Test 1 Chapter 43 Assessment of the nervous system Flashcards Preview

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Flashcards in Test 1 Chapter 43 Assessment of the nervous system Deck (76):

The nervous system controls everything neuro such as ______, _______, and _______.

mobility, sensation, and cognition.


The major divisions of the nervous system are the ________ and the __________.

central nervous system CNS and the peripheral nervous system PNS.


The central nervous system is composed of the ______ and the ______.

the brain in the spinal cord.


What does the brain do?

The brain directs and regulates the function of the nervous system and is contained within the Skull.


What is the spinal cord surrounded by?

The spinal cord is surrounded by clear fluid called cerebrospinal fluid or CSF and is contained in the vertebrae to protect it.


What is the PNS Composed of?

The peripheral nervous system PNS is composed of:
- your cranial nerves,

- your spinal nerves such as thoracic and lumbar, and all of those others

-as well as the autonomic nervous system.


What are the two divisions of the ANS?

The autonomic nervous system can be divided into the sympathetic and parasympathetic.


What do neurons do?

Neurons, transmit impulses our messages, this is how you are able to walk, move things, squeeze things.

Some process information and some retain it so they are very smart. At the end of the neuron you have the synapses.This is where all of that occurs, an example is touching the muscles and giving of the impulses.

Each neuron will produce a specific neurotransmitter.


What are the two types of neurons?

There are two types of neurons, motor and sensory.


What do motor neurons do?

Motor neurons are responsible for moving.


What do sensory neurons do?

Sensory neurons are responsible for sensing.


What is myelin sheath and what does it do?

The Myelin sheath transmits information and is very important part of the neuron.

It is a lipid covering, it is white, and it allows impulses to travel quickly.

Some neurons are not covered with Myelin sheath and those are gray.

If the neuron is supposed to be covered and it is not, that causes problems.


What do neuroglial cells do and how many types are there?

Neuroglial cells very in size and shape, and provide protection, structure, and nutrition for neurons.

There are four types of the cells. Each one has a different function. They help within the blood brain barrier and help regulate cerebrospinal fluid.

1. Astroglial
2. Ependymal
3. Oligodendrocytes
4. Microglial


Just a Note:

Anatomy and physiology review

Central nervous system: structure and function.
1. Brain, directs the regulation and function of the nervous system.
2. Spinal cord, directs and regulates function.


What are Meninges?

protective covering over the brain and spinal cord.


Where is the epidural space located?

Located down in spinal cord

used for giving a woman an epidural during childbirth


What are the 3 main areas of the brain?

the brainstem, cerebellum, and forebrain.


What is the brainstem for?



What is something important that the Cerebellum is responsible for

coordination of movements


What is the forebrain responsible for?

very large so does many things such as processing cognitive functions, and storage of visual memory.


Table 43 – one cerebral lobe main functions

What is the main functions of the frontal lobe?

The primary motor area also known as the "motor strip, or cortex"

broca's speech center on the dominant side.

voluntary eye movement.

access to current century data.

access to past information or experience.

affective response to a situation.

regulates behavior based upon judgment and foresight.


ability to develop long-term goals, reasoning,

concentration, abstraction.


What are the main functions of the parietal lobe?

Understand sensation, texture, size, shape, and spatial relationships.

Three-dimensional or spatial perception.

Important for singing, playing musical instruments,

and processing nonverbal visual experiences.

Perception of body parts and body position awareness.

Taste impulses for interpretation.


What are the main functions of the temporal lobe?

Auditory Center for sound interpretation.

Complicated memory patterns.

Wernecke's area for speech.


What are the primary functions of the occipital lobe?

It is the primary visual center.


What is the primary function of the limbic lobe?

Emotional and visceral patterns connected with survival.

Learning and memory.


What is something that you could see if someone had an accident and damaged their frontal lobe?

If someone's frontal lobe is damaged, this could cause judgment issues and blurting out inappropriate things.


What is something that you could see if someone's temporal lobe is damaged?

If someone's temporal lobe is damage, that could result in hearing loss on that side, so we would need to speak to the person on the other side. .


Anatomy and physiology review of the spinal cord.
Spinal cord -

1.  Starts reflex activity.
2. Controls body movement mobility.
3. Regulates organ function.
4.*** Transmits impulses to and from the brain.


What is the Cauda equina?

Cauda equina is where everything breaks or branches off from the spinal cord.


Anatomy and physiology review of the peripheral nervous system: structure and function.
Composed of:

1. Spinal nerves, 31 pairs, such as cervical thoracic lumbar ect.

2. Cranial nerves1-12

3. Autonomic nervous system = sympathetic and parasympathetic.


What is the Sympathetic NS Responsible for?

Sympathetic, fight or flight.
Dilates pupils
Dries spit
Increases heart rate
Slows digestion and secretion
Stimulates glucose release in liver
Stimulates release of Epi and Norepi in kidneys
Relaxes bladder


What is the Parasympathetic NS Responsible for?

Parasympathetic, rest and digest.
Constricts pupils
Makes spit
Slows heart rate
Increases digestion and secretion
Increases bile release
Contracts bladder


Table 43-3

What is cranial nerve number one?


Origin- olfactory bulb.

Type- sensory.

Function, smell.


What is cranial Nerve number two?


Origin- midbrain.

Type- sensory.

Function, central and peripheral vision.


What is cranial nerve number three?


Origin- midbrain.

Type- motor to Eye muscle.

Function- Eye movement via medial and lateral rectus and inferior oblique and superior rectus muscles; lid elevation via Levator muscle and pupil constriction (parasympathetic); Ciliary muscles.


What is cranial nerve number four?


Origin- lower midbrain.

Type- motor.

Function- eye movement via superior oblique muscles.


What is cranial nerve number five?


Origin- Pons .

Type- sensory. And motor.

(sensory) sensation from skin of face and scalp and mucous membranes of the mouth and nose.

(motor) Muscles of mastication or chewing.


What is cranial nerve number six?


Origin- inferior pons.

Type- motor.

Function- Eye movement via lateral rectus muscles.


What is cranial nerve number seven?


Origin- inferior pons.

Type- sensory, motor, parasympathetic motor.

(sensory) pain and temperature from ear area. Deep sensation from the face. Taste from anterior two thirds of the tongue.

(motor) Muscles of the face and scalp.

(parasympathetic) Lacrimal , submandibular, and sublingual salivary glands.


What is cranial nerve number eight?


Origin- pons medulla junction.

Type- sensory.

Function- hearing and equilibrium.


What is cranial nerve number nine?


Origin- medulla.

Type- sensory, motor, parasympathetic motor.

(sensory) pain and temperature from the ear. Taste and sensation from posterior one third of tongue and pharynx.

(motor) Skeletal muscles of the throat.

(parasympathetic) Parotid glands.


What is cranial nerve number 10?


Origin- medulla.

Type- sensory, motor, parasympathetic motor.

(sensory) pain and temperature from the ear. Sensation from the pharynx, Larynx, thoracic and abdominal viscera.

(motor) Muscles of the soft palate, pharynx and Larynx.

(parasympathetic) Thoracic and abdominal viscera. Cells of the Secretory glands. Cardiac and smooth muscle innervation to the level of the splenic flexure.


What is cranial nerve number 11?


Origin- medulla anterior grey horn of the cervical
Type- motor.

Function- skeletal muscles of the pharynx and Larynx and sternocleidomastoid and trapezius muscles.


What is cranial nerve number 12?


Origin- medulla.

Type- motor.

Function- skeletal muscles of the tongue.


Anatomy and physiology review of neurologic changes associated with aging.



Older people have slower movement and slower response time.

Pupils decrease in size a older people do not get as much light as they are used to, so they are at risk for falls.

Make sure to keep the room clean, no clutter, no rugs, no slip socks, bed alarms ect..


Chart 43-1
Physiologic changes in the nervous system related to aging.

1. Slower processing time

2. Recent memory loss.

3. ***Decreased touch sensation.

4. Change in perception of pain.

5. Changes in sleep patterns.

6. Altered balance and or decreased coordination.

7. Increased risk for infection.


1. Slower processing time

nursing implications provide sufficient time for the affected older adult to respond to questions and or direction.

Allowing adequate time for processing helps to differentiate normal findings from neurological deterioration.


2. Recent memory loss.

Nursing implications, reinforce teaching by repetition and written teaching aids.

Greatest loss of brain weight is in the white matter of the frontal lobe. Intellect is not impaired, but the learning process is slowed.

Repetition helps the patient learn new information and recall it when needed.


3. ***Decreased touch sensation.

Nursing implications, remind the patient to look where his or her feet are placed when walking.

 Instruct the patient to wear shoes that provide good support when walking.

If the patient is unable, change his or her position frequently, such as every hour if he or she is in the bed or the chair.

Decreased sensation may cause the patient to fall.


4. Change in perception of pain.

Nursing implications, Ask the patient to describe the nature and specific characteristics of pain.

Monitor additional assessment variables to detect possible health problems.

Accurate and complete nursing assessment ensures that the interventions will be appropriate for older adults.


5. Changes in sleep patterns.

Nursing implications, ascertain sleep patterns and preferences.

Ask if sleep pattern interferes with daily living.
Adjust the patient's daily schedule to his or her sleep pattern and preferences as much as possible e.g. evening versus morning bath.

Most older adults require less sleep then do younger adults. However, frequent rest periods are needed.


6. Altered balance and or decreased coordination.

Nursing implications, instruct the patient to move slowly when changing positions.

If needed, advise the patient to hold on to the hand rails when ambulating.

Assess the need for an ambulatory aid, such as a cane. The patient may fall if moving too quickly.

Assistive and adaptive aids provide support and prevent falls.


7. Increased risk for infection.

Nursing implications, monitor carefully for infection.

Older adults often have structural deterioration of microglia the cells responsible for cell mediated immune response in the central nervous system.


Anatomy and physiology review of assessment methods.


person place time... alert and oriented times 3.

A change in LOC could mean something is going on.

This is the first sign that something is wrong.

Could mean the patient may have a UTI, or something else similar.

This is why we need to check on every patient regardless of age. And be careful asking the date, because some people don't know that anyway.


What is the first sign that someone has had a stroke?

If a person has a stroke, their level of consciousness is the first to change.






cannot be fully aroused.



responds to pain only.



prolonged unconsciousness.


Remote long term memory, can be tested by

asking patient about their birthday, the schools that they attended, the city of their birth, or anything from the past that can be verified.

Nurses often ask the maiden name of the person's mother, which is sometimes listed on the admission form and can be checked.


Recent recall memory can be tested during

the history and checked on the medical record:
1. The accuracy of the medical history.
2. Dates of clinic or physician appointments.
3. The time of admission.
4. Healthcare provider seen within the past few days.
5. Mode of transportation to the hospital or clinic.
6. What the patient had for breakfast.


Immediate new memory, is tested by

giving the patient two or three unrelated words, such as apple, street, and chair. And asking them to repeat the words to make sure they were heard.

After five minutes, while continuing with the examination, ask the patient to repeat the words.


Loss of memory (especially recent) is the first sign of

a neurological problem.


Assessment for gait and equilibrium.

To test equilibrium,

ask the patient to stand with arms at their sides, feet and knees close together, and eyes open.

Check for swaying, and then ask them to close their eyes and maintain position.

The examiner should be close enough to prevent falling if the patient cannot stay erect.

If they sway with their eyes closed but not when their eyes are open the Romberg's sign, then the problem is probably proprioceptive.



awareness of body position.


If the patient sways with their eyes both open and closed,

the neurologic disturbance is probably cerebellar in origin.


Just Notes,

Glasgow coma scale-- is divided into 3 sections:(eye opening, motor response,and verbal response.) and is used in most health care agencies to help describe the patient's level of consciousness.

A score of 15 represents normal neurologic functioning. A score of 7 represents a comatose state. The lower that the score is the lower the patient's level of consciousness. 3 is the lowest that the scale goes.


What do you need to know about an intubated person and the Glasgow coma scale-

And intubated patient will score lower on the Glasgow coma scale because they cannot give you a verbal response during that part of the scale. So you place the T beside it to show that they were intubated.


Decerebrate posturing-

damage to brainstem itself. Rigidity characterized by extension of the arms and legs, pronation of the arms, planter flexion, and opisthotonos.


Decorticate posturing-

indicates cortical spinal issue. Arms, wrists, and fingers are flexed with internal rotation and planter flexion of the legs.


Which is worse, Decerebrate posturing or Decorticate posturing?

Decerebrate posturing


What cranial nerve does PEERLA assess?

Cranial nerve number 3, 4, 6
oculomotor, Trochlear and Abducens

If a patient presents and they are having a hard time seeing or has cataracts or glaucoma, pupils might be a little bit irregular. Do not be alarmed by this, we are more interested in how they respond to light and accommodation.


What is the first line of defense for a stroke?

CT, this is the first line of defense for a stroke.

A stroke has to be categorized before we can treat it.
In order to categorize a stroke, you must get a CT first. The results of this will determine the intervention.


What color does blood appear on a CT?

Blood appears white on a CT, which is hemorrhagic in nature.

This is stopped by surgery.


What color does a clot appear on a CT?

Clots appears dark on a CT which is ischemic in nature. Give TPA. Monitor for bleeding.


Which type of stroke is worse, an ischemic stroke or hemorrhagic stroke?

A hemorrhagic stroke is worse because It has to be fixed with surgery and patients have a longer recovery time. (may not gain all function back either)