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2013-09-03 00:27:42

this makes me nervous
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  1. Cranial Nerves
    How they are tested:
    common odors to one nostril at a time
  2. Cranial Nerves
    How they are tested:
    • Visual acuity
    • Visual fields
    • Optic disc
  3. Cranial Nerves
    How they are tested:
    • EOMs
    • Doll's eyes
    • Light exam direct & consensual; accomodation
  4. Cranial Nerves
    How they are tested:
    • EOMs
    • Doll's eyes
  5. Doll's eyes
    when head is moved, eyes move in opposite direction
  6. Cranial Nerves
    How they are tested:
    • EOMs
    • Doll's eyes
  7. Cranial Nerves
    How they are tested:
    • Smile, frown, show teeth, puff cheeks
    • Taste (anterior 2/3 of tongue), close eyes
  8. Cranial Nerves
    How they are tested:
    Vestibular usually not tested
  9. Cranial Nerves
    How they are tested:
    • Swallow on command, gag reflex
    • Taste (posterior 1/3 of tongue)
  10. Cranial Nerves
    How they are tested:
    Gag reflex, midline elevation of uvula
  11. Cranial Nerves
    How they are tested:
    Spinal accessory
    Shrug shoulders and turn head against resistance
  12. Cranial Nerves
    How they are tested:
    Protrude tongue (deviates to affected side)
  13. Central Nervous System (2)
    • Brain
    • Spinal cord
  14. Peripheral Nervous System (2)
    • samatic nerv. system
    • autonomic nerv. system
  15. Blood-Brain Barrier
    filter; limits movement of substances from the blood to the brain; selective
  16. Meninges
    • Coverings of nerv. tiss. in brn & sp. cord;
    • supports, protects, & nourishes;
    • 3 layers
  17. 3 layers of Meninges
    • Dura Mater
    • Arachnoid
    • Pia Mater
  18. Dura Mater
    • outermost layer
    • tough membrane w two layers
  19. Arachnoid
    delicate; lies beneath Dura
  20. Arachnoid Villa
    projections that extend into the Dura
  21. Pia Mater
    • innermost layer
    • Vascular membrane w many small plexuses of blood vessels
  22. Meninges Layers give rise to:
    • three potential spaces
    • -Epidural
    • -subdural
    • -subarachnoid
  23. Epidural Space
    external to the dura
  24. Subdural Space
    between dura and arachnoid
  25. Subarachnoid Space
    between arachnoid and pia
  26. Four main areas of the brain
    • Cerebrum
    • Diencephalon
    • Brainstem
    • Cerebellum
  27. Dienchepalon
    thalamus and hypothalamus
  28. Brainstem
    midbrain, pons, and medulla
  29. Cerebrum/Cerebral Cortex
    2 frontal lobes, 2 parietal lobes, 2 temporal lobes, & 2 occipital lobes

    Divided into L and R hemispheres connected by corpus callosum
  30. Speech is controlled by
    dominant hemisphere of cerebrum
  31. Two speech centers
    • Broca's (verbal and expressive)
    • Wernicke's (reception and understanding)
  32. Basal Ganglia of Cerebrum
    • deep inside, extra pyramidal system
    • postural adjustments and movement
  33. Thalamus*
    regulates all sensation except smell
  34. hypothalamus
    controls hormonal activity, regulates water metabolism, appetite, sleep cycles, temp, & thirst
  35. Epithalamus
    • often calcified by yound adulthood
    • radiopaque
  36. Subthalamus
    contains sensory tracts and connections to basal ganglia
  37. Pituitary Gland (hypothalamus)
    • master gland
    • controls numerous hormonal functions
    • 2 lobes, ea. releasing specific hormones into circulation under the regulation of the hypothalamus
  38. Brainstem
    deep in center of hemispheres and not visible when intact brain is viewed

    contains core of tiss called the reticular activating system
  39. Reticular activating system
    • in brainstem
    • regulates centers for resp, cardio, afferent and motor, and state of consciousness
  40. Cerebellum
    • posterior cranial fossa
    • 3 main functions:
    • -keeps bd oriented in space
    • -maintains equilibrium
    • -antigravity muscles
  41. cerebrospinal fluid
    colorless, odorless fluid found in vent of brain, central canal or sp. cord, and subarch. space.

    Made of H2O, glucose, NaCl, and Protein*
  42. cerebrospinal fluid
    four main functions
    • cushions nerv. sys.
    • supports wt of brain
    • carries nutrients to brain
    • removes metabolites
  43. Adult brains contains ____ ml of CSF
  44. Functions of Nervous System
    • *Coordinates and controls ALL activities of the body*
    • 1. receives info from internal and external environments
    • 2. communicates info bw bd and cns
    • 3. processes info received to determine response to situations
    • 4. transmits info for bd action, control or modification (ex. touching something hot)
  45. Speech areas of the brain:
    • located in cerebrum
    • -Broca's - controls verbal and expressive
    • -Wernicke's - reception and understanding
  46. Normal age related chages of the nervous system
    • -loss of brn cells w actual loss of brn wt.
    • -nerve cell loss diffuse and gradual.
    • -decrease in bld flow to brn.
    • -labile and unpredictable.
    • -nerve impulse velocity decreases = slows sensory & motor conduction.
    • -merky eye movement.
  47. Neurological Exam
    • Assessment begins with pt history while interviewing.
    • - OBSERVE:
    • *speech pattern
    • *mental status
    • *intellectual functiong
    • *reasoning ability
    • *movement or lack of "
  48. primary vs secondary h/a
    *primary- not associated w any other pathologic cause (migraines, tension, & cluster)

    *secondary- caused by known path. cause (meningitis, tumors, subarachnoid hemorrhage)
  49. migraines
    • cerebral bld vess narrow (vasoconstriction)
    • followed by significant vasodilation & inflammation.
    • releases serotonin = h/a;
    • vary in duration, freq, and intensity
  50. cluster h/a
    • similar to migraines
    • brief (45 mins or less)
  51. tension h/a
    stress-induced muscle tension over neck, scalp, and face
  52. s/s migraines
    • depression, irritability, vision disturbances, nausea, paresthesias before onset pain
    • unilateral pain, intense
    • begins in the temple eye area
    • tearing and vomiting
    • sensitive to light and sound
  53. s/s cluster h/a
    • no warning signs
    • series of episodes followed by long periods of no sx.
  54. s/s tension h/a
    • anxiety, stress, and stimuli
    • brn tumor or abscessed tooth
    • location varies
    • n/v/dizzy/tinnitus/tearing
  55. h/a treatment
    • common meds
    • lying in a quiet, dark room
    • relaxation techniques
  56. meningitis s/s
    h/a, nuchal rigidity, irritability, decr LOC, photophobia, hypersensitivity, seizures, +Kernig's sign, +Brudzinski's sign
  57. s/s Parkinson's
    • sx dont occur until 70% of neurons are destroyed
    • TRAP- tremor, rigidity, akinesea/bradykinesia, postural instability
    • wkness, fatigue, fine motor movement difficulty, loss of facial expression, difficulty chew/swallowing, voice changes, memory loss, prob-solving difficulties, visual spatial deficits
  58. myasthenia gravis
    • muscle wkness, fatigue.
    • ptosis, diplopia - eye muscles.
    • inability keep mouth closed/chew/swallow - cranial nerves.
    • emotion-less face.
    • weak neck, head falls forward
  59. myasthenia gravis
    tensilon test- given IV, pt will have brief but significant increase in muscle strength in previously weakened muscles
  60. signs of a stroke (5)
    • sudden numbness/wkness of face, arm, or leg, esp on one side of bd.
    • sudden confusion, trouble speaking, or understanding.
    • sudden trouble seeing in one or both eyes
    • sudden trouble walking, dizziness, loss of balance, or coordination.
    • sudden, severe h/a with no known cause.
  61. Nonmodifiable risk factors for CVA
    cannot be changed: age, race, gender, heredity.
  62. CVAs more common in
    mes, african americans, ages 51-74, family hx
  63. Causes of stroke among the young
    drug abuse, bc pills in combo w smoking, congenital heart conditions, mitral valve prolapse, a fib, infectious endocarditis, sickle cell anemia, rheumatic fever, leukemia
  64. Modifiable risk factors for CVA
    can be eliminated or controlled reducing risk for cva.
  65. Intervention for Modifiable CVA risk factor:
    antihypertensive drugs, wt control, stress management, smoking cess, limited etoh, low-fat diet, reduced na
  66. Intervention for Modifiable CVA risk factor:
    cardiac disease
    • drug therapy to improve bld flow and prevent clots.
    • tx of a fib
  67. Intervention for Modifiable CVA risk factor:
    • balanced program drug therapy, diet, wt control, exercise.
    • blood glucose monitoring
  68. Intervention for Modifiable CVA risk factor:
    • maintain good hydration, esp in older adults.
    • monitor effects of diuretic and antihypertensive therapy
  69. Intervention for Modifiable CVA risk factor:
    Conditions that increase risk of bld clotting
    eg. sickle cell
    • good hydration
    • drug therapy
  70. Intervention for Modifiable CVA risk factor:
    Excessive etoh consumption
    • limit to 1 oz pure etoh or less
    • (2 cans beer, 2 sm glasses wine, 2 cocktails)
    • avoid binge drinking
  71. Intervention for Modifiable CVA risk factor:
    cigarette smoking
    • advise pts of risks
    • risk falls with cessation
    • self-help programs
    • md for drugs
  72. Intervention for Modifiable CVA risk factor:
    • maintain normal bd wt
    • proper diet teaching
    • wt control programs
    • modifying eating behaviors
    • healthy nutritional practices
    • exercise as specified by dr
  73. Intervention for Modifiable CVA risk factor:
    high-fat diet
    • instruct in meal planning and prep
    • reduce sat fats in diet
  74. Intervention for Modifiable CVA risk factor:
    drug abuse
    treatment programs
  75. spinal shock
    • temporary, profound disruption of sp cord function.
    • occurs immediately after injury (30-60 mins)
    • may last for days, weeks, or months
    • state of areflexia, complete loss of motor, sensory, relex, and autonomic functioning
  76. only time to assess deep pain
    pt unconscious
  77. when to monitor LOC
    • immediately - dont wait until pt is unresponsive
    • look for early indications
  78. signs that need to be reported stat
    • incr cranial press, incr sys, decr pulse
    • going to head
  79. best med for migraine ha
  80. Nsg dx for immobile stroke pt
    impaired skin integrity, decr peristalsis (constipation), pneumonia
  81. autonomic disreflexia
    sweating above that level
  82. motionless face
    myasthenia gravis
  83. hemisphere speech is located
    dominant side
  84. csf made of
  85. ooottafagvah
    • olfactory
    • optic
    • oculomotor
    • trochlear
    • trigeminal
    • abducens
    • facial
    • acoustic
    • glossopharyngeal
    • vagus
    • spinal accessory
    • hypoglossal
  86. afferent nerves
    sensory in nature
    peripheral nerves transmit info to CNS
  87. efferent nerves
    motor in nature
    peripheral nerves transmit info away from CNS
  88. somatic nerv sys
    skeletal muscles: movement
  89. automnomic nerv sys
    • automatic bd functions
    • para/sympathetic nerv sys
  90. sympathetic nerv sys
    • maintains homeostasis
    • fight or flight
  91. parasympathetic nerv sys
    revereses stress response
  92. axon
    sends info away from cell bd
  93. dendrite
    • recieves info from axon at synapse
    • conducts impulses to cell bd
  94. inside neuron
    proteins and k
  95. outside cell
    high in sodium
  96. sodium potassium pump
    • distribute na and k
    • produces charge
  97. basic phenomenon underlying all nervous system function
    action potential excitability
  98. when ap occurs
    • neuron stimulated- incr in membrane permeability to na- na moves in and k moves out
  99. which conduction decreases faster
  100. more age related changes
    • reaction time increases with age
    • decline in short term memory
    • hearing loss high freq
    • tactile sensation decr
    • temp discrimination decr
    • difficulty fine motor skill
    • taste and smell decline
    • tendon reflexes brisk
    • slow gait
    • decr muscle bulk
    • pupils smaller
    • achilles tendon jerk absent
  101. best indicators of neuro status
    • changes LOC most sensitive
    • arousal (alertness) and awareness (content) and self and environment
    • eye opening assesses arousal, spontaneous when spoken to; painful stimuli can be used if not opened with verbal; person place and time, mood and behavior; family helpful
  102. aphasia
    impairment in language function
  103. dysarthria
    causes indistinct word articulation or enunciation from interference w things such as muscle of tongue, palate, pharynx, or lips
  104. test perception
    • place familiar object in hand w eyes closed- name object
    • pain, temp, touch
    • motion and position
  105. romberg test
    • motion and position
    • have pt stand erect w feet together and eyes closed- if pt loses balance = presence of pathologic condition
  106. three nerves tested together
    3, 4, and 6
  107. motor status
    • gait and stance
    • muscle tone
    • coordination
    • involuntary movements
  108. glascow coma scale
    • 3 is lowest score
    • 15 highest
    • 7 or lower is a coma
  109. mini mental status exam
    simple questions, problems in a number of areas
  110. nurses roles
    cranial nerves
    support ventilation, tissue perfusion, orientation, bd temp, prevent injury, promote mobility, nutrition, promote bowel elimination, urinary, skin integrity, self care, support familty, teaching
  111. lyrica is an
  112. lyrica side effects
    edema, dry mouth, suicidal thoughts, low platelet count
  113. lyrica precations
    • tapered off slowly over week
    • report muscle pain, tenderness or wkness (d/c)
  114. lyrica special precaution**
    if pt has elevated creatinine kynex --> d/c
  115. arresept is for
    • antialtzheimers
    • temporarily lessons dementia associated altz
  116. s/e aresept
    a fib, bruising, hot flashes, wt loss/gain
  117. plavix is for
    anti-platelet agent
  118. s/e plavix**
    hypercholerdemia (high chol)
  119. plavix precautions
    • monitor bleeding time'
    • for surgury- stop 5-7 days before!!!**
  120. immetrex
    h/a, migraines
  121. immetrex s/e
    • vasoconstriction in large intercranial arteries!!**
    • shot/po/nasal
    • dizzy, warm, tingling sensation
  122. immetrex teaching
    • used only during migraine attach
    • does not prevent them**
  123. tpa
    • thrombolytic agent
    • MIs, ischem stroke, *pulm embolism*
  124. tpa contraindicated in 4
    • active internal bleeding**
    • recent head/spine trauma**
    • uncontrolled htn**
    • known blding tendencies**
    • check list before
  125. tpa antidote
  126. valium
    • benzodiazapine
    • status epilepticus and seizures**
    • crosses bld-brn barrior
  127. valium precautions
    • bad--> stat epilept. duration only 15 mins**
    • causes resp depression (monitor)
    • administer slowly (esp iv push) causes apnea/cardiac arrest
  128. valium
    given rectally for seizures
  129. neurontin
    nerv syst seizure tx (plus many more)
  130. neurontin s/e
    suicidal, confusion, depression
  131. neurontin given in
    • scored tablets
    • other 1/2 must be used next dose
    • if not, discard it bc it loses effectiveness
  132. dilantin
    tx granmal seizures
  133. dilantin s/e
    suicidal, nystagmus, low bp, drug induced hepatitis-- monitor drug levels!!**
  134. dilantin teaching
    maintain good dental hygeine**
  135. prostigman
    myasthenia gravis
  136. prostigman s/e
    seizures, bronchospasm, bradycardia, hypotension,
  137. prostigman antidote
  138. carbedopa/levodopa
    • combo drug
    • parkinsons
  139. carbedopa/levodopa s/e
    involuntary movement, psycho probs, urges, melenoma**
  140. can only be diagnosed after death
  141. normal icp
    0-15 mmHg
  142. icp inadequate perfusion causes 4
    • carbon dioxide to incr
    • o2 to decr
    • pH to decr
    • leads to anoxia and hypotension
  143. types of herniations
    subfacial , uncal, transforaminal
  144. ICP medications
    osmotic diuretic
    mannitol, promotes fluid removal from enematous brain tiss
  145. ICP meds
    decadron - used to reduce edema associated w tumors or abcesses
  146. ICP meds
    dilantin - prevent seizures
  147. ICP meds
    opiods and sedatives
    • used cautiously bc of resp depressant effect*
    • may alter pts ability to cooperate w an accurate neuro exam
  148. ICP meds
    phenobarb - given to slow cerebral metabolic rate and minimize the damage caused by IICP induced ischemia
  149. postictal
    time immediately after seizure as pt recovers
  150. interictal
    time bw seizure activcty
  151. automatisms
    • automatic behavious such as lip smacking, chewing, rubbing, picking at clothes
    • seen before seizure
  152. ansence seizures
    • no motor signs
    • short lasting
    • children
    • hard to detect
    • daydreaming (no postictal state)
  153. tonic-clonic
    • tonic phase- muscles become rigid
    • clonic - rythmic muscle jerking
    • may hear a cry
  154. myoclonic
    • cause one+ muscles to jerk
    • causes person to fall (no postictal)
  155. atonic
    brief loss of tone in one+ muscle, drop things or fall (no post)
  156. status epilepticus
    • episode acitvity lasting at least 30 mins
    • repeated seizes w/o full recovery bw each
    • prolonged seiz lead to cellular exhaustion and destruction even death
  157. primary ha
    • not associated w any known patholagic cause
    • migraines, tension, and cluster
  158. secondary ha
    caused by a known pathologic condition such as meningitis, tumors, or subarachnoid hemorrhage
  159. kernigs sign
    the inability to extend the legs when the knee is flexed at the hip
  160. brudzinskis sign
    the hig and knee flex when the pts neck is flexed
  161. encephalitis
    • infl of brn tiss by bact, virus, or fungi, mosquitos
    • degenerative changes in nerve cells of brn and infl and necrosis
  162. guillian barre syndrome
    • autoimmune response to viral infection
    • motor wkness and paralysis
  163. nsg role in lumbar puncture
    monitor insertion site for swelling, redness and drainage
  164. assessing pupils
    size, shape, response to light, and equality
  165. assessing pain
    • using broken wooden applicator
    • sharp vs dull sensation
    • sharp pain recognized = pain sensation
  166. deep pain sensation
    may be pressure on a sensory nerve
  167. agnosia
    failure to recognize/identify objects despite intact sensory function
  168. signs of decreased LOC
    • minimal agitation/drowsiness
    • restless or suddenly quiet - significant change
    • somnolence, lethargy, stupor, semi, coma
  169. somnolence
  170. lethargy
    excessive drowsines
  171. stupor
    decreased responisiveness and lack of spontaneous motor activity
  172. semicomatose
    in stuopor but can be aroused
  173. coma
    cannot be aroused
  174. Early s/s IICP
    • decr LOC
    • h/a that increases w cough/strain
    • pupillary changes (dilation w slowed constriction)
    • contralateral motor/sensory losses
  175. Late s/s IICP
    • further decrease LOC
    • change vs
    • incr systolic bo
    • decr diastolic bp
    • widened pulse pressure
    • slow pulse
    • resp dysrythmias (shallow, slow, irregular, apnea)
    • hiccups
    • fever wo infection
    • vomiting
    • decerebrate/decorticate posturing
  176. postictal nsg interventions
    • clear secretions
    • open airway
    • o2 as needed
    • assess for injuries (abrasions, bruises, tongue biten)
  177. interictal nsg interventions
    • siderails up and padded
    • suction at bedside
    • no glass thermometers
    • disable locks on doors
    • helmets for those walking
  178. status epilepticus tx
    • iv anticonvulsants
    • if that doesnt work- general anesthetic agents and neuromuscular blocking agents used
  179. intracranial surgery baseline assessment
    • important to base your findings during surgery while you assess pts.
    • complications include decreased LOC
    • vs and neuro checks done hourly
  180. nsg interventions during a seizure
    • moves objects away
    • cradle head in lap
    • do not restrain
    • do not force anything in mouth
    • turn to one side
    • note time seize began and how it progressed
    • assess and document post status
    • allow to rest quietly
    • call 911 if tonic clonic lasts more than 4 mins or if seizes occur in rapid succession
  181. meningitis s/s
    ha, nuchal rigidity, irritability, decr loc, photophobia, hypersensitivity, seizures, + kernigs and + brudzinskis