Neuro week 1 Flashcards
(151 cards)
1
Q
What does the central nervous system consist of?
A
Brain and spinal cord
2
Q
What does the peripheral nervous system consist of?
A
cranial nerves and spinal nerves
3
Q
Nervous system function
A
Control all motor, sensory, autonomic, cognitive and behavioral activities
4
Q
What is the PNS further divided into?
A
somatic and autonomic
5
Q
Synapse
A
gap between where the two neurons meet. Either the neuro is going to tell the next one to do something (excite) or stop (inhibit)
6
Q
What does a neuron do?
A
Communicate messages/information from one neuron to the next or to the target cell. They either stimulate/terminate the activity of the target cell.
7
Q
Catecholamine: when are they released?
A
in response to physical or emotional stress
8
Q
What are examples of catecholamines?
A
Noradrenaline
Adrenaline (epinephrine)
Dopamine
9
Q
What does adrenaline (epinephrine) do?
A
Hormone produced outside the brain, break down in communication, weakness and rapid fatigue of muscles under voluntary control.
10
Q
Acetylcholine
A
major transmitter of the parasympathetic nervous system
11
Q
Acetylcholine - source
A
Many areas of the brain; autonomic nervous system
12
Q
Acetylcholine: action
A
Usually excitatory; parasympathetic effects sometimes inhibitory (stimulation of heart by vagal nerve) – voluntary muscle contraction, controls heartbeat, and stimulates hormones
13
Q
Acetylcholine: example of dysfunction
A
↓ Leads to Myasthenia gravis
14
Q
Serotonin: source
A
-Brainstem, hypothalamus, dorsal horn of the spinal cord
15
Q
Serotonin: action
A
Inhibitory, helps control mood and sleep, inhibits pain pathways, regulation of appetite and temperature
16
Q
Serotonin: example of dysfunction
A
↓ Leads to depression
17
Q
Dopamine: source
A
Substantia nigra and basal ganglia
18
Q
Dopamine: action
A
Usually inhibits, affects behavior (attention, emotions) and fine movement but can also be excitatory
- Plays a role in behavior, learning, sleep, mood, focus, attention, immune health, pleasurable reward
19
Q
Dopamine: example of dysfunction
A
↓ Leads to Parkinson disease (found in the basal ganglia. Hard for them to initiate movement and to smooth movement out)
20
Q
Norepinephrine: what?
A
(major transmitter of the sympathetic nervous system) * fight or flight
21
Q
NE: source
A
Brainstem, hypothalamus, postganglionic neurons of the sympathetic nervous system
22
Q
NE: action
A
Usually excitatory; affects mood and overall activity
Seen rarely
23
Q
Gamma-aminobutyric acid (GABA): source
A
Spinal cord, cerebellum, basal ganglia, some cortical areas
24
Q
GABA: action
A
Inhibitory
*Mood modulator – Low levels lead to restlessness, anxiety and irritability
25
GABA: example of dysfunction
↓ Leads to seizures
26
Enkephalin, endorphin: source
Nerve terminals in the spine, brainstem, thalamus and hypothalamus, pituitary gland
27
Enkephalin, endorphin: action
Excitatory; pleasurable sensation, inhibits pain transmission
28
Enkephalin, endorphin: example of dysfunction
Poor pain control
If we do not have enough endorphins lack of pain control
29
Cerebrum consists of what?
```
2 hemispheres
Thalamus
hypothalamus
basal ganglia
connections for cranial nerve II and II
```
30
What does brainstem consist of?
midbrain
pons
medulla oblongata
connections for cranial nerves III through XII
31
Thalamus
relays information regulation of conscious and alertness
32
Hypothalamus job
Important for endocrine system
Regulates the pituitary secretion of hormones influencing metabolism, reproduction, stress response, and urine production
It works with the pituitary to maintain fluid balance
Emotional, Responses, aggressive and sexual behavior
Hunger, sleep/wake cycle, BP
Controls and regulates the autonomic nervous system and maintains temperature regulation by promoting vasoconstriction or vasodilatation.
33
Basal ganglia function
Controls fine motor movments
Planning and coordinating movements and posture
Inhibit unwanted muscular movement
Disorders results in exaggerated uncontrolled movements
Muscle rigidity
Athetosis
Chorea
Parkinson disease
Huntington disease
Spasmodic torticollis
34
Athetosis
Movement of a slow, squirming, writhing, twisting
35
Chorea
spasmodic, purposeless, irregular, uncoordinated motions of the trunk and extremities and facial grimacing
36
Brainstem function
autonomic function (involuntary), HR, breathing, swallowing
37
Midbrain, pons function overall
Motor and sensory pathways
38
Pons (portion of it) controls what?
HR, respiration and BP
39
Medulla oblongata: function
respiratory function
40
Cerebellum function
```
Coordination and movement
Balance (postural)
Awareness of body parts.
Balance
Coordination
Timing
Damage results in loss of muscle tone, weakness, fatigue
Ataxia and incoordination
```
41
Frontal lobe
Largest lobe
The major functions are concentration, abstract thought, information storage or memory, and motor function.
The frontal lobe is responsible in large part for a person’s affect, judgment, personality, emotions, attitudes, and inhibitions, and contributes to the formation of thought processes.
42
Motor strip location
Location: frontal lobe
lies in the frontal lobe, anterior to the central sulcus
43
What does the motor strip do?
responsible for muscle movement
44
What are nursing consideration when working with a client who has damage to temporal lobe?
receptive speech issues, effected long term memory…reinforce teaching, chart to help them ID letters/objects to help them communicate what they want/need, pictures to remind family members, patience with them, giving them time to determine if they have aphasia or are confused, yes/no questions
45
What are nursing considerations when working with a client who has damage to their frontal lobe?
safety, fall risk, siderails (only 3 max.), etc.
46
Parietal lobe function
primary sensory cortex
This lobe analyzes sensory information such as pressure, vibration, pain, and temperature, and relays the interpretation of this information to the thalamus from the sensory cortex.
It is also essential to a person’s awareness of the body in space, as well as orientation in space and spatial relations.
47
Where is the parietal lobe?
posterior to the motor strip
48
Stereogenesis
ability to perceive an object using the sense of touch
processed in parietal lobe
49
What are nursing considerations when working with a client who has damage to parietal lobe?
walkers/assistive devices, communicate location of belongings/food, assistance while getting up, good lighting, correct temperature, nonverbal cues, remove tripping hazards)
50
Temporal lobe function
contain the auditory receptive areas
The interpretive area of the temporal lobe provides integration of visual and auditory areas and plays the most dominant role of any area of the cortex in thinking
Long-term memory recall is also associated with this lobe.
51
Where are the auditory and receptive areas located in the temporal lobe?
around temple regions
52
What is located in the posterior region of the temporal lobe
is the area responsible for receptive speech referred to as Broca’s area and Wernicke’s area. For most people, whether right- or left-handed, Broca’s area and Wernicke’s area. is in the left lobe
53
Occipital lobe function
primary visual cortex
visual reflexes
involuntary eye movements.
54
Nursing considerations when working with a client who has occipital lobe damage?
placing belongings/food close and describing where it is/placing belongings in their center field of vision
55
What are the structures that protect the brain?
Bones
Membranes
Fluid cushioning
Chemical (?)
56
Skull
Hard, protecting it from injury
57
What are meninges?
connective tissue covering the brain and spinal cord
Provides protection, support and nourishment
58
What are the 3 meningeal layers?
dura, arachnoid and pia
59
Dura
outermost meningeal layer, very tough, thick, inelastic, fibrous and gray
60
Epidural layer
potential space that lies outside the dura (meninge)
61
Arachnoid layer
– middle membrane, thin, delicate membrane – white due to no blood supply.
Has small finger-like projections (villi) which absorb CSF
62
What happens when trauma occurs to the arachnoid layer?
When trauma occurs (trauma or hemorrhagic stroke) the villi become obstructed, and hydrocephalus can occur – also blocks the absorption of CSF leaving it to accumulate.
63
Pia (meningeal layer)
thin, transparent, hugs the brain – very vascular
64
Herniation
when the cranial cavity/brain tissue is being compressed or displaced downward.
65
Normal neurological assessment
```
Pain
Headaches/Migraines
Seizures
Dizziness and Vertigo
Visual Disturbances
Weakness
Abnormal Sensation
```
Family History
Social History
66
Neuro assessment: assessing cerebral function
LOC = primary energy for the brain is glucose. Brain is dependent on blood flow for brain glucose. When blood sugars drop
Mental status - short/long term memory
Perception
Motor ability
Language ability
67
agnosia
inability to interpret or recognize objects seen through the special senses
68
Neuro assessment: physical assessment
Cerebral function
Cranial nerves
Motor system
69
Neuro assessment: motor system
```
strength
balance
coordination
ataxia
Romberg test
grading deep tendon reflexes
sensory examination
```
70
Ataxia
incoordination of voluntary muscle action (usually walking or reaching for objects)
71
Romberg test
balance test – feet together, arms side, first with eyes open, then closed both for 20-30 seconds, slight swaying is normal, loss of balance is + test
72
Deep tendon reflexes: grading
absence of reflexes is significant 0-4+ ( can be subjective) present, diminished, absent
73
Deep tendon reflexes: clonus
hyperactive - sustained
74
Deep tendon reflexes: superficial reflexes
include corneal, gag/swallow, upper/lower abdominal, plantar reflexes
75
Corneal reflex
clean wisp of cotton lightly touching the outer corner of each eye on the sclera – if blink ok, can be unilateral or bilateral, need eye protection to prevent corneal damage
76
Gag reflex
gently touching the back of the pharynx with a cotton tipped applicated. Must touch both sides of the uvula – swallowing precautions if no gag reflex
77
Plantar (babinski) reflex
stroking the lateral side of the foot with a tongue blade – intact CNS = toes curl, not intact CNS = toes fan out
78
Broca area function
control of muscles for speech production and ability to comprehend grammatical structure
79
wernicke's area
comprehension of speech sounds and language
80
Diagnostic evaluation: Computed tomography scanning nursing considerations
```
allergies (shellfish)
Fluids if receiving constrast
Preparation
Lie quietly
Kidney function
```
81
PET: preparation
sensations
dizziness
lightheadedness
HA
no surar prior; typically NPO (no dextrose fluids)
82
PET: contraindications
pregnancy and breastfeeding
83
MRI: nursing considerations
Relaxation techniques
Magnetic field - NO nic patch
Monitor kidney function
84
Cerebral angiography: nursing considerations
well hydrated - clear liquids
monitor injection site for hematoma
void prior to procedure
client will experience a brief feeling of warmth in face, behind eyes, jaw, teeth, tongue and lips with a metallic taste when contrast is injected
check pulses
monitor neuro s/s for at least 24 hours after
85
EEG: nursing considerations
sleep deprived, taking away seizure medications
86
Lumbar puncture: nursing considerations
Headache most common s/s after (May occur a few hours to several days after the procedures)
- Bedrest after
- Bifrontal or occipital (location HA)
- Severe upon standing
87
What is the lumbar puncture HA caused by?
CSF leakage at puncture site
88
lumbar puncture management
bed red, analgesic, hydration, blood patch
89
lumbar puncture complications
```
Herniation
Abscess
Epidural hematoma
Meningitis
Temporary voiding difficulties
```
90
Blood brain barrier
Endothelial cells in the brain capillaries
| All substances entering the brain must filter through these cells and astrocytes
91
What can damage the BBB
Blood brain barrier can be altered by trauma, cerebral edema and cerebral hypoxemia
Implications for selection of medications to treat CNS disorders
92
Spinal cord
Connection between the brain and the periphery
93
Spinal cord - location
Extends from the foramen magnum at the base of the skull to the base of the first lumbar vertebrae
94
what is passed the 2nd lumbar?
cauda equina (nerve roots)
95
where is a lumbar puncture done?
L3-L4
96
Circle of Willis
Collateral circulation
Arterial bifurcations - common site for aneurysm formation
where all vasculature meets in brain (bottom part)
97
Describe the cerebral circulation
Brain does not store nutrients so it requires high blood flow
Blood flows against gravity
98
Describe the arteries in the brain
Arteries - internal carotids - anterior circulation
Vertebral arteries (become the basilar artery) - then into the vertebrobasilar artery - supplying the posterior circulation of the brain
99
Describe the veins of cerebral circulation
Veins - join larger veins - cross the subarachnoid space and empty into the dura sinuses (dura mater)
Empty into the internal jugular vein
100
What nerves are located in the cerebral hemisphere?
Olfactory (I)
| Optic (II)
101
What nerves are located in the midbrain
Oculomotor (III)
| Trochlear (IV)
102
What nerves are located in the pons?
Trigeminal (V)
Abducens (VI)
Facial (VII)
Acoustic (VIII)
103
What nerves are located in the Medulla?
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XII)
Spinal accessory (XI)
104
Cranial nerve 1: name, type, dysfunction
Olfactory
Sensory
Dysfunction: inability to ID odor, termed anosmia
105
Cranial nerve 2: name, type, dysfunction
optic
sensory
Dysfunction: decreased visual acuity and visual fields
106
Cranial nerve 3: name, type, dysfunction
Oculomotor
Motor nerve
Dysfunction:
inability to move the eyes in the visual field described
Ptosis of affected eye
Nonreactive or dilated pupils
107
Cranial nerve 4: name, type, dysfunction
Trochlear
Motor
Dysfunction: inability to look down and in
108
Cranial nerve 5: name, type, dysfunction
Trigeminal
Mixed nerve type
Dysfunction:
- Absence of corneal reflex
- Diminished sensation to forehead, maxillary and mandibular region
- Weakness of muscles responsible for chewing
109
Cranial nerve 6: Name, type, dysfunction
Abducens
Motor
Dysfunction: inability to look laterally, double vision
110
Cranial nerve 7: name, type, dysfunction
Facial
mixed nerve type
Dysfunction:
- facial paralysis
- Facial asymmetry, droop of mouth
- Absent nasolabial fold
- Decreased ability to taste
111
Cranial nerve 8: name, type, dysfunction
Accoustic
sensory
dysfunction: decreased hearing in affected ear
112
Cranial nerve 9: name, type, dysfunction
Glossopharyngeal
Mixed
Dysfunction: Dysphagia, Absence of gag reflex
113
Cranial nerve 10: name, type, dysfunction
Vagus
mixed nerve type
Dysfunction: Hoarse or nasal quality to voice, Slurred speech
114
Cranial nerve 11: name, type, dysfunction
Spinal accessory
motor nerve
dysfunction: inability to shrug shoulders
115
Cranial nerve 12: name, type, dysfunction
Hypoglassal
Motor nerve
Dysfunction: tongue weakness
116
Skull fracture: nursing considerations
Be alert for CSF leakage
- Rhinorrhea (nose leak)
- Otorrhea (ear leaking)
- raccoon eyes
- Battle's signs
117
What should the nurse keep in mind if there is a CSF leakage is suspected?
Do not insert anything into the orifice is it leaking from
118
What are we concerned about when someone has a skull fracture or CSF leak?
Meningeal tear leading to meningitis
119
What are telltale signs of of meningitis
High fever, stick neck, n/v, HA, sensitivity to light, seizure, sleepy
120
What does CSF look like?
Should be clear and colorless
121
How can CSF be tested?
Lumbar puncture
122
What is normal for CSF? (what should be in it)
Less than 5 WBC in CSF,
50-80 glucose (minimal amount)
15-60 protein
Should NOT have RBC
123
What kind of patients might present with a CSF leak?
trauma and surgery are two most common
124
Causes of increase ICP
```
Injury
Increased CSF
Bleeding
Hematoma
Hydrocephalus
Encephalopathy
Subarachnoid Hemorrhage
```
125
What does CPP stand for?
Cerebral perfusion pressure
126
How do we figure out CPP (cerebral perfusion pressure)
MAP - ICP
127
Increased ICP: cranial vault
10% intravascular blood
80% brain tissue
10% CSF
an increase in any of these causes increased intracranial pressure
Brain tissue has limited ability to expand, compensation occurs by increasing absorption or decrease production of CSF or decreasing cerebral blood volume
128
What should a nurse do with anyone with increased ICP?
increase HOB at least 30 degrees
129
Signs and symptoms of ICP
```
(MIND)
Mental status change
Irregular breathing
Nerve changes
Decerebrate/decorticate
```
```
(CRUSHED)
Cushing triad
Reflexes
Unconscious
Seizures
Headache
Emesis
Deterioration
```
130
What are receiving sensory impulses
Thalamus integrates all sensory impulses except olfaction
Awareness of pain
Recognition of touch and temperature
Sense of movement and position
Ability to recognize size, shape and quality of objects
May be integrated at the spinal cord or relayed to the brain
131
What is sensory loss
transection of spinal cord yields complete anesthesia below level of injury
132
Motor and sensory functions include what
upper/lower motor neurons
coordination
receiving/sending sensory impulses
sensory loss
133
Comparison of Lesions of the Upper Moto Neurons and Lower Motor Neurons
UPPER MOTOR NEURON LESIONS:
- loss of voluntary control
- increased muscle tone
- muscle spasticity
- no muscle atrophy
- hyperactive and abnormal
LOWER MOTOR NEURON LESIONS:
- loss of voluntary control
- decreased muscle tone
- flaccid muscle paralysis
- muscle atrophy
- absent or decreased reflexes
134
Gero: structural changes
Brain weight decreases
Cerebral blood flow reduced
DTR decreased or absent
Stage IV sleep is reduced
135
Gero: motor alterations
Flexed posture
Shuffling gait
Rigidity of movement
Reaction time decreased
136
Gero: sensory alterations
Visual and hearing loss
| Home environment modification
137
Gero: temp regulation and pain perception
Need a warmer environment
| Pain reaction decreased
138
Gero: taste and small alterations
Decreased appetite
Decrease smell
Smoke, gas leaks, bad food
139
Gero: tactile and visual alterations
Longer to recover moving from dark to light area
| Difficulty identifying objects by touch
140
Gero: mental status
Drug toxicity
Delirium
Vitamin B deficiency
Thyroid disease
141
What are names of 6 primary brain tumors
```
Gliomas
Meningiomas
Acoustic neuromas
Pituitary adenomas
angiomas
cerebral metasteses
```
142
Primary brain tumors: risk factors
```
Exposure to ionizing radiation and cancer
Cig
cell phone use
powerlines
genetic risk factors
```
143
Primary brain tumors: clinical manifestations
Increased ICP – seizures, ,localized symptoms sensory loss, facial paralysis (HA, papilledema (edema of optic disk), visual changes, Personality changes, fatigue, vomiting, visual disturbances
144
Primary brain tumors: assessment
check LOC, Emegent AIRWAY then metabolic eval – labs, structural
145
Primary brain tumors: medical management
Surgical, Radiation, Pharm = chemo
146
Primary brain tumor: nursing management
Monitor for increased ICP, neuro checks, VS
147
Spinal cord tumors: metastatic Spinal Cord Tumors
– common cancer to spread – lung, breast and GI
148
Spinal cord tumors: spinal cord compression
Medical Emergency = paralysis
Iv steroids (Dexamethasone)
149
Spinal cord tumors: assessment
Sensory changes
Back pain
Sphincter dysfunction
150
Spinal cord tumors: medical management
MRI diagnostic
151
Spinal cord tumors: nursing management
Pre-op care
Post-op = changes in condition
Managing pain
Promote home and community based care
