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Pathophysiology - Unit IV > Nervous System > Flashcards

Nervous System Flashcards

1. The Nervous System. 2. Sensory Nerves (Afferent Nerve Fibers) 3. Motor Nerves (Efferent Nerve Fibers) 4. Cranial Nerves 5. Motor Pathways 6. Sensory Pathways 7. Autonomic Nervous System 8. Neurologic Tests 9. Intracranial Pressure 10. Cerebral Perfusion Pressure 11. Cerebral Edema

1
Q

What are the two divisions of the NS?

A

Central NS & Peripheral NS.

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2
Q

What is the cell of the NS?

A

The neuron.

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3
Q

What is gray matter?

A

Cluster of neuron cell bodies.

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4
Q

What is white matter?

A

Neurons myelinated axon pathways.

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5
Q

What do Schwann cells do?

A

Provide the myelin in the periphery.

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6
Q

What do oligodendrocytes do?

A

Myelinate the central NS.

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7
Q

What are the diseases that affect the oligodendryocytes?

A

Multiple sclerosis (MS), Gullain-Barre.

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8
Q
  • What does the vegetation state do?
A

Causes structural damage.

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9
Q
  • What is the most critical indicator of NS function?
A

Loss of consciousness.

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10
Q
  • What are breathing patterns and respirations based on?
A

CO2 levels.

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11
Q
  • What type of respirations will be seen in NS function?
A

Kussmal breaths & Chain Stokes.

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12
Q
  • What happens to cerebral vessels with high CO2 levels?
A

The vessels dilate.

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13
Q

What are the sensory nerves in the NS?

A

Afferent nerve fibers.

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14
Q

What do the cranial nerves do?

A

Transmit sensory information from the head to the brain.

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15
Q

What do peripheral nerves do?

A

Transmit sensory information from the rest of the body to the brain.

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16
Q

How do peripheral nerves transmit sensory information from the rest of the body to the brain?

A

By the way of the spinal cord.

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17
Q

What are the four types of basic neurons in the sensory nerves?

A
  1. Unipolar
  2. Bipolar
  3. Multipolar
  4. Pyramidal Cell
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18
Q

What is the most common type of neuron in the sensory nerves?

A

Multipolar neuron.

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19
Q

Where does the multipolar neuron travel from?

A

Spinal cord to muscle.

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20
Q

What are the motor nerves in the NS?

A

Efferent nerve fibers.

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21
Q

How does the motor output of the brain work?

A

1 Cranial nerves innervate various parts of the head.

2. Peripheral nerves innervate the rest of the body.

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22
Q

What nerve is an exception in the motor nerves?

A

The vagus nerve.

Cranial Nerve X

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23
Q

What is one of the roles of CNX?

A

To communicate between the brain and the thoracic and abdominal viscera.

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24
Q
  • How many cranial nerves are there?
A

12

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25
Q
  • CN I?
A

Olfactory

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26
Q
  • CN II?
A

Optic

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27
Q
  • CN III?
A

Occulomotor

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28
Q
  • CN IV?
A

Trochlear

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29
Q
  • CN V?
A

Trigeminal

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30
Q
  • CN VI?
A

Abducens

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31
Q
  • CN VII?
A

Facial

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32
Q
  • CN VIII?
A

Vestibulocochlear (acoustic)

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33
Q
  • CN IX
A

Glossopharyngeal

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34
Q
  • CN X
A

Vagus

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35
Q
  • CN XI
A

Accessory

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36
Q
  • CN XII
A

Hypoglossal

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37
Q
  • CRANIAL NERVES ABBREVIATION?
A

Ooo! oo! OOO! To touch and feel! Very gooey vagina. AH.

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38
Q
  • What does the olfactory nerve do?
A
  • CN I

- Smell

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39
Q
  • What does the optic nerve do?
A
  • CN II

- Vision

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40
Q
  • What does the occulomotor nerve do?
A
  • CN III

- Most eye movement, pupillary construction, upper eyelid elevation.

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41
Q
  • What does the trochlear nerve do?
A
  • CN IV

- Down and in eye movement.

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42
Q
  • What does the trigeminal nerve do?
A
  • CN V
  • Chewing
  • Corneal reflex
  • Face and scalp sensations
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43
Q
  • What does the abducens nerve do?
A
  • CN VI

- Lateral eye movement

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44
Q
  • What does the facial nerve do?
A
  • CN VII
  • Expressions in forehead, eyes, and mouth.
  • Taste
  • Salivation
  • Tears
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45
Q
  • What does the vestibulocochlear nerve do (acoustic)?
A
  • CN VIII
  • Hearing
  • Balance/equilibrium
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46
Q
  • What does the glossopharyngeal nerve do?
A
  • CN IX
  • Swallowing
  • Salivation
  • Taste
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47
Q
  • What does the vagus nerve do?
A
  • CN X
  • Swallowing
  • Gag reflex
  • Talking
  • Sensations of throat, larynx, and abdominal viscera
  • Activities of thoracic and abdominal viscera (i.e. heart rate and peristalsis)
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48
Q
  • What does the accessory nerve do?
A
  • CN XI
  • Shoulder movement
  • Head rotation
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49
Q
  • What does the hypoglossal nerve do?
A
  • CN XII

- Tongue movement

50
Q

What are the two types of neurons in the motor pathways?

A
  • Upper motor neurons

- Lower motor neurons

51
Q

What are upper motor neurons?

A

Neurons projecting from cortex to spinal cord

52
Q
  • What do upper motor neurons do?
A
  1. Influence and modify spinal reflex arches.

2. Spinal reflex arch control action in the synapse of the spinal cord.

53
Q
  • Are upper motor neurons a quick response?
A

Yes.

54
Q

What are lower motor neurons?

A

Neurons projecting from the spinal cord to the muscles.

55
Q

What does weed do to impulses?

A

Quickens the impulses between neurons.

56
Q

What can cause UMN lesions?

A
  • Weakness
  • Paralysis
  • Spasticity
  • Increased reflexes
  • Babinski’s sign
57
Q

What is Babinksi’s sign?

A

When the big toe go up.

58
Q

What can cause LMN lesions?

A
  • Weakness
  • Paralysis
  • Flaccidity
  • Decreased Reflexes
  • Muscle Atrophy
59
Q

When will the motor deficit be on the opposite side of the lesion?

A

If a lesion occurs ABOVE the decussation (crossing) of the corticospinal tract in the medullary pyramids.

60
Q

What happens above the brain?

A

Opposite side is affected.

61
Q

When will the motor deficit be on the same side as the lesion?

A

If a lesion occurs BELOW the decussation (i.e. spinal cord or a peripheral nerve).

62
Q

What happens below the spinal cord?

A

Same side is affected.

63
Q

How many spinothalmic tracts are there?

A
  1. Anterior tracts.

2. Lateral tracts.

64
Q
  • What does the anterior spinothalmic tract sense?
A

Vague touch.

65
Q
  • What does the lateral spinothalmic tract sense?
A

Pain and sensory perceptions.

66
Q

What are the two branches of the ANS?

A

SNS & PNS.

67
Q
  • What does the SNS do?
A
  • Fight or flight response.

- Mobilize energy in the times of need.

68
Q
  • What does the PNS do?
A
  • Rest & Digest.

- Conserves and stores energy.

69
Q
  • What neurotransmitter is released in the parasympathetic?
A

ACH.

70
Q

Homeostasis is?

A

Dynamic balance between the autonomic branches.

71
Q

What are the neurologic tests?

A
  1. Pupil Test
  2. Doll Eyes.
  3. Caloric Ice Water Test
  4. Decorticate vs. Decerebrate
72
Q

What is the “dolls eyes” test?

A
  • Oculocephalic reflex.

- Turn head to see if eyes stay fixed on object or turn with head.

73
Q

What does it mean if eyes turn with the head in dolls eyes test?

A

Dysfunction in the brain.

74
Q

What is the “caloric ice water” test?

A

Occulovestibular reflex.

75
Q
  • What occurs in decorticate?
A
  • Fixed wrists and fingers.

- Elbows are bent with hands up near chest.

76
Q
  • What does decorticate indicate?
A

Severe brain damage.

77
Q

What is the difference between death and brain dead?

A
  • Brain death is the death of the brain stem, the whole brain, both cerebrum and stem are dead.
  • Lungs stop (respiratory center not working).
  • Heart and all other organs fail from lack of O2.
78
Q

What is limited in ICP?

A

The intracranial space.

79
Q

What does ICP stand for?

A

Intracranial pressure.

80
Q
  • What is ICP related to?
A

Decreased cerebral perfusion.

81
Q
  • What is a direct consequence of increased INP?
A

Brain tissue hypoxia.

82
Q
  • What can too much blood in the brain cause?
A

Raise in intracranial pressure.

83
Q

What can cause intracranial pressure?

A
  • Tumors
  • Edema (from infection, post-stroke, inflammatory disease, etc.)
  • Bleeding
84
Q

What is the skull like?

A

A vault.

85
Q

What are three things in the skull?

A
  • Brain tissue (80%)
  • Intravascular blood (10%)
  • Cerebrospinal fluid (10%)
86
Q

What is normal ICP?

A

Pressure exerted by a total volume of the three things in the skull (brain tissue, intravascular blood, CSF).

87
Q

What can measure the pressure in ICP?

A

Transducer.

88
Q

How is the patient during the procedure with ICP?

A

Supine with HOB elevated to 30 degrees.

89
Q

What is normal ICP?

A

0-15 mmHg.

90
Q

What is Monro-Kellie Hypothesis?

A
  • Anything that causes an increase in one of the three elements (brain tissue, intravascular blood, CSF).
  • Must be compensated for by a decrease in 1 or 2 of the other elements.
91
Q

What factors influence ICP?

A
  • Vasogenic influence.

- Cytotoxic influence.

92
Q

What is the most common factor that influences ICP?

A

Vasogenic influence.

93
Q

What is vasogenic influence related to?

A
  • Changes in arterial pressure (BP)
  • Changes in venous pressure (CVP)
  • Intra-abdominal/intrathoracic pressure (mass or bleeding)
  • Posture
  • Tempt
94
Q

What is cytotoxic influence?

A

Fluid and protein shift from exctracellular space into cells r/t oncotic pressure.

95
Q

What can cause cytotoxic influence?

A
  1. ABGs
  2. Chemical event (catecholamines)
  3. Ischemic event
  4. Brain bleeding
96
Q

What are the diagnostics for ICP?

A
  1. Intra-ventricular catheter or epidural transducer.
  2. MRI, CT
  3. X-Rays of skull, chest and spine
  4. EEG
  5. Cerebral angiograms
  6. Doppler Studies
  7. PET
  8. Neuro checks, V/S
  9. Lumbar puncture NOT done if ICP suspected - risk for herniation.
97
Q

Why is the lumbar puncture not done if ICP is suspected?

A

Risk for herniation.

98
Q

What are S&S of increased ICP?

A
  • Nausea
  • Headache
  • Visual changes
  • Seizures
  • Behavioral changes
  • Neurological Deficits
99
Q
  • What meds would you give for ICP?
A

IV Mannitol

100
Q
  • Why would you give IV Mannitol for ICP?
A

Increases the osmolarity of the blood so as to draw water from the edema into the blood.

101
Q
  • What is important to prevent with ICP treatments?
A

ICP. Lol.

102
Q
  • Why is it important to prevent ICP?
A

Because with ICP you can have brain stem herniation that is irreversible damage and immediate death.

103
Q

What is dangerous with ICP?

A

Lumbar puncture.

104
Q

Why is lumbar puncture dangerous with ICP?

A

It can create negative pressure in the spinal canal that can precipitate herniation.

105
Q

What does CPP stand for?

A

Cerebral perfusion pressure.

106
Q
  • Formula for CPP?
A

CPP = MAP - ICP

107
Q
  • What must CPP be maintained at?
A

> 50

108
Q
  • What is the MAP equation?
A

MAP = DP + 1/3 (SP-DP)

109
Q

Pathway of CPP?

A
  1. Cranial insult
  2. Tissue edema and inflammatory process
  3. Increase in ICP
  4. Compression of the vessels
  5. Decrease in cerebral blood flow
  6. Decrease in 02 delivery = Cell Death
  7. Edema around necrotic tissue
  8. Increased ICP pressure on the brain stem with resultant decrease in respiratory effort
  9. Increased CO2
  10. Vasodilation increases CO2
  11. Increased ICP due to vasodilation
  12. Death
110
Q

What can cerebral edema cause?

A

ICP.

111
Q

What are the three types of cerebral edema?

A
  1. Vasogenic
  2. Cytotoxic
  3. Interstitial
112
Q

What is vasogenic edema caused by?

A

Increased permeability of the capillary endothelium of the brain after injury to the vascular structure.

113
Q
  • Why is vasogenic edema important?
A

Because the BBB is disrupted.

114
Q

What does cytotoxic edema affect?

A

Cellular elements of the brain tissue.

115
Q

What does the cytotoxic edema cause?

A

Failure of active transport systems.

116
Q

What happens to the cells with cytotoxic edema?

A

They lose their K and gain large amounts of Na.

117
Q

Where does cytotoxic edema mostly occur?

A

Gray matter.

118
Q

What causes interstitial edema?

A

Transependymal movement of CSF from the ventricles into the extracellular spaces of the brain tissues.

119
Q

What does interstitial edema cause?

A

Increased hydrostatic pressure within gray matter.

120
Q

Where is interstitial edema seen most?

A

In non-communicating hydrocephalus.

Pathophysiology - Unit IV (4 decks)

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