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Neurological exam
| Question | Answer |
|---|---|
| Two major types of cells that make up the nervous system | Glia cell Neuron/nerve cell |
| Cell that receives and transmits messages | Neuron |
| Supports and protects the neurons | glia cells |
| 3 neuron types | Motor/efferent, sensory/afferent, intermuncial |
| Neuron that transmits impulses away from the brain or spinal cord to muscle or glandular tissue | Motor/efferent |
| Neuron that transmits nerve impulses to the spinal cord or brain | Sensory/afferent |
| Conducts impulses from sensory to motor neurons. | Internuncial |
| Neuron that lies entirely within the CNS | Internuncial |
| Receives impulses from adjacent cells, relays them into cell body. | Dendrites |
| Long projection which transmits impulses away from the cell | axon |
| Covers most fibers in the CNS, allows impulses to travel more smoothly and quickly. | Mylin |
| all peripheral nerve fibers are covered by a sheath called | neurilemma |
| Some of this cell forms the neurilemma, and also secretes mylin | Schwann |
| If destroyed which will regenerate? Nerve cells or nerve fibers? | Fibers |
| I am destroyed by Guillane barre, or MS. Without me, the person is fatigued | Mylin |
| My main role is to support/protect the neuron. | Glia cell |
| Most tumors in the CNS arise from ______ cells. With a brain tumor, you can have a ________ overgrowth | Glia cells neuroglia overgrowth |
| Composed of central and peripheral divisions | Nervous system, central- brain and spinal cord |
| Control center of CNS | Central brain/spinal cord |
| Links the CNS with the rest of the body | Peripheral division; includes the autonomic nervous system, cranial and spinal nerves |
| Six divisions of the brain | 1. Cerebrum 2. diencephalons (includes Thalmus/hypothal 3. cerebellum 4. medulla oblongata 5. pons 6. midbrain |
| Parkinsons is a degeneration of.... | basal ganglia |
| S/S of...... decreased blink rate, absence of arm swing while waking, balance problems, cogwheel movement. Decreased dopamine | Parkinsons |
| Two hemispheres make up the cerebrum, each is divided into two lobes... | Frontal, parietal, temporal, occipital |
| Memory and reasoning are centered in the _________ cortex. | cerebral |
| Which lobe? helps regulate personality and thought processes, contains motor speech area, written speech, controls voluntary muscle movement | frontal lobe |
| Lobe that contains centers for hearing, taste and smell | Temporal |
| Lobe that is the major area of perception. How we perceive things, distinguishes size, shape, distance. Hot, cold, pressure and pain | Parietal |
| Lobe that receives and interprets visual stimuli, contains visual speech area. Allows us to read and understand what is read. | occipital |
| Area located deep within the cerebral hemispheres. Assists with voluntary movement, and control of autonomic movement. allows smoothness to voluntary movements. | basal ganglia |
| This area includes the hypothalmus and thalmus | Diencephalon |
| control center for appetite, temperature, water balance, BP, pituitary function and hormone balance. | Hypothalmus |
| Acts as a relay point, all sensory impulses stop here. it synthesizes and relays the impulse to the appropriate cortical area | Thalmus |
| Area of the brain responsible for coordinating voluntary muscle activity. Maintains posture, balance, muscle tone. | Cerebellum |
| _____ system controls appetite, sexual activity, and aggression. | Lymbic |
| Gray or white matter? Nerve cells | Gray |
| White matter | Fiber |
| You are working with your preceptor nurse who is performing a neurological assessment on a patient just admitted from a MVA. She assesses his response to pressure but not to temperature. What should you do? | Nothing,she is correctly leaving out temperature because both senses come from the same area; parietal lobe. If one sense works, the others will also. |
| This area of the body is composed of the midbrain, pons, and medulla. | brain stem |
| All vital centers are located here. A. Occipital lobe B. Temporal C. Cerebellum D. medulla | D. medulla |
| This area is the pathway between the brain stem and upper brain | Midbrain |
| Sometimes considered the upper part of brain stem, acts as a relay station between the higher and lower centers | Midbrain |
| Area that regulates our breathing; pneumotaxic center | pons |
| I tell the body what to do,without me, you are dead. I control respiratory, vomit, cardiac, vasomotor, hiccuping. | medulla oblongata |
| meninges that lines skull, outermost layer of brain. Major vessels go underneath in the subarachnoid space. | Dura mater; tough mother |
| Mater that hosts 80% of aneurysms | Dura mater |
| Layer of meninges right next to the brain. | Pia mater |
| middle layer of the meninges | arachnoid mater |
| The white matter of the spinal cord contains _________. | Nerve fibers, forms tracts that take information to and from brain. |
| Csf is secreted by the _______ ______, which are networks of capillaries that project from the pia mater into the lateral ventricles of the brain. | Choroid plexus |
| CSF circulates through all ventricles, through the central canal in the cord, into the _________ spaces, then back into the blood | subarachnoid |
| How many milliliters of CSF are in the body of an adult? | 145 |
| Pupils dilated, sympathetic or para? | Sympath |
| Salivary gland watery secretions, sympathetic or para? | Para |
| Bronchi constricts sympathetic or para? | para |
| Increased HR sympathetic or para? | sympath |
| Dilation of coronary vessels sympathetic or para? | sympath |
| Gi muscles stimulated peristalsis sympathetic or para? | para |
| GU muscles, relaxed detrussor muscle sympathetic or para? | sympath |
| You are a man, a bear is chasing you, how would your penis react? sympathetic or para? | sympath- ejaculate Para- erection Nobody wins |
| Skeletal muscle vessels how do their reactions between sympathetic or para differ? | Sympath, dilation occurs Para, has no effect |
| Skin and other vessels, how do their reactions between sympathetic or para differ? | Sympath, constriction occurs, para, no effect |
| These drugs mimic sympathetic nervous system | Adrenergic |
| these drugs mimic parasympathetic | Cholinergic |
| Which cranial nerves are all checked together? | 3- Ocular 4- trochlear 6- abducens |
| Nerve for sense of smell, where originated in brain? | I. Olfactory/ Sensory; anterior ventral cerebrum |
| Nerve for vision where originated in brain? | II. optic/ Motor; thalamus |
| Nerve for pupils and eyelid opening origination? | III/. oculomotor/ Motor; midbrain IV. trochlear; Motor VI. abducens; Motor |
| cranial nerve IV. Origination? | IV. Trochlear- *according to tb- one eye movement muscle; superior oblique muscle. Motor; midbrain |
| Nerve for sensation to face, allows to clench teether and palpate jaw muscle, corneal sensation. origins? | V. trigeminal /Both; pons |
| Nerve for Eye movement, origin? | VI. abducens. motor; pons |
| Nerve that allows you to make faces. Taste on the front 2/3 of tongue. Origins? | VII. facial; both; pons/medulla junction |
| Nerve that allows hearing and balance. Origins? | VIII. vestibulocochlear; sensory; junction of pons/medulla |
| Nerve that supports ability to move superior pharyngeal muscles; taste from pharynx to posterior tongue. | IX. glossopharyngeal; both; medulla |
| Nerve that controls gag reflex, swallow, ahhh sound, taste on back 1/3 of tongue. origin? | X. Vagus; both; medulla |
| Nerve that allows shoulder shrug and turn of head. Origin? | XI. accessory; motor; medulla |
| allows movement of tongue. Origin? | XII. hypoglossal: motor; medulla |
| Which nerves should be assessed every time you do an assessment? | II. optic III. oculomotor IV. trochlear VI. abducens X. Vagus |
| How do you test the vagus nerve? | *tongue depressor on back of tongue, assess gag reflex. *tell them to say ahh *Offer them water, watch them swallow *place something on the back 1/3 of tongue and see if they can taste it. |
| Positive babinski in an adult reveals? | upper motor neuro damage, seen with cerebral hemisphere lesions. |
| S/S of IICP | *Change in LOC *Decreased sensory/motor response* Pupil changes, PERRLA 1.5-6mm is normal *VS changes are late *projectile vomiting not related to eating *HA r/t compression of arteries/veins and cranial nerves. |
| Normal intracranial pressure? | 0-15 |
| Medical management of IICP? | *Mannitol most common given over 30minute. Very hypertonic, pulls fluid from brain tissue. assess fluid/electro close. *Lasix, bumex, edecrin. Reduces blood volume. causes reduction in prod of CSF *Mechanical vent; PaO2/Co2 remains in normal limits. |
| CO2 normal levels? | Normal 35. |
| Mannitol administration? | Give IV, always use a filter, patient will be on a foley. |
| IV fluids used with IICP? | .45, .9NS or RL. NOT D5W |
| Norm CPP (cerebral perfusion pressure) XX-XX Less than __ is ischemic Less than __ death | *70-100 *50 *30 |
| How is MAP calculated? | MAP= SBP + 2 dBP/3 |
| CPP= ? | CPP=MAP-ICP |
| Nursing DX altered tissue perfusion What interventions? | *HOB at 30 degrees *head in midline position no extreme rotataion/flexion of neck *Avoid valsalva *Hip flexion <60 degrees *Avoid turn/suction/loud noises. Etc. allow 15-60 minutes between activity *Conrol seizure quickly with Valium, Dilantin, or at |
| Nsg DX Ineffect breathing pattern; maintain airway to prevent hypoxia/hypercarbia Interventions? | *Suction PRN *Monitor ABG’s *Caution with suctioning; it will increase ICP, go down 2 times suction no longer than 10-15 seconds |
| NSG DX R/F fluid volume deficit/overload Interventions? | *Watch Urine output *Keep strict I&O *IV fluids as ordered. *Watch labs, Normal Na+ 135-145, very imp to brain Less than 120/more than 150 causes changes, seizure |
| Normal ICP? | < or = to 15 norm |
| Patient undergoing Continuous ICP monitoring has an ICP of ___ to ___ They display symptoms. | 20-25 |
| ICP is life threatening if at __ level. | 40 or more |
| Three ways to monitor continuous ICP | 1 Ventricular Cath 2 Subarachnoid screw/bolt 3 Subdural or epidural placement. |
| The most common (70-80%) type of skull fX is..... treated by? | Linear, TX with Tylenol for pain |
| *Skull fx, bone broken or crushed into small pieces. TX dependent on severity When/what kind of tx will be done? | *Surgery may be done immediately to remove fragments. *Cranioplasty maybe delayed for 6mo to allow postop swelling to subside |
| An inward depression of the bone fragment in the skull, can be seen/felt | depressed fx |
| Fracture that occurs at the base of the skull (over frontal/temporal lobes) S/S that indicate fracture? | Basilar fracture, indicated by- * CSF coming from the ear/nose. *Raccoon eyes *Battles sign *Blood behind the eardrum. |
| Basilar fracture, diagnosed by Xray T/F? | false, dx by presence of Csf, raccoon eyes, blood behind eardrum, battles sign |
| Which hematoma? A . usually arterial in origin b. frequent associated with fx of temporal bones (meningeal artery) c. unconscious immed after injury then lucid and alert for hours/days, followed by coma. d. show signs of IICp | Epidural |
| Which hematoma is a bleed between the skull and dura | epidural |
| Contusion that occurs in the area of the brain opposite site of trauma | contrecoup |
| TX of basilar fx includes (select all that apply) A. Levaquin, given prophylactally B. Sterile cotton in nose or ear C. Bedrest D. Acetaminophen | B,C,D |
| Epidural bleed, what surgical tx is necessary? | Evacuation, prognosis better with early detect/tx. DX by CT |
| S/S of what serious disorder? Irritable, motor weakness, ipsolateral pupil dilation | IICP |
| which hematoma? Bleed between the dura and arachnoid in the subdural space. | subarachniod |
| S/S of which hematoma *H/A,drowsiness, worsening confusion *Ipsilateral pupil dilation *often mistaken for stroke | Chronic subdural hematoma |
| 1. Test which includes placing ice cold water in ear. Why is it done? | Occulovestibular response; tests brain activity |
| Known as Doll’s eyes occulocephalic reflex | If head is turned rapidly, eye response is to go opposite way head is turned |
| What reflex assessment requires a drop to be placed in the eye to Determine brain activity? | Corneal reflex |
| Patient is 56 years old, says her doc diagnosed her with a primary tumor. She Has had a history of liver problems and assumed that is where this tumor came from. She asks you if this tumor will spread to her brain. What do you tell her? Teaching? | Primary tumors rarely met outside the CNS, which is where they originate. Her liver problems would not be the origination, primary comes from the CNS |
| Tumor which arises from tissue outside the CNS and spreads to the brain | secondary/metastatic |
| CNS tumor patient, can they donate their organs? | yes |
| Most common brain tumor, accounts for 65% | Glioma, arise from glial cells |
| Type of glioma? Most common, rapid growth. | astrocytoma |
| Highly malignant glioma, spreads rapidly, sends out ‘feelers” | Glioblastoma Think "Glee"+ "jazz hands"=feelers |
| Glioma rapid extension, highly malignant, often seen in children | Medulloblastoma |
| Why are the gliomas difficult to remove? | Primarily infiltrates the tissue, not encapsulated |
| Arise from meninges, most common in African American | mengioma, can be removed |
| Tumor within the frontal lobe (localized) would cause what manifestations? | personality change |
| Location of tumor that would cause visual changes? | occipital |
| Tumor location that affects perception, heat/cold. | parietal |
| What signs would you expect to see in a patient with a tumor On their temporal lobe? | few s/s |
| Signs/symptoms of generalized tumor? | *h/a, intermit, worst in morning. *projectile vomit, not related to eating *papilledema MAY BE FIRST SIGN *seizure *dizziness/vertigo *Mental stat changes |
| What related to the optical disk may be the first sign of ICP? | Optic disk blurred, not sharply defined. |
| Surgery that tx grossly infiltrated tumors. CT scan id site of tumor, Radioactive pellets may be implanted. Laser/radiation can be delivered With this approach. | Stereotactic (3D image) |
| Surgery that allows deep inaccessible tumor to be tx. No incision, disadvantage Is lag time btwn tx and desired result. | Gamma knife |
| Cranial surgery performed at the posterior fossa, below the cerebellum/brain stem, What are nsg consideration? | *Mtn neck in straight alignment *Avoid flexing neck, prevents tear of suture line *Position on either side, or kept flat, may be at an elevation of 10-15 degree |
| Cranial surgery on the anterior /mid fossa. Nsg considerations? | *kept with head elevated 30-45 degrees to promote drainage. * mtn nasal packing, reinforce if needed *teach to avoid blowing nose. *frequent oral care |
| Reasons for cranial surgery to be done | *removal of tumor, hematoma, or scar tissue that causes seizures *Clip/ligate aneurysm or other vascular abnorm *Drain abscess *Repair fx *Remove object *obtain tissue for biopsy |
| Post op care for cranial surgery Monitor for edema, pain, monitor ICP are main goals. what is the major complication? | IICP r/t edema/bleed. *Position at 30°, hips flexed less than 60° *admin diuretics, assess for fever, NO restraints |
| Assess saturation of dressings or leaking from ear/nose indicates what abnormality after Cranial surgery? | CSF leakage |
| postop cranial surgery, what expectations may you see relating to body temperature? | Erratic, hypothermia may be t/r excess dehydration before surgery. Hyper may be t/r blood in cranium, underlying infection. Or stim of hypothal during surgery |
| What can cause diabetes insipidus to occur after cranial surgery? | too little adh can occur due to injury of the hypthalmus or in edema. SiADH may occur due to excess ADH secretion= low NA level |
| you're a nurse in neuro ICU. Your patient is 2days postop cranial surgery to remove a tumor, you note that the dressing displays slight drainage. What do you do? A. Change it? B. Report that it wasn't done? C. Note the appearance in chart? D. Call MD | C. Dsg won't be changed for up to 3 days and will be done by the surgeon the first time. |
| Patient with meningitis has cloudy CSF, what is likely the cause of their case of meningitis? | bacterial = cloudy |
| Most likely origin of Viral meningitis? | almost always related to a viral infection outside of the CNS (respiratory or GI) Virus enters body replicates and spreads to brain via the blood. |
| Which cranial nerves are involved in a case of Bacterial meningitis? Which may be permanently damaged? | 3. oculomotor 4. trochlear 6. abducens 7. facial 8. acoustic **Hearing may not return** |
| Pt dx with bacterial meningitis is on IV ampicillin, he wants to know how long he'll have to be on the meds. A. 3-4 days B. 12-16 C. 8-10 D. long as Lulu says | C- 8-10 days, 4-6x per day. |
| Isolation required for the bacterial meningitis patient for how many days? | MS. G: In direct contact iso at least 24 hours after initiation of antibiotics. **Textbook says til negative culture! |
| Stiff painful neck R/T irritated meninges, seen with meningitis | nuchal rigidity |
| How do you test for kernig sign? | Patient supine- flex hip, bend at knee. If when you attempts to straighten knee it causes extreme pain, this is a positive kernig sign and indicates meningeal irritation. |
| Patient lying flat, you attempt to bend their neck forward, chin to chest. If the entire body bends in response to pain, what is this test? | Positive brudzinski |
| Inflammation of the brain tissue, most always viral cause A. meningitis B. encephalitis C. Cranitis D. Epiduritis | B |
| viral causes of encephalitis, select all: A. Mosquito B. Measles C. Herpes D. Caused by chronic inflammation of GI or Resp organs. | A- ARBO virus carried by mosquito would be epidemic B, C. most common non epidemic |
| S/S of which illness? *H/A *malaise *dizziness *NV *restless *irritable *stiff neck, tremor, convulsions | encephalitis |
| Teaching for drug Topiramate (Topamax) and What is it given for? | Given for seizure prevention or migraine teach : *don't abruptly discontinue, may cause seizure *avoid tasks that require alertness until response to drug is known *take adequate fluid to decrease r/f renal stone devel. |
| Triptans work by affecting the ________ receptors | Serotonin |
| Teaching for patient prescribed Sumatriptan (Imitrex) | Contraind with pts who have Hx or manifestations of ischemic cardiac, cerebrovascular or peripheral vascular problems. *uncontrolled HTN, imitrex may increase bp *excess dosage may cause tremor, decreased respirations |
| Topiramate (Topamax) SE? | *Hypoglycemia *parasthesia *weight loss *cognitive change Must be taken 2-3 months to determine effectiveness |
| Lobe of brain which controls voluntary muscle movement | Frontal |
| Pressure needed to insure blood flow to the brain | cerebral perfusion |
| Type of vascular headache tx with prednisone and lithium | cluster |
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purpleapple87
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