Neuro Flashcards
(93 cards)
1
Q
Neuro function: Controls _____, _______, ______, cognition and behavioral activities.
A
Motor; sensory; autonomic
2
Q
Neuro Function: Links motor and _______ pathways. Monitors body posturing. responds to _______/______ environment. Maintains homeostasis.
A
sensory; internal/external;
3
Q
Neuro Function: Directs all psychological, ______, and physical activities via ______ and electrical messages.
A
biological; chemical
4
Q
Neuro Function: What are the 5 chemicals in the brain?
A
- Acetacholine 2. serotonin 3. dopamine 4. GABA 5. Endorphins
5
Q
Function: What are the two systems involved in the brain function?
A
- Central nervous system (CNS)- brain and spinal cord 2. Peripheral nervous system (PNS- cranial nerves, spinal nerves
6
Q
Neuro Function: The PNS is divided into two systems, what are they?
A
- Autonomic- involuntary 2. Somatic- voluntary
7
Q
Autonomic Nervous system: ________ is the major center for regulation. Maintains and restores internal ________.
A
Hypothalamus; homeostasis
8
Q
Autonomic Nervous system: What internal organs are regulated by the ANS?
A
lungs, blood vessels, digestive organs, and glands
9
Q
Autonomic Nervous system: The ANS is divided into two systems, what are they?
A
- Sympathetic- “fight or flight” 2. Parasympathetic- controls visceral functions, in noxstress situations parasympathetic rules.
10
Q
Assessment: Clinical manifestations They can be subtle or intense, fluctuating or permanent, inconvenient or devastating. What are 6 manifestations?
A
- pain 2. seizures 3. dizziness 4. visual disturbances-acuity 5. weakness 6. abnormal sensations- numbness, tingly
11
Q
Physical examination: Cerebral function 1. mental status 2. intellectual functioning 3. thought content 4. emotional status 5. perception 6. motor/ language abilities
A
- are they coherent? 4. do they have mood swings? 5. can the patient properly identify and name things (agnosia-inability to name objects) 6. do they have the ability to speak?
12
Q
Physical examination: Motor system 1. muscle strength 2. balance and coordination 3. reflexes
A
- is it weak or stronger on one side? 2. Romberg test- Ask the patient to stand with feet together and then close his or her eyes. If the patient is able to maintain balance with the eyes open but sways or falls with the eyes closed (i.e., a positive Romberg test) 3. Chart 0-4: normal-2, brisk-3, quick-4
13
Q
Physical examination: Sensory Collections of _______ data. Most deficits are peripheral ___________. Tests- tactile sensation, _________ pain, vibration, position sense.
A
subjective; neuropathies; superficial
14
Q
Physical examination: sensory 1. motor ability 2. language ability 3. impact on life 4. gerontology
A
- ask how it affects their life 4. structural changes, motor alterations, sensory alterations, temperature and pain perception, taste/smell alterations, tactile/visual alterations, mental status
15
Q
Dermatomes: Spinal nerves
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
A
16
Q
Seizures:
Disorder taht involve periodic disturbances in the brains _________ activity, resulting in some degree of temporary brain _________.
A
electrical; dysfunction
17
Q
Seizures:
_________, uncontrolled electrical discharge of ______ in the brain that interrupt normal function
A
paroxysmal; neurons
18
Q
Seizures:
May be associated with loss of consciousness, excess _________, or loss of _____/________, disturbed behavior, mood, sensation, and _______.
A
movement; tone/movement; perception
19
Q
Seizures:
Most seizures are sudden and ______. Often the symptom of underlying condition-systemic or _______ disturbances are not considered to be _______ if seizures leave after condition clears.
A
transient; metabolic; epilepsy
20
Q
Seizures: Etiology
- high fever
- brain infections
- metabolic disorder- DM
- inadequate brain oxygenation- hypoxia
- structural damage- trauma
A
- fluid accumulation
- toxic drugs/ substance
- withdrawal
- ceratin drugs
- Heart problems
21
Q
Seizure Disorders:
Partial seizures begin in 1 part of the brain. Name the 2 types of partial seizures:
A
- simple partial
- complex partial
22
Q
Seizure disorders: Generalized Seizures
Involve electrical discharges in whole brain.
Name the 6 types of gerneralized seizures:
A
- tonic-clonic
- tonic
- clonic
- absence- petite-mal
- atonic
- myoclonic
23
Q
Generalized: Tonic-clonic
Name the phases of a Tonic-clonic seizure
A
24
Q
Generalized: Tonic phase
Name the 5 occurances during this phase
A
- neuronal hyperexcitation
- loss of consciousness
- apnea
- dilated pupils
- duration 15-60 seconds
25
Generalized: Clonic Phase
Name the 4 occurances during this phase
1. inhibitory neurons interrupt seizure discharge
2. hyperventilation
3. rhythmic jerking of extremities
4. duration- 60-90 seconds
26
Generalized: Postictal Phase
Name the 8 possible occurances during this phase:
What is Todd's paralysis?
1. deep sleep
2. muscle soreness
3. headache
4. amnesia
5. visual disturbances
6. dysphagia
7. aphagia
8. duration varies
Todd's paralysis: temporary motro deficit of ARM or LEG that can last u to 24 hours.
27
Recovery position:
Take at least 10 seconds to study image.
What is the recovery position?
28
EEG for diagnosis of Seizures:
What are important things to know about EEGs being done before and after?
Deprive patient of sleep for 24hrs. Labs for electrolytes, anemia, heart problems and DM. CT and MRI may be done to look for structural problems
29
Seizures: Nursing management during and after
What are 3 things to prevent injury?
What are other nursing management responsibilities?
1. side-lying position
2. suction available
3. bed in low position, padded siderails up
\*if possible loosen clothing
Support and documentation are other nursing management responsibilities.
\*patient is at risk for respiratory distress have O2 available
30
Seizure Nursing observation and documentation
1. circumstances prior to seizure
2. Occurrence of an Aura
3. First obvious sign of seizure
4. types of movements
5. area of body involved
6. eyes- pupil size, open/closed, turned to one side?
6. Presence of automatisms
7. incontinence
8. paralysis/wekness of extremities pose-24hrs
9. inability to speak post
10. movements at end
11. sleeps afterward, cognitive staus after
31
Epilepsy:
Condition in which a patient has spontaneous unproveoked recurring ______ caused by a chronic underlying condition. Eitiology attributed to a group of abnormal ______ (seizure focus) that undergo spontaneous firing- possibly due to \_\_\_\_\_\_(gliosis).
\*there is new evidnece that other cells may be the problem
seizures; neurons; scarring
32
Epilepsy:
Incidence rate (new onset) high in ___ year of life, _______ in childhood & teens, plateuing in _______ \_\_\_\_, and sharp _____ in elderly.
1st; declining; middle age; rise
33
Epilepsy:
Previously a stigma but acceptable now. What is primary and secondary?
What are the causes?
primary- idiopathic
secondary- cause is known and the epilepsy is a syptom of another underlying cause
Causes:
idiopathic- genetic/gevelopmental defect
acquired- hypoxemia
34
Epilepsy: Medical management
Individualized due to the varied forms of the condition. Management is aimed at _______ and _________ of seizures
prevention; management
35
Epilepsy: Medical management
What testing will be done for epilepsy?
1. EEG
2. CT
3. MRI
4. SPECT
5. Tox screen
6. Genetics
36
Epilepsy: Medical management
Pharmacologic Therapy
There are many available. Start with _____ med with ________ dose. Monitor \_\_\_\_\_\_
single; increasing; levels
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Epilepsy: Medical management
Pharmacologic Therapy
May need to switch med if ot working. When ____ or with _____ change/stress may need dose adjustment.
sick; weight
38
Epilepsy: Medical management
Pharmacologic Therapy
Sudden _______ can cause frequent seizures or ______ \_\_\_\_\_\_\_
withdrawal; status epilepticus
39
Epilepsy: Medical management
Pharmacologic Therapy
Name 3 side effects of phramacologic therapy
1. idiosyncratic/allergic
2. acute toxicity
3. chronic toxicity
\* seizure meds should be taken on an empty stomach, levels should be monitored. No alcohol, and other medications being used must be addressed by MD for interactions
40
Epilepsy: Nursing Management
What are the 4 nursing managements and PC of epilepsy?
1. preventing injury
2. reducing fear- educate
3. improving coping- decrease stress, get enough sleep
4. monitoring and managing potential complications- injury
PC: Status epilepticus and toxicity
41
Epilepsy: Monitor drug levels
Subtherpaeutic and toxic: breakthrough seizures. What are 4 adverse effects?
1. lethargy
2. nystagmus- involuntary movement of the eyes
3. ataxia- loss of control of bodily movement
4. dysarthria- difficult or unclear articulation of speech that is otherwise linguistically normal
42
Epilepsy: monitor drug levels
What are food and drug interactions?
1. delayed absorption
2. potentiated
3. inactivated
43
Epilepsy: KEtogenic diet
4:1 ____ to _____ and carbohydrates
may be useful in \_\_\_\_\_\_
Difficulty with compliance.
fats; protein; children
44
Epilepsy: Surgery
Extensive preoperative testing to determine eloquent areas. What are 3 considerations?
1. medically intractable epilepsy
2. feasibility of surgery
3. likelihood of success.
\*risk to benefit
45
Epilepsy: Vagal nerve stimulator
## Footnote
The vagusnerve lies between the carotid and the jugular vein.(It’s the only cranial nerve that is more easily accessible.)The electrodes are wrapped around the left vagus nerve.
Where does the vagusnerve lie? and how does the vagal nerve stimulator work?
46
Status Epilepticus:
Series of generalized seizures:
1. Clinical/electrical- After how long is it considered status epilepticus?
2. Medical emergency- when does it become an emergency?
3. what are the precipitating factors?
1. \>15-30 minutes
2. (1) heavy metabolic load (2). respiration interruption and even arrest at peak, producing hypoxia (3). can lead to anoxia, cerebral edema, possible irreversible brain damage and death
3. drug withdrawal, fever, infection
47
Status epilepticus: Medical management:
Stop seizures to promote adequate cerbral oxygenation. What are 3 things done for medical management?
1. Airway- ET tube, O2
2. Meds IV
3. Monitor: EEG, VS, labs including electrolytes, glucose, med levels.
48
Staticus Epilepticus: PCs
1. aspiration
2. Wernicke's encephalopathy
3. neurological deterioration, continuation of SE
4. dehydration
5. fever
6. hypermetabolism
7. disability
8. metabolic
9. ARF-acute repiratory failure
10. autonomic dysfunction
11. cerebral edema
12. systemic complications
13. death
49
Parkinson's Disease:
Slow progressice disabling neurologic moving disorder with GRADUAL onset.
1. Tremor when muscles are at rest
2. Rigidity with impaired movement
4. bradykinesia
5. shuffling gate
6. pin rolling
7. psych changes- depression
8. mask like bland expression
9. micrographic- sm handwritting
10. monotone- soft and quick
11. GI/GU issues
12 Aphasia (later)- inability to speak
13. apraxia (later)-inability to perform particular purposive actions
14. agnosia (later)- inability to interpret sensations and hence to recognize things
50
Parkinson's Disease:
Patho: decreased \_\_\_\_\_\_\_; it cannot pass from one _______ \_\_\_\_\_\_ at an adequate pace.
dopamine; nerve ending
51
Parkinson's Disease: Etiology
Part of the _____ \_\_\_\_\_ degenerate, reducing the production of ______ and the number of connections between nerve cells and the basal ganglia.
basal ganglia; dopamine;
52
Parkinson's Disease: Etiology
Basal ganglia cannot smooth out the movements, leading to \_\_\_\_\_, ______ and slowed reduced movement
tremor; incoordination; movement
53
Parkinson's Disease: Etiology
Mostly idiopathic but some \_\_\_\_\_\_\_. Mostly in men in their \_\_\_\_. Hard to pinpoint start time. Not noticed at first. S/S increase with \_\_\_\_/\_\_\_\_\_
secondary; 50's; stress/fatigue
54
Parkinson's Disease: Etiology
Variation in the ____ can make the person more at risk but _____ does not play a role. Exposure to \_\_\_\_\_\_. There is some thought that this could be _________ in nature.
genes; genetics; toxins; autoimmune
55
Parkinson's Disease: Diagnostics
Bases on \_\_/\_\_. Difficult because aging can cause some of the same \_\_\_\_\_\_\_
S/S; symptoms
56
Parkinson's Disease: Diagnostics
Give significant dose of \_\_\_\_\_\_\_\_-\_\_\_\_\_\_\_\_, if improved then positive for \_\_\_\_\_\_\_\_\_\_\_
carbidopa-levodopa
Parkinsons
\*S/E: Hallucinations & compulsive behaviors
57
Parkinson's Disease: Diagnostics
\_\_\_ & _____ can be done to rule out any stuctural disorders.
CT, MRI
58
Parkinson's Disease: Diagnostics
\_\_\_\_\_ _____ to evalute levodopa uptake and conversion
PET scan
59
Parkinsons: Medical Management
No cure, ______ symptoms and keep function is the goal, care \_\_\_\_\_\_\_\_\_\_
controlling, individualized
\*goal: improved ADLs
60
Parkinsons: Medical Management
Meds, Dopamine precursor - ________ \_\_\_\_\_\_\_\_,
\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_
carbidopa-levodopa, beta blockers
\*30 - 1 hr before eating to help with dysphagia
61
Parkinsons: Medical Management
Name 3 Surgeries that can be done for Parkinsons.
Palidotomy, stimullation, stem cell implants
\*watch B/P
62
Parkinson's: Nursing
As the nurse what are 6 things to enhance?
1. Mobility-wide stance
2. maintain self care independence- use velcro instead of buttons
3. adequate bowel elimination- increase fiber
4. Maintain nutrition- increase calorie diet
5. effective communication- listen carefully, be patient
6. develop positive coping
\*#1 educate on drugs; report S/E
63
Degenerative Disorders:
Name the 8 degenerative disorders.
1. Parkinson's Disease
2. Huntington's disease
3. Alzheimer's Disease
4. Amyotrophic lateral Sclerosis
5. Muscular Dystrophies
6. Degenerative disk disease
7. Herniation of a cervical intervertebral disk
8. Post-Polio syndrome
64
Multiple Sclerosis
Study image for 10 seconds
What covers the nerves?
65
Multiple Sclerosis:
Autoimmune activity results in _________ of nerve sheath. Scarring is the result leading to slowing and blockage of the electrical impulses that control _______ coordination, strength, sensation and vision.
demyelization; muscle
66
Multiple Sclerosis:
Mostly in women age \_\_-\_\_.
Name at least 3 causes.
20-40;
1. Genetic susceptibility
2. Possibly viral- herpes
3. Risk factors
67
Multiple Sclerosis:
What are the patterns of MS?
What is an early sign in diagnosis?
1. Relapsing remitting clearly defined flare-ups
2. Primary progressive- gradual decline
3. Secondary progressive- second step of relapsing remitting
4. Pregressive relapsing-primary progressive with sudden worsening.
\*starts in the eyes. early as 16 years or late as 60
68
Multiple Sclerosis:
What are 4 important clinical manifestations?
1. Numbness/weakness in limbs usually one side or bottom half of body.
## Footnote
2. Loss of vision- partial or complete
3. double vision/blurring
4. Tingling or pain in parts of body
69
Multiple sclerosis:
What other clinical manifestations for MS?
1. electric shock sensation that occurs with certain head movements
2. fatigue, ataxia
3. dizziness
4. Muscle stiffness and SPASTICITY
5. slurred speech, dysphagia
6. paralysis problems with elimination and sexual function
7. mental changes
70
Multiple Sclerosis:
Who can develop MS?
DM1, thyroid problems, IBS, Smokers
71
Multiple sclerosis: Management
There is no cure. What individualized diagnostics would be done?
1. pulmonary function
2. spinal tap- increase WBCs in spinal fluid
3. MRI
4. Electrical studies
72
Multiple Sclerosis: Medications
What type of medications would be given for MS?
1. virus fighters
2. immuno suppressors/ Steroids
3. Muscle relaxants: BACLOFEN, CYCLOBENZAPINE
4. Drugs to decrease relapse
5. pain meds
6. meds to rectify sexual, bowel and bladder problems
73
Multiple Sclerosis:
What are the treatments for MS?
1. Plasmaphoresis: gets rid of antibodies
2. Physical Therapy: keep them moving or stretching
3. Counseling
\*Stem cells can also be used
74
Multiple Sclerosis: Nursing
As the nurse what interventions should you do?
1. encourage rest, exercise, AVOID HEAT, and a well balanced diet (increased protein, increased carbs, decrease gluten, decrease fat)
2. enhance bladder/bowel control, sexual function-suppository or catheter
3. improve cognitive and sensory funtion
4. promote selfl-care
\*increase fluids, keep cool, check CBG
75
Myasthenia Gravis:
A _____ in the normal communication between muscle and \_\_\_\_\_.
Breakdown; nerves
76
Myasthenia Gravis:
\_\_\_\_\_\_\_\_\_ disorder that impairs the passing of signals at the neural junction. Antibodies attack the ______ \_\_\_\_
Autoimmune; receptor sites
77
Myasthenia Gravis:Etiology
Name 4 causes of MG.
Name 3 triggers.
Causes: 1. blockage and/or destruction of the receptor site for the Ach pathway
2. Thymus tumor- 15% of people with MG, possible thyroid
3. a different antibody ausing a defferent autoimmune problem
4. can be genetic
Triggers: 1. fatigue eyes closing
2. stress
3. meds
78
Myasthenia Gravis: Clinical Manifestations
Muscle weakness escalating with continues use. They will be strongest in the AM.
Name 8 clinical manifestations.
1. initially ocular- PTOSIS (cant open eyes), double vision
2. facial and throat weakness
3. expression impaired
4. speech impaired and voice fades
5. chewing and swallowing impaired
6. neck, shoulders and hips affected more than distal area
7. Generalized weakness to include respiratory
8. no effect on sensation or reflexes.
79
Myasthenia Gravis: diagnostics
What would each of the following diagnostic tests include?
1. Routine physical examination
2. Tensilon test
3. blood testing
4. ice bad
5. nerve testing
6. scans
7. pulmonary test
1. Routine physical examination- reflexes, strength, tone, touch/sight senses, coordination and balance, weakness improves with rest
2. Tensilon test- administer to see increased strength
3. blood testing- for antibodies
4. ice bag- to see if eyes open when applied
5. nerve testing- function of nerves
6. scans - for tumors
7. pulmonary test- to find out function of pulmonary
80
Myasthenia Gravis: Therapies
What 6 therapies would be used with MG?
1. Anticholinesterase
2. Steroids
3. Immunosuppressants
4. Plasmaphoresis
5. IV immunoglobin G
6. Thymectomy
81
Myasthenia Gravis: Complications
What complications can occur in an MG crisis?
1. Acute exacerbation of the disease with weakness in the chest muscle
2. patient will probably need ventilation
3. blood filtering to get rid of some of the antibodies
4. aspiration
5. all respiratory Problems
82
Myasthenia Gravis: Self care
Plan ahead and ______ routine for energy conservation. Learn about \_\_\_\_\_\_\_\_\_\_\_.
adjust; medications
83
Myasthenia Gravis: Self care
Recognition and ________ of PCs. ______ precautions at home.
prevention; safety
84
Myasthenia Gravis: Self Care
\_\_\_\_\_\_ devices when possible. Eye patches for ______ \_\_\_\_\_\_.
electric; double vision
85
Guillain Barre'Syndrome:
- This will occur bottom up
- weakness that is progressive
- 30% may not recover
- leads to paralysis
- At bedside: trach set, EKG, O2, ventilator
86
Guillain Barre'Syndrome:
Autoimmune attack destroys nerve \_\_\_\_. Acute, rapid, segmental __________ of peripheral nerves and some cranial nerves. ___________ happens in recovery
myelin; demyelization; remeylization
87
Guillain Barre'Syndrome: Etiology
Exact cause is unknown. It is usually preceded by what 4 immune system stimulation?
1. infectious illness
2. respiratory infection
3. stomach flu
4. immunizations
88
Guillain Barre'Syndrome: Clinical manifestations
Begins with ________ and muscle weakness of lower extremities and progresses upwards. May affect ______ & intercostal muscle.
hyporeflexia; diaphragm
89
Guillain Barre'Syndrome: Clinical Manifestations
Cranial nerves that are affected are \_\_\_\_\_, vagus, & glossopharangeal. Bulbar paralysis such as facial weakness and \_\_\_\_\_\_\_
optic; dysphagia
90
Guillain Barre'Syndrome: Clinical manifestations
Autonomic dysfuntion includes: orthostatic hypotension, abnormal ____ responses, bowel and bladder dysfunction, and BP fluctuations and irregular \_\_\_\_\_\_\_\_\_. Pain and \_\_\_\_\_\_\_
vagal; heartbeat; pain and numbness
91
Guillain Barre'Syndrome: Diagnostics
Patient history and ______ \_\_\_\_\_.
Spinal tap- fluid has _____ protein levels after 7-10 days.
Elctromyography (EMG) and other nerve ______ testing.
Clinical signs; elevated; conduction
92
Guillain Barre'Syndrome: Management
* ICU care possibly on vent, IVIG, \_\_\_\_\_\_\_\_\_.
* Prevention of PC due to \_\_\_\_\_\_\_.
* Physical therapy
* Adaptive devises
* Meds to handle BP /\_\_\_\_\_\_\_
* Deal with fear, \_\_\_\_\_\_– Communication
* Adequate nutrition
plasmaphoresis; immobility; tachycardia; anxiety
93
Guillain Barre'Syndrome: PCs
Name the two main PCs.
1. respiratory distress and arrest
2. dysphagia- aspiration, nutritional adequacy, urinary retension
