disorder involving lower motor neurons and muscle fibers
Immune system attacks synaptic junctions between nerve and muscle fibers
177
Tic Douloureux
Trigeminal Neuralgia
Damage to 5th cranial nerve (could even be from surgery) that is chronic and due to compression by a small artery that wears away CN V's myelin
It may be associated with MS, tumors, AVM, injuries (sinus, oral, CVA, facial trauma)
PNS disorder
178
Treatment for Tic Douyloureux
Meds, Injection, surgery
179
Bells Palsy
Temporary facial paralysis from damage/trauma to facial nerve (CN VII) from swelling, inflammation, or compression
Could potentially be viral and can be treated with antibiotics or prednison
risk for aspiration and low self esteem is possible
TEMPORARY and can affect anyone (can recover in 2 weeks to several months)
PNS disorder
180
GBS
Gullain barre syndrome (PNS disorder)
Autoimmune disorder that is an acute inflammatory demyelination of peripheral nerves
It is rapidly progressive and may be bacterial or vial in origin or links to immunizations or Epstein barr syndrome - We truly do not know the cause
Treatment is more supportive as it is progressive
181
Peripheral Neuropathy
PNS issue
motor and sensory issues seen in hands and feet
caused by diabetes, toxins, vit b 12 deficiency, autoimmune issues, neurologic conditions
s/s: numbness, tingling, burning, cramping
182
Depression
May accompany anxiety and has many causes
can affect all ages, races, genders
NEED TO ASSESS - asking will not cause a suicide attempt and they need assistance
BE ATTUNED TO THE POTENTIAL
183
At risk populations for depression?
chronic disease patients
LGBTQ
"devastating" acute condition patients
184
Neurologic Nursing Diagnoses
risk for injury
risk for activity intolerance / activity intolerance
ineffective airway clearance
anxiety
risk for aspiration
disturbed body image
imbalanced body temp
bowel incontinence
powerlessness
risk for infection
impaired verbal communication
caregiver role strain
unilateral neglect
impaired urinary elimination
impaired walking
wandering
compromised family coping
