Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Chapter 23
Neurological
| Question | Answer |
|---|---|
| Hyporeflexia | which is the absence of a reflex, is a lower motor neuron problem. It occurs with interruption of sensory afferents or destruction of motor efferents and anterior horn cells, e.g., spinal cord injury |
| Reinforcement is another technique to relax the muscles and enhance the response | (blank) |
| Biceps Reflex (C5 to C6). | You can feel as well as see the normal response, which is contraction of the biceps muscle and flexion of the forearm |
| Triceps Reflex (C7 to C8) | The normal response is extension of the forearm |
| Brachioradialis Reflex (C5 to C6). | The normal response is flexion and supination of the forearm |
| Quadriceps Reflex ("Knee Jerk") (L2 to L4) | Extension of the lower leg is the expected response. You also will palpate contraction of the quadriceps |
| Achilles Reflex ("Ankle Jerk") (L5 to S2) | The normal response as the foot plantar flexes against your hand |
| Clonus | repeated reflex muscular movements |
| Test for clonus | when the reflexes are hyperactive. Support the lower leg in one hand. With your other hand, move the foot up and down a few times to relax the muscle. Then stretch the muscle by briskly dorsi |
| Neurologic Screening Examination | Mental status, Cranial nerves (II – VII) |
| Motor function | Gait and balance, Knee flexion hop or shallow knee bend |
| Sensory function | Superficial pain and light touch, arms and legs, Vibration, arms and legs |
| Reflexes | Biceps, Triceps, Patellar, Achilles |
| Neurologic Complete Examination | Mental status, Cranial nerves II through XII, |
| Motor system | Muscle size, strength, tone, Gait and balance, Rapid alternating movements |
| Sensory function | Superficial pain and light touch, Vibration, Position sense, Stereognosis, graphesthesia, two |
| Pupillary Response | Note the size, shape, and symmetry of both pupils. |
| Pupillary Response | Abnormal Findings, In a braininjured person, a sudden, unilateral, dilated and nonreactive pupil is ominous . |
| Pupillary Response | Abnormal Findings, Cranial nerve III runs parallel to the brain stem. |
| Pupillary Response | Abnormal Findings, When increasing intracranial pressure pushes the brain stem down (uncal herniation), it puts pressure on cranial nerve III, causing pupil dilatation. |
| Vital Signs | Measure the temperature, pulse, respiration, and blood pressure as often as the person's condition warrants |
| Vital Signs | Pulse and blood pressure are notoriously unreliable parameters of CNS deficit,Any changes are late consequences of rising intracranial pressure |
| Vital Signs | Abnormal Findings, The Cushing reflex shows signs of increasing intracranial pressure: blood pressure—sudden elevation with widening pulse pressure; pulse—decreased rate, slow and bounding |
| The Glasgow Coma Scale (GCS) | A reliable quantitative tool |
| The Glasgow Coma Scale (GCS) | The GCS is a standardized, objective assessment that defines the level of consciousness by giving it a numeric value |
| The Glasgow Coma Scale (GCS) | The total score reflects the brain's functional level |
| The Glasgow Coma Scale (GCS) | A fully alert, normal person has a score of 15 |
| The Glasgow Coma Scale (GCS) | A score of 7 or less reflects coma |
| Superficial Reflexes | The receptors are in the skin rather than the muscles |
| Level of Consciousness | *** A change in the level of consciousness is the single most important factor *** |
| Level of Consciousness | *** It is the earliest and most sensitive index of change in neurologic status |
| Level of Consciousness | *** A change in consciousness may be subtle. Note any decreasing level of consciousness, disorientation, memory loss, uncooperative behavior, or even complacency in a previously combative person |
| Level of Consciousness | *** Note the ease of arousal and the state of awareness, or orientation |
| Level of Consciousness | *** Assess orientation by asking questions about: Person; own name, occupation, names of workers around person, their occupations, Place; where person is, nature of building, city, state, Time; day of week, month, year |
| Reflex Grading | 4+ Very brisk, hyperactive with clonus, indicative of disease, Clonus is a set of short jerking contractions of the same muscle, Hyperreflexia is the exaggerated reflex seen when the monosynaptic reflex arc is released from the influence of higher cortic |
| Reflex Grading | 3+ Brisker than average, may indicate disease |
| Reflex Grading | 2+ Average, normal |
| Reflex Grading | 1+ Diminished, low normal |
| Reflex Grading | 0 No response |
| Hyporeflexia | which is the absence of a reflex, is a lower motor neuron problem. It occurs with interruption of sensory afferents or destruction of motor efferents and anterior horn cells, e.g., spinal cord injury |
| CN I | Olfactory Sensory Smell |
| CN II | Optic Sensory Vision |
| CN III | Oculomotor Mixed EOM movement, raise eyelids and parasympathetic pupil constriction |
| CN IV | Trochlear Motor down and inward eye movement |
| CN V | Trigeminal Mixed motor (mastication muscles); sensory (sensation of the face,scalp, cornea, nose) |
| CN VI | Abducens Motor lateral movements of the eye |
| CN VII | Facial Mixed motor (facial muscles, close eyes, labial speech); sensory (taste) parasympatheic (saliva and tear secretion) |
| CN VIII | Acoustic sensory hearing and equilibrium |
| CN IX | Glossalpharyngeal Mixed motor( phonation and swallowing) sensory (taste (outer third), gag reflex) parasympathetic (parotid gland, carotid reflex) |
| CN X | Vagus , Mixed, Motor(talking and swallowing) sensory (greater sensation from carotid body, carotid sinus, pharnyx, viscera) parasympathetic (carotid reflex) |
| CN XI | Spinal , motor, trapezius and sternomastoid muscles |
| CN XII – Hypoglossal, motor, movement of tongue | (blank) |
| Paresis | is a partial or incomplete paralysis. |
| Paralysis | is a loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation. |
| Dysmetria | is the inability to control range of motion of muscles. |
| Paresthesia | is an abnormal sensation, e.g., burning, tingling. |
| Cranial Nerve I—Olfactory Nerve | (blank) |
| Cranial Nerve II—Optic Nerve | (blank) |
| Cranial Nerves III, IV, and VI—Oculomotor, Trochlear, and Abducens Nerves | (blank) |
| Ptosis | (drooping) occurs with myasthenia gravis, dysfunction of cranial nerve III, or Horner's syndrome |
| Strabismus | (deviated gaze) or limited movement |
| Cranial Nerves III, IV, and VI—Oculomotor, Trochlear, and Abducens Nerves | (blank) |
| Nystagmus | is a backandforth oscillation of the eyes. Endpoint nystagmus, a few beats of horizontal nystagmus at extreme lateral gaze, occurs normally. Assess any other nystagmus carefully, noting: |
| Pendular movement | (oscillations move equally left to right) or jerk (a quick phase in one direction, then a slow phase in the other). Classify the jerk nystagmus in the direction of the quick phase. |
| Cranial Nerve V—Trigeminal Nerve | (blank) |
| Cranial Nerve V—Trigeminal Nerve | (blank) |
| Corneal Reflex. | **This procedure tests the sensory afferent in cranial nerve V and the motor efferent in cranial nerve VII** |
| Cranial Nerve VIII— | Acoustic (Vestibulocochlear) Nerve |
| Cranial Nerves IX and X—Glossopharyngeal and Vagus Nerves | (blank) |
| Cranial Nerve XI—Spinal Accessory Nerve | (blank) |
| Cranial Nerve XII—Hypoglossal Nerve | (blank) |
| Atrophy—abnormally small muscle with a wasted appearance; occurs with disuse, injury, lower motor neuron disease such as polio, diabetic neuropathy. | (blank) |
| Hypertrophy—increased size and strength; occurs with isometric exercise. | (blank) |
| Flaccidity—decreased resistance, hypotonic. | (blank) |
| Spasticity and rigidity—types of increased resistance | (blank) |
| Gait | *** Inability to tandem walk is sensitive for an upper motor neuron lesion, such as multiple sclerosis*** |
| Ataxia—uncoordinated or unsteady gait | (blank) |
| Positive Romberg sign is loss of balance that occurs when closing the eyes | A positive Romberg sign occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication), loss of proprioception, and loss of vestibular function |
| Cerebellar Function | (blank) |
| Abnormal Findings | (blank) |
| Hypalgesia—decreased pain sensation | (blank) |
| Analgesia—absent pain sensation | (blank) |
| Hyperalgesia—increased pain sensation | (blank) |
| Hypoesthesia—decreased touch sensation | (blank) |
| Anesthesia—absent touch sensation | (blank) |
| Hyperesthesia—increased touch sensation | (blank) |
| Posterior Column Tract | (blank) |
| Tactile Discrimination (Fine Touch)Abnormal Findings | lesions of the sensory cortex or posterior column |
| Stereognosis | Test the person's ability to recognize objects by feeling their forms, sizes, and weights |
| Astereognosis—inability to identify object correctly. Occurs in sensory cortex lesions, e.g., brain attack (stroke) | (blank) |
| Posterior Column Tract | (blank) |
| Graphesthesia | The ability to "read" a number by having it traced on the skin. Graphesthesia is a good measure of sensory loss if the person cannot make the hand movements needed for stereognosis (e.g. arthritis) |
| TwoPoint Discrimination | Test the person's ability to distinguish the separation of two simultaneous pin points on the skin. |
| Abnormal Findings | An increase in the distance it normally takes to identify two separate points occurs with sensory cortex lesions |
| Extinction | Simultaneously touch both sides of the body at the same point. Ask the person to state how many sensations are felt and where they are. Normally, both sensations are felt. |
| Abnormal Findings | The ability to recognize only one of the stimuli occurs with sensory cortex lesion; the stimulus is extinguished on the side opposite the cortex lesion |
| Point Location | Touch the skin, and withdraw the stimulus promptly. Tell the person, "Put your finger where I touched you." (You can perform this test simultaneously with light touch sensation), |
| Abnormal Findings | With a sensory cortex lesion, the person cannot localize the sensation accurately, even though light touch sensation may be retained. |
| Stretch, or Deep Tendon Reflexes (DTRs) | Measurement of the stretch reflexes reveals the intactness of the reflex arc at specific spinal levels as well as the normal override on the reflex of the higher cortical levels |
| Corticospinal or Pyramidal Tract. | The area has been named "pyramidal" because it crosses through the pyramids of the medulla |
| Corticospinal or Pyramidal Tract. | Motor nerve fibers originate in the motor cortex and travel to the brain stem, where they cross to the opposite side (pyramidal decussation) and then pass down in the lateral column of the spinal cord |
| Corticospinal or Pyramidal Tract. | At each cord level, they synapse with a lower motor neuron contained in the anterior horn of the spinal cord |
| Corticospinal or Pyramidal Tract. | Ten percent of corticospinal fibers do not cross, and these descend in the anterior column of the spinal cord |
| Corticospinal or Pyramidal Tract. | ***Corticospinal fibers mediate voluntary movement, particularly very skilled, discrete, purposeful movements, such as writing*** |
| Extrapyramidal Tracts | Include all the motor nerve fibers originating in the motor cortex, basal ganglia, brain stem, and spinal cord that are outside the pyramidal tract, Older, "lower," more primitive motor system , These subcortical motor fibers maintain muscle tone and con |
| Cerebellar System | Coordinates movement, maintains equilibrium, and helps maintain posture, The entire process occurs on a subconscious level |
| Upper motor neurons | Complex of all the descending motor fibers that can influence or modify the lower motor neurons, Located completely within the CNS |
| Lower motor neurons | Located mostly in the peripheral nervous system,Any movement must be translated into action by lower motor neuron fibers |
| A nerve is a bundle of fibers outside the CNS | (blank) |
| The peripheral nerves carry input to the CNS via their sensory afferent fibers and deliver output from the CNS via the efferent fibers | (blank) |
| There are four types of reflexes: | Deep tendon reflexes,Superficial (corneal reflex, abdominal reflex), Visceral (pupillary response to light and accommodation), Pathologic (Babinski's or extensor plantar reflex) |
| The deep tendon (myotatic or stretch) reflex has five components | An intact sensory nerve (afferent), A functional synapse in the cord, An intact motor nerve fiber (efferent), The neuromuscular junction, A competent muscle |
| Cranial nerves enter and exit the brain rather than the spinal cord | 12 pairs of cranial nerves supply primarily the head and neck, except the vagus nerve which travels to the heart, respiratory muscles, stomach, and gallbladder |
| Spinal Nerves | The 31 pairs of spinal nerves arise from the length of the spinal cord and supply the rest of the body, Named for the region of the spine from which they exit: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal “Mixed" nerves because they conta |
| Central nervous system (CNS) | includes the brain and spinal cord |
| Peripheral nervous system | includes the 12 pairs of cranial nerves, the 31 pairs of spinal nerves, and all their branches, Carries sensory messages to the CNS from sensory receptors (afferent nerves),Carries motor messages from the CNS out to muscles and glands (efferent nerves),C |
| Cerebral Cortex | The cerebral cortex is the cerebrum's outer layer of nerve cell bodies, which looks like "gray matter" because it lacks myelin, Center for humans' highest functions, governing thought, memory, reasoning, sensation, and voluntary movement |
| Hemispheres | Left hemisphere is dominant in most (95 percent) people, including those who are lefthanded, Divided into four lobes: frontal, parietal, temporal, and occipital |
| The frontal lobe | personality, behavior, emotions, and intellectual function |
| The precentral gyrus of the frontal lobe | voluntary movement |
| The parietal lobe's postcentral gyrus | sensation |
| The occipital lobe | visual receptor center |
| The temporal lobe | auditory reception center |
| Wernicke's area in the temporal lobe | language comprehension ,When damaged in the person's dominant hemisphere, receptive aphasia results |
| Broca's area | in the frontal lobe motor speech, When injured in the dominant hemisphere, expressive aphasia results |
| THE CENTRAL NERVOUS SYSTEM (CNS) | The basal ganglia gray matter buried deep within the two cerebral hemispheres that form the subcortical associated motor system (the extrapyramidal system) , They control automatic associated movements of the body, (e.g., the arm swing alternating with t |
| Thalamus | The thalamus main relay station for the nervous system,Sensory pathways of the spinal cord and brain stem form synapses |
| Hypothalamus | A major control center with many vital functions: temperature, heart rate, and blood pressure control, sleep center, anterior and posterior pituitary gland regulator, and coordinator of autonomic nervous system activity and emotional status |
| Cerebellum | Motor coordination of voluntary movements, equilibrium, and muscle tone,It does not initiate movement but coordinates and smooths it |
| Brain Stem | The brain stem is the central core of the brain consisting of mostly nerve fibers. It has three areas: Midbrain, pons, medulla |
| Midbrain | contains many motor neurons and tracts |
| Pons | containing ascending and descending fiber tracts |
| Medulla | contains all ascending and descending fiber tracts connecting the brain and spinal cord,Vital autonomic centers (respiration, heart, gastrointestinal function),Contains nuclei for cranial nerves VIII through XII,Pyramidal decussation (crossing of the mot |
| Spinal Cord | The main highway for ascending and descending fiber tracts that connect the brain to the spinal nerves, and it mediates reflexes |
| Sensory Pathways | Sensation travels in the afferent fibers in the peripheral nerve, then through the posterior (dorsal) root, and then into the spinal cord, There, it may take one of two routes Spinothalamic tract , Posterior (dorsal) columns |
| Spinothalamic Tract | The spinothalamic tract contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch |
| Posterior (Dorsal) Columns | These fibers conduct the sensations of position, vibration, and finely localized touch. |
| Position (proprioception | Without looking, you know where your body parts are in space and in relation to each other |
| Vibration | Feeling vibrating objects |
| Finely localized touch (stereognosis | Without looking, you can identify familiar objects by touch |
Created by:
holtanmir
Popular Nursing sets