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Neurological exam

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
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
Created by: purpleapple87