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4 major divisions of brain
- Cerebrum
- Diencephalon
- Brain stem
- Cerebellum
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What joins the cerebrum?
Corpus collosum
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4 lobes of Cerebrum
- Frontal
- Pariatal
- Occipital
- Temporal
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Function of grey matter
- Memory
- Perception
- Communication
- Initiation of voluntary movment
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Parietal functions
- Interprets
- Tactile sensations (touch, pain, temp, shape 2 point discrimination)
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Frontal lobe functions
- Voluntary and skeletal action
- Talking, writing, emotions, intellect, reasoning ability, judgement
- Contains brocas area responsible for speach
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Broca's Area
responsible for speech
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Occiptal function
- Read with understanding
- visual center
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Temporal functions
- Hearing
- Contains wernickis area
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Wernicke's area
Located in temoral, interprets auditory stimuli
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Consists of the thalamus and hypothalamus
Diencephalon
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Thalamus is composed of what matter?
Grey
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Relays sensory nerve singal between cerebrum brainstem and spinal cord
Thalmus
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Directs impulses to appropriate areas of cerebral cortex
Thalamus
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Dicrects impulese to appropriate areas of cerebral cortex
Thalamus
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regulates water balance
hypothalamus
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visual signs
hypothalamus
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sleep cycles
hypothalamus
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pain perception
hypothalamus
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emotional status
hypothalamus
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controls pituitary gland
hypothalamus
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Located between cerebral cortex and spinal cord
Brain stem
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Consistis primary of nerve fibers
Brain stem
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Has three parts
Midbrain
Pons
Medulla oblongata
Brain stem
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Involved in vision, hearing, eye movements body
Midbrain
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Relays impulses between higher celebral centers and lower pons, medully, cerebellum and spinal cord
midbrain
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Links cerebellum to cerebrum and midbreain to medulla
pons
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Responsible for various reflex actions
Pons
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Contains nuclein for crainal nerves
medulla oblongota
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Has centers controlling and regulating respiratory fucntion, heart rate and force, and blood pressure
Medulla oblongata
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Located behind the brain stem and under cerebrum
Cerebellum
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Smothing of voluntary movements
Cerebellum
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Maintenance of equilibrium
Cerebellum
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Maintenance of muscle tone
Cerebellum
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Extends from medulla oblongata to 1st lumbar
Spinal cord
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Carries information to and from the CNS
PNS
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has 31 pairs of spinal nerves and 12 pairs of cranial nerves
PNS
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Catagories of spinal nerves
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Sensory root of each spinal nerve innervates an area of the skin called a
dermatome
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how many pairs of cranial nerves?
12
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Cranial neves evolve from
brain or brain stem
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Transmit motor or sensory impulses
crainial nerves
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carried by both cranial and spinal nerves
ANS impulses
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Maintains internal homeostasis of the body
ANS
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Incorporates sympathetic and parasympathetic nervous system
ANS
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Activated during stress
SNS
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Decreased gastric secreations
SNS
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Dilates pupils and relaxes lens
SNS
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Diverts blood away from GI tract and skin
SNS
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Enhances blood flow to skeletal muscles and lungs
SNS
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Functions to restore and maintain normal body functions
PNS
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Promotes rest and digest response
PNS
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Promotes calming of the nerves and enhances digesting
PNS
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Dilates blood vessels leading to the GI tract
PNS
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Constricts teh bronchiolar diameter when the need for 02 has diminished
PNS
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Stimulates salivary gland secreation and accelerates peristalsis
PNS
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Loss of sensation or gtingling sx of damage to
brain, spinal cord or periferal nerves
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Must achieve a certain blood level to be effective
Seizure medications
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Morning headaches that subside after arising may be an early sign of
increased interccranial pressure such as that seen with a brain tumor
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Dizzyness associated with
- CAD
- Cerebellar abcess
- Menier's disease
- inner ear infection
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difficulty with coordiation in neuro diseases involve
cerebellum, basal ganglia, extrapyramidal tracts, or vestibular portion of cranial nerve VIII
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Decreased smell associated with
Cranial nerve I or brain tumor
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Decreased taste
Cranial nerves VII or IX
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Decrease in smell and taste in older people is
normal
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Ringing in ears caused by dysfunction of which nerve
VIII
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Changes in vesion with cranial nerve
II
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Cranial nerve damage can be caused by
III, IV, VI
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transient blind spot is an early sign of
stroke
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Injury to what can impari the ability to use or understand verbal language
cerebral cortex
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Cranial nerves related to difficulty swallowing
X, XII
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Loss of bowel control or urin retention and bladder distension are seen with
spinal cord injuries or tumors
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muscle weakness or paraysis can result from
- CVA
- Spinal cord compression
- Nerve injury
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Progressive weakness is a sx of several
nervous system diseases
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24 hour, recent memory caused by
- amnesic disoorders
- Korsankoffs syndrome
- Delerium
- Dementia
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Head injuries, even if minor can produce
long term neurologic deficits and affect level of functioning
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peripheral neuropathy can result from deficiencies in
Niacin, B12, folicc acid
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DTR depends on
Sensory nerve, functional synapse in spinal cord, intact motor nerve, a neuromuscular juntion and ompentent muscles
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Neuro check consists of
- Level of consciousness
- PUpillary check
- Movement and strength of extremeties
- Sensation in extemities
- Vital signs
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DTR grading
0-4 (4 hyperactive) 0 no response +2 normal +4 hyperactive
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Eyes are open and client answers questions but falls back asleep
Lethargic
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Opens eyes to loud voice, responds slowly witht confusion
Seems unaware of environment
Obtuned
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Awakesn to vigourus shake or painful stinuli but returns to unresponsive sleep
Stuporia
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Unresponsive to all stimuli
Eyes remain shot
Coma
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Diencephalon, midbrain or pons assumes what posture
Decerabrate
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Decerebrate posture
Extension posturing
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Decorticate posture
Abnormal flexion
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Lesions of corticospinal tract assume ________ posture
Decorticate
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<15 GCS
some impairment in LOC
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<10 GCS
need for emergency attention
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Geriatric depression scale normal
< or equal to 10
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Geriatric depression scale abnormal
10 - 30
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memorey test, over 80 should be able to remember how many of 4 words?
2-4
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normal score for mini mental status exam
between 24 - 30
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Mini mental score of < 21 means
may be seen in delirium or dementia
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Cranial nerve 0
vestigial
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Cranial nerve I testing
plug nose, test smell in each nare
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Cranial nerve II testing
- Snellen to assess distance vision
- Assess visual field by confrontation
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Cranial nerve III, IV, VI
- Margins of eyelids of each eye
- Extraocular movements/cardinal fields
- Pupillary response to accomodation and light
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Cranial nerve V test
- Clench teeth and palpate temoral and masseter muscles for contraction
- FOrehead cheeks chin with sharp and dull objects
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Cranial Nerve VII test
- ask to
- Smile
- Frown
- Wrinke forehead
- Show teeth
- Puff out cheeks
- Purse lips
- Raise eyebrows
- Close eyes against resistance
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Cranial nerve VII testing sensory funtion
2/3 tongue
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Cranial nerve tests IX and X
Posterior 1/3 tongue
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Cranial nerve VIII
Cover ear and whisper, do on both sides
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IX and X tests
- motor: open and say ah
- Gag reflux
- Swallow
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XI test
Shrug against resistance, turn head against resistance
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XII test
Mobility of tonge
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astereognosis
inability to identify objects in hand
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brudzinksi's sign
neck down, hips legs up for meningitis
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Kernig's sign
bend hip and leg and back down, if painful maybe meningieal irritation
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