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neurologic system
ch 25
| Question | Answer |
|---|---|
| risk factors for CVA | smoking, diabetic, coronary artery disease, transient ischemic attack, atrial fibrillation, high serum cholesterol, obesity, alcohol, cocaine, age, gender, family history, race, history of CVA, hypertension |
| gender risk for CVA | men at greater risk than women, pregnant women have a greater risk than non preg, bc pills increase risk |
| race risk for CVA | blacks more at risk bc of uncontrolled hypertension |
| diabetic risk for CVA | plaque in A, hight cholesterol, vasoconstriction |
| coronary artery disease risk for CVA | plaque in A, high cholesterol, vasoconstriction |
| transient ischemic attack risk for CVA | temporary loss of consciousness, warning sign of CVA |
| atrial fibrillation risk for CVA | microclots can form adn can travel to brain |
| high serum cholesterol risk for CVA | plaque |
| obesity risk for CVA | high cholesterol |
| alcohol risk for CVA | chronic, hypertension |
| cocaine risk for CVA | vasoconstriction |
| tonic stage of seizure | exxtremities held rigidly |
| clonic stage of seizure | arms move btwn flexion and extension rhythmically |
| postictal stage of seizure | pt difficult to arouse, extremely drowzy |
| absent seizures | no recollection, pt doesnt know its happening |
| test CN II | peripheral vision, snellen chart, confrontation test |
| test CN I | properly identify aromatic substances |
| test CN III, IV, VI | observe eyes for extra ocular movt |
| PERRLA | observe eyes for pupillary size, shape, equality, constriction, accomodation |
| constriction | pupils get smaller when light shined in eye |
| accomodation | when both eyes move together |
| test balance | observe walking, romberg test, eyes closed stand on one foot, tandem walking, hop on one foot then other, knee bends, walk on toes/heels |
| test coordination | rapid pronation/supination on thighs, alternately touch nose with index fingers (eyes closed), touch finger to thumb rapidly, move index finger btwn nose and examiner finger, heel to shin of opp leg |
| romberg test | pt standing, feet together, arms at side, eyes open/closed |
| graphesthesia | identification of number/letter drawn on hand, back, other area |
| streognosis | identification of familiar object in hand |
| DTR (deep tendon reflexes) | muscle contraction response to direct/indirect percussion of tendon |
| procedure for DTRs | pt relaxed, lying or sitting down, patellar, plantar and ankle clonus reflexes, 4+ scoring system |
| patellar reflex | contaction of quadriceps muscles, extension of lower leg |
| plantar reflex | plantar flexion of toes |
| ankle clonus | if hyperactive reflexes, sharply dorsiflex foot, maintain no movt |
| change in level of consciousness is most sensitive indicator of | alterations in cerebral function |
| can determine if pt is alert/oriented by | way that questions are answered during the history |
| awareness | higher level function, controlled by reticular activating system |
| wakefulness | controlled by brainstem |
| recall | tell series of numbers then 5 min later ask them again |
| awareness is assesed by | orientation, memory, attention, calculation, recall, language, judgement, insight, abstraction |
| first orientation to disappear | time/date |
| 2nd orientation to disappear | place |
| last orientation to disapper | person |
| orientation returns in which order | opp in which lost |
| arousal | modified assesment for unconsious, assume they can hear, pupillary rxn (hold eye open and shine light), smell breath (ketones, alcohol) |
| CN III | pupillary response, originates in brainstem |
| small reactive pupils | bilateral cerebral dysfunction |
| bilaterally dilated pupils | overdose of hallucinogens or CNS stimulants, pressure in brainstem compressing CN III bilaterally |
| glascow coma scale | assess for best response to eye opening, motor response and verbal response |
| test for meningeal irritation | used when meningitis is suspected, kernigs sign |
| kernigs sign | flexing one leg at hip and knee then extending knee, no pain means negative, pain along vertebral column when leg is extended is a positive sign of inflamm of meninges |
| brudzinskis sign | tests for meningeal irritation |
| procedure for brudzinskis sign test | client supine, neck flexed |
| + brudzinskis sign | client passively flexes knee in response to head flexion, reports pain along verterbral column |
| meningitis | inflamm of meninges that surround brain spinal chord, invasion of bacteria, viruses, fungi, parasites, or other toxins |
| most common meningitis | bacterial |
| viral meningitis | self limiting infection with full recovery |
| symptoms of meningitis | severe headache, fever, generalized malaise |
| signs that show meningitis | stiff neck, + kernigs sign, + brudzinskis sign |
| result of menigitis | level of consciousness may decrease, may progress to stupor or coma, confusion, agitiation, irritability can occur |
| 2nd most common neurodegenerative disease after alzheimers | parkinsons |
| clinical findings of parkinsons | resting tremor, bradykinesia (slow movt), rigidity, masklike fcies, trunk forward flexion, muscle weakness, shuffling gait, finger pill rolling tremor, cogwell rigidity (when pull arm up it shakes down) |
| parkinsons | develops slowly, brains dopamine producing neurons in substantia nigra of basal ganglia degenerate |
| how a CVA happens | cerebral blood vessels occluded by thrombus/embolus or intracranial hemorrhage occurs, brain tissues ischemic |
| occurence of CVA by what | 80% by blood vessels, 20% by hemorrhage |
| hemorrhage | hypertension or cerebral aneurysm (weakened area of artery that ballons from high pressure) |
| symptoms of CVA | directly related to areas of brain involved/extent of ischema , sudden unilateral numbness/weakness of face, arm, leg, trouble walking, dizziness, loss of balance, sudden severe headaches, aphasia, sudden confusion, dysphagia, part loss of vision |
| guillian barre syndrome | widespread demyelinization of nerves of PNS |
| Gullian barre syndrome believed to be caused by | cell mediated immune response to viral infection, respiratory/GI viral infection weeks before onset |
| recovery of Gullian barre | 80-90% have few or no residual deficits, could die if respiratory depression develops rapidly |
| clinical findings of gullian barre | ascending paralysis, descending variation, deep tendon reflex absent, paralysis of thorax (respiratory depression) |
| ascending paralysis | begins with weakness/paresthesia in lower extremities, ascends to upper extremities/face |
| descending variation | facial, glossopharyngeal, vagus, hypoglossal CNs. downward to hand, cant reach feet |
| in romberg test if client sways with eyes closed but not open problem is | proprioceptive |
| in romberg if client sways with eyes open and closed prob | cerebellar disorder |
| pupils should appear | equal, round and reactive to light and accomodation (documented as PERRLA) |
| what can cause diminished to absent pupillary constriction, ptosis of eye, altered superior and inferior movt of eyeball | increased intracranial pressure or trauma to midbrain, causes pressure on CNIII |
| glascow coma scale is used to asses | level of consciousness using a 15pt scale |
| glascow coma scale asseses | best response to eye opening, motor response, verbal response |
Created by:
ashley0683
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