NRSG 2500 unit 11

What is composed of the CNS

Brain and spinal cord

What is composed of the PNS

cranial and spinal nerves, autonomic and somatic systems

What nervous system is when anything acts unconsciously (heart rate, rr, pupil response, urination, sexual arousal)

autonomic nervous system

What nervous system is when it works when things act voluntary (muscles, organs, reflexes)

somatic nervous system

What is the basic functional unit in the body

neuron

What 3 things makes up neurons

dendrites, cell body, axon

What is the thing that works in the body that is used to communicate between neurons

neurotransmitters

Parkinsons, myasthenias graves, traumatic brain injuries, strokes all are caused because they have a imbalance in what

a imbalance in neurotransmitters

What part of the brain is responsible for vision/sight

the occipital lobe/back of the brain

What area in the brain is responsible for short term memory, emotions, equilibrium aka balance, understanding language and music and what you are hearing, and how to control behavior

occipital lobe/association area of the brain

What area of the brain helps initiate voluntary muscles/is responsible for this

motor function area

What area of the brain is responsible for speech and muscles associated with speech

Brocas area in the brain

What area in the brain is in charge of auditory/hearing

auditory area in the brain

What area in the brain is responsible for emotions, pain, hunger, and fight or flight response

the emotional area in the brain

What area in the brain helps us know when we feel pressure on out body/know what we can feel

the sensory association area of the brain

What area in the brain is responsible for our sense of smell

the olfactory area

What area in the brain is responsible for our sensation from muscles and skin and knowing our left and right and knowing where my body is/what position, etc

the sensory area in the brain

What area in the brain is responsible for evaluating weight, textures, temperature of objects

the somatosensory association area of the brain

What area of the Brain is known for being over written and spoken language comprehension

the wernicke area in the brain

What area in the brain is responsible for eye movement

motor function area but for eyes

What area in the brain is responsible for concentration, planning, creativity, inhibition, judgment, making decisions, and emotional expression

the frontal lobe in the brain

What is the main neurotransmitter of the sympathetic nervous system

norepinephrine

What is the main neurotransmitter of the parasympathetic nervous system

acetylcholine

What are the 5 areas of neurological function that we assess during a neurological assessment

cerebral function, cranial nerves, motor system, sensory system, and reflexes

What are we assessing when it comes to cerebral function during a neurological assessment

mental status, intellectual cognition function, thought content, emotion status, language ability, impact on lifestyle, LOC, perception, motor, and speech

What are we assessing when it comes to cranial nerves during a neurological assessment

sensory, motor, or mixed nerves

What are we assessing when it comes to the motor system during a neurological assessment

posture, gait, muscle tone and strength, coordination, and balance

What are we assessing when it comes to the sensory system during a neurological assessment

tactile sensation, superficial pain, vibrations, and position sense

What are we assessing when it comes to reflexes during a neurological assessment

gag, corneal, plantar (babinski), and deep tendon

What is the most important indicator of our pts condition when assessing a altered mental status

their LOC is the most important indicator of a pts condition

What things do we assess for a pt with a altered mental status

• LOC

• Glasgow coma score

• Pupils (round and reactive)

• Motor (symmetry vs asymmetry)

• Sensation (if numb, tingling, or painful stimuli)

• Speech (aphasia - receptive, expressive, or global), or slurred

• Voluntary vs involuntary reflexes

What is the Glasgow coma score

helps us look at a pts mental status and how awake they are by looking at verbal, eye opening, and motor response.

Normal range for Glasgow coma score

3 (bad) to 15 (good)

If a pt has a Glasgow coma score of 3 that wasn’t affected by meds or anything, then what is the pt

pt is brain dead

What do we want to look for when looking at a pts pupils

if they are round and reactive

If a pts pupils are fixed and dilated and don’t respond to light, what is the pt then

the pt is brain dead because of their pupils

If a pt has had head and neck trauma, what do we not want them to do

we do NOT want them to get up and walk/be motor so we will have them lay flat w c spine precautions

Receptive aphasia

also known as wernickes aphasia where pt can speak good but sentences don’t make sense and don’t realize what they said was not right. Has a hard time reading and understanding spoken and written words

Expressive aphasia

also known as brocas aphasia when a pt can understand what someone says but they have a hard time communicating themselves

Global aphasia

caused from a injury that affects both the front and back regions of the left hemisphere of the brain and is a combo of both expressive and receptive aphasia where the pt has a hard understanding words and speaking

What are the 12 cranial nerves

1. Olfactory

2. Optic

3. Oculomotor

4. Trochlear

5. Trigeminal

6. Abducens

7. Facial

8. Acoustic

9. Glossopharyngeal

10. Vagus

11. Spinal accessory

12. Hypoglossal

Which cranial nerves have to do with the eyes

2, 3, 4, and 6

Which cranial nerve has to do with sense of smell

olfactory/1

Which cranial nerve has to do with vision/being able to see

optic/2

Which cranial nerve has to do with muscles that move the eye, pupil constriction, and lens

oculomotor/3

Which 2 cranial nerve has to do with muscles that move the eye

trochlear/4, abducens/6

Which cranial nerve has to do with the forehead, jaw, and cheek and moving them

trigeminal/5

Which cranial nerve has to do with facial expression and muscle movement, saliva, tears, taste

facial/7

Which cranial nerve has to do with hearing and the equilibrium

acoustic/8

Which cranial nerve has to do with taste and swallowing

glossopharyngeal/9

Which cranial nerve has to do with the muscles of pharynx, larynx, sensation in the external ear, etc

vagus/10

Which cranial nerve has to do with the sternocleidomastoid and trapezius muscles

spinal accessory/11

Which cranial nerve has to do with the movement of the tongue

hypoglossal/12

What is a continuum from normal altertness and full cognition/consciousness to coma

LOC

Altered LOC is not the disorder but is the result of what?

pathology

Coma is when a pt is what

unconscious, unarousable, and unresponsive

Akinetic mutism

unresponsiveness to the environment and makes no movement or sound but sometimes opens eyes

Persistent vegetative state/irreversible coma

devoid of cognitive function but has a sleep-wake cycle, swallow, cough, and eye movement

Locked in syndrome

pt is alert and aware on inside, but is unable to move or respond except for eye movements due to lesion affecting the pons, so pt communicates by blinking

Brain death

cessation and irreversibility of brain functions including the brain stem. So they body is alive, but the pt is dead by having loss of all brain function

What tests to do to determine if a pt is brain dead

a cranial nerve assessment and apnea test

What are the 2 abnormal postures when responding to stimuli/from severe brain injury

decorticate posturing and decerebrate posturing

Decorticate posturing

pts arms are flexed into them, and are adducted, and legs are internally rotated and feet flexed

Decerebrate posturing

pt is in a position where their arms are flexed out and away from them, is adducted, and feet are flexed

Monro-Kellie Hypothesis

when space is limited inside the skull and explains the dynamic equilibrium of cranial contents since the skull can’t decrease and ICP increases

What are the three components in the mono-kellie hypothesis

blood, cerebral spinal fluid, and brain tissue

How does blood, cerebral spinal fluid, and brain tissue work with each other within the monro-kellie hypothesis

where there is an increase in one, it requires another one to decrease to have compensation and ICP will increase as a result (ex: if I have a increase in blood, the skull can’t change in size so we have to compensate ICP and brain tissue by decreasing CSF or shift brain tissue)

What are normal circumstances where ICP increases

coughing, sneezing, straining

Intracranial autoregulation

the compensatory mechanism that allows the brains ability to change the diameter of the blood vessels to maintain a constant cerebral blood flow during alterations in systemic blood flow

How can intracranial autoregulation be impaired

it is impaired in pts who are experiencing a pathological and sustained increase in ICP

A increase in ICP leads to what with cerebral perfusion

a decrease in cerebral perfusion which leads to ischemia, cell death, and edema

Cushings Triad

a late sign of increased ICP where it is a clinical phenomenon in which cerebral blood flow decreases significantly

What are s/s pts with cushings triad may have

increase in bp, decrease pulse, decrease respirations, wide pulse pressure, bradycardia, hypertension, bradypnea

What are some causes of intracranial regulation dysfunction

ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), tumors, head injuries, surgury, infection, encephalopathy, vascular malformation, hydrocephalus

Stroke pt education

BE FAST, call 911 if you see s/s, know the risk factors, after care aka keep follow up appointments, take meds as directed

Stroke BE FAST pt ed s/s

BALANCE aka sudden loss of it, EYES aka sudden changes here, FACE is weak suddenly, ARMS are weaker, SPEECH is hard or slurred, TIME of when s/s started and call 911

Ischemic stroke

the disruption of blood supply due to a obstruction usually of the thrombus or embolism that causes a infarction of brain tissue (can be blood clot)

Manifestations of a ischemic stroke

numb or weakness of face, arm, or leg, especially on one side. Confusion, change in mental status, speech, balance/coordination, sudden vision changes

Ischemic stroke treatment

thrombolytic therapy aka tPA, monitor vs, LOC, ICP, elevate HOB unless contraindicated to decrease ICP, maintain airway and ventilation, continuous hemodynamic montioring and neurological assessment, meds, stent/clot removal

How often do you have to have neuro checks when you have had a ischemic stroke

every 15 minutes in the ICU for the first 24hr due to thrombolytic therapy since it increases the risk for bleeding

Hemorrhagic stroke

caused from bleeding into the brain tissue, the ventricles, or subarachnoid space

Manifestations of a hemorrhagic stroke

similar to a ischemic stroke but pt will have a SEVERE HEADACHE, early and sudden changes in LOC, vomiting form increase brain pressure

Treatment for hemorrhagic stroke

monitor vs, LOC, ICP, may have to place a external ventricular drain (EVD) or craniotomy, maintain airway and ventilation, treat vasospasm, HTN, potential seizures, and prevent bleeding, use nimodipine for vasospasm

Transient Ischemic Attack (TIA)

a temporary neurological deficit that results from a temporary impairment of blood flow. Aka it is a WARNING of a impending stroke

TIA’s have what type of s/s and when do s/s resolve

have stroke symptoms and symptoms completely resolve within 24hr and have no long term deficits like a true stroke

Diagnostic tests for strokes/brain issues

CT, MRI, PET, cerebral angiography, myleography, noninvasive carotid flow studies, lumbar puncture, transcranial doppler, nerve conduction studies, EEG, EMG, labs like electrolytes glucose proteins and drug levels

When would doing a lumbar puncture be contraindicated for a pt with a stroke

contraindicated for pts with a increase in ICP cause it can increase the risk of herniation

Normal ICP level in adults

0-10, upper limit is 15

Normal ICP level in kids

3-7

Normal ICP level in infants

1.5-6

A high ICP means what with perfusion

means a lower perfusion or CPP

A ICP >20 in adults warrants what

immediate treatment interventions, cause a increase ICP decreases cerebral perfusion and can cause ischemia, cell death, and edema

With disease or injury ICP may increase, which does what to CPP

decreases CPP

Lower level of CPP range

50-70

Optional CPP range

70-80

Brain tissues may shift through the dura and may result in what

results in herniation where blood supply is cut off to the brain

A higher CO2 level from respiratory acidosis and causes vasodilation causes what with ICP

it causes ICP to increase

Early s/s of increased ICP

CHANGES IN LOC, slows speech or delayed response, pups change, weakness, headache

Late s/s of increased ICP

BLOWN PUPIL, posturing, cushings triad, respiratory and vasomotor changes, further LOC changes

What are different monitors what can monitor ICP

intraventircular catheter, subarachnoid screw, intraparenchymal sensor, subdural bolt