Neuro (test 4)

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Cerebellum

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Cerebellum

"Ballerina" controls balance and movement

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Cerebrum

Center of intellect and consciousness

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How many cranial nerves are there?

12

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CNS is made up of ___ and ____

brain and spinal cord

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Synapse

Space between two neurons

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Axons are surrounded by ___ sheath

myelin

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homeostasis

internal body balance

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Normal cerebrospinal spinal fluid pressure

70-125 cm

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

True

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Aging related changes to nervous system

  • loss of neurons

  • blood flow to brain is decreased

  • homeostasis is harder to maintain

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Romberg test

Measures function of cerebellum

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

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glasgow coma scale measures

  • eye opening

  • motor response

  • verbal response optimal score is 15

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

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Nystagmus

rapid back and forth eye movement

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Decorticate posturing

deCOREticate: extremities flexed inwards towards core

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decerebrate posturing

extremities flexed away from core/body

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Should a neuro check be delegated to UAP?

no

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dysphagia

difficulty swallowing

  • high fowler's while eating and 30 min after

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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)

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Concussion

Closed head injury

  • brief disruption in LOC

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Contusion

brain is bruised blood vessels break and edema develops

  • increased ICP possible

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Coup-countercoup injury

Head is moving and hits a stationary object

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Coup vs countercoup

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

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Subdural hematoma

Rupturing of blood vessels in the dura

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Three layers of skull

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

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Battle sign

bruising behind the ear

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

20-30 degrees

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Normal ICP

0-15

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Signs of increasing ICP/ cushing's triad

  • rising systolic B/P

  • widening pulse pressure

  • bradycardia with full bounding pulse

  • rapid or irregular respirations

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HOB at __ for increased ICP

20-30 degrees with head and neck midline

  • hip flexion less than 90 degrees

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Nursing care for patient with increased ICP

  • neuro checks each hour

  • elevate hob 20-30 degrees

  • give stool softeners

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Tetra/quadriplegia

sensory loss of both arms and legs

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paraplegia

paralysis of both legs

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levels of spinal cord injury

C5 or above= needs resp help (mechanical ventilation)

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Can moving patients with spinal injuries be delegated?

No

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Epilepsy

When correcting a metabolic problem does not stop seizures

  • spontaneous recurrent seizures

  • classified as partial or generalized

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partial vs generalized seizures

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

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Petit mal seizures

Only last a few seconds without aura or warning

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Postictal

after a seizure

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Atonic or akinetic seizures

loss of body tone leading to collapse

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Status epilepticus

rapid, unrelenting seizures with no rest periods

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If patient is having a seizure

make area safe, move objects from around the person

  • do not move the person

  • cushion the head

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Transient ischemic attack

  • Mini stroke

  • brief interruption of blood flow

  • many of these pts have strokes later

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Stroke (CVA)

-Interruption of blood flow to brain

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

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Aneurysm

ballooning of an artery wall

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FAST stroke acronym

Face Arms speech time

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

right sided

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Bacterial meningitis

  • inflammation of membranes covering brain and spinal cord

  • caused by infectious agent getting into bloodstream

  • infection can easily spread to brain

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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)

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Viral meningitis

-HIV and herpes are causes

  • more mild than bacterial meningitis

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Encephalitis

  • acute inflammation of the brain

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

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food that triggers migraines

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

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Bell's palsy

Weakness or paralysis of facial nerves

  • usually only on one side of face

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