The Nervous System Flashcards

Question

Cranial IX

Answer 1

Glossopharyngeal -- motor, parasympathetic, and sensory information from nose, mouth, and throat; enables swallowing.

Answer 2

vagus nerve -- swallowing and speaking

Answer 3

accessory nerve -- supplies sternocleidomastoid and trapezius muscles

Answer 4

hypoglossal -- efferent nerve for tongue musculature.

Answer 5

Pharm. Class: Benzodiazepine; Anti-Anxiety Agent Indications: anxiety Onset: Rapid Duration: 1-2 hrs

Answer 6

Pharm. Class: Benzodiazepine Indication: Anxiety Onset: Intermediate Duration: 6-12 hrs

Answer 7

Pharm. Class: Benzodiazepine Onset: Intermediate Duration: 18-50 hrs

Answer 8

Pharm. Class: Benzodiazepines Indication: Anxiety; seizure Onset: Intermediate Duration: 2-6 hrs

Answer 9

Pharm. Class: Long-Acting Benzodiazepine Indication: anxiety; MHSU Duration: 20-50hrs

Answer 10

Pharm. Class: Anticonvulsant Action: treats seizures; provides prophylaxis through blocking sustained high-frequency repetitive firing action potentials in the brain. Therapeutic Level: 10-20mg/L Considerations: May cause gingival hyperplasia; antacids can reduce effects on the body.

Answer 11

Pharm Class: NSAID; #1 fever control Therapeutic Indication: antipyretic; non-opioid analgesia Action: inhibits the synthesis of prostaglandins which leads to decrease in transmission of pain signals and fever response. Considerations: 4g max daily dose; long-term 3g per day recommended; monitor liver function Antidote: Acetylcysteine.

Answer 12

Pharm. Class: antipyretic; non-opioid analgesic Indication: pain, arthritis, stroke, MI prophylaxis Action: inhibits the production of prostaglandins which decreases ischemic symptoms of heart disease. Considerations: Risk of bleeding (D/C within 5 days of surgery); caution with paediatric patients; may cause peptic ulcers; give with food.

Answer 13

Pharm. Class: CNS depressant; opioid analgesia Action: binds to opioid receptors in the brain to alter perception of pain while producing CNS depression. Considerations: constipation; CNS depression; monitor HR, RR Antidote: Naloxone. Other Opioids: fentanyl, hydromorphone, morphine, oxycodone, oxycontin.

Answer 14

- battle sign - raccoon eyes - cerebrospinal rhinnorhea - torn/non-torn dura

Answer 15

Bruising over the mastoid process

Answer 16

you could insert the NG tube directly into the brain

Answer 17

testing rhinnorhea for presence of CSF halo around droplet on paper. Additionally, the presence of glucose would indicate CSF fluid.

Answer 18

dura pulled off the skull; rapid expansion of arterial blood between duramatter and skull.

Answer 19

dura attached; slow expansion of venous blood between arachnoid and dura.

Answer 20

accumulation of CSF causes increase in ICP Causes: tumour; hemorrhage; infection; congenital Treatment: - VP shunt (tube inserted to redirect csf to the urinary tract) - External Ventricular Drain (drains CSF directly)

Answer 21

inflammation of the spinal cord or brain, caused by virus or bacteria

Answer 22

Nucchal rigidity; photophobia; Kernig's sign

Answer 23

Involuntary flexion of legs

Answer 24

steroids analgesia Antibiotics if bacterial Bacterial/Viral should be on contact precautions Prevention with HiB Vaccine (Health Promotion)

Answer 25

damage to the spinal cord causes permanent damage to the strength, sensation, and other bodily functions below the site of injury. - signs and symptoms depend on the site of injury - higher the injury, more function lost - Injuries above T-6 cause autonomic dysreflexia

Answer 26

medical emergency! Characterized by sudden, severe hypotension, bradycardia, headache, stuffiness, flushed skin, diaphoresis, blurred vision, and anxiety. Patho: irritation below the SCI sends nerve signals to the spine. Nerve signals are blocked at the SCI, causing increasing BP. Brain sends signals to lower BP, but it is blocked off by SCI, causing diaphoresis and headache and increased ICP.

Answer 27

Sit up to lower the BP Antihypertensives (hydralazine) find stimulus and remove it urinary rentention -- catheterize constipation -- remove impaction

Answer 28

occurs when blood vessels that carry oxygen and nutrients to the brain is blocked by a clot or bursts.

Answer 29

bleeding; bessel ruptures and bleeds into the brain; blood accumulates, increasing ICP; may be caused by aneurysm; characterized by severe headaches.

Answer 30

lack of oxygen to the brain caused by clot; may be embolic or thrombotic; sudden in onset.

Answer 31

dizziness, loss of balance, blurry vision, abnormal pupil response, and hemianopia.

Answer 32

unilateral facial droop; unilateral Arm/leg weakness; aphasia, aphasia, altered level of consciousness.

Answer 33

CT to determine brain perfusion - get bleeding under control - if caused by aneurysm, coiling or clipping - craniotomy - EVD

Answer 34

CT to determine brain perfusion - permissive hypertension - antibthrombolytics (TPA breaks up clot to restore blood flow; must be done within 60 min) - percutaneous thrombectomy (surgery to remove the clot)

Answer 35

involves specific area of the brain

Answer 36

involving the entire brain

Answer 37

no loss of consciousness

Answer 38

impaired consciousness from confusion to loss of consciousness

Answer 39

seizure characterized by muscle stiffening and jerking motions.

Answer 40

sudden, brief contractions of a muscle or group of muscles.

Answer 41

no movement at all.

Answer 42

Stay with patient note time, duration, and characteristics remove harmful objects in the environment cushion head loosen restrictive clothing assist to side-lying maintain airways and protect from injury. Medications: Lorazepam (short term); Phenytoin (long-term) Considerations: monitor therapeutic levels; do not stop meds abruptly.

Answer 43

- O2 and suction ready - side rails up and padded - pillow under head - bed in lowest position - side-lying

Answer 44

Progressive nervous system disease caused by degeneration of dopamine neuron's; starts with tremors.

Answer 45

Tremors (usually starts on one side) rigidity hypophonia mask-like face akinesia stooped posture difficulty balancing OH

Answer 46

Fall precautions Comfort care PT/OT/SW Medications: Carbidopa/Levidopa to increase dopamine in the brain.

Answer 47

autoimmune; CNS inflammation; damage to myelin sheaths, damaging nerve transmission

Answer 48

- tingling/numbness - weakness - optic neuritis - ataxia - nystagmus - tremor - slowed speech - hypotonia - epilepsy seizures - msk spasticity

Answer 49

No cure Comfort care Corticosteroids for exacerbations to reduce inflammation plasmapheresis -- plasma exchange

Answer 50

autoimmune disease that destroys the communication between muscles; diagnosed with tension test.

Answer 51

weak muscles and ptosis

Answer 52

cholinesterase inhibitors, corticosteroids, immunosuppressants.

Answer 53

a systemic inflammatory reaction to infection that the body cannot tolerate; may be viral, fungal, or bacterial.

Answer 54

decreased urine output, change in LOC, hypotension, hypoperfusion of tissues; edema, tachycardia, increased lactase*; decreased spo2; tachypnea; warm, flushed skin.

Answer 55

Abrupt onset Favorable prognosis if the underlying cause is treated May be caused by infection, medications, F&E imbalance, or sensory impairment Impairments with attention that fluctuate in intensity Difficulty with judgment and executive functioning Memory impairments Altered level of consciousness Emotional lability

Answer 56

valerian root melatonin

Answer 57

Phenytoin is indicated in the prevention of seizures. Phenytoin's most common adverse effects include gingival hyperplasia, excessive body hair growth, and folic acid deficiency. The normal phenytoin level is 10-20 mcg/mL, and toxicity is any level greater than 40 mcg/mL. Features of phenytoin toxicity include nystagmus, unsteady gait, and a worsening mental status as the levels rise.

Answer 58

Also known as Ambien. Sleeping agent; treats insomnia

Answer 59

Medication prescribed to help alcoholics quit drinking

Answer 60

medication used to manage and treat autoimmune conditions such as plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, AS, etc.

Answer 61

Medical Emergency prolonged seizure that lasts longer than 5 minutes or repeated seizures over 30 mins - a potential complication of all seizures - notify PHCP and TEAM immediately - Priorities: airway, supplemental O2, IV access

Answer 62

Aspirin and NSAIDs Aspirin disrupts the normal mucosal defense and repair, making the mucosa more susceptible to acid. The nurse should instruct this client on the importance of avoiding aspirin and all other nonsteroidal anti-inflammatories (NSAIDs) now and in the future.

Answer 63

The cardinal features of Huntington’s disease include chorea (brief, involuntary movements involving the trunk, limbs, and face). This disease has common psychiatric symptoms such as depression, paranoia, delusions, and hallucinations. Weight loss is also a common finding caused by the excessive energy expended in abnormal movements. Huntington’s disease is a neurodegenerative disease that is not well understood. This disease causes neuropsychiatric symptoms such as chorea, dystonia, abnormal eye movements, hallucinations, and weight loss. Treatments include VMAT2 inhibitors such as tetrabenazine. Adjunctive treatments such as benzodiazepines may be utilized for symptoms such as uncontrolled chorea.

Answer 64

Autonomic dysreflexia (AD) is a condition in which the involuntary nervous system overreacts to external or bodily stimuli. It’s also known as autonomic hyperreflexia. This reaction causes: A dangerous spike in blood pressure Bradycardia Constriction of your peripheral blood vessels Other changes in your body’s autonomic functions The condition is most commonly seen in people with spinal cord injuries above the sixth thoracic vertebra, or T6. It may also affect people who have multiple sclerosis, Guillain-Barre Syndrome, and some head or brain injuries. AD can also be a side effect of medication or drug use. AD is a severe condition that’s considered a medical emergency. It can be life-threatening and result in: Stroke Retinal hemorrhage Cardiac arrest Pulmonary edema The symptoms of AD may include: Anxiety and apprehension Nasal congestion High blood pressure with systolic readings often over 200 mmHg A pounding headache Flushing of the skin Profuse sweating, particularly on the forehead Lightheadedness Dizziness Confusion Dilated pupils Sweating above the level of injury. In individuals with spinal cord injury at or above the T6 level, there is a loss of normal autonomic nervous system control, leading to a lack of sympathetic regulation of the sweat glands. As a result, when a noxious stimulus or irritation occurs below the level of injury, it can trigger a reflex sympathetic response, leading to sweating above the level of injury.

Answer 65

Absent bowel sounds, gastric distention, bradycardia, hypotension, and flaccid paralysis are concerning findings for spinal shock. When caring for a client following a spinal cord injury, spinal shock is one of the many complications which may occur within 48 hours following the injury. Spinal shock may occur immediately following a spinal cord injury or within 48 hours of the insult. The cause is thought to be the excessive amount of potassium in the extracellular space that reduces neural transmission. Manifestations associated with spinal shock include flaccid paralysis, absent bowel and bladder control, and loss of reflex activity. Males may develop priapism. Treatment involves frequent assessment of vital signs, correcting any fluid or electrolyte abnormalities, and prompt administering corticosteroids.

Answer 66

Standard American Society of Anesthesiologists (ASA) recommends monitoring the client's heart rate, blood pressure, ECG, capnography, and temperature during any electroconvulsive therapy (ECT) procedure, as clients undergoing an ECT procedure often experience a temporary rise in blood pressure during treatment. While preparing a client scheduled to undergo electroconvulsive therapy (ECT), the nurse should understand that applying a blood pressure cuff to the client must be performed before the client's ECT procedure. Electroconvulsive therapy (ECT) is indicated for the treatment of severe or treatment-resistant depression, psychosis, bipolar disorder, and catatonia. Modern electroconvulsive therapy (ECT), delivered under heavy sedation/general anesthesia, is typically well tolerated, although confusion and memory impairment may occur acutely. Response to six to ten electroconvulsive therapy (ECT) treatments is usually dramatic and, at times, life-saving.

Answer 67

Ptosis, or eye drooping, occurs with cranial nerve III (oculomotor) lesions, myasthenia gravis, and Horner syndrome. Dysfunction of cranial nerve III is also associated with dilated pupil, absent light reflex, and impaired extraocular muscle movement.

Answer 68

The twelve cranial nerves include - CN I: Olfactory CN II: Optic CN III: Oculomotor CN IV: Trochlear CN V: Trigeminal CN VI: Abducens CN VII: Facial CN VIII: Vestibulocochlear CN IX: Glossopharyngeal CN X: Vagus CN XI: Accessory CN XII: Hypoglossal

Answer 69

In clients with multiple sclerosis, an autoimmune reaction occurs. This autoimmune reaction causes immune cells and antibodies to attack and destroy the myelin sheath (a coating made of fat and proteins that protects nerves and helps transmit electrical signals) and the underlying nerve fibers in the brain, optic nerves, and spinal cord. During plasmapheresis, these antibodies are removed from the client's plasma, removing the cause of myelin sheath demyelination.

Answer 70

The cause of multiple sclerosis (MS) is unknown but likely involves an attack by the immune system against the body's own tissues (i.e., an autoimmune reaction). In most multiple sclerosis clients, periods of relatively good health alternate with episodes of worsening symptoms. MS is a progressive disease, as symptoms gradually worsen over time. Clients may experience visual problems, abnormal sensations, and weak or clumsy movements. Diagnosis is based on clinical symptoms, physical examination, and magnetic resonance imaging. Treatment includes corticosteroids, immunomodulators to prevent exacerbations and delay eventual disability, antidepressants, and/or supportive care. Life span is typically unaffected unless the disorder is very severe.

Answer 71

Bell's palsy is an unexplained episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours. This condition results from damage to the facial nerve (the 7th cranial nerve). Pain and discomfort usually occur on one side of the face or head. Bell’s palsy can strike anyone at any age. It occurs most often in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell's palsy affects men and woman equally. It is less common before age 15 or after age 60. Bell's palsy is not considered permanent, but in rare cases, it does not disappear. Currently, there is no known cure for Bell's palsy; however, recovery usually begins 2 weeks to 6 months from the onset of the symptoms. Most people with Bell's palsy recover full facial strength and expression.

Answer 72

It is thought that it may be due to inflammation that is directed by the body's immune system against the nerve controlling movement of the face. Bell's palsy is sometimes associated with the following: Diabetes High blood pressure Injury Toxins Lyme disease Guillain-Barré syndrome Sarcoidosis Myasthenia gravis Multiple sclerosis Infection, especially following a viral infection with Herpes simplex virus (a virus that is related to the cause of the common "cold sores" of the mouth)

Answer 73

These are the most common symptoms of Bell's palsy: Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid Loss of feeling in the face Headache Tearing Drooling Loss of the sense of taste on the front two-thirds of the tongue Hypersensitivity to sound in the affected ear (hyperacusis) Inability to close the eye on the affected side of the face The symptoms of Bell's palsy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

Answer 74

Your healthcare provider can usually diagnose Bell’s palsy by looking at your symptoms. There are no specific tests used to diagnose Bell’s palsy. However, your healthcare provider may order tests to rule out other conditions that can cause similar symptoms and to determine the extent of nerve involvement or damage. These tests may include: Electromyography (EMG) to determine the extent of the nerve involvement Blood tests to determine if another condition such as diabetes or Lyme disease is present Magnetic resonance imaging (MRI) or computed tomography (CT) to determine if there is a structural cause for your symptoms.

Answer 75

Steroids to reduce inflammation Antiviral medicine, such as acyclovir Analgesics or moist heat to relieve pain Physical therapy to stimulate the facial nerve Some people may choose to use alternative therapies in the treatment of Bell's palsy, but there is no proof they make a difference in recovery. Such treatment may include: Relaxation Acupuncture Electrical stimulation Biofeedback training Vitamin therapy, including B12, B6, and the mineral zinc

Answer 76

reatment for an acute migraine headache (MH) involves abortive medications such as ketorolac (NSAID), dexamethasone (corticosteroid), and acetaminophen-caffeine. Depending on the severity of the MH, the provider takes a stepwise or aggressive approach to treatment. The treatment for an acute migraine headache aims to abort the headache and the associative symptoms such as nausea and vomiting. Commonly, a client may be prescribed an anti-emetic such as metoclopramide to assist with abating the symptoms. The below table reviews the treatment options for a migraine headache. * Verapamil * Propranolol Topiramate * Onabotulinumtoxin-A * Valproic Acid Nortriptyline * Galcanezumab Abortive Treatment Ketorolac Acetaminophen Caffeine Magnesium sulfate * Dexamethasone Sumatriptan

Answer 77

an excessive amount of urine output for 1 hour and is concerning for diabetes insipidus given the procedure the patient recently underwent. Any urine output greater than 300 mL is alarming and the healthcare provider should be notified immediately. Diabetes insipidus is a severe complication from neurosurgery that occurs around the pituitary. This amount of urinary output can lead to shock if not treated promptly.

Answer 78

Raynaud's phenomenon (RP) results from vascular spasms in the fingers that are triggered by cold temperatures and emotional stress. P may be a finding associated with other autoimmune conditions such as scleroderma. Clinical features of RP include cutaneous vasospasms that are painful. During the vasospasms, the affected area will change colors (cyanosis to flushing). These vasospasms may impact the fingers, ear, nose, and face. Triggers for these vasospasms include stress and exposure to cold temperatures. ➢ Mainstay medical management includes calcium channel blockers such as nifedipine or amlodipine. These medications help prevent these painful vasospasms. ➢ Nursing care focuses on having the client wear gloves in cold environments and avoid injuries to the affected area. Smoking cessation should also be stressed, as it may worsen the condition.

Answer 79

Upper respiratory infections or stomach infections correlate with the development of Guillain-Barre syndrome. Guillain-Barre syndrome is a disorder that involves the peripheral and cranial nerves causing ascending paralysis.

Answer 80

Epilepsy is an idiopathic condition that requires management with anticonvulsants such as topiramate, valproic acid, or phenytoin. Acute seizures are managed with benzodiazepines such as lorazepam or diazepam. These medications work to terminate a seizure. During an acute seizure, the nurse should place the patient on their side, loosen restrictive clothing, and anticipate a prescription for a parenteral benzodiazepine such as diazepam.

Answer 81

An array of symptoms may be reported for a client experiencing a migraine headache (MH). The most common manifestations associated with an acute migraine headache include Unilateral frontotemporal pain that may be described as throbbing or dull Sensitivity to light (photophobia) and sound (phonophobia) Nausea and/or vomiting Altered mentation (drowsiness) Dizziness, numbness, and tingling sensations

Answer 82

miosis; mood changes; change in LOC; respiratory depression reduced salivation; pruritis; pneumonia (aspiration); hypotension; headache; infrequent elimination (constipation/urinary retention); nausea; restlessness; emesis

Answer 83

Fentanyl is an opioid medication that may be given in a variety of routes, including intravenous, intramuscular, transdermal, intranasal, and buccal. Prior to the administration of an opioid, the nurse should assess the client's pain level, blood pressure, and respiration. The fentanyl patch should be applied no greater than 72 hours.

Answer 84

The most common side effects of rivastigmine are flu-like symptoms, dizziness, and weight loss. The FDA has approved limited drugs for Alzheimer’s Disease. The most effective medications act by intensifying the effect of acetylcholine at the cholinergic receptor. Acetylcholine is naturally degraded in the synapse by the enzyme acetylcholinesterase. When acetylcholinesterase is inhibited, acetylcholine levels increase and significantly affect the receptors.

Answer 85

Mirtazapine is an agent used to treat depressive and anxiety disorders. This medication causes sedation and is dosed at night. This may be helpful for those with depressive disorders and who suffer from concomitant insomnia. Mirtazapine has the following side effects – Increased appetite Weight gain Sedation Dizziness Confusion

Answer 86

Delirium is an altered sensorium. It is characterized by acute changes in the patient’s level of consciousness. Many causes of delirium include medications (dexamethasone, opioid toxicity), nicotine withdrawal, dehydration, uncontrolled pain, constipation, urinary retention, infection, hypoxia, renal failure, hyponatremia, hypercalcemia, hyperglycemia, and emotional distress. Initially, non-pharmacological interventions should be attempted to identify and address reversible etiology and relieve terminal agitation/delirium. For example, address the reversible causes such as treating constipation or discontinuing medications such as dexamethasone, modifying precipitating factors such as sensory deprivation or uncontrolled pain, etc. If no rapidly reversible factors are identified or if the patient is terminal, dopamine antagonists must be used.

Answer 87

Hyperactive delirium is characterized by agitation, restlessness, and emotional lability. Hypoactive delirium is characterized by flat affect, apathy, lethargy, or decreased responsiveness.

Answer 88

Alzheimer's disease is a form of dementia, not delirium. Vascular disease (tiny cerebral infarcts) is a direct contributor to dementia. A preventative measure for vascular dementia is mitigation of hypertension and diabetes as these two conditions directly cause vascular dementia.

Answer 89

DTs can be fatal if untreated. DTs result from florid alcohol withdrawal causing the client to experience hallucinations, hypertension, agitation, nystagmus, and potential seizure activity. Clonidine is an alpha-agonist and is primarily used in the treatment of hypertension. Clonidine is helpful during DTs because it lowers the client's blood pressure and gives the client some drowsiness which is useful if they are agitated.\ ✓ Delirium Tremens (DTs) are a medical emergency and may cause autonomic hyperactivity, resulting in tachycardia, diaphoresis, fever, anxiety, insomnia, and hypertension. ✓ Delusions and visual and tactile hallucinations are common in alcohol withdrawal delirium. ✓ This may occur within 72 hours following the last alcoholic beverage consumed. ✓ Withdrawal seizures may occur within 12 to 24 hours after alcohol cessation. ✓ These seizures are generalized and tonic-clonic. Additional seizures may occur within hours of the first seizure. ✓ Diazepam is given intravenously as a common treatment for withdrawal seizures. Nursing care for DTs includes - Rapid assessment of the client's vital signs Initiate seizure precautions and establish patent intravenous access Obtain a prescription for benzodiazepines, such as lorazepam or diazepam Administer intravenous fluids and electrolytes to replete the lost fluids Assess the client using the CiWa-Ar scale to trend the severity of the symptoms