Neurologic Assessment - Exam 6 Flashcards Preview

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With what glascow coma scale would you intubate a patient?

GCS less than or equal to 8


What are the criteria for glascow coma scale for infants?

Eye opening: Spontaneously, To speech, To pain, No reponse

Best Verbal Response: Coos, babbles, Irritable, cries, Cries to pain, Moans, grunts, No response

Best Montor Response: Spontaneous, Localizes pain, withdraws from pain, flexion (decorticate), extension, decerebrate), no response


What are the criteria for the glascow coma scale for a child/adult?

Eye opening: spontaneously, to command, to pain, no response

Best verbal response: oriented, confused, inappropriate words, incomprehensible, no response

Best motor response: obeys commands, localizes pain, withdraws from pain, flexion (decorticate), extension (decerebrate), no response)


What is a normal GCS score?



What is the progression of deteriorating brain function?

Level of consciousness deteriorates and improves in a perdictable pattern (except in direct and massive brain damage). Progressive loss of the higher levels of function occurs initially then the more primitive levels, and finally the life-sustaining functions. A diminished level of consciousness and behavior changes are early manifestations of cerebral involvement. The midbrain and brainstem functions are affected sequentially with characteristic changes in motor function, pupillary response and breathing patterns.


What is the progression of level of consciousness?

  1. Alert, oriented to time, place, and person
  2. Responds to verbal stimuli, decreased concentration, agitation, confusion, lethargy, disoriented
  3. Requires continuous stimulation to rouse
  4. Reflexive positioning to pain stimulus
  5. No response to stimuli


What is the progression of pupillary response?

  1. Brisk and equal; pupils regular
  2. Small and reactive
  3. Pupils fixed (nonreacive) in midposition
  4. Pupils fixed in midposition


What is the progression of motor response?

  1. Purposeful movement; responds to commands
  2. Decorticate positioning with upper extremity flexion (flexion positioning)
  3. Decerebrate positioning with adduction and rigid extension of upper and lower extremities
  4. Extension of upper extremities with flexion of lower extremities or flaccidity


What is the progression of breathing?

  1. Regular pattern with normal rate and depth
  2. Yawning, sighing respirations
  3. Cheyne-Stokes respirations with cresscendo-decrescendo pattern in rate and depth followed by periods of apnea
  4. Central neurologic hyperventilation with rapid, regular, and deep respirations; apneustic breathing with prolonged inspiration and pauses at full inspiration and following expiration
  5. Cluster or ataxic breathing with irregular pattern and depth of respirations; gasping respirations or apnea


What are gerontological considerations?

  1. Reduction in total brain weight
  2. Loss of neurons and changes in neurotransmitters
  3. Decrease in blood flow to the cerebrum (20%)
  4. Decreased CSF production
  5. Decrease in cerebellar function can lead to impaired balance/coordination
  6. Decreased sensory fibers can lead to altered perception of touch and pain
  7. Decrease in thermal sensitvity (hot-cold)
  8. Nerve conduction slows
  9. Decreased reaction time
  10. Pupil size diminishes, pupils react more slwoly to light and dark


What are the brain fast facts?

  1. Only 1-2% of body weight
  2. Receives 15% of rest cardiac output
  3. Accounts for 20% of total body oxygen consumption
  4. Cerebral blood flow (50ml/100gm of tissue) remains constant over a wide range of BP and intracranial pressure due to autoregulation of cascular resistance


What is the central nervous system?

Made up of the brain and spinal cord


What is the spinal cord?

A bundle of neurons that transmit information in ascending and descending tracts


What is the brain?

One function is expression of language VIA broca's area


What is the brainstem?

Contains the midbrain, pons, medulla, and reticular formation, where the respiratory and vasomotor centers are located


What is the cerebrospinal fluid?

Circulates within the subarachnoid space and provides a fluid cushion for the brain and spinal cord


What is a neurotransmitter?

A chemical agent involved in the transmission of an impulse across the synaptic cleft


What is the peripheral nervous system?

Includes all neuronal structures that lie outside the CNS


What are the spinal nerves?

Each one contains motor and sensory nerve fibers


What are the cranial nerves?

12 pairs of nerves that may be motor, sensory, or both


What is the autonomic nervous system?

Controls involuntary functions of cardiac and smooth muscle and glands


What is the blood brain barrier?

Protects the brain from foreign substances in the blood that may injure the brain


What is the function of the frontal lobes?

  1. Memory retnetion
  2. Higher cognitive functions
  3. Voluntary eye movements
  4. Speech
  5. Voluntary motor movement


What is the function of the parietal lobes?

Spatial information


What is the function of the temporal lobes?

  1. Receptive speech
  2. Integration of somatic, visual, and auditory data


What is the function of the occipital lobe?

  1. Vision
  2. Visual image interpretation


What is the function of the cerebellum?

  1. Coordinate voluntary movement
  2. Controls balance and coordination


What is the function of the brainstem?

  1. Regulation of basic body function
  2. Vasomotor center (BP)
  3. Respiratory center


Why should the RN have some knowledge about the location of different brain functions?

Injury or disease to a specific area (eg temporal lobe on left) will cause a specific symptoms (expressive aphasia (anterior temporal) or receptive aphasia


What is the oculomotor nerve function and nursing assessment?

Nerve III

Pupil reaction (parasympathetic)

Eye movements (motor)

Check pupil reaction to light. Have patient follow your finger with their eyes up, down, side to side.

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