Neuro Final

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em1277
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Neuro Final
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2013-12-18 15:40:48
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Neuro Final
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  1. GCS - Eyes -1
    • Does not open eyes
    • No response
  2. GCS - Eyes - 2
    Opens eyes in response to painful stimuli
  3. GCS - Eyes - 3
    Opens eyes in response to voice
  4. GCS - Eyes - 4
    Opens eyes spontaneously
  5. GCS - Verbal - 1
    Makes no sounds
  6. GCS - Verbal - 2
    Incomprehensible sounds
  7. GCS - Verbal - 3
    Utters inappropriate words
  8. GCS - Verbal - 4
    Confused, disoriented
  9. GCS - Verbal - 5
    Oriented, converses normally
  10. GCS - Motor - 1
    Makes no movements
  11. GCS - Motor - 2 
    • Extension to painful stimuli (decerebrate response)
    • Abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist.
  12. GCS - Motor - 3
    • Abnormal flexion to painful stimuli (decorticate response)
    • Adduction of arm, internal rotation of shoulder, pronation of forarm, flexion of wrist
  13. GCS - Motor - 4
    Flexion/Withdrawal to painful stimuli
  14. GCS - Motor - 5
    Localizes painful stimuli
  15. GCS - Motor - 6
    Obeys commands
  16. GCS range and classifications
    • 3-15
    • Severe: ≤8
    • Moderate: ≤ 9-12
    • Minor: ≥13
  17. Cranial nerve I
    • Olfactory (nose)
    • smell
    • Sensory
  18. Cranial nerve II
    • Optic nerve (eyes)
    • Central and peripheral vision
    • Sensory
  19. Cranial nerve III
    • Oculomotor (eyebrows)
    • Movement and constriction of eyeball
    • (Reactivity to light)
    • Motor
  20. Cranial nerve IV
    • Trochlear (2 under nose)
    • Move eyes down
    • Motor
  21. Cranial nerve V
    • Trigeminal (face)
    • covers the face (forehead, cheek, jaw)
    • Contraction of chewing muscles
    • Both
  22. Cranial nerve VI
    • Abducens (One on each side of nose)
    • Eye movement to the sides
    • Motor
  23. Cranial nerve VII
    • Facial (head)
    • (Facial movements and expression)
    • Sense of taste
    • Contraction of facial muscles
    • Secretion of saliva
    • Both
  24. Cranial nerve VIII
    • Vestibulocochlear (Ears)
    • Sense of hearing and equilibrium
    • Sensory
  25. Cranial nerve IX
    • Glossopharyngeal (Base of tongue)
    • Taste
    • Secretion of saliva
    • Sensory input for cardiac, respiratory, and blood pressure reflexes
    • Contraction of pharynx
    • Both
  26. Cranial nerve X
    • Vagus (base of tongue)
    • Sensory input  for cardiac, respiratory and blood pressure reflexes
    • Sensory and motor input to larynx
    • Decreased HR
    • Peristalis
    • ↑ digestive secretions
    • Both
  27. Cranial nerve XI
    • Spinal accessory (shoulders)
    • Contraction of neck and shoulder muscles
    • Motor
  28. Cranial nerve XII
    • Hypoglossal (tip of tongue)
    • Movement of the tongue
    • Motor
  29. Sensory neurons that form receptors in internal organs
    Visceral sensory neurons
  30. Sensory neurons that form receptors in skin, skeletal muscle and joints
    Somatic sensory muscles
  31. Myelin sheath
    Structure that insulates neurons
  32. Cerebellum
    Coordination and muscle tone
  33. Ascending tracts of spinal cord
    They are made of white matter and carry sensory impulses
  34. If yo have impaired function of IX and X cranial nerves, what will you do to maintain safety?
    Withhold food and liquids
  35. Lumbar puncture
    • Ensure of signed informed consent
    • Side lying position with knees to chest
    • After -
    • HOB flat for 6-8 hours  
    • ↑ fluids
    • Assess site for drainage
    • Assess movement and sensation of lower extremities
  36. Decorticate and decerebrate posturing indicates damage to what area of brain?
    Brain stem
  37. Sympathetic Nervous system response
    • ↓ peristalsis (diminished bowels sounds)
    • Urination prevented
    • ↑ sweating
    • Relaxation of bladder
    • ↑ HR
    • Dilated bronchioles
    • Dilated pupils
    • Decreased salivary secretion
  38. Abnormal in aging nervous system
    • Depression
    • Tremors in hands
  39. Normal age related changes to nervous system
    • Forgetfulness
    • ↓ problem solving ability
    • ↓ postural stability

    Altered sleep patterns
  40. Pre-op procedure for CT
    • Questioned about allergies to contrast material, iodine or shellfish
    • BUN & creatnine levels checked
    • Warn them of warm sensation
    • Nausea, difficulty breathing should be reported
  41. Hypothalamus
    • Production of ADH and oxytocin
    • Regulation of body temp
    • Regulation of food and fluid intake
    • Stimulation of responses in emotional situations
  42. Romberg's test
    • Stand with feet together with eyes closed for up to 20 seconds
    • Swaying or leaning to side may be seen in cerebellar dysfunction
  43. Meningitis
    S/S
    Treatment
    • Inflammation of brain and spinal cord caused by bacterial or viral infection.(strep)
    • Nuchal rigity
    • Headache
    • Photophobia
    • Petechiae
    • Positive Kernig & Brudinski's sign
    • Late signs are lethargy and seizures
    • Quiet/dark environment.
    • Antibiotics
    • Disease is improving when patient can touch chin to chest
  44. Kernig's sign
    • Caused by inflammation of meninges and spinal nerve roots
    • Flex hip 90° and try to extend knee.
    • If pain, +
  45. Brudinski's sign
    • Caused by inflammation of meninges and spinal nerve roots. 
    • Positive when flexion of neck causes hip and knee to flex
  46. Encephalitis
    • Inflammation of brain tissue
    • Viruses are most common cause (Herpes simplex)
    • Nuchal rigidity
    • Confusion
    • ↓ LOC
    • Ataxia
    • Hemiparesis
    • Complications: Blindness, seizures, ↓ cognition
  47. S/S of increased ICP
    • Cushing's triad (bradycardia, irregular respirations, widening pulse pressure)
    • Rising temperature
    • Headache
    • Dilated pupil on affected side
    • Early sign is: ↓ LOC
  48. Nursing care for brain injury (aneurysms)
    • Keep HOB at least 30°
    • No narcotics, codeine may be used
    • Avoid flexing neck and hip flexion
    • Decrease stimuli (quiet, dark room)
    • Stool softeners
    • Little if no suctioning
  49. Treatment for migraine
    • Dark, quiet room
    • Imitrex
    • Rest
  50. Migraine
    Caused by vasoconstriction, followed by vasodilation
  51. Cluster headache
    • Causes: Stress, vascular disturbance
    • Alcohol may worsen
    • Quiet, dark environment with NSAIDS
  52. Partial seizures
    • Begin on one side of cerebral cortex
    • S/S: repetitive, purposeless behaviors (automatisms)
    • Simple Partial: Lasts <1min and don't lose consciousness
    • Complex partial: consciousness is lost. Can last 2-15 min. (automatic repetitive movement - lip smacking)

  53. Generalized seizures
    • Affect entire brain
    • Absence seizures: most often in children. Period of staring
    • Tonic-clonic: Tonic: 30-60 sec - rigidity, pupils fixed & dilated, hands/jaw clenched. Clonic: jerky motion of muscles
  54. Postical period
    • Recovery period after seizure.
    • Disoriented
    • Sleepy
    • Headache
    • Confusion
  55. Status Epilepticus
    • At least 30 min of seizure activity w/o return of consciousness
    • Usual cause is abrupt discontinuation of anticonvulsants
    • Adequate oxygenation must be maintained
    • Diazepam or Lorazepam
  56. Most common cause of traumatic brain injury
    Motor vehicle accidents
  57. Interventions for seizures
    • Precautions: Pad side rails, Assist patient to safety, Keep suction at bedside
    • During: Do not restrain, turn to side,
    • monitor VS when able, protect from injury
  58. Brachytherapy
    • Radiation that takes 3-5 days
    • Patients are confined to their rooms and interaction is kept to a minimum
  59. What should you monitor when taking Tegretol (anticonvulsant)?
    • CBC
    • Tegretol also used to help relieve nerve pain
  60. Autonomic Dysreflexia
    • Occurs with injuries above T6
    • Most common cause is bladder distention
    • Other causes are UTI, ulcers, impaction
    • S/S: Sudden high BP, bradycardia, diaphoresis, headache, pale skin below injury, gooseflesh
    • Place in high fowlers and monitor BP, check to see if catheter is patent, perform rectal exam
  61. Teaching for stem cells
    • Encouraging results
    • Stem cells are collected from hip bone
    • They are reinjected into body to stimulate nerve regeneration
  62. Mannitol
    • Diuretic
    • Reduces ICP
    • Electrolytes must be carefully monitored
  63. Concussion
    • Mild brain injury
    • If there is loss of consciousness, it's <5min
    • No skull or dura injury
  64. Subdural hematoma
    • Bleeding between dura and arachnoid membranes 
    • Venous blood
    • Older people & alcoholics prone to chronic subdural hematomas
  65. Epidural hematoma
    • Blood between dura and skull
    • Arterial blood
    • CT not MRI
    • Unconscious at accident scene
  66. Complications of ICP
    • Diabetes insipidus
    • Hydrocephalus (shunt may be needed)
  67. Types of brain tumors
    • Primary: from CNS
    • Intra-axial: from glial cells with cerebrum, cerebellum or brainstem (infiltrate brain tissue)
    • Extra-axial: from skull, meninges, pituitary gland, cranial nerves (compress brain)
    • Secondary: Metastasized from elsewhere in body (most common)
    • Patients at risk for seizures
  68. Post op care after intracranial surgery
    • Neurologic assessment every hour for 1st 24 hours
    • CT scan
    • Check for CSF drainage: blood tinged in center with yellowish ring around it
    • Anticonvulsants for up to a year
  69. Herniated disk
    • disk moves out of position, the nucleus herniates, compressing nerve root
    • S/S: Cervical: pain and muscle spasm in neck. Numbness or tingling. 
    • Thoracic: not common
    • Lumbar: low back pain, pain radiating down leg
    • Severely herniated L5-S1 disk may affect bladder and is emergency
  70. Common side effect of many muscle relaxants
    Drowsiness
  71. Treatment for herniated disk
    • Rest
    • Physical therapy
    • Traction
    • Medication (muscle relaxants)
    • TENS unit
    • Surgery
    • Teach log rolling technique
  72. Injury at C5 or above
    • C3 : usually fatal because breathing muscles are paralyzed
    • C4-C8: Quadriplegia
  73. Spinal shock
    • Immediately after spinal injury: Cord below injury stops working
    • Vasodilation
    • Hypotension
    • Bradycardia
    • Hypothermia
    • Keep patient covered
  74. Birth control after spinal cord injury
    • No oral contraceptives because of risk of DVT
    • Norplant and condom Ok
  75. Parkinson's
    • Arises from basal ganglia in cerebrum
    • Loss of dopamine production, excess acetycholine
    • S/S: Muscular rigidity, bradykinesia, akinesia, changes in posture, resting tremors, shuffling short steps
    • Levodopa to convert into dopamine
  76. Huntington's disease
    • Inherited
    • Progressive loss of normal movement and intellect
    • Involuntary, irregular, jerky, dancelike movements, constant motion
    • Aspiration is primary cause of death
  77. Alzheimer's
    • Deficiency of acetylcholine
    • Aricept or Exelon delays progression
    • Namenda also to treat
  78. Which side of body is affected after stroke?
    Opposite the side of the cerebral infarct (contralateral)
  79. tPA
    • Clotbuster medication
    • May be used for ischemic strokes
    • Can only be used within 3 hours of symptom onset
    • Risk of hemorrhage, so rule out risks of bleeding
  80. Anti-platelet agent
    • Aspirin
    • Plavix
  81. Cerebral angiogram
    • Detects vascular lesions in the brain
    • Contrast material fills the aneurysm
    • Sedation may be required
  82. S/S of Vertebrobasilar/cerebellar artery stroke
    • Bilateral hemiparesis
    • Visual changes
    • Altered LOC
    • Dysphagia
  83. Subarachnoid hemorrhage
    • CVA with slowest rate of recovery
    • Highest probability of causing severe neurological deficits
    • Often fatal
  84. Multiple Sclerosis
    • Demyelination and destruction of nerve fibers
    • Permanent loss of muscle function
    • Avoid stressful situations and infection (UTI)
    • ACTH to treat symptoms
  85. Tensilon test
    An anticholinesterase drug used to diagnose MG. If muscle strength improves (Ptosis improves) MG is diagnosed.
  86. How does Prostigmin work?
    Increases acetylcholine at synapses
  87. Guillain-Barre syndrome
    • May be auto-immune reaction to virus or vaccines
    • Evaluate ABG's first to determine resp status
    • Weakness that progresses to paralysis
    • Ascending GBS most common
  88. Trigeminal Neuralgia
    • Intense, sudden pain on one side of face
    • Sensitive to temperature, air flow, touch
    • Provide soft foods at room temperature
    • 5th cranial nerve
  89. Bell's Palsy
    • Loss of motor control, paralysis on one side of face
    • Facial droop  
    • Inability to close affected eye
    • Drooling
    • Sense of taste lost
    • Speech difficulties
    • Attend to inability to close eye first
    • 7th cranial motor nerve
  90. Plasmapheresis
    • For MS and MG who don't respond to steroids
    • Used to remove antibodies from blood that are attacking myelin
    • Assess CBC, platelet count, clotting
  91. Myesthenia Gravis
    • Disease at neuromuscular junction
    • Tymectomy can be done to treat
    • S/S: Weakness, Ptosis, Mask-like expression, voice may fade
  92. Myesthenic Crisis
    • Not enough medication causes 
    • S/S - Ptosis, difficulty swallowing/speaking, dyspnea, weakness
  93. Cholinergic crisis
    • Too much anticholinterase drugs 
    • S/S: SLUDGE:
    • Salivation
    • Lacrimation
    • Urination
    • Diarrhea
    • GI cramping
    • Emesis
    • (Liquid pouring out of every orifice)
  94. Demographic groups at higher risk for stroke
    • African americans
    • American indian
    • 75 years or older
    • Pregnant women
    • Previous TIA
  95. Signs of stroke - FAST
    • Facial droop
    • Arm drift (eyes closed, arms held out in front. Does one arm drift?)
    • Speech - Difficulties understanding and speaking?
    • Time
  96. Side effects of statins (Pravastatin)
    • Muscle aches
    • Diarrhea
    • Irritability
  97. Symptoms of stroke
    • *Sudden*:
    • Numbness or weakness of face, arm, leg, especially on one side
    • Confusion
    • Visual disturbances
    • Loss of balance/coordination
    • Severe headache
  98. S/S of ALS
    • Progressive muscle weakness  
    • Decreased coordination
    • Difficulty chewing, swallowing, speaking
  99. Teaching for Lioresal
    • Avoid operating machinery until effects are known
    • Monitor for respiratory depression
    • May cause constipation, so try to prevent
  100. Teaching for Dilantin
    Be sure to brush and floss daily
  101. Meds for seizure disorder
    Neurontin
  102. Teaching for Mirapex
    • Do not drive until effects are fully known
    • Increase fluids and fiber
    • You may experience sudden bouts of sleepiness
    • Take med with food to reduce nausea
  103. Cranial nerves involved in movement of eye
    • Oculomotor (III)
    • Trochlear (IV)
    • Abducens (VI)
  104. The shape of the lens is changed by?
    • Ciliary muscle
    • Permits focusing of light at varying distances
  105. Vitreous Humor
    • The substance in the large posterior cavity between the lens and retina.
    • Helps keep the retina in place
  106. Aqueous humor
    The tissue fluid that nourishes the lens and cornea
  107. Vision involves
    The focusing of light rays on the retina and transmission of nerve impulses to occipital lobes of cerebral cortex
  108. Visual impairment occurs at _____?
    Legal blindness occurs at______?
    • 20/70
    • 20/200
    • i.e. 20/70: can see at 20 feet what the normal person can see at 70 feet
  109. Peripheral fields are measured with what test?
    Visual fields
  110. Muscle balance and eye movement are measured how?
    • Six cardinal fields of gaze
    • Corneal light reflex test
  111. During eye exams, how should the room be lit?
    Slightly darkened
  112. Arcus senilus
    • Whitening of the outer rim of cornea. 
    • Considered normal and doesn't affect vision
  113. Estimation of intraocular pressure is measured how?
    • Tonometer
    • Readings above normal may indicate glaucoma
  114. Stapes
    Transmits vibrations to the fluid filled inner ear at the oval window
  115. Where are the receptors for hearing?
    • The organ of corti
    • The receptors are hair cells which contain endings of cochlear branch of eighth cranial nerve
  116. Weber test
    • Tuning fork placed in center of head.
    • Normally the sound is heard the same in both ears
  117. The area of most acute color vision
    Fovea centralis - contains only cones
  118. Meneiere's disease
    • Balance disorder
    • S/S: vertigo, hearing loss, tinnitus.
    • Acute attacks occur 2-3 times yearly with eventual remission
    • Avoid alcohol, caffeine and tobacco
    • May be placed on methotrexate or given gentamicin injection
  119. Otosclerosis
    • Formation of new bone along stapes that causes conductive hearing loss
    • Hereditary
    • No cure. Hearing aids to improve
    • Stapedectomy is treatment of choice
  120. Sensorineural hearing loss
    • Originates in cochlea and involves hair cells and nerve endings
    • Casues: Infections (measles, mumps, meningitis) drugs, noise, aging
  121. Macular degeneration
    • Leading cause of visual impairment over 50
    • Degeneration of macula. 
    • S/S: slow loss of near vision, dark or empty spot in center of vision, ↓ in color distinction
    • No treatment for dry
  122. Cataracts
    • Opacity of lens
    • S/S: painless, halos around lights, difficulty reading in bright light, ↓ color vision, blurring of vision
    • Treatment: removal of cloudy lens
  123. Acute angle-closure glaucoma
    • Occurs in people who have narrowed junction where iris meets cornea.
    • Medical emergency , blindness if not treated
    • Unilateral, rapid onset
    • S/S: severe pain, blurred vision, rainbows around lights, photophobia
    • Treatment: mannitol to reduce IOP, analgesics, complete bedrest.
    • Mydriatics (atropine, benadryl) contra and may cause blindness
  124. Primary open angle glaucoma
    • Schlenm's canal degenerates and blocks flow of aqueous, Increase in IOP
    • risk ↑ >40
    • S/S: Develops bilaterally. Gradual, painless, halos around light, visual changes
    • Isopto or Pilocar to constrict pupil. Diamox, propine, Timoptic to slow progression.
    • Lifelong use of eyedrops
  125. Retinal detachment
    • Separation of retina from choroid
    • 3 causes: tear in retina, fibrous tissue in vitreous, fluid accumulation in subretinal space
    • S/S: sudden change in vision, flashing lights or floaters, progressing to curtain being lowered, no pain
  126. Diabetic retinopathy
    • 3 stages: Background, preproliferative and proliferative
    • S/S: reduction is visual acuity or color vision
    • Common to have no symptoms until proliferative stage
    • Dx: exam of internal eye yearly if you have diabetes
  127. Presbyopia
    • Lenses lose elasticity
    • Decrease in ability to focus on close objects
    • Associated with aging and usually occurs after age 40
  128. Hyperopia
    • Farsightedness
    • See images far better than close.
    • Eyeball is too short.
    • Corrected with convex lenses
  129. Myopia
    • Nearsightedness
    • Eyeball elongated
    • See close better than far
    • Corrected with concave lenses
  130. Conjunctivitis
    • Bacterial (pink eye) caused mostly by strep or staph.
    • Very contagious
    • Treated with antibiotic eyedrops
    • Cipro to treat - give on empty stomach
  131. Aging and the ear
    • Damage to hair cells in organ of corti
    • Presbycusis (high pitched range lost) caused by loss of hair cells and decreased blood supplying the ear.
    • Inability to distinguish s, z, t, f, and g
  132. Auditory areas of brain
    Temporal lobes of cerebral cortex
  133. Normal age related changes to eye
    • Decreased color vision
    • Glare adaptation difficult
    • Decreased peripheral vision
    • Decreased depth perception
    • Increase in farsightedness

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