Neuro Review

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Neuro Review
2014-10-08 19:30:04
Neuro Review

Neuro Review N176
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  1. Frontal lobe
    Lesion here...
    • behavior
    • memory
    • judgment
    • speech

    Lesion here:  Personality changes
  2. Parietal Lobe
    Lesion here....
    • Pain
    • touch
    • temp
    • Interpretation of distance, size shape, texture

    Lesion here:  spatial disorientation
  3. Occipital Lobe
    Lesion here...
    • Vision
    • Lesion here:  Hallucinations
  4. Temporal Lobe
    • controls receptive and expressive speech
    • hearing
    • smell/taste
    • interpretation
  5. Limbic System
    • moods
    • feelings
    • instincts
    • self preservation
  6. Basal Ganglia
    motor control and fine body movements
  7. Hypothalamus
    • temp control
    • water metabolism
    • appetite control
    • hormone control
  8. RAS
    Reticular Activating System

    controls sleep and wake cycle....if the patient is arousable the RAS is functioning
  9. Cerebellum
    • controls coordination of muscle movement
    • balance
  10. Brain Stem
    respiratory and vasomotor control center
  11. Where do the cranial nerves arise from?
    brain stem
  12. What assessment will tell you the mid brain is functioning?
  13. How can you tell the pons is functioning?
    Lower pons?
    • Corneal reflex
    • Dolls eyes
  14. Medulla
    controls respiration and BP
  15. How do you know the medulla is functioning?
    spontaneous respirations and BP maintained without mechanical support
  16. What does the brain count on for metabolism?
  17. What is necessary for the oxidation of glucose for energy in the brain?
  18. How long does it take for brain damage to occur from no O2
    2-5 minutes
  19. Describe CSF
    • clear
    • colorless and odorless

    fills ventricles and subarachnoid space and spinal cord

    made of water, protein, O2, CO2, electrolytes and glucose
  20. Normal CSF pressure
    80-180mm H20 pressure in recumbent position
  21. Neuro assessment consists of
    • LOC
    • Pupillary light reflexes
    • Motor ability
    • Sensory Ability
    • Reflexes
    • Breathing pattern
  22. Assessment of mental status includes
    • persons memory
    • mentation-thinking
    • behavior
  23. What's the most sensitive indicator of a patients neuro condition?
  24. AOX4
    • Alert and Oriented....
    • Person
    • Place
    • Time
    • Purpose
  25. Glasgow Coma Scale Categories
    • Eye Opening Response
    • Motor Response
    • Verbal Response
  26. Assessing motor function on an unconscious patient
    Upper extremities...apply painful stimulus and  observe for withdrawl

    Lower extremities....flex legs so heels on bed and release knees-weak or paralyzed limb will extend and externally rotate.  Observe for gross abnormalities by looking at position of arms and legs noting flaccidity, contractures, spasticity and posturing
  27. Assessing motor strength with numbers
    • 5/5 normal movement against gravity and resistance
    • 4/5 full ROM against mod. resistance/gravity
    • 3/5 full ROM against gravity only
    • 2/5 extremity can move but not against gravity (can roll but not lift)
    • 1/5 muscle contracts, extremity cant move
    • 0/5 no muscle contraction or movement
  28. Tests for coordination and fine motor skills
    • thumb-finger
    • index-finger
    • finger-nose
    • heel-shin
  29. Tests for Balance and Equilibrium
    • GAIT
    • Romberg
    • Push patient
    • Stand on one foot, eyes closed, arms at side...maintain for 5 seconds
  30. Romberg test
    Stand erect with feet together and eyes closed

    mild sway is normal, but a loss of balance is abnormal
  31. Normal gait
    • heel toe tandem
    • smooth and symmetrical with a regular rhythm
    • arm swing
  32. Where's Broca's area located and what is it's function?
    frontal lobe

    • speech
    • writing
    • language processing and comprehension
  33. Where's Wernicke's area located and what's its function?
    Temporal/Parietal Lobes

    involved in the understanding of written and spoken language
  34. If you have a problem in the brain stem, how will it show up in speech?

    • defect in articulation, enunciation and rhythm
    • breaks in rhythm, slow, slurred speech
  35. If you have a problem with Broca's area you will....
    • understand others
    • recognize your own errors in speech
    • have poor articulation
    • speech will be labored/garbled
  36. If you have a problem in Wernicke's area you will....
    • have normal speech
    • voices are heard and recognized, but words are meaningless
    • mispronounce words
  37. How do you assess peripheral nerve sensory function?
    • touch/pain
    • temperature or deep pressure
  38. How do you assess cortical sensory function?
    Stereogenesis-ID familiar objects by touch and manipulation

    Graphesthesia-draw a number on the palm with a q tip, have person ID it
  39. How do you grade a deep tendon response?
    • 0=no response
    • 4=brisk, hyperactive

    2=active or expected response
  40. What will happen to your temp with head trauma?
    elevates to high levels from damage to the hypothalamus
  41. What will signify an increase in ICP?
    • increased systolic BP
    • widened pulse pressure
    • brady
  42. Assessment of cranial nerves....initially, subsequently
    • initially all
    • subsequently II-VI and IX and X
    • cuz they regulate pupil response, eye movement and protective mechanisms
  43. What does Doll's Eyes assess?
    cervical spine injury....DR. do!!

    when the head is rotated to the right, the eyes should move in the opposite direction, like a dolls eyes

    if they don't do this it is an indication of a lesion at the brain stem
  44. Oculovestibular Reflex test
    • Dr. does
    • HOB at 30
    • Ice water, syringe, IV cannula-squire water in to ear

    • Intact brain stem and cerebrum-profound nausea/nystagmus
    • Intact brain stem only-eyes move toward irrigated ear
    • Neither brain stem or cerebrum in tact-asymmetric eye movements or no eye movements