Neuro (test 4)

Part of final review

Cerebellum

Cerebellum

"Ballerina" controls balance and movement

Cerebrum

Center of intellect and consciousness

How many cranial nerves are there?

12

CNS is made up of ___ and ____

brain and spinal cord

Synapse

Space between two neurons

Axons are surrounded by ___ sheath

myelin

homeostasis

internal body balance

Normal cerebrospinal spinal fluid pressure

70-125 cm

True or false? Once destroyed, cells in the brain cannot be replaced

True

Aging related changes to nervous system

• loss of neurons

• blood flow to brain is decreased

• homeostasis is harder to maintain

Romberg test

Measures function of cerebellum

• have patient stand with feet together and close eyes, if normal, balance will be maintained.

glasgow coma scale measures

• eye opening

• motor response

• verbal response optimal score is 15

• 3 or less indicates total comatose, 8 indicates comatose level

Nystagmus

rapid back and forth eye movement

Decorticate posturing

deCOREticate: extremities flexed inwards towards core

decerebrate posturing

extremities flexed away from core/body

Should a neuro check be delegated to UAP?

no

dysphagia

difficulty swallowing

• high fowler's while eating and 30 min after

Aphasia

Inability to express oneself in speech or writing, or inability to comprehend language

• r/t head injury

• receptive, expressive or global types (see page 496 for more)

Concussion

Closed head injury

• brief disruption in LOC

Contusion

brain is bruised blood vessels break and edema develops

• increased ICP possible

Coup-countercoup injury

Head is moving and hits a stationary object

Coup vs countercoup

Coup = original impact contrecoup = brain bouncing off front of skull (secondhand injury)

Subdural hematoma

Rupturing of blood vessels in the dura

Three layers of skull

D: dura (top) A: arachnoid (middle) P: pia (inner layer) (dope ass pie)

Battle sign

bruising behind the ear

HOB should be how high to promote drainage from the head/ for patients with head injury

20-30 degrees

Normal ICP

0-15

Signs of increasing ICP/ cushing's triad

• rising systolic B/P

• widening pulse pressure

• bradycardia with full bounding pulse

• rapid or irregular respirations

HOB at __ for increased ICP

20-30 degrees with head and neck midline

• hip flexion less than 90 degrees

Nursing care for patient with increased ICP

• neuro checks each hour

• elevate hob 20-30 degrees

• give stool softeners

Tetra/quadriplegia

sensory loss of both arms and legs

paraplegia

paralysis of both legs

levels of spinal cord injury

C5 or above= needs resp help (mechanical ventilation)

Can moving patients with spinal injuries be delegated?

No

Epilepsy

When correcting a metabolic problem does not stop seizures

• spontaneous recurrent seizures

• classified as partial or generalized

partial vs generalized seizures

partial = affecting one side of body generalized = both sides of body

Petit mal seizures

Only last a few seconds without aura or warning

Postictal

after a seizure

Atonic or akinetic seizures

loss of body tone leading to collapse

Status epilepticus

rapid, unrelenting seizures with no rest periods

If patient is having a seizure

make area safe, move objects from around the person

• do not move the person

• cushion the head

Transient ischemic attack

• Mini stroke

• brief interruption of blood flow

• many of these pts have strokes later

Stroke (CVA)

-Interruption of blood flow to brain

• caused by either a hemorrhage (blood vessels rupture and blood leaks) or a clot

Aneurysm

ballooning of an artery wall

FAST stroke acronym

Face Arms speech time

Stroke/damage on the left side of the brain causes ___ sided paralysis

right sided

Bacterial meningitis

• inflammation of membranes covering brain and spinal cord

• caused by infectious agent getting into bloodstream

• infection can easily spread to brain

S/S of bacterial meningitis

• sudden onset fever

• severe HA that is worsened by moving of the head

• positive brudzinski sign (bend patients neck forward, if knees and hips flex, this is positive)

• positive kernig sign (inability to extend the leg past a 90 degree angle)

Viral meningitis

-HIV and herpes are causes

• more mild than bacterial meningitis

Encephalitis

• acute inflammation of the brain

• ticks and mosquitoes are carriers S/S= stiff neck, photophobia, lethargy

food that triggers migraines

Alc, caffeine, chocolate, citrus fruits, artificial sweeteners, meats with nitrates, tyramine foods

Bell's palsy

Weakness or paralysis of facial nerves

• usually only on one side of face