Neuro 1 with SLM

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Neuro 1 with SLM
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2013-11-05 17:37:46
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N172 Neuro lecture 1 and SLM
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  1. What are neurotransmitters?
    chemical messengers of the nervous system
  2. Name two NTS
    • Acetylcholine (ACh)
    • Norepinephrine (NE)
  3. ACh vs  NE
    • ACh-excitatory NTS
    • NE-excitatory and inhibitory
  4. Cholinergic
    nerves that transmit impulses through the release of ACh

    Excitatory or Inhibitory
  5. Adrenergic
    nerves that transmit impulses through the release of NE
  6. Where do you find cholinergic receptors?
    viscera, skeletal muscle cells and adrenal medulla
  7. Where do you find Adrenergic receptors?
    • heart
    • lungs
    • kidney
    • blood vessels

    *all target organs stimulated by the Sympathetic except for the heart
  8. Two types of Adrnergic nerve receptors
    Alpha and Beta
  9. Describe Alpha Adrenergic receptors
    they bind to alpha receptors to stimulate arterial vasoconstriction
  10. Describe Beta Adrenergic Receptors
    • binding  to beta receptors inhibits 2 types of responses...
    • Beta 1-receptors in heart to regulate rate and force of contraction
    • Beta 2-receptor cells of the lungs, arteries, liver and uterus
  11. Left vs. Rt Hemispheres of the brain
    Left controls language

    Rt controls nonverbal perceptual functions
  12. Thalamus
    sorting, processing and relaying station of the brain
  13. Hypothalamus
    • regulation of temp
    • water metabolism
    • appetite
    • emotional expression
    • sleep wake cycle
    • thirst
  14. Midbrain
    center for auditory and visual revlexes
  15. Pons
    controls respiration
  16. Medulla Oblongata
    controls heart rate, blood pressure, respiration and swallowing
  17. Cerebellum
    • coordinates skeletal muscle activity
    • maintenance of balance
    • controls fine motor movements
  18. What are the only things that can pass through the blood brain barrier
    • lipids
    • glucose
    • some amino acids
    • water
    • carbon dioxide
    • oxygen
  19. What is blocked by the blood brain barrier?
    • urea
    • creatinine
    • some toxins
    • proteins
    • most antibiotics
  20. What part of the brain is responsible for providing emotional and behavioral responses to environmental stimuli?
    Limbic system
  21. Reticular Activating System is responsible for
    relaying sensory input from all body systems to the brain

    alert and responsiveness
  22. What sort of messages to ascending pathways transmit?
    • pain
    • temperature
    • crude touch
  23. What sort of messages do descending pathways transmit?
    • sensations of fine touch, position and vibration
    • purposeful movements
    • stimulate/inhibit muscle actions
    • muscle tone
    • gross body movements
  24. Somatic reflexes result in
    skeletal muscle contractions
  25. Autonomic reflexes result in
    activate cardiac and smooth muscle and glands
  26. What does the ANS regulate?
    • the bodies environment...
    • visceral motor system:
    • cardiac muscle
    • smooth muscle
    • glands
  27. What is the primary controller of the ANS?
    Reticular formation in the brain stem
  28. What part of the nervous system do ACh and NE effect?
    • ACh-parasympathetic
    • NE-sympathetic
  29. SNS stimulation causes....
    fight or flight

    • dilated pupils
    • increased mental alertness
    • inhibits secretions (dry mouth) and diaphoresis
    • decreased urine output
    • Increased blood clotting
  30. What does the sympathetic nervous system do to the heart and lungs
    Causes dilation of arteries and increases the rate and force of the contraction....arteries vasoconstrict

    Bronchioles dilate
  31. What does the sympathetic system do to the liver
    • increases the release of glucose by the liver
    • increasing the metabolic rate
  32. What does the sympathetic nervous system do to the blood vessels of the abdomen and skin?
    vasoconstriction
  33. What does the parasympathetic nervous system cause?
    • constriction of pupils
    • stimulation of glandular secretions
    • constriction of bronchioles
    • increased peristalsis and secretion of GI fluid

    **Basically runs our body during non stressful times
  34. What is MS?
    it's a degenerative disorder of the CNS characterized by the demyelinization of nerve fibers of the brain and spinal cord myelin sheath.
  35. What's affected with MS?
    the motor and sensory conduction pathways of the CNS

    • person becomes uncoordinated (trips)
    • and has a muttled brain
  36. How do you get MS?
    • have a susceptible gene
    • infection by a slow virus
    • immune problem
  37. Who's most likely to get MS?
    A European American woman 20-50 years old
  38. What triggers a MS exacerbation?
    • Infections-URI or UTI
    • Trauma
    • Immunization
    • Delivery after pregnancy
    • Stress
    • Change in climate
  39. What's the problem with MS?
    impulses don't move from nerve to nerve
  40. Signs and symptoms of MS
    • weakness/paralysis
    • diplopia
    • scanning speech
    • muscle spasms
    • numbness/tingly
    • constipation
    • spastic/hypotonic bladder
    • fatigue
    • depression
    • problems with airway clearance
    • problems with chewing/swallowing
  41. Cognitive changes for a person with MS
    Can be severely fatigued

    Changes are mainly seen in short term memory, attention, processing information, word finding and visual perception.

    NO CHANGE IN INTELLIGENCE
  42. What meds do you use MS acute exacerbations?
    • Corticosteroids
    • ACTH
    • Methylprednisolone
    • Prednisone
  43. Side effects for MS patients on Corticosteroids, ACTH, Methyloprednisolone and Prednisone
    • Edema
    • Euphoria
    • weight gain
  44. Patient teaching for MS patients on Corticosteroids, ACTH, Methyleprednisolone, Prednisone
    • Restrict fluid intake
    • Don't stop abruptly
    • Know drug interactions
  45. 3 Meds used to prevent MS exacerbations
    • Betaseron
    • Copaxone
    • Novantrone
  46. Side effects of MS drug Betaseron
    • Flu like symptoms
    • local skin rash
    • depression
  47. Labs to watch with Betaseron
    • CBC
    • Blood chemistries
    • LFT

    *every 3 months**
  48. Side effects of Copaxone for MS
    • Skin reactions
    • chest pain
    • weak
  49. Side effects for Novantrone for MS
    • NVD
    • Hepatotoxicity
    • cardiovascular disease
    • Myelosuppression
  50. Keep in mind with Novantrone for MS
    there is a lifetime dose limit because of cardiotoxicity

    Monitor CBC and LFT every month
  51. Patient teaching for Betaseron  and Copaxone for MS
    How to perform self infection and report side effects
  52. Patient teaching for Novantrone for MS
    • Need regular monitoring and follow up
    • Talk with HCP prior to getting immunizations
    • Maintain adequate fluid intake
    • **Urine may turn blue-green**
  53. 2 Meds given to MS patients for Urinary Retention (Flaccid Bladder)
    Urecholine and Prostigmin
  54. Side effects of Urecholine and Prostigmin for Flaccid Bladder/Urinary retention
    • Hypotension and cardiac dysfunction
    • Diarrhea
    • Diaphoresis
    • Peptic Ulcers
    • Allergies/Asthma
  55. Patient teaching for Urecholine and Prostigmin for Flaccid Bladder/Urinary Retention
    Consult HCP before using any other meds....including OTC
  56. 2 meds used for Spastic Bladder (Urinary frequency and urgency)
    • Probathine
    • Ditropan
  57. Side Effects of Probathine and Ditropan used for Spastic Bladder/Urinary frequency and urgency
    • Anticholinergic-cant see, pee, spit, poop
    • HTN
    • Urinary retention....if take too much
  58. Patient teaching for Probathine and Ditropan for Spastic Bladder/Urinary frequency and urgency
    Consult HCP prior to taking any other meds..

    **If you take sleeping aids or anithistamines could possibly have a potentiated effect
  59. Who is contraindicated for taking Probanthine and Ditropan for Spastic Bladder/Urinary frequency and Urgency
    • Hx of glaucoma
    • cardiac dysfunction
    • Intestinal obstruction
  60. Drugs for muscle spasms
    • Valium
    • Baclofen
    • Dantrium
    • Zanaflex
  61. Similar side effects and patient teaching for all muscle relaxers
    SE-drowsiness, ataxia

    PT. Teaching-avoid driving, no CNS depressants and don't drink
  62. Whos contraindicated to take valium
    person with glaucoma
  63. Patient teaching for valium
    • can be addictive
    • avoid long term use
  64. What don't you take if you are on valium?
    • barbituates
    • MAOI
    • antidepressants
  65. Who shouldn't take Baclofen?
    person with history of hypersensitivity and renal damage

    *don't take if you have a seizure disorder
  66. How do you take Baclofen
    with food or milk
  67. What will happen if you abruptly stop taking Baclofen
    have hallucinations
  68. Who should use Dantrium cautiously?
    anybody with a history of respiratory or cardiac dysfunction
  69. Dantrium can cause
    hepatotoxicity
  70. What will happen if you take Dantrium or Zanaflex and take tranquilizers or drink alcohol?
    photosensitivity
  71. Prior to starting Dantrium you must....
    get a baseline LFT
  72. Who should take Zanaflex cautiously?
    • persons with liver or renal disease
    • hypotension
    • bradycardia
  73. How do you take Zanaflex
    with small meals to help with nausea
  74. Patient teaching for Zanaflex
    change positions slowly cuz of orthos
  75. Whats a new drug to treat relapsing forms of MS?  How does it work?
    Monoclonal antibodies

    • blocks access for lymphocytes to the CNS...
    • KILLS T CELLS
  76. Why do persons with MS get PT/OT?
    • ROM exercises to prevent contractures
    • gait training
    • aids for ambulating
    • assistive devices
    • techniques to maintain indep.  with ADL
    • braces and adaptive equipment
  77. Exercise OT/PT with MS is used to...
    increase coordination and train patient to substitute unaffected muscles for impaired ones.

    *lots of exercises done in water
  78. How does spasticity with MS get treated?
    • antispasmodic drugs
    • surgery (neurectomy, rhizotomy, cordotomy)
    • dorsal-column electric stimulation
  79. How are tremors treated with MS?
    if unmanageable with drugs...treat with thallamotomy or deep brain stimulation
  80. When a person has an acute exacerbation from MS what do we do?
    • they will  probably be on bedrest and be immobile...
    • so to prevent complications reposition/skin care
    • TCDB
    • toileting/peri care
  81. Nutritional therapy for a person with MS
    • mega vitamins (cobalamin and vitamin c
    • low fat
    • gluten free
    • roughage/taw vegetables
  82. How do you overcome nystagmus?
    patch an eye
  83. MS patients need to adjust caloric intake....how?
    increase cuz need more due to spasticity
  84. Later stages MS and communication....
    coding yes or no with eyes....allow time for responses
  85. What happens to airways with MS
    becomes inadequate so suctioning may be required and IS used to help with respiratory muscles
  86. What's Myasthenia Gravis?
    an autoimmune disease of the neuromuscular junction that is characterized by fluctuating weakness of certain skeletal muscle groups
  87. How does MG work?
    Antibodies to ACh attack the receptors causing a decrease in the number of ACh receptor sites at the neuromuscular junction....prevents ACh molecules from attaching and stimulating muscle contraction
  88. Age range for people to get MG
    10-65...peak age for women is 20-30
  89. MG is usually caused by 2 things....
    Thymic abnormalities or hyperplasia (increased cell production)
  90. 2 Anticholinesterases to treat MG
    • Neostigmine
    • Pyridostigmine
  91. How do Neostigmine and Pyridostigmine work?
    they at at the neuromuscular junction and allow ACh to concentrate at the receptor site promoting muscle contractions
  92. 2 Surgeries to treat MG
    • Thymectomy
    • Plasmaphoresis
  93. What are you concerned about after a Thymectomy?
    • focus on preventing complications and controlling pain
    • at risk for pneumothorax
  94. How long for remission to occur with a thymectomy?
    can be several years
  95. Plasmaphoresis and MG
    • it is used for patients with respiratory problems
    • need a CVC or AV fistula or graft to do

    *removes anti acetycholine antibodies to improve sever muscle weakness, fatigue and other symptoms
  96. Why do people with MG have breathing issues?
    • cuz poor cough mechanisms
    • decreased cage expansion
    • diminished diaphragm movement
    • decreased expiratory effort
  97. How do you help a person with MG with their respiratory issues?
    • encourage hydration; percussion postural drainage and suction
    • TCDB q 2h
    • Semi Fowlers
    • check lung sounds, rate and character
    • Pulse ox as needed
  98. Why does a person with MG have impaired swallowing?
    weakness of the laryngeal and pharyngeal muscles involved with swallowing.

    *Need to make changes with foods cuz at risk for aspiration
  99. Home care goals for a person with MG
    • prevention/recognition of crisis situation
    • understanding the disorder and coping with the physical, psychosocial problems and impaired self care abilities
  100. When doing a neuro check....what is the progression if the patient isn't responding?
    • speak....get louder
    • supra orbital pressure
    • trapezius squeeze
    • sternal rub
  101. What is the first thing to change in a person if there is a neurological problem?
    LOC....

    start acting confused or disoriented
  102. What part of the brain is in charge or alertness and persons arousal?
    RAS....and it's connection to the thalamus and cerebral cortex

    This is the lowest level of consciousness and observation is centered around the patients ability to respond to verbal/noxious stimuli appropriately
  103. What part of the brain is concerned with awareness?
    Cerebral Cortex

    It is a higher functioning test which deals with orientation to person, place time and pupose

    Mentation, memory and attention span
  104. Lethargic
    state of drowsiness or inaction, patient needs increased stimulus to be awakened
  105. Delirium
    confusion with disordered perceptions and decreased attention span.

    marked anxiety with motor and sensory excitement
  106. Obtunded
    a duller difference to external stimuli exists and response is minimally maintained
  107. Stuporous
    can be aroused only by vigorous and continuous external stimuli
  108. What's Glascow Coma Scale based on?
    • eye opening
    • verbal response
    • motor response

    It is a practice means of monitoring changes in LOC

    3-15 score
  109. Eye opening responses for GCS
    • 4-Spontaneously
    • 3-To speech
    • 2-To pain
    • 1-No response

    **record "C" if eyes closed by swelling
  110. Motor responses for GCS
    • 6-Obeys verbal commands
    • 5-localizes pain
    • 4-Flexion withdrawl
    • 3-Flexion abnormal
    • 2-Extension abnormal
    • 1-No response

    *Record best upper limb response
  111. Verbal response for GCS
    • 5-oriented x 3
    • 4-conversation confused
    • 3-speech inappropriate
    • 2-sounds incomprehensible
    • 1-no response

    **Record "E" for ET tube and "T" for Tracheostomy
  112. Where are 10 of the 12 cranial nerves located?
    in the brain stem
  113. Cranial Nerve assessment

    1st time...thereafter
    • first time all should be assessed....
    • after that 2-6, 9 and 10

    Cuz they regulate pupil response, eye movement and protective mechanisms
  114. Saying for Cranial Nerves
    Oh, oh, oh, to touch and feel a guys veiny slimy hotdog

    • olfactory
    • optic
    • oculomotor
    • trochlea
    • trigeminal
    • abducens
    • facial
    • auditory
    • glossopharyngeal
    • vagus
    • spinal accessory
    • hypoglossal
  115. Olfactory
    smell
  116. Optic
    • Vision
    • tested with Snellen and Rosenbaum charts
  117. Oculomotor
    • raise eyelids
    • constrict pupils
    • change eye lens shape
  118. Which Cranial Nerve is used in PERRLA?
    Oculomotor....III
  119. Trochlear
    downward and inward eye movements
  120. Trigeminal
    Facial Movement and Sensation

    *inspect face for muscle atrophy and tremors
  121. Abducens
    lateral eye movement
  122. Facial
    • facial expression
    • taste
    • secretion of saliva and tears
  123. Auditory
    hearing and equillibrium

    Weber and Rhine test
  124. Glossopharyngeal
    Speech, Swallowing and Gag Reflex

    **Test to ID sour and bitter tastes and test gag reflex for ability to swallow
  125. Vagus
    Speech, Swallowing and Gag Reflex
  126. Spinal accessory
    • turn head
    • shoulder shrug

    **Problems here after radical neck surgery
  127. Hypoglossal
    tongue movement for speech and swallowing

    **test tongue strength with index finger when tongue is pressed against the cheek

    **Evaluate quality of linqual speech sounds (l,t,d,n)
  128. If you are testing swallowing which 2 cranial nerves are you assessing?
    • Glossopharyngeal IX
    • Vagus X
  129. Which cranial nerves are tested together to tell you eye motion?
    • III Oculomotor
    • IV Trochlear
    • VI Abducens
  130. If you want to do a swallow test which cranial nerves involved?
    IX Glossopharhngeal
  131. Test muscle strength by asking the patient to....
    push and pull against the resistance of your arm as it opposes flexion and extension of the patient's muscle...

    Done at shoulder, elbow, wrist, hips, knees and ankles

    **Note any weakness or asymmetry of strength between the same muscle groups of the right and left side
  132. How do you test muscle tone?
    by passively moving the limbs through their ROM, there should be slight resistance to these movements
  133. Hypotonia
    Hypertonia
    • flaccidity
    • spasticity
  134. Myoclonus
    involuntary spasm of muscles....tics/tremors
  135. Athetosis
    slow, writhing, involuntary movements of extremities
  136. Chorea
    involuntary purposeless rapid motions
  137. Dystonia
    impairment of muscle tone
  138. How do you test the cerebellum?
    • Just look at their posture while standing and their gait
    • Note the pace and rhythm of the gait and the arm swing
  139. How do you test fine motor skills?
    • Thumb-Finger
    • Index Finger-Index Finger
    • Finger-Nose
    • Heel-Shin
  140. Normal motor strength score
    5/5....normal movement against gravity and resistance
  141. 4/5 Motor Strength
    full ROM against moderate resistance and gravity
  142. 3/5 Motor Strength
    full ROM against gravity only, NOT against resistance

    Can hold hand up, but cant hold it up against resistance
  143. 2/5 Motor Strength
    extremity can move...but not against gravity

    **can roll but cant lift
  144. 1/5 Motor Strength
    muscle contracts but extremity cant move

    **spinal cord injury
  145. 0/5 Motor Strength
    No visible or palpable muscle contraction or movement of the extremity
  146. Test for Balance and Equillibrium
    • Romberg
    • when you push a patient they should sway mildly, but not have a loss of balance.

    done with eyes open and closed
  147. What's a normal Deep Tendon Reflex test?
    2

    • 0 is no response
    • 4 is hyperactive
  148. Babinski Reflex
    Used to assess for a brain or nervous disorder

    • Pt. lays supine
    • Stroke lateral-plantar aspect of the bottom of the foot with your thumbnail

    After the age of 2 it is abnormal to have a positive result with dorsiflexion of the big toe and fanning of other toes
  149. Tests to DX MS
    • PMH
    • Cerebral Spinal Fluid
    • MRI
  150. What do you need to know with seizure disorders?
    • Precipitating factors?
    • Febrile?
    • Neurologic Assessment
    • Seizure description:onset, duration, frequency and postictal state
  151. Diagnostic studies for seizure disorders
    • CBC
    • Urinalysis
    • Lytes
    • CSG
    • CT, MRI, PET
    • EEG
  152. Gerontologic considerations and neurological disorders
    high incidence with elderly
  153. Med problems that cause neurological disorders
    Phenytoin...cuz is hard on liver and is metabolized in liver causing (antiseizure med)

    Phenobarbitol and Primidone affect cognition
  154. Collaborative Management and General patient education for MS...Goals and Plan
    • achieve a good balance of exercise and rest
    • eat nutritiously
    • avoid the hazards of immobility(contractures/pressure ulcers)
    • avoid exposure to infections
    • know your meds for side effects, interactions and OTC reactions
  155. Why is the thymus removed with Myasthenia Gravis patients?
    cuz the thymus increases production of ACh antibodies which attack the ACh receptors not allowing ACh to bind to receptor sites.
  156. When do you take Neostigmine for Myestenia Gravis?
    30 minutes prior to meal time
  157. Main issues of Myasthenia Gravis
    • Fatigue
    • Ineffective Airway Clearance
    • Impaired Swallowing
  158. What causes Myasthenia Crisis?
    this occurs from under medication or the body not responding to the medication. 

    Adjust or change meds...Tenselon?
  159. What causes Cholingergic Crisis?
    this occurs from over medication and allowing too much ACh to be present so muscles stop responding to ACh
  160. S/S of Cholinergic Crisis....and what do I do?
    • Worsening of Myasthenia symptoms
    • Flaccid Paralysis
    • Respiratory Failure
    • Increased sweating and salivation

    Give them Atropine
  161. S/S of Myasthenia Crisis and what do I do?
    • increased weakness or paralysis...especially of the diaphragm and chest muscles......
    • respiratory failure
    • severe ocular or bulbular symptoms

    change meds... or go on Tenselon?
  162. If a person has < or = an 8 score with Glasgow coma scale....what does this mean?
    coma
  163. Why would a person have an elevated temperature with brain trauma?
    they hypothalamus has probably been damaged
  164. What's a widened pulse pressure?  What does it mean with a head trauma person?
    The SBP is increasing, but the DBP isn't.

    Increased ICP....
  165. What happens to the pulse as ICP advances?
    Bradycardia
  166. Cranial Nerves...Sensory, Motor or Both
    Some say marry money but my brother say big brains matter more
  167. Positive result of Babinski means the person may have.....
    • ALS
    • Brain Tumor/injury
    • Meningitis
    • MS
    • Spinal Cord Injury, defect or tumor
    • Stroke

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