Neuro Stuff
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| Two main structured divisions of the nervous system. | Central nervous system and the peripheral nervous system.
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| Central Nervous System | is made up of the brain and spinal cord. it occupies a medial positon in the body and is responsible for interperting incomming sensory info and issuing instructions based on past experiences.
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| Peripheral nervous system: | contains 2 main divisons: the somatic nervous system (sends messages from the cns to the skeletal muscles) and the autonomic system, aka the involuntary nervous system, because it's actions take place without concious control.
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| neurons | transmitter cells, carry messages to and from the brain and spinal cord. it is the basic nerve cell of the nervous system and is composed of the cell body, axon and dendrites.
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| the cell body | contains a nucleus surrounded by cytoplasm
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| the axon | cylindric extension of a nerve cell that conducts impulses away from the neuron cell body
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| dendrites | branching structures that extend from a cel body and recieve impulses.
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| between each neuron there is a gap called the _____________. Nerve impulses are transmitted through the action of a neurotransmitter. | synapse
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| cerebrum | the largest part of the brain. it is the outer porton composed of gray matter and is called the cerebral cortex. It also holds the frontal lobe, parietal lobe, temporal lobe, and occipital bloe. It controls movement on the opposite side of body.
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| brain stem | is located at the base of the brain and contains the midbrain (responsible for motor movement and the relay of impulses, auditory and visual reflexes). Pons (sends impulses to the structures that are inferior and superior to it.)
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| the brain stem also includes the: | medula oblangata which controls the heart beat rythem of breathing, swallowing, coughing, sneezing, vomiting and hiccups.
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| cerebellum | is the second largest portion of the brain. it is responsible for coordination of voluntary movement and maintenance of balance, equilibrim and muscle tone.
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| spinal cord | has two main functions: conducts impulses to an from the brain, and serves as a center for reflex actions.
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| peripheral nerves | comprises the motor nerves, sensory nerves, and ganglia outside the brain and spinal cord. It is composed of 31 pairs of spinal nerves, and 12 pairs of cranial nerves, and the autonomic nervous system.
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| cerebrospinal fluid | fluid that surrounds the brain and skull
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| What does the peripheral nervous system contain? | The PNS comprises the motor nerves, sensory nerves, and ganglia outside of the brain and the spinal cord composed of 31 pairs of spinal nerfes, 12 pairs of cranial nerves and the autonomic nerveous system.
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| Spinal nerves | has 31 pairs. They transmit sensory information to the spinal cord through the afferent neurons and motor info from the CNS to the various areas of the body through efferent neurons.
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| Cranial nerves | 12 pair. They conduct impulses between the head, neck, and brain excluding the vagus nerve which serves organs in the thoracic and abd cavities.
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| autonomic Nervous system | control the activities of the smooth muscle, cardaic muscle and all glands. It maintains internal homeostasisi and has two divisions.
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| Two divisions of the Autonomic Nervous System: | sympathetic nervous system and parasympathetic system.
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| Sympathetic Nervous System | Contorl the fight or flight response. hightened bp, hr and adrenal secretions.
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| parasympathetic Nervous System | Calms the body, slows the heart beat, decreases bp and adrenal hormone output.
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| Physiological changes that occur in the nervous system with aging: | Loss of brain weight and a substantial loss of neurons. Genreal decline in interconnections of dendrites, reduction in cerebral blood flow, decrease in brain metabolism and 02 utilization. altered sleep/wake ratio, decrease in ability to reg body temp.
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| More physiological changes that occur in the nervous system with aging: | A decrease in the velocity of nerve impulses, blood supply to the spinal cord is decreased resulting in decreased reflexes.
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| The Glascow Coma Scale | System for assessing the degree of conciousness, or impairment in the criticall ill and for predicting the duration + outcome of coma, particulary w/ head injury.
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| What are the three parts of the Glascow Coma Scale? | 1. eye opening 2. best motor response 3. best verbal response.non-neurological impaired 14-16lowest score is 38 or less is a coma
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| Assess History: | symptoms experiences, pt understanding and perception of what is happening, look for s/s of: headaches, clumsiness loss of function in extremity, change in visual acuity, new or worsened seizure activity, numbness, tingling, personality changes, fatigue.
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| Assess Mental Status: | orientation, mood, behavior, general knowledge, short and long term memory, attention span, ability to concerntrate and a change in LOC.
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| Assess Language and Speech: | look for aphasia, and dysarthria
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| Assess Motor Functions: | gait, muscle tone, coordination, involuntary movements, and muscle stretch reflexes.
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| Assess Cranial __________. | nerves
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| Prevention of neurological problems: | avoid durgs and ETOH, save use of cars, safe swimming practices, safte storage of firearms, use hard hats w/ construction, safe sex, and protective equip w/ sports.
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| 5 S/S of ICP: | 1. visual changes and headaches. 2. change in LOC and blown pupil. 3. widended pulse pressure, increased BP, bradycardia, and hyperflexia. 4. vomiting 5. papilledema (choked eye disc)
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| NSG Interventions for ICP: | elivate HOB 30-45 degrees to promote venous return, place neck in neutral positon, avoid flexion of hip as well as head, restrict fluids, avoid vaslavas manuever, insert foley, admin o2 via mask or cannula, and increase body temp.
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| Tonic Clonic (Grand-Mal) Seizure: | loss of conciousness and falling to floor. signs: aura, cry, loss of conciousness, fall, tonic clonic movements, incontinennce, cyanosis, excessive salvation, tongue or cheek biting. posticatal peroid: need 1-2hr for sleep after.
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| Absence (Petite-Mal)Seizure | usually occurs during childhood and decreases with age. Sudden LOC w/ little or no tonic clonic movement, occurs without warning, and appears a few hours after arising or when pt is quiet. Signs: vacant facial expression w/ eyes focused straight ahead.
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| Psychomotor (austomatisms) seizure: | occurs at any age. characherstics; change in awareness assoc w/ complex disorientation of feelign and tingking and partially coordinated motor activity. signs: behaves as if partially concious, appears drunk, may do anti-social things, incont. sleep nee
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| Jacksonian Focal (local or partial): | occurs in pt w/ brain disease. Characteristerics: depends on site or focus. may or May not be aggressive. Signs: Commonly start in hand, foot, or face. May end in toinc clonic. aura, numbness ingling, crawling feeling and post pandrial peroid.
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| medications for ICP: | osmotic duauretics, and steriods such as decadron and also phenabarbatual
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| intractable pain | pain that is unbearable and does not respond to treatment.
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| non-surgical methods of neuro pain control | TENS, spinal cord stimulation, nerve block, and medication
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| 3 Classic Sx of Parkinson's Disease: | tremmors, rigidity, and bradykenesia
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| Parkinson's Disease | degenerative disease caused by the depletion of dopamine that interferes with the inhibition of excitatory impulses which results in a dysfunction of the extrea pyramidal system. It is slow and progressive results in a crippling disability.
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| Parkinson's Can Result In: | Falls, self-care deficits, depression and failure of body systems.
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| Alterations With Parkinson's Include: | Alterations in muscle tone and function, sensory and perceptual function, propriception, and agnosia, as well as seizures.
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| propriception | the ability to discern the position of the body and its parts without directly looking at them.
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| agnosia | the inability to recognize familiar objects.
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| The Gold Standard Test For Dx MS: | Is an MRI, because they can see the lesions on the spinal cord.
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| Multiple Sclerosis (MS) | Chronic progressive noncontagious disease of the myelin sheath. The cause is unknown but thought to be r/t and autoimmune response or viral infection. Onset is 20-40 usually, and consists of peroids of remission and exacerbation
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| Multiple Sclerosis Cont: | It varies in severity and location, the degree of disability varies, medical management includes meds and assistive devices.
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| Alzheimer's Disease | Chronic degenerative disease of unknown cause gradual rogressive decline of cognition and may begin early 40-50y. Major cause of dementia in the elderly. Early sx: deline in short term memory change in speech, judgement and behavior.
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| charastics of Alzheimer's Diesease: | bradykinesia, muscular rigidity, imbalance, altered VS with changes in positon.
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| Assessments Of Alzheimer's Disease: | pill-rolling movement of one or both extremeities, rigitiy or stiffness of extremities, loss of coordination and balance, shuffling gait, toooped posture, restlessness and pacing, masklike face, slow low voice, drooling, lack of posture adjustment.
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| RPR Test For Sphylisys R/T Alzheimer's: | MD's test for syphylisys to rule it out when looking at a posible dx for alzheimers.
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| NSG Interventions For Alzheimer's | are pallative. safety: alarms on doors etc, respite for care givers, megace to increase appetiete, and Aricept or Nemendia to try and slow the process.
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| Myasthenia Gravis | neuromuscular disease characterized by marked weakness and abnormal fatigue of the voluntary muscles often first seen in eye function. There is a defect in the transmission of nerve impulses at the myoneural junction. thought to be autoimmune.
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| Questionable Causes Of Myasthenia Gravis Include: | insufficient secretion of acetylcholine! Excessive secretion cholinesterase. unresponsiveness of the muscle fibers to acetycholine- a neuro transmitter. And thymic dysfunction in 10-70% of pt.
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| Progressive Symptoms Of Myasthenia Gravis: | attentiveness, long term memory loss, lack of hygiene, inability to recognize the familiar, ultimately unable to communicate or proform voluntary motor functions.
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| diagnostic tests for Myasthenia Gravis: | No known diagnostic tests are available at this time.
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| Nursing Interventions for Myasthenia Gravis: | No known tx. Education and supportive care, slow calm manner, responds more readily to tone of voice and gestures than to conversation.
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| S/S Of Myasthenia Gravis: | weakness and fatigue, difficulty chewing, dysphagia, ptosis, diplopia, weak, hoarse voice, difficulty breathing, diminished breath sounds, resp paralysis and failure. the pt will eventually die.
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| Myasthenia Gravis is currently thought to be: | a disruption of the nerve signal to the receptors on the muscle endplates, d/t antibody attack on ACh receptor sites. The Tyumus is heavily implicaited.
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| Amyotrophic Lateral Sclerosis, AKA Lou Gehrig's disease: | Progressive degererative disease involving the motor system. Sensory and autonomic systems not involved. Mental status does not change as a result of this disease. Death from respiratory infection 2ndary to compromised resp. function.
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| Death ususally occurs within ______ years of onset of amyotrophic lateral sclerosis, aka lou gerig's disease. | 5 years
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| People are usually dx with Amyotrophic Lateral Sclerosis, AKA Lou Gehrig's disease in their ____________. | Mid 30's to 70's.
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| Amyotrophic lateral Sclerosis, AKA Lou Gehrig's disease is 3x more like to effect _________ than ____________. | males than females.
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| Onset S/S of Amyotrophic Lateral Sclerosis: | clumsyness, weakness, hard to climb stairs, difficulty with speech and swallowing.
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| Myasthenic Crisis | an acute exacerbation of disease caused by inadequate amount of meds, infection fatigue or stress.
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| Treatment of myasthenic Crisis: | increase anticholinesterase medications.
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| A Myasthenic Crisis can occur when a patient is __________________________. | overstressed physiologically
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| cholinergic Crisis | Caused by overmedication with anticholinesterase. Treatment: hold medication and give atropine if ordered.
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| Tensilon Test | Used to diagnose MG and to differentite between myasthenic crisis and cholinergic crisis.
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| Huntington's Disease (too much dopamine): | Genetically transmitted and it affects both men and women. Involves basal ganglia and the extrapyramidal motor system. Onset 35-40y, and is genetically transmitted.
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| charastics of huntington's disease: | abnormal and excessive involuntary movements (writing & twisting fo face, limbs and body) deterioration of netal status, no cure treatment is pallative.
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| Bell's Palsy (facial paralysis) | leower motor neuron lesion of the 7th cranial nerve that may occur as a result of trauma, hemorrhage, meningitis, or a turmor. Causes paralysis of one side of the face. usually recovery happens within a few weeks. Posible cause herpes simplex 1.
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| Bell's Palsy Nsg Interventions: | protect the eyes. Eyes can be excessively dry or teary. tinnitus can happen.
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| Trigeminal Neuralgia | Very painful sensory disorder. Severe, recurrent, sharp facial pain along the 5th nerve. Caused by degeneration of or pressure on nerve. Cause unknown. Also called tic Douloureux.
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| Guillian-Barre Syndrome (polyneuritis) | Acute infectious neuronitis of the cranial and peripheral nerves. Immune system overacts to the infection/ destroys myelin sheath. usually preceded by mild upper resp infection or gastritis.
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| Guillian-Barre S/S | starts with weakness of lower extremities and gradually progresses to upper extremities and facial muscles. Recovery is slow and can take years.
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| Major Nursing Concern for Guillian-Barre syndrome (polyneritis) | Breathing Problems.
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| kernig's sign | the inability to extend legs.
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| brudzinski's sign | flexin of the hip and kknee when neck is flexed
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| meningitis | inflammation of the lining of the brain and spinal cord
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| causes of mengitis | bacterial and viral organisms ther eis also fungal and protozoal meningitis.
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| predisposing Factors To Meningitis | droplet spread/ close living quarters. sinus infections- cocaine use, skull fractures or brain or spinal injury, use of nasal sprays on compromised immune system.
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| assessment of meningitis | severe headach, fever, confusion, seizures and coma, nuchal rigidity, lethargy and rash
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| diagnosis of meningitis | diagnosed by lumbar puncture where the CSF is analized for organisms.
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| Treatment of meningitis | big doses of antiboitics and primary preventions: vaccine.
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| agnosia | the inability to recognize objects by sight
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| dysgraphia | difficulty writing
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| dysarthria | slurred speech
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| nuchal | neck
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| diplopia | cross-eyed
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| nystagmus | rapid shaking of the eyes
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| hemianopsia | visual field cut (see only 1/2)
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| homonymous hemianopsia | visual field cut both eyes
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| dysphagia | difficulty swallowing
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| ataxia | impared ability to coordinate movement
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| agnosia | inability to recognize objects by sight
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| aneurysm | a localized dialation of the wall fo a blood vessle
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| aphasia | an abnormal condition in which lang function is deffective or absent becasue of injury ot certian areas of the cerebral cortex
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| apraxia | impairment of the ability to preform purposful acts or to use objects properly
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| ataxia | impaired ability to coordinate movement
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| aura | sensation of light or warmth that may precede the onset of a migrane or seizure.
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| bradykinesia | abnormal sloweness of voluntary movements and speech
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| diplopia | double vision
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| dysarthia | difficult poorly articulated speech resulting from interference in the control over the muscles of speech
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| dysphagia | difficulty swallowing
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| flaccid | weak, soft and flabby muscles lacking normal tone
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| hemianopia | deffective vision or blindness 1/2 visual field
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| hyperreflexia | neurologic condition characterised by increased reflexes and reactions.
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| nystagmus | involuntary rythmic movement of the eyes
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| paresis | a lesser degree of movement deficit from partial or imcomplete parylisis
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| postictal peroid | a rest peroid of variable length after a seizure.
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| to feed someone with a stroke or brain injury it can be better to have them ________________ while eating. | tuck their chin.
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| In an baby this test is normal, in an adult it is not normal. | Brudateinski's Test.
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