neuro 2

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copperkid2
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166331
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neuro 2
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2012-08-19 20:24:00
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neuro 2
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  1. what is dementia?
    • not a disease but symptom of different disorders
    • progressive loss of mental functioning that interferes with memor, ability to think clearly and learn, and eventually ability to function
  2. what can cause dementia
    • huntington's, parkinson's adn alzheimer's cause dementia
    • multiple TIAs
    • medications, chronic alcoholism, neurologic infections, head injuries
    • ppl with less education, few leisure activities and less intellectual stimulation are more likely to develop it
  3. which neuropsychological test is commonly used to diagnose dementia
    • Mini-mental state exam
    • determines degree of memory, personality and behavioral changes
  4. what is delirium
    • temporary mental disturbance that occurs rapidly or gradually
    • considered a medical emergency and should be diagnosed and treated promptly
  5. delirium is characterized by...
    disorganized thinking and difficulty staying focused and is usually seen in older adults experiencing illness
  6. what can cause delirium
    • medication
    • pain
    • oxygen deficiency
    • urinary catheters
    • fluid and electrolyte imbalances
    • change in environment
    • nutritional deficiency
  7. pathophysiology of parkinson's disease
    • cells that make dopamine are slowly destroyed
    • acetylcholine imbalance is created due to lack of dopamine
    • excess acetylcholine causes tremor, muscle rigidity  and akinesia (loss of muscle movement)
  8. parkinson's is linked to the use of which drug
    phenothiazines
  9. signs and symptoms of parkinson's
    • muscular rigidity
    • bradykinesia (slow movement)
    • akinesia (loss of muscle movement)
    • posture change 
    • tremors
    • shuffling short steps
    • pill rolling tremor
    • normal blinking diminished
  10. parkinson's complications
    • constipation
    • orthostatic hypotension
    • drooling
    • dysphagia
    • frequent urination
    • seborrhea (type of skin rash)
    • diaphoresis
  11. common side effect of anticholinergics
    constipation
  12. parkinson's drugs
    • L-Dopa
    • symmetrel
    • artane (anticholinergic)
    • cogentin (anticholinergic)
  13. huntingtons disease
    • progressive, hereditary, degenerative, incurable neurologic disorder
    • progressive loss of movement and intellect
    • involuntary movements start with the arms, face and neck
  14. What is the major difference betweeen huntingtons disease and multiple sclerosis
    loss of intellect happens with huntington
  15. what movements are involved with huntington's disease
    • hesitant speech
    • eye blinking
    • irregular trunk movements
    • abnormal tilt of head
    • constant motion
  16. will holding the chin down while swallowing lessent the chance of aspiration
    yes
  17. which disease is the most common of the several types of dementia
    alzheimer's
  18. which neurotransmitter is deficient in alzheimer's pts
    acetylcholine
  19. how many stages of alzheimer's are there
    • 4
    • stage 1: increaseing forgetfullness 2 - 4 years
    • stage 2: progressive cognitive deterioration 2 - 12 years
    • stage 3: progression to complete dependency
    • stage 4: complete dependency
  20. what is important to determine with alzheimer's and huntington's pts before their cognitive impairment becomes severe
    methods required to sustain life i.e. intubation and tube feeding
  21. which medications are commonly used to treat alzheimer's
    • acetylcholinesterase (AChE) inhibitors; aricept and exelon
    • inhibit breakdown of acetylcholine
    • increased acetylcholine levels allow better function of remainin neurons
    • antidepressants, antipsychotics and antianxiety drugs only treat the associated depression 
  22. what is a transient ischemic attack (TIA)
    • temporary blockage of blood to the brain that causes stroke-like symptoms
    • effects last less than 24 hours with complete recovery
  23. which races are most at risk for a stroke
    • african americans
    • hispanic americans
    • multiracials
    • native americans
  24. what is a penumbra
    area of brain tissue surrounding the damaged tissue that may be revived if a pts stroke is end fast enough
  25. what is a cva (stroke)
    disruption of blood flow to teh brain resulting in death of brain cells
  26. thrombotic stroke
    occlusion in an artery stops blood flow
  27. embolic stroke
    blood clot travels to the brain and stops blood flow in a small vessel
  28. types of stroke
    • ischemic: blood flow is occluded
    • hemorrhagic: cerebral blood vessel ruptures and no blood travels to the rest of the brain
  29. which type of stroke involves rupture of a vessel on the surface of the brain and is usually caused by an aneurysm
    subarachnoid hemorrhage
  30. stroke usually caused by uncontrolled htn and occurs in the deeper tissues of the brain
    intracerebral hemorrhage
  31. five warning signs of an impending stroke
    • sudden numbenss or weakness of face, arm or leg; especially on one side of the body
    • sudden confusion or trouble speaking or understanding
    • sudden trouble seeing in one or both eyes
    • sudden trouble walking, dizziness, loss of balance or coordination
    • sudden severe headache with no known cause
  32. modifiable risk fact for stroke
    • high blood pressure
    • smoke
    • diabetes mellitus
    • cardiovascular disease
    • atrial fibrillation
    • asymptomatic carotid stenosis
    • TIAs
    • sickle cell anemia
    • dyslipidemia
    • obesity
    • excessive alcohol intake
    • poor diet (high fat and sodium, low potassiumn)
    • physical inactivity
    • postmenopausal hormone therapy
  33. what does the acronym FAST mean in relation to stroke
    • helps recognize signs of stroke
    • Facial droop
    • Arm drift
    • Speech
    • Time
  34. dysphasia
    difficulty speaking
  35. expressive aphasia
    pt knows what he wants to say but cant speak
  36. receptive aphasia
    pt cant understand written or spoken words
  37. ataxia
    poor balance or a stumbling, staggering gait
  38. hemianopsia
    • vision loss associated with stroke
    • change is described as a curtain dropping, fog or gray-out/black-out of vision
    • vision loss involves eye on same side as diseased artery
  39. acute phase therapy for stroke pts
    • abc (airway breathing circulation)
    • oxygen given if O2 sat is below 92%
    • monitor LOC
    • treat temp over 99.6F, hyperthermia has poor outcomes
    • no IV solutions with glucose
  40. what is tPA used for
    • dissolves clots for pts experiencing ischemic stroke
    • must be given within 3 hrs of onset
    • blood pressure below 185/110
  41. is dvt (deep vein thrombosis) a concern for stroke pts
    • yes
    • confinement to bed makes them a high risk
  42. what is unilateral neglect
    • primarily seen in right hemisphere infacrctions
    • pts do not acknowledge left side of environment and may not be aware of the left side of their own body
    • treatment focus's on providing stimuli to all senses on the left side and focusing on the left side
  43. if an aneurysm ruptures which kind of hemorrhage is usually caused
    subarachnoid
  44. what is the most common symptom associated with an aneurysm
    severe headache
  45. complications of cerebral hemorrhage
    • hydrocephalus: blood in ventricular system backs up CSF in brain
    • vasospasm: blood vessel diameter narrows
    • similar to those of stroke
  46. why is glucose monitored in pts with cerebral hemorrhage
    elevated glucose (over 140) indicates worsening of infarct and hemorrhage
  47. multiple sclerosis
    chronic loss of myelin sheath blocks transmission of nerve impulses to the affected portion of the body
  48. signs and symptoms of MS
    • musle weakness
    • tingling sensations
    • numbness
    • visual disturbance in one eye at a time
  49. MS has periods of exacerbation and remission, what are some factors can exacerbate the condition
    • extreme heat and cold
    • fatigue
    • infection
    • physical and emotional stress
  50. analysis of the CSF  of a pt with MS will show an increase in which chemical
    immunoglulin G (IgG)
  51. therapeutic measures for pt with MS
    • interferon therapy
    • steroids: adrenocorticotropic hormone (ACTH), prednisone
    • immunosuppressants: imuran, cytoxan
    • anticonvulsants: tegretol, diazepam, baclofen, zanaflex
  52. what is plamapheresis
    • plasma exchange that removes antigens from blood plasma
    • helps suppress inflammation and immune response
    • treatment for sudden severe MS attacks that dont respond to high doses of steroids
  53. myasthenia gravis
    • body attacks and destroys acetylcholine receptors in the body
    • without acetylcholine receptors no stimulus for muscle contraction
    • reduced receptors cause loss of voluntary muscle strength
    • associated with thymus disorders
  54. hallmark sign of myasthenia gravis
    increased muscle weakness during activity and improvement after strength
  55. which activities are affected by myasthenia gravis
    • eye and eylid movements
    • chewing
    • swallowing
    • speaking
    • breathing
    • skeletal muscle function
  56. what is ptosis
    eyelid drooping
  57. myasthenic crisis
    • pt with myasthenia gravis stopped taking meds
    • sudden onset of muscle weakness
  58. cholinergic crisis
    • overmedicated with anticholinesterase drugs
    • characterized by the acronym SLUDGE
    • Salivation
    • Lacrimation
    • Urination
    • Diarrhea
    • Gastrointestinal bleeding
    • Emesis
  59. tesnsilon test
    • used for myasthenia gravis pt
    • injected with tensilon
    • if muscle strengthe increased dramatically; diagnosed with myasthenia gravis

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