Neuro Flashcards
(93 cards)
1
Q
12 cranial nerves
A
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Touch
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
2
Q
Fx Olfactory nerve
A
Smell
3
Q
Fx Optic nerve
A
See
4
Q
Fx occulolotor
A
Adjust pupil, eye lens, move eyelids, rotate eye balls
5
Q
Fx trochlear
A
Move eyeballs
6
Q
Fx trigeminal
A
Chew, feel face and mouth
7
Q
Fx Abducens
A
Move eyeballs
8
Q
Fx Facial
A
Facial expressions, tears, sensations in tongue
9
Q
Fx vestibulocochlear
A
Hearing and balance
10
Q
Fx Glossopharyngeal
A
Saliva, swallow, taste
11
Q
Fx vagus
A
Control of peripheral nervous system (PNS)
12
Q
Fx accessory nerve
A
Move neck & shoulders, swallow
13
Q
Types of stroke (include subtype)
A
Ischemic
Hemorrhagic
-intracerebral (more common)
-subarachnoid (bleed between pia mater and arachnoid mater)
14
Q
Types of intracerebral hemorrhage
A
- Intraparenchymal: Just brain tissue
- Intraventricular: extends into ventricle
15
Q
4 Lobes of cerebral cortex
A
Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
16
Q
Fx of frontal lobe
A
Movement
Executive fx
17
Q
Fx of parietal lobe
A
Sensory info
18
Q
Fx of temporal lobe
A
Hearing
Smell
Memory
Facial recognition
Visual recognition of language
19
Q
Fx of occipital lobe
A
Vision
20
Q
Fx of cerebellum
A
Muscle coordination
Balance
21
Q
Fx of Brain stem
A
Vital fx
-heart rate
-blood pressure
-breathing
-GI fx
-consciousness
22
Q
Arteries that supply brain with blood
A
-internal carotid artery
-vertebral arteries (combine to form basilar artery)
23
Q
Causes of ischemic stroke
A
-hypertension
-arteriovenous malformations
-vasculitis
-vascular tumors
-cerebral amyloid angiopathy
24
Q
How hypertension causes stroke
A
-Hyaline arteriolosclerosis: stiff and brittle, more likely to rupture
-micro aneurysm: found on small arteries
25
Hemorrhagic Conversion
Bleeding into dead tissue
26
Stroke in anterior or middle cerebral artery symptoms
Numbness & muscle weakness
27
Stroke affecting Broca’s area (usually in left frontal lobe)
Slurred speech
28
Stroke affecting Wernicke’s area (usually in left temporal lobe)
Difficulty understanding speech
29
Effects of posterior cerebral artery stroke
Can affect vision
30
Imaging diagnosis of stroke
CT scan, MRI, and also angiography (with contrast to see where blood pooling in brain)
31
Medical treatment of intracerebral hemorrhage
-Drugs: control hypertension, relieve intracranial pressure
-surgery: craniotomy (relieve pressure if bled near surface of skull by removing part of skull;
Stereotactic Aspiration: aspirate off blood to relieve pressure
32
Signs of Parkinson’s
1. Resting tremors
2. Rigidity
3. Bradykinesia
4. Postural instability
33
Excitatory neurotransmitters
Epinephrine
Norepinephrine
Glutamate
34
Inhibitory neurotransmitters
Serotonin
GABA
dopamine
35
Two parts of Autonomic Nervous System (ANS)
Sympathetic
Parasympathetic
Have opposing fx
36
6 Parts of neuro assessment
1. Mental status
2. Cranial nerves
3. Mobility &motor Fx
4. Deep tendon reflexes
5. Sensory Fx
6. Cerebellar Fx ( fine motor)
37
ABCD TIA assessment
Age 60 or older
BP 140/90 or higher
Clinical features like one sided weakness
Duration
38
TIA tx
-Can be at home
-increase perfusion to brain by removing plaque
-carotid angioplasty w/stent
-anti platelet drugs to prevent stroke
-control BP and DM w/ meds, lifestyle
39
Features of ischemic thrombotic stroke
Onset-gradual
Factors- HTN, atherosclerosis
Deficits- headache, speech, visual, confusion
Characteristics- awake, CSF normal, no seizure
Duration- gradual over weeks or months with deficits present
40
Features of ischemic embolic stroke
Onset- sudden
Factors- cardiac disease
Deficits- worst at onset, paralysis, expressive aphasia
Characteristics- awake, CSF normal, no seizure
Duration- usually rapid improvement
41
Features of hemorrhagic stroke
Onset is sudden
Factors- HTN, vessel d/o, genetic
Deficits- focal deficits, severe, frequent
Characteristics- lethargy/stupor/coma, bloody CSF, usually seizures
Duration- varies, possible permanent neuro deficits
42
Manifestations of hemorrhagic stroke
Neuro deficits
Headache
Nausea/vomiting
Decreased levels of consciousness
HTN
43
History for stroke
First priority is get pt to stroke center
Onset, progression of sx
Medical hx: head trauma, DM, HTN, heart disease, anemia, obesity
Medication, Rx, OTC, herbal, illicit
Lifestyle: smoking, diet, exercise, travel/ leisure
44
Stroke: neuro assessment
Focused: LOC, cognition, mobility, sensory perception
Balance, gait, communication, vision
Cranial nerves, photophobia
R/out hypoglycemia, hypoxia
Headache in hemorrhage, “ worst in my life”
NIHSS- NIHS stroke scale
Eligibility for fibrinolytics
45
Stroke in right cerebral hemisphere
-Unaware of deficits, impulsive, poor judgment
-left sided paralysis
-Left sided neglect
-spatial/perceptual deficit
-deny / minimize problems
-impulsive with rapid performance, short attention span
-impaired judgment
-impaired concept of time
46
Stroke in left cerebral hemisphere
-Problems with speech, language aphasias, analytical thinking
-right sided paralysis
-impaired right/left discrimination
-aware of deficits so anxious, depressed
-slow performance, cautious
-impaired language and math comprehension
47
Embolic stroke features
Heart murmur,
atrial fibrillation
BP 180/110 - 200/120
48
Hemoglobin range
12-18
49
Hematocrit range
37-52%
50
aPTT range
30-40 seconds
51
INR
No anticoagulant 0.8-1.1
Afib, DVT, &PE 2-3
52
PT range
11-12.5 seconds
53
HgA1C
4 - 5.7%
54
tPA use
-reestablishes blood flow through blocked arteries
-must be started within 3 - 4 1/2 hours of signs of stroke
55
tPA screening
Must be
-under 80
-no hx of stroke and DM
-active bleeding
-NIHSSS score must be under 25
-imaging shows less than 1/3 brain tissue damaged
- dosage 0.9 mg/kg, 90 mg/hr with first 10% given in first minute
- verify dose, do not push med, vs every 10-15 min, if high BP give antihypertensive (labetolol)
-no tubes until stable 24 hours
-follow up CT
56
Endovascular therapy
-Small stent placed in artery,
-clot catches on stent’s mesh, both removed
-assess neuro and cardiovascular status
57
Post stroke meds (7 types)
-Antiplatelet: aspirin, clopidogrel
-anticoagulant if cardiac like afib
-low molecular weight heparin
-stool softener to prevent strain
-analgesic
-anti anxiety
-statins
58
Signs of hemorrhagic stroke
1. LOC
2. Behavior changes: restless, irritated, confused
3. Headache, nausea, vomiting, aphasia, change in speech
4. Ataxia
5. Seizures
6. Late sign: constricted pupils
7. Very late sign: Cushing’s triad (severe HTN, widened pulse pressure, decreased HR), posturing
59
Actions for Hemorrhagic stroke
60
Hemorrhagic stroke meds
Calcium channel blockers
61
Intervention for right sided stroke
62
Intervention for left sided stroke
63
Migraine assessment
64
Med for Moderate to severe headaches
65
Migraine management meds
66
4 phases of seizures
1. Prodromal phase
2. Aural phase
3. Ictal phase
4. Postictal phase
67
Tonic clonic seizure characteristics
68
Tonic seizure characteristics
Loss of muscle tone for about 30 sec
69
Clonic seizure characteristics
Contraction, relaxation, for several min.
70
Myoclonic seizure characteristics
Jerking/stiffening extremities for a few seconds
71
Atonic seizure characteristics
Sudden loss of muscle tone, postictal confusion, may fall
72
Complex partial seizure characterized
LOC, 1-3 min, unaware during, amnesia after
73
Simple partial seizure characterized
Conscious during, has aura or deja vu, unusual sensations, unilateral movements
74
Refractory status epilepticus (RSE)
Seizures continue despite first and second line therapy
75
Seizures: imaging
76
Drugs for generalized tonic clonic and focal onset seizures
77
Drugs for generalized onset nonmotor and myoclonic seizures
78
Parkinson disease incidence and prevalence
Affects up to 1 mil Americans
Incidence increases with age
4% diagnosed before 50 yo
Men 1.5x more likely than women
79
Risk factors for PD (primary)
Genetic 15%
Well water
Pesticides
Herbicides
Industrial chemicals
Metals
Wood pulp mills
Rural residence
TBI
80
Secondary / atypical PD
Drug induced (antipsychotics)
Brain tumors
81
PD nonmotor sx
1. Depression
2. Anxiety
3. Apathy
4. Fatigue
5. Pain
6. Urinary retention
7. Constipation
8. ED
9. Memory changes
10. Sleep disturbances
82
PD complications
1. Dysphasia can lead to malnutrition or aspiration
2. Pneumonia, UTIs, skin breakdown
3. Orthostatic hypotension
4. High fall risk
83
Huntington
1. Hereditary: autosomal dominance
2. Caused by alterations in dopamine, GABA, glutamate from basal ganglia
3. Sx onset 30-50
4. Gradual decline 15 years; progressive dementia, uncontrolled rapid jerky movements
84
PD labs and imaging
85
Levodopa / carbidopa
- levodopa crosses blood brain barrier where it is converted to dopamine in basal ganglia
-carbidopa inhibits enzyme that breaks levodopa down before it crosses blood brain barrier
- give on time to avoid PD sx; with meals to aid absorption
-side effects are orthostatic hypotension, drowsiness, psychotic episodes
86
Entacapone
Blocks COMT, thus prolonging effect of levodopa
87
Selegiline
Increase dopamine, reducing s/s of PD
Must avoid tyramine foods (cured), alcohol
88
Rivastigmine or donepezil
Treat dementia
89
Amantadine
Antiviral with anti PD effects given early in disease
90
PD hypo mobility
Occurs within 3-5 yrs
Off episodes (dose wearing off)
Combination of carbidopa, levodopa, and entacapone
Apomorphine: must be with antiemetic
91
Surgical management of PD
Deep Brain Stimulation (DBS)
Stereotactic pallidotomy
Fetal tissue transplant
92
Donepezil or rivastigmine nursing implications
Can decrease HR, monitor for dizziness, avoid if cardiac disease, take in evenings, titrate any dosage change
93
Memantine
Side effects: dizziness, headache, confusion, constipation
Can be given with donepezil
Indicated for advanced AD
