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NURS202 Summary > week 7: neurological sys and mental health > Flashcards

week 7: neurological sys and mental health Flashcards

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1
Q

CNS

A

brain
spinal cord

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2
Q

Brain: Cerebral cortex

A

frontal lobe
parietal lobe
occipital lobe
temporal lobe
bronca’s area
wernicke’s area

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3
Q

cerebral cortex: frontal lobe

A

Personality, behaviour, emotions, intellect, voluntary movement (precentral gyrus)

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4
Q

cerebral cortex: parietal lobe

A

sensations

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5
Q

cerebral cortex: occipital lobe

A

vision

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6
Q

cerebral cortex: temporal lobe

A

auditory, smell, taste

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7
Q

cerebral cortex: broca’s area

A

in frontal lobe, controls speech production
expressive aphasia: person can’t talk, produces garbled sound

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8
Q

cerebral cortex: wernicke’s area

A

top of temporal lobe, controls speech comprehension
receptive aphasia: person can’t understand language

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9
Q

basal ganglia

A

Bands of grey matter deep in brain; has motor function

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10
Q

thalamus

A

Primary relay system of the brain; messages btwn/ brain and spinal cord

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11
Q

Hypothalamus

A

Controls vital, homeostatic functions (heart rate, temp, BP), autonomic response and pituitary gland

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12
Q

cerebellum

A

Motor coordination, equilibrium (body balance), muscle tone

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13
Q

brainstem + components

A

Central core of the brain, nerve fibres, cranial nerves
Midbrain: Most anterior; merges into thalamus/hypothalamus, has motor neurons/tracts
Pons: Has ascending/descending fibre tracts (messages to/from brain/body)
Medulla Oblongata: Continuation of spinal cord; also has ascending/descending tracts but also vital autonomic centres (respiratory, cardiac, GI), cranial nerves
If this breaks, you’re dead

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14
Q

spinal cord

A

Has ascending and descending tracts; connects to the cranial nerves
Sends messages/sensations from the body to the brain, reacts in motor ways
Looks like a butterfly in cross section, mediates reflexes

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15
Q

pathways of CNS**

A

Sensory Pathways: Sends messages to the brain; afferent fibres
Spinothalamic Tract: Deals with crude/light touch; pain and temperature
Posterior/Dorsal Columns: Deals with finely localized touch (stereognosis, identifying objects by touch without looking); position (in 3D space), vibration

Motor Pathways:Sends messages from the brain; efferent fibres
Pyramidal Tract: Fine voluntary movement (writing)
Extrapyramidal Tract: Gross voluntary movement (walking)
Cerebellar System: Coordination and Posture (subconscious)

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16
Q

PNS

A

Peripheral Nervous System:
Reflex Arc: Basic defense mechanisms of the nervous system; involuntary, unconscious
Deep Tendon (Myotatic): Ex., knee jerk/patellar, biceps, achilles, triceps
Superficial: Ex., corneal reflex, abdominal
Visceral (Organic): Pupillary response/light accommodation
Pathological: Abnormal; ex., seeing Babinski reflex in adults

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17
Q

I Olfactory

A

Sensory
Smell - Only tested if smell is lost; close one nostril and sniff two different, familiar smells, change nostril between smells

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18
Q

II Optic

A

Sensory
Visual acuity, fields, optic disc

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19
Q

III Oculomotor

A

Motor
Eyelids, Pupillary light response, field of gaze

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20
Q

IV Trochlear

A

Motor
Inward/Down Eye movements; III, IV, VI tested together

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21
Q

V Trigeminal

A

Both
Jaw muscles, touch forehead/cheek/chin

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22
Q

VI Abducens

A

Motor
Lateral eye movement

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23
Q

VII Facial

A

Both
Facial muscles, tastes

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24
Q

VIII Acoustic or Vestibulocochlear

A

Sensory
Hearing and Balance

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25
IX Glossopharyngeal
Both Pharynx (swallowing, speaking), gag reflex, taste of back tongue
26
X Vagus
Both Heart, breathing, pharynx/larynx (talking, swallowing), test w/ IX
27
XI Spinal Accessory
Motor Shrugging shoulders, head rotation (trapezius, sternomastoid)
28
XII Hypoglossal
Motor Tongue movement
29
mnemonic and function
Mnemonic: “Oh Oh Oh To Touch And Feel A/Virgin Girl’s Vagina And Hymen” Function: “Some Say Marry Money But My Brother Says Big Brains/Butts/Boobs Matter More
30
spinal nerves
Spinal Nerves: There are 31 pairs and each innervate a dermatome (an area of skin); used for sensory (feeling, afferent) and motor (moving that part of the body, efferent). 8 Cervical: In general, head and arms 12 Thoracic: In general, torso and some of the arms 5 Lumbar: In general, the legs 5 Sacral: In general, the bowel/bladder/sexual 1 Coccygeal: No idea what it does tbh Useful to know the dermatomes for neuro, epidurals,
31
autonomic nervous system
Part of the nervous system that deals with involuntary homeostasis Sympathetic (Fight or Flight) Parasympathetic (Rest and Digest)
32
tremors
Involuntary shaking, vibrating, trembling
33
paralysis
Loss of motor function as a result of neurological lesion, innervation problems
34
paresis
Weakness of voluntary movements/impaired movement
35
dysmetria
Incoordination; Inability to control the RoM of muscles
36
paraesthesia
Abnormal numbness or tingling feeling
37
dysphagia
Difficulty swallowing
38
dysarthria
Difficulty forming words (ex., expressive aphasia)
39
dysphasia
Difficulty with language comprehension (ex., receptive aphasia)
40
syncope
Sudden loss of strength, temporary loss of consciousness (fainting), lack of brain blood p
41
vertigo
Sensation of rotational spinning (vs. dizziness = swimming feeling)
42
mental health subjective data
Be aware of any mental health diagnoses; they affect the neurological exam ex., decreased LoC = depression, schizophrenia = inability to react to pain Any childhood diseases/surgeries/traumas (i.e., concussions) Childhood abuse? “Have you ever suffered from any childhood abuse” It’s better to ask than assume Chronic Illnesses Functional Assessment: Nutrition, Sleep, Activity, Elimination, Interpersonal Relationships, Self Esteem, Spirituality, Coping/Stress Mgmt, Substance Abuse Screen for suicidal/homicidal ideation Have you ever thought about killing yourself or have made a plan? Have you thought about hurting yourself or anyone else? Note if the patient expresses sadness, hopelessness, despair Refer to more qualified HCP at a hospital
43
neurological subjective
headaches head injuries lightheaded, dizzy, faint, or have vertigo seizures shakes or tremors weakness coordination numbness or tingling diff swallowing problem speaking stroke, spinal cord injury, meningitis, encephalitis, congenital defects environmental/occupational hazards meds alcohol mood-altering drugs
44
objective data: optic cranial nerve
Visual Acuity (Snellen Chart) - Letter chart Confrontation: Go to patient’s eye level; cover one eye; compares yours and patient’s peripheral vision --- Patient says “now” when they can see your finger, from side, above, below
45
objective data: oculomotor cranial nerve
PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation “I’m gonna shine a light in your eye”, then “Focus on my finger, look at the wall” Palpebral fissure/Upper Eyelid droop (Ptosis) (slide finger down)
46
objective data: cranial nerve oculomotor, trochlear, abducens (motor)
Cardinal directions of eye movement Can you see my fingers in your periphery; follow finger without moving head Shine light in eye to test for dilation
47
objective: cranial nerve trigeminal
Sense: Light touch (cotton wisp) forehead, cheek, chin bilaterally; Motor: Palpate clenched jaw (TMJ)
48
objective: facial (motor) cranial nerve
Facial Expressions - Smile, Frown,Close eyes tight, lift eyebrows, show teeth Puff Cheeks (and press in cheeks) Not tested: Taste test
49
objective: cranial nerve acoustic/vestibulocochlear
Whispered voice test (no tuning fork) 1/2 meter, arms length away from one ear, other is covered: Whisper a two syllable word ”firetruck, baseball, sunscreen” and get them to repeat it back; repeat bilaterally
50
objective: cranial nerve glossopharyngeal, X vagus
Depress tongue, Say “ahh” to see uvula, test gag reflex (don’t), see movement of soft palate & tonsillar pillars - uvula, soft palate moves up, tonsils medially
51
objective: cranial nerve - spinal accessory
(Motor): Head rotation (sternomastoid) and Shoulder shrug (trapezius) against resistance
52
objective: cranial nerves - hypoglossal (motor)
Tongue thrust out, strength/symmetry, lingual “light, tight, dynamite”
53
cerebellar balance tests
Gait: Normal Walking Tandem Walking (Heel to Toe): Trying to walk in a straight line from heel to toe Romberg Test: Eyes closed, feet together for 20 seconds; positive if they fall
54
cerebellar coordination and skilled movements
Rapid Alternating Movements: Patting knees with front/back of hands, thumb to finger touch Finger to Finger Test: Touch your nose, touch my finger (and I move my finger) Finger to Nose Test: Close eyes, stretch out arms, touch nose alternating Heel-to-Shin Test: Taking your heel and sliding it down your opposite shin
55
sensory system/reflexes
Pain: Sharp vs. Dull point (broken tongue depressor) - Ask them if they feel “sharp/dull” Light Touch: Using a cotton ball, touch skin: Say “now/yes” when you feel it Vibration: Using a tuning fork on arm, shin bones Position Sense: Eyes closed, moving arm/fingers/toes up or down Stereognosis: Recognizing an object while eyes are closed (ex., key, pencil, coin) Graphesthesia: Draw a number on their hand and get them to tell you what number (ex. 7) 2-Point Discrimination: Two pinpoints on skin (ex., paperclips) and see how close it gets Most sensitive: Fingertips, Least sensitive: Upper arms, thighs, back Extinction: Touch both sides of body at same point, state how many sensations felt/where Point Location: Point to where you were touched
56
reflexes
Graded from 0-4+ where 2 is normal
57
Bicep (C5/C6)
Support arm at forearm; strike on thumb to hit biceps tendon (biceps contract, forearm flex)
58
Tricep (C7/C8)
Support arm and let dangle above elbow; hit tricep tendon (swings out) Brachioradialis (not tested)
59
quadriceps (L2-L4)
Patellar Reflex; leg dangling or if supine supporting leg; hit patellar tendon for knee jerk (swings out)
60
achilles (L5-S2)
Knee flexed, externally rotated, foot dorsiflexed, strike achilles tendon You’ll feel plantar flexion
61
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best Eye Opening: /4 Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None Motor Response: /6 Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation -> -> Flexes extremities in response to pain -> Flexes body entirely -> No response Verbal Response: /5 Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response Can also assess pupil size, dilation, other neuro parts
61
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best Eye Opening: /4 Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None Motor Response: /6 Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation -> -> Flexes extremities in response to pain -> Flexes body entirely -> No response Verbal Response: /5 Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response Can also assess pupil size, dilation, other neuro parts
61
glasgow coma scale
Scoring system for patients with altered Level of Consciousness or after neurological conditions/surgery; assesses brain as a whole Scoring: Out of 15; <8 = severe brain injury, 9-12 = moderate, 13-15 = mild, 15 = best Eye Opening: /4 Opens eyes simultan./spontaneously -> After being spoken to -> Responding to Pain -> None Motor Response: /6 Follows Commands (can you raise your arms, legs, smile?) -> Localized movements to pain (ex., sternal pinch/rub) -> Nonpurposeful movements after stimulation -> -> Flexes extremities in response to pain -> Flexes body entirely -> No response Verbal Response: /5 Oriented = Person/Place/TIme -> Converses but is confused -> Inappropriate responses (unrelated) -> Incomprehensible sounds/grunts/moans -> No response Can also assess pupil size, dilation, other neuro parts
62
stroke
In general, refers to a loss of oxygen in the brain, corresponding cell death; two types Ischemic Stroke: Refers to a blood clot that prevents blood flow to the brain Treated with blood thinner/clot buster Hemorrhagic Stroke: Refers to a burst blood vessel in the brain that prevents oxygen Blood thinners would kill you; surgical, no intervention Common signs of stroke: FAST - Face, Arms, Speech, TIme; Severe headache Get them to a CT scan (computerized tomography) ASAP so they can identify the type of stroke and then treat it appropriately: extremely time sensitive

NURS202 Summary (12 decks)

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