Neuro (test 4)

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