Quiz 10: 202

CNS vs PNS

• includes brain and spinal cord. processes and interprets information

• all nerves outside the CNS, transmits to/from CNS

autonomic nervous system divisions

sympathetic: fight or flight- increases HR, dilates pupils, slows digestion

parasympathetic: rest and digest- slows HR, increases digestion, conserves energy

sympathetic vs. parasympathetic effects

• ↑ HR, BP, bronchodilation, pupil dilation, ↓ GI activity.

• ↓ HR, BP, bronchoconstriction, pupil constriction, ↑ GI activity

neurological dysfunction

best indicator- level of consciousness (LOC)

Glasgow coma scale

measures: eye opening, verbal response, motor response

normal: score of 15 highest, lowest 3

cognitive function

mental ability to learn, remember, problem-solve, and concentrate

mini-mental status exam

measures: cognitive impairment- memory, orientation, attention, language

neurological tests

MMSE (mini-mental): test for cognitive function and cognitive impairment- memory, orientation, attention, and language

Romberg: stand with feet together, eyes closed- checks balance

nose-to-finger: patient touches own nose then examiner’s finger- coordination

heel-to-shin: slide heel down opposite shin- cerebellar function

Babinski: stroke foot sole- abnormal (toes fan out) in adults - neurological damage

ataxia

lack of muscle coordination

coma

unconscious, unresponsive

GCS

Glasgow coma scale

lethargic

drowsy, slow response

paresthesia

tingling, numbness

stupor

only responsive to vigorous stimuli

headaches

most common: tension

• Primary types: Tension (band-like), migraine (unilateral, pulsating), cluster (severe, one-sided, around eye).

• diary: Tracks triggers, frequency, duration, helps guide treatment.

brain tumors

• Complications: ↑ ICP, seizures, neurological deficits.

• Nursing interventions: Neuro checks, seizure precautions, pain management, monitor ICP

seizures

• Aura: Sensory warning before seizure (smell, taste, feeling).

• EEG teaching: No caffeine, clean hair, may be sleep-deprived.

• Safety: Turn on side, clear area, do not restrain or insert anything.

• Emergency: >5 mins or status epilepticus → call 911, airway management

meningitis

risks: crowded living, head trauma, immunosuppression

signs: fever, neck stiffness, headache, photophobia

Kernig’s sign: pain on leg extension

Brudzinski’s sign: neck flexion causes leg to bend

diagnosis: lumbar puncture

treatment: antibiotics, corticosteroids, droplet precautions

encephalitis

cause: viral (HSV, West Nile)

treatment: antivirals (acyclovir), supportive care

Huntington’s disease

genetic: autosomal dominant, via blood sample

patho: cellular deterioration, loss of neurons, progressive and fatal

manifestations: chorea (jerky movements), mood changes, cognitive decline

Parkinson’s disease

deficiency: dopamine

symptoms: resting tremors, muscle rigidity, bradykinesia (slowness of movement), akinesia (loss of movement)

alzheimer’s disease

patho: no proven cause

diagnosis: clinical assessment, ruling out other causes

symptoms: memory loss, confusion, impaired judgement

interventions: safety, structure, routine, reorientation

nuchal rigidity

stiff neck (common in meningitis)

phonophobia

sensitivity to sound

photophobia

sensitivity to light

low back pain

cause: muscle strain, disc degeneration

spinal stenosis: narrowed spinal canal compresses nerves and roots

treatment: nonpharm- exercise, PT, heat, acupuncture, massage

pharm- NSAIDs or muscle relaxants, acetaminophen, opiods, systemic corticosteroids

herniated nucleus pulposus “slipped disc”

risk: trauma or lifting, age, gender, obesity, smoking, occupation

manifestations: pain, numbness of affected extremity, weakness, inability to control movement

EMERGENCY: when loss of bowel and bladder, saddle anesthesia, chronic pain, pain in back, arm, leg, or neck

multiple sclerosis

patho: breakdown of myelin sheath

• loss of myelin sheath around spinal cord, nerves do not die just cannot conduct

symptoms: numbness or weakness, vision loss, double or blurred vision, tingling, electric shock sensations, tremor, fatigue, dizziness

diagnosis: history and exam- definitive dx; 2 sep. symptomatic events, MRI; changes in at least 2 separate location

Amyotrophic lateral sclerosis (ALS)

patho: rapid progressing, fatal CNS disease that affects voluntary muscle control

symptoms: progressive muscle weakness, spasticity- upper motor, flaccidity- lower motor

management: H&P, rule out other causes, symptom relief, physical occupational speech therapy

spinal cord injury

symptoms: vary by injury level

autonomic dysreflexia: sudden increase BP, headache, sweating above injury, bradycardia - emergency

Myasthenia gravis

patho: anti-acetylcholine receptor antibodies prevent binding of acetylcholine, decreased acetylcholine sensitivity

symptoms: ocular- 2/3 pt, ptosis (eyelid droop), difficulty swallowing

bulbar: 16%, cranial nerves IX, X, XI, phonation, chewing, swallowing

general: 16-20%, proximal muscles, difficulty with ADLs

guillain-barre syndrome

patho: immune response- destroys myelin of peripheral nerves, lower extremity weakness, usually precipitated by infection

symptoms: symmetrical ascending moto weakness and paralysis

trigeminal neuralgia

symptoms: pain- acute onset sudden, sharp, throbbing, shock-like, attacks vary in frequency

first-line treatment: antiepileptics- carbamazepine, reduce excitability of neurons

baclofen