Chapter 47: Neurological System Function, Data Collection, and Therapeutic Measures (Video Notes)

A comprehensive set of practice flashcards covering neural anatomy, brain regions, autonomic nervous system, aging effects, neurological assessment, diagnostic tests, procedures, stroke signs, posturing, communication, nutrition, and clinical review questions based on the lecture notes.

Describe the basic components of a multipolar neuron and the function of each part.

Soma (cell body) contains the nucleus and is the control center; Dendrites receive signals and conduct information to the soma; Axon carries nerve signals away from the cell body; Myelin sheath insulates the axon (Schwann cells in PNS, oligodendrocytes in CNS); Neurofibral nodes (nodes of Ranvier) occur at intervals; Axon terminals end in synaptic knobs with neurotransmitter vesicles.

Which cells form the myelin sheath in the peripheral nervous system (PNS) and the central nervous system (CNS)?

Schwann cells form myelin in the PNS; oligodendrocytes form myelin in the CNS.

What are the gaps in the myelin sheath called, and what is their function?

Neurofibral nodes (nodes of Ranvier); they enable saltatory conduction and rapid transmission of impulses.

Name the three types of neurons and their primary roles.

Sensory (afferent) neurons detect stimuli and transmit to the CNS; Interneurons connect sensory to motor pathways and process information within the CNS; Motor (efferent) neurons relay messages from the brain to muscles or glands.

What is the difference between white matter and gray matter in the spinal cord?

White matter contains myelinated axon tracts and appears white; gray matter appears gray due to lack of myelin and contains motor neurons and interneurons, organized into posterior (dorsal) and ventral (anterior) horns (and lateral horns in some regions).

What is the central canal of the spinal cord and what circulates there?

The central canal carries cerebrospinal fluid (CSF) through the spinal cord.

What is the cauda equina and why is it named so?

A bundle of nerve roots at the end of the spinal cord that resembles a horse’s tail.

Describe the basic reflex arc.

Somatic receptors detect a stimulus; afferent (sensory) fibers carry the impulse to the spinal cord; interneurons may process within the spinal cord; motor neurons initiate a response causing muscle contraction.

List the major regions of the brain and their general functions.

Cerebrum (higher functions), Diencephalon (between cerebrum and midbrain), Cerebellum (coordination), Brainstem (midbrain, pons, medulla) for basic life functions.

What are gyri and sulci in the brain?

Gyri are thick ridges; sulci are shallow grooves; fissures are deep sulci.

Which brain area is typically involved in speech production and which lobe contains it?

Broca's area; located in the frontal lobe (usually left hemisphere).

Which brain regions are associated with hearing, language comprehension, and vision?

Temporal lobe (hearing, Wernicke's area for language comprehension); Parietal lobe (somatic senses, taste); Occipital lobe (vision).

What are the cranial nerves listed in the notes (I–XII)?

Olfactory (I), Optic (II), Oculomotor (III), Trochlear (IV), Trigeminal (V), Abducens (VI), Facial (VII), Vestibulocochlear (VIII), Glossopharyngeal (IX), Vagus (X), Accessory (XI), Hypoglossal (XII).

Where do sympathetic preganglionic neurons originate and where are the ganglia typically located?

Originates in the spinal cord; ganglia lie in sympathetic chains along either side of the spinal cord, close to the cord.

Compare the lengths of preganglionic and postganglionic fibers in the sympathetic vs parasympathetic divisions.

Sympathetic: preganglionic fibers are short, postganglionic fibers are long; Parasympathetic: preganglionic fibers are long, postganglionic fibers are short.

Why is the parasympathetic division considered more localized in its effects?

Because its ganglia reside in or near the target organ, producing more localized responses.

Name some aging-related changes in the nervous system.

Decreased blood flow to the brain; lipofuscin deposition in nerve cells and amyloid in vessels; decreased acetylcholine and dendritic loss; decreased norepinephrine and dopamine; impaired cognition, memory, sleep patterns; increased falls; overall slower mental and motor function.

What are the components of a Basic Neurological Assessment?

Level of consciousness; vital signs; pupil response to light; extremity strength and movement; sensation.

What subjective data should be gathered in a neurological assessment?

Mental status, intellectual function, thought content, perception, language ability, memory, pain.

What should you do for Cue Recognition 47.1 when a patient pulls at tubes and drains?

Assess for delirium and possible causes; ensure safety; reorient as needed.

What should you do for Cue Recognition when a patient becomes suddenly lethargic?

Immediately notify the healthcare provider (HCP) or RN of the change in level of consciousness.

What does the Glasgow Coma Scale (GCS) evaluate and what are its components?

Level of consciousness with three components: Eye opening, Verbal response, and Motor response (scales 3–15).

What does the FOUR Score assess in coma evaluation?

Eye response, motor response, brainstem reflexes, and respiration to evaluate coma status.

What does BE FAST stand for in stroke recognition?

Balance loss or coordination; Eyes vision trouble; Face drooping; Arms weakness or numbness; Speech difficulty; Time to act.

What is normal pupil assessment?

Pupils equal, round, reactive to light and accommodation.

Name examples of laboratory tests commonly used in neurological assessment.

Thyroid, Vitamin B12, Complete blood count (CBC), Creatine kinase (CK), Erythrocyte sedimentation rate (ESR), Electrolytes, Hormone levels, VDRL, Liver function tests, Renal function.

What are the preprocedure and postprocedure care points for a lumbar puncture?

Pre: verify informed consent, assist with positioning; Post: bedrest 6–8 hours, encourage fluids, monitor puncture site, monitor movement/sensation and headache.

What are typical pre- and postprocedure considerations for a CT scan with contrast?

Pre: check allergies to contrast, obtain order for any needed sedation; Post: encourage fluids if contrast used; teach about warmth sensation and signs of allergic reaction.

What should be checked before an MRI and what postprocedure care is required?

Pre: ensure no pacemaker or metal present; administer analgesic/sedative as ordered; teach relaxation. Post: typically no special care.

What are common pre- and postprocedure considerations for an angiogram?

Pre: informed consent, clear liquid diet if ordered, IV access, sedation as ordered. Post: keep patient flat 4–6 hours, apply pressure to the site for 3–6 hours, monitor vitals, pulses, catheter site, and encourage fluids.

What are key pre- and postprocedure considerations for a myelogram?

Pre: check for allergies to contrast and shellfish, assess seizure history, verify informed consent. Post: similar to lumbar puncture; encourage fluids; head of bed elevated 30 degrees.

What are basic EEG pre- and postprocedure care steps?

Pre: ensure hair is clean and dry, review medication orders; Post: wash hair.

List some therapeutic measures for neurologic patients related to movement and positioning.

Maintain functional positions; avoid injury; prevent contractures; mobilize as soon as possible.

What nutrition-related interventions are used for patients with impaired swallowing?

Thicken liquids; sit upright during meals; monitor meals; use enteral (tube) feedings if needed.

How should communication problems be addressed in neurological patients?

Be mindful of dysarthria and aphasias; use yes/no questions, correct substituted words, anticipate needs, use gestures, and be patient.

What is ISBARR and what is its purpose in healthcare communication?

Identify, Situation, Background, Assessment, Recommendation, Read-back/Repeat; a structured handoff/communication tool.

Describe Decorticate posturing.

Wrists and fingers flexed; feet plantar flexed; legs internally rotated; elbows flexed; arms adducted.

Describe Decerebrate posturing.

Wrists and fingers flexed; arms adducted; forearms pronated; elbows extended; feet plantar flexed.

What is the significance of the cranial nerve list for neurological assessment?

Knowing which nerves exist (I–XII) helps identify specific cranial nerve function and potential deficits during assessment.

Which cranial nerve is primarily responsible for heart rate and blood pressure regulation?

Vagus nerve (X).

Which two pupillary responses are assessed in pupil assessment?

Pupillary response to light and accommodation.

What is the role of the lateral sulcus in the brain's anatomy as described in the notes?

Separates the temporal lobe from the frontal and parietal lobes; marks cortical boundaries related to sensory processing and language areas.

When performing a neurological check, why is vital sign monitoring included with level of consciousness?

Vital signs reflect autonomic and brainstem function; changes can indicate deterioration in neurological status.