Wk 10 - Neuro Func Flashcards
(115 cards)
1
Q
What are the 3 layers of the meninges?
A
Epidural Layer: Dura - thick and strong
- in the epidural space: fat and small vessels
Subdural layer: Arachnoid - connecting
- in the subdural space: not really a space
Subarachnoid layer: Pia - thin and hugs brain and spine
- in the subarachnoid space: CSF & major blood vessels
2
Q
What is the purpose of the meninges?
A
secures and absorbs shock
3
Q
What is effected if brainstem is damaged?
A
autonomic nervous sys
- breathing
- HR
- BP
- digestion
4
Q
Intracranial pressure
A
pressure inside the cranial vault
5
Q
Intracranial pressure is dependent on what factors/volumes?
A
- Brain
- CSF
- Blood
6
Q
What are some examples of things that can change brain vol (one of the three components that regulate intracranial pressure)
A
- atrophy: changing w/ ageing, or health conditions
- tumor: takes up space
- surgery: removal of tumor
- health conditions: AD, stroke
- trauma
- infection
- alzheimers
7
Q
What are some examples of things that can change blood flow vol (one of the three components that regulate intracranial pressure)
A
- stroke: clot or bleed
- deformity: AVM, aneurysm
- injury: SDH, SAH, epidural hemorrhage
- changes in hydration (too much/little)
8
Q
What are some examples of things that can change CSF vol (one of the three components that regulate intracranial pressure)
A
- injury
- surgery (cause) - can cause leak, complication of epidural (break through dura - “dural tear”
- surgery (fix) - VP shunt to fix (hydrocephalus, EBP (epidural blood patch for dural tear)
9
Q
What color is CSF?
A
clear, colorless
10
Q
what can happen if CSF leaks? (basic)
A
headache
11
Q
C3-5
A
Phrenic nerve - diaphragm
12
Q
T4
A
nipple line
13
Q
T10
A
belly button
14
Q
L1-5
A
most common site of injury
15
Q
if there is an injury what type of pain is it?
A
neuropathic
16
Q
Radiculopathy
A
associated w/ nerve pinching causing neuropathic pain
17
Q
PNS overview
A
Sensory Neurons - afferent
- somatic/visceral sensory ganglia
- cranial nerve ganglia
- Autonomic: PNS (far from spine)/SNS (close to spine)
Motor Neurons - efferent
18
Q
Afferent
A
sensory goes to CNS
(sense pain)
19
Q
Efferent
A
Motor goes away from CNS
(run away)
20
Q
The PNS consists of
A
ganglion and nerves
21
Q
Ganglion
A
nerve clusters coming out from spinal cord
22
Q
Nerves extend to
A
extending to skin and all other organ, muscles, bones, etc.
23
Q
Vision Issues
A
- cataracts
- glaucoma
- refractive errors
- diabetic retinopathy
- macula degeneration
24
Q
Macular Degeneration
A
- leading cause of vision loss, affects >50yrs
- incurable
- loss of central vision
25
Cataracts
- everyone will develop it with age, gradually and without pain
- blurs all vision
26
Diabetic Retinopathy
- leading cause of vision loss <50yrs
- uncontrolled diabetes
- sever vision loss/blindness
27
Glaucoma
- second most common cause of vision loss >65
- visual field loss, decrease acuity, halo, or blindness
28
Refractive Errors
- **Myopia** - nearsighted
- **Hyperopia** - farsighted
- **Presbyopia** - difficulty reading small print
29
Hearing Issues
- Otosclerosis
- Otitis media
- Presbycusis
- Meniere's Disease
- Cerumen Accumulation
- Conductive Hearing Loss
- Sensorineural Hearing Loss
- Central Auditory Processing Disorder
30
Conductive Hearing Loss
- inefficient sound waves outer to inner ear
- ear canal blockage - cold, allergy, infection
31
Central Auditory Processing Disorder
- auditory center damage (pathway to medulla)
- central cortex pathway damage
- TBI, tumor, heredity
32
Otitis Media
- eardrum and middle ear damage
- infection
- can lead to permanent hearing loss
33
Otosclerosis
- hereditary
- ossicle hardening
- causes tinnitus
34
Sensorineural Hearing Loss
- cochlea or nerve damage
- causes - excess noise, meds, virus
35
Cerumen Accumulation
- wax build-up that can harden
- common in elderly
36
Presbycusis
- low-pitched sounds are heard better
- Muffles hearing
- age related hearing loss
37
Meniere's Disease
- inner ear disease
- fluid in the ear
- can cause tinnitus, hearing loss, vertigo
38
Tinnitus
ringing in the ear
39
Vertigo
dizziness
40
Xerostomia (causes/risks)
- dry mouth
- decreases saliva
- thicker mucus
Causes:
- medications
- cancer
- ageing
Risks:
- food aversions decreasing calorie intake
41
Olfaction
decreases with age due to reduces sensory neurons and bulb cells
affects sensitivity to odours and taste discrimination
42
Senses in Older Persons
**decreased blood flow**:
- decreased cardiac output
- decreased peripheral blood flow
**changes to nervous sys**
- decrease in nerve cells
- myelin sheath degeneration
- decreased neurotransmitters/conduction rate
43
nociception
pain - somatic/visceral
neuropathic
44
Pain Patho
- **transduction** where the pain starts
- **transmission** is how the pain reaches our brain
- **perception** is how our bodies define the pain
- **modulation** where we have our signals and response
45
Transduction
where the pain starts
46
Transmission
how the pain reaches our brain
47
Perception
how our bodies define the pain
48
Modulation
where we have our signals and response
49
other senses
- **Kinesthetic**: movement awareness
- **Proprioception**: position awareness
- **Stereognosis**: recognition of object texture and size
50
What to consider when assessing cognition?
- the 3Ds: dementia, delirium, depression
- culture, education, values, beliefs, and previous experience of client
51
Cognition Assessment Tools
- GCS
- MOCA
- AEIOUTIPS
- Neuro
- MMSE
- CAM/PRISME
- NIHSS
52
Changes with age that affect Neuro (sensations)
- peripheral neuropathy
- brain atrophy
- hardened disks/vertebrae overgrowth
53
Peripheral Neuropathy
happens when the nerves located outside the brain/spinal cord (peripheral nerves) damaged
54
Brain Atrophy
is the **loss of brain cells** (neurons) and their connections, leading to a decrease in brain vol/potentially impacting cognitive/motor func
55
Sensory Processing
how the brain receives, organizes, uses information from our senses (touch, movement, smell, taste, vision, and hearing) to respond appropriately to the environment
56
3Ds
- dementia
- delirium
- depression
57
GCS
Glasgow Coma Scale
58
CAM/PRISME
delirium scale
59
What is the following question testing (related to cognition)?
Can you tell me what brought you to the hospital?
Memory
60
What is the following question testing (related to cognition)?
Don’t count your chickens before they hatch!
Abstract Thinking
61
What is the following question testing (related to cognition)?
What do you think of when I ask about heart health?
Association
62
What is the following question testing (related to cognition)?
How are you going to manage with your broken foot at home?
Judgement
63
How can we help to keep our clients safe?
- **appropriate stimuli**: not too much, not too little
- **family support**: education on their family members condition (i.e. their safety needs, medications, etc.)
- **environment**: using ceiling lift, shower/toilet grab bar, personal belongings, is area cluttered (tripping hazards)?, well lit?
- **medication review**: reviewing of meds and side effects - getting pharmacist to see what patient really needs to be on
- **use of assistive devices**: PT/OT, walker etc., helping them understand how to use them, note they may not want to use the devices b/c it is perceived as for old people
64
Presbycusis
- difficulty discriminating some constants/hearing high-freq sounds
Reduced:
- hearing acuity
- speech intelligibility
- pitch discrimination
- hearing threshold
65
Presbyopia (reduced/increased effects)
difficulty reading due to lens stiffening
Reduced:
- visual field
- night vision
- accommodation
- depth perception
- colour discrimination
Increased:
- glare
66
CVA
Cerebral Vascular Accident
AKA **Stroke**
- TIA - temporary disruption of blood flow to part of brain
- Ischemic Stroke - thrombus/embolus
- Hemorrhagic Stroke - brain bleed
67
What is the main/most commons direct cause of stroke in Canada/worldwide?
Hypertension
68
TIA
temporary **disruption of blood flow** to part of brain, no permanent damage
**mini stroke**, symptoms resolve on their own w/out intervention (often w/in minutes)
1 in 3 people who have TIA's will have a stroke
S/S and risk factors same as ischemic stroke
69
Most common cause of Ischemic Stroke?
Atherosclerosis
70
Ischemic Stroke
most common, caused by **thrombus/embolus**
71
Hemorrhagic Stroke
caused from **bleed in the brain**
72
CVA Risk Factors
- hypertension
- atherosclerosis
- smoking
- age >65yrs
- diabetes
- obesity
- atrial fib
73
Ichemia
reduced/restricted blood flow
74
Ischemic Stroke: **Thrombotic**
blood vessels in the brain
risk factors same as all arterial disease
- atherosclerotic plaque
- clot formation
the **brain does not get enough O2**
75
Ischemic Stroke: **Embolic**
moves to the blood vessels in the brain
atherosclerosis, smoking/ETOH, obesity, High LDL, HTN, atrial fib
less commonly can be cause by air, vegetation, amniotic
76
Less Common causes of Embolic Ischemic Stroke
**Air** - air bubbles getting into vascular sys
**Vegetation** - ie. oral infection from flossing, gets into cardiac valve, flicks off into brain
**Amniotic** - **pregnancy** - get amniotic fluid in the bloodstream
77
Treatment **specific for** Ischemic Stroke
- open up the blood vessels
- increase the odds of recovery
- don't let it happen again
- **Break up the clot**: t-RA = recombinant tissue plasminogen activity (thrombolytic)
- **Remove the clot**: EVT (endovascular treatment) - thrombectomy
78
Ischemic Stroke can either be
Thrombotic (fixed clot)
Embolic (floating clot)
79
Preventions for Ischemic (to prevent further damage)
Prevent clots - **do not thin the blood**
**Antiplatelets**
- platelets will not stick as easily
- Meds: ASA, Plavix (Clopidogrel)
**Anticoagulants**
- Interfere w/ the coagulation cascade
- Meds: Heparin, Warfarin, Rivaroxaban, Apixaband
80
Hot Stroke
symptoms which are hyperacute and within 6hrs
stroke the occurs less than 6hrs ago
81
VAN+
Larger Vessel Occlusion
82
Types of Hemorrhagic Strokes
Intracerebral
Subarachnoid
83
Intracerebral Hemorrhage
bleeding into the brain tissue
**S/S**:
- headache
- nausea/vomiting
- changes to LOC
- seizure (ICP)
**Causes**:
- HTN
- trauma
- tumor
- infection
- medications
- AVM
84
Blood in the cranial vault means
increased intracranial pressure (ICP)
85
ICP
intracranial pressure
86
Subarachnoid Hemorrhage
bleeding into the **subarachnoid space**
**S/S**:
- worst headache ever (thunder clap)
- nuchal rigidity (stiff neck)
- Photophobia
- nausea/vomiting
**Causes**:
- AVM
- aneurysm
- trauma
- bleeding disorder
- medication
87
Thunder clap
worst headache ever
88
Nuchal Rigidity
stiff neck
89
Treatment **specific for** Hemorrhage
coiling
- prevents clots from forming, prevents entry of blood into weak space. via artery.
clipping
- to clip off broken area. via craniotomy.
both under general anesthetic
90
Nursing Process
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
91
What is Cushing's Triad?
Symptoms
- low HR (bradycardia)
- irregular respirations
- widening pulse pressure
92
increased pressure can cause...
herniation
93
CVA Diagnostics
Looking at type and causes/risks
doing a CT - to find out what type of stroke
Lab work
- ECG
- INR (international normalized ratio - clotting factors)
- CBC - blood count
94
Identify Stroke Using
FAST VAN
95
FAST VAN
F - Face
A - Arm
S - Speech
T - Time
V - Vision
A - Aphasia
N - Neglect
96
NIHSS
stroke severity, monitor for changes
97
TOR-BSST
stroke swallowing assessment
98
AEIOU TIPS (for 101)
**A**: Alcohol/Acid Base Disorders/Ammonia/Arrhythmias
**E**: Epilepsy/Electrolyte Disorders;
**I**: Insulin
**O**: Overdose
**U**: Underdose/Uremia
**T**: Trauma/Tumor/Thermal Insult (Hypothermia)
**I**: Infection
**P**: Psychiatric/Poisoning
**S**: Stroke/Shock
99
What is the meaning of stupor and lucid
**Stupor**: state of near-unconsciousness or insensibility
**Lucid**: expressed clearly; easy to understand.
100
Neuro Assessment for Right Brain Stroke
- Emotional highs/lows
- Concentration/attention span
- Judgement/Impulsiveness
- Confusion/memory loss
>> Agnosia - objects, faces, places, etc.
>> Anomia – names of everyday objects
- Vision
- Neglect left side
101
Neuro Assessment for Left Brain Stroke
- Cautious/Compulsive behaviours
- Apraxia (movement)
- Aphasia (more on next slide)
>> Expressive aka Broca’s aphasia
>> Receptive aka Wernicke’s aphasia
- Dysarthria (slurring)
- Comprehension
- Neglect right side
102
Obtundation
is a state similar to lethargy in which the patient has
- a lessened interest in the environment
- slowed responses to stimulation
- tends to sleep more than normal with drowsiness in between sleep states.
103
Reticular Activating Sys
is found in the midbrain, pons, medulla and part of the thalamus.
It controls levels of wakefulness, enables people to pay attention to their environments and is involved in sleep patterns.
104
Stroke Immediate Complications
- Airway
- Increased Intracranial Pressure (ICP)
- Seizure
- Death (ex: brains stem stroke)
- Infection: UTI/Urosepsis, Pneumonia
105
Stroke Ongoing Complications
- nutrition
- communication
- motor function
- behaviour
- memory
106
Broca's Area
Expressive (non-fluent) from frontal lobe stroke
- in the left hemisphere
- may still be able to sing!
- Comes from the opposite side of the body.
- May be able to understand but not respond.
- Difficulty in forming complete sentences or trouble in understanding sentences, or may experience both
107
Wernickes
Receptive (fluent) from temporal stroke
- central processing disorder.
- Characterized by the client using wrong or meaningless words that do not make sense.
108
Nursing Process - Assessment
Focus:
- collect
- organize
- validate
- document
eg. Martha, 86yrs,
Dx: Rt. CVA
Hx: HTN, Arthritis, COPD, Colon Ca.
109
Nursing Process - Diagnosis
Focus
- analyze
- identify good/bad
- formulate nursing diagnosis
The purpose is to **identify client needs**
110
Nursing Process - Planning
Focus
- prioritize
- formulate goals and expected outcomes
- select nursing interventions
- write care plan
111
Nursing Process - Implementation
Focus
- begin interventions
- supervise, delegate, communicate w/ team
- determine nursing assistance needed
- reassessing... always
112
Nursing Process - Evaluation
Focus
- collect data and compare
- connect nursing interventions
- draw conclusions
- continue, modify or terminate
113
Kinesthetic
movement awareness
114
Proprioception
position awareness
115
Stereognosis
recognition of object texture and size
