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85 Cards in this Set

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what are neurons
basic functional unit of the nervous system. It is capable of functioning, electrical stimuli
what are the neurotransmitters
PNS: acetocholine-excites
serotonin-increased with seizure activity. tend to relax
SNS: Norepinephrine-speeds up everything, excitory
dopamine-inhibatory
FRONTAL LOBE
performs high level of cognitive functions and memory storage
somatic motor control
controls voluntary eye movements
controls motor aspect of speech, BROCCA are
affect, judgement, personality and inhibition
TEMPORAL LOBES
interpretive area;responsible for the intergration of somatic, auditory and visual data
primary auditory association;WERNCKES
auditory receptive area
PARIETAL LOBE
predominantly sensory lobes
responsible for sense of position and space of body
visual spatial information
OCCIPITAL LOBES
visual center
interpretation
eye reflexes
DIENCEPHALONS AND HYPOPHYSIS
COMPRISED OF THE THALAMUS AND PIT GLAND
temp and water regulation
sleep wake cycle, hunger and agression
CEREBELLUM
Coordination of movement
BALANCE
position sense
intefration of sensory
BRAIN STEM
integration system
comprised of mid-brain, pons and medulla
where most of the cranial nerves start
RAS system-resp for alertness-keeps you awake
Substantia nigra-affected in parkinson disease
protective structures
SKULL
at about 18 mo forms a rigid container
protective structures
MENNINGES
dura matter- tough outer layer
arachnoid-thin spider
Pia matter-covers all meniges
CSF- clear and colorless circulates in subarachnoid space. NO RBC's
protective structures
BBB
affected by age, decreased proteins and cell membrane changes
Things that pass the BBB
glucose
gases
CO2
water
etoh
penicllin does not pass readily vs. erythromycin
where are lumbar punctures done
18in to reduce spinal cord injuries.
Cerebral circulation
arterial
anterior circulation-carotids
post circ-vertebral arteries>join basilar.circle of willis
Cerebral circulation
venous
vessel wall are thinner to the brain, don't follow path of arteries, no valves
ICP
normal
10-20mmHg
CPP cerebral perfusion pressure
normal
60-130mmHg
How do you position pts with increased ICP
elevate HOB to promote venous drainage, use a soft collor to remain in neutral postion
Motor and Sensory functions
Motor
the motor cortex, a vertical band w/in each cerebral hemisphere, controls voluntary movements of the body
What would you see if injury to this area if upper motor lesions
PRESENT W/ A STROKE
loss of voluntary control
increased tone, spasticity, no atrophy of muscle
+babinski sign
reflex is altered
crossing of corticoid pathways, contra lateral paralysis
If lwr motor lesions
Pt with HERNIATED DISK, TRAUMA OR GUILLANE BARRE
loss of voluntary control, decreased tone(polio) flaccid
atrophy
decreased reflexes
SENSORY
sensory impulses
Basic guidelines for assessment
mental staus
avoid suggesting symptoms
ellicit all data r/t symptoms
consider culture and ethnic
medications
What are the 5 major functions of the physical exam
cerebral functiong
crainal nerves
motor system
sensory system
reflexes
ASSESSING CEREBRAL FUNCTIONING
mental status
intellectual functioning-have them count/spell
thought content-clear,relevant,coherent. ask if seeing/hearing anything
emotional status-irritable, angry, flat
perception-agnosia-inability to interpert/recgonize objs ie may see a pencil but not know what it is for
motor and lang ability
Glascow coma scale
Total 3-15
BEST SCORES ARE THE HIGH ONES
Cranial Nerves
#1
OH/SOME
olfactory-sense of smeell, have them close eyes and identify. abnormal with head trauma, smk, drug abuse, alleries
Cranial Nerves
#2
OH/SAY
Optic-visual field
the affected side of vision corresponds to the paralyzed side
Diplopia-double vision
Homonymous Hemianopsis-loss of 1/2 visual field. results from stroke. perm/temp
Cranial Nerves
#3
OH/MAKE
Occulomotor-test occular motor movement. pupil response
NYSTAGMUS -jerky movement back and forth of eye see with >ICP
CONVERGENCE-eyes move together
ACOMMADATION-focus far then close and see if adjust
PTOSIS-droopy eye lid
pupilary respone-round and oval may mean >ICP
unilateral dilation-herniation, injury brain stem
pin point-drugs, damage to pons
Cranial Nerves
#4
TO/Money
Trochlear-test occular motor movement. pupil response
NYSTAGMUS -jerky movement back and forth of eye see with >ICP
CONVERGENCE-eyes move together
ACOMMADATION-focus far then close and see if adjust
PTOSIS-droopy eye lid
pupilary respone-round and oval may mean >ICP
unilateral dilation-herniation, injury brain stem
pin point-drugs, damage to pons
Cranial Nerves
#5
TOUCH/but
Trigemianl-corneal/blink reflex. cotton ball across eye lid
chewing is altered
facial sensations
Cranial Nerves
#6
AND/My
Abducens-test occular motor movement. pupil response
NYSTAGMUS -jerky movement back and forth of eye see with >ICP
CONVERGENCE-eyes move together
ACOMMADATION-focus far then close and see if adjust
PTOSIS-droopy eye lid
pupilary respone-round and oval may mean >ICP
unilateral dilation-herniation, injury brain stem
pin point-drugs, damage to pons
Cranial Nerves
#7
FEEL/BROTHER
Facial-have pt show teeth
Important w/ pt who have a CVA, might have injury to facial nerve, intercranial nerve lesions or trauma if facial paralysis
provide good oral care, drink on unaffected side
Cranial Nerves
#8
Various/SAYS
Auditory/acpistoc-hearing, alteration safety measures. assist with amb
Cranial Nerves
#9
GIRLS/BAD
GLOSSOPHARYNGEAL-tast/swallow, assess gag/cough reflexdysphagia, aspiration risk sit upright for meals
Cranial Nerves
#10
VAGINAS/Buisness
VAGUS-CVA look at upper palate, speech for hoarseness, vocal paralysis
Cranial Nerves
#11
AND(some)/MARRY
Spinal accessory-shrugging of shoulders
cranial nerves
#12
Hinneys/MONEY
HYPOGLOSSAL-stick tounge out, push tounge against cheek, poor articulation of words, polio or stroke
Assessment of motor function
bulk-muscle
tone-ready to respond
strength-hand grasps
coordination-touch finger to nose . Take one heel up opp shin
Romberg test-stand with hands at side, feet together for 30s walk in straight line
gait-walk heel toe/scissors gait
ABNORAML FINDING OF MOTOR ASSESSMENT
ataxia-abn gai
hypotonia/hypertonic-lack of tone/high tone
involuntary movements
pronation drift-hand out in front one hand to supination
Posturing; DECORTICATE-involves adduction/flexion of upper extremites, internal rotation of lwr extremities and plantar flexion of feet (alt LOC)
DECEREBRATE-involving extension and outward toration of upper extremities and plantar fleion of feet(severe brain injury)
Assess Sensory system
five senses
oain-acute/chronic, neurogeneitc pain
Temp-hot/cold
position-neglect of body part
vibration-tuning fork
touch
GRAPHESTHESIA-draw # in hand and have pt identify
STEREOGNOSIS-pt id object in hand w/eyes closed
ASSESS REFLEX
biceps/triceps
brachioradialis
patellar
achilles 0-4 0 is absent and 4 is hyperreflexiaclonus can't stop!!
What is bainski respone
sharp object up the sole of the foot, downgoing toes with plantar stimulation. In pt who have CNS prob the toes fan out and are drawn back. Normal in newborns
DIAGNOSTIC TESTS
CT-rule out heorrhagic stroke
MRI
PET
SPECT
ANGIOGRAPHY-injected into femoral artery Bleeding precautions
Myelography
LUMBAR PUNCTURE- done at L3
DO NOT DO ON SOMEONE WITH >ICP CAN CAUSE BRAIN HERNIATION.
assess CSF and CSF pressure
corotid ultrasound
EEG/EMG
LUMBAR PUNCTURE
process
take three vials to make sure no RBC present. send for protein,glucose WBC w/meningitis
ck site for leakage, have pt prone for 2-3h to reduce/prevent leakage.hydrate to reduce headaches
WARNING SIGNS OF STROKE
sudden numbness or weakness of the face, arm, leg esp on 1 side of body
sudden confusion,trouble speaking or understanding
sudden trouble seeing in 1 or both eyes
sudden trouble walking, dizziness, loss of balance coordination
sudden sever headache with no known cause
STROKE
non-modifiable risks
age, race (more african americans) Gender (woman more than men
STROKE
Midifiable risk factors
healthy lifestyle
HTN
Cardiovascular disorders
abdnormal cholesterol/lipids
elevated Hct
DM- keeo A1C <6
Drug use
Excessive ETOH consumption
CEREBRAL INFARCTION
patho
disruption of CBF
ischemic cascade results in malfunction of cellmembrane with no action potential the cell dies
What is th epenumbra region
Tissue that surrounds the area of necrosis, helps protect the brain
What are the two major types of stroke and their causes?
ISCHEMIC-vascular occlusion by throbolic, embolic or lacunar(sm vessels occluded)
may present w/TIA
Hemorrhagic-intracerebral, subarachnoid. C/o headache. Symptoms are sudden
What is the Time course of brain attacks
TIA/warning last sec to hours
Reversible Ischemic Deficits/Warning last2d
Evolution-2d of symptoms worsening
Completion
TIA
Define
duration
cause
treatment
mini brain attack
seconds to 24h
decreased bloodflow. typically carotids
meds to prevent stroke, antiplatlets, ASA,plavix, surgery
S/S ischemic stroke
motor loss
sensory loss
verbal deficits
cognitive changes
emotional changes
LEFT HEMISPHERE STROKE
affects R side
Motor-r side hemiplegia or hemiparesis. flacid < reflexes
COMMUNICTION-aphasia
PERCEPTUAL changes-R field
Altered intellectual ability
SLOW CAUTIOUS BEHAVIOR
RIGHT HEMISPHERE STROKE
L SIDE paralysis or weakness
L visual field disturbance
SPATIAL-PERCEPTUAL PROBLEMS
INCREASED DISTRACTIBILITY
Quick and impulsice
POOR judgement
lack of awarness of deficits
DIAGNOSTIC studies
CT/MRI
EEG
Cerebral flow studies
cardiac evaluation
NIH STROKE SCALE
used to predict outcomes and treatment. If score is >20 or 22 then thrombolytics are contraindicated
<10 is a positive outcome
PHARMACOLOGICAL MANAGEMENT
Platelet aggregation-ASA plavix
Anticoags
Thrombolytic therapy
THROMBOLYTIC THERAPY
r-TPA-give w/i first 3h of s/s
contraindicated with trauma, recent falls, prior stroke or MI in the past 3mo
BIGGESt complication is HEMORRHAGE
d-dimer,cbc,pt/int,ptt
BP SBP<180
DBP<100
REHABILITATION
maximize clients independence promoting optimal function as a team
OUTCOMES AND GOAL OF REHAB
promote SC activites
attain max mobility
maintain stable body functions
avoid complications of immobility
relief of sensory and perceptual deprivation
inprove though process
achieve form of communication
effective coping and family funciton
HOW TO ATTAIN MAX MOBILITY
Provide full PROMto affected limb, prevent shoulder adduction, position hands and fingers in neutral position, est. exercise prog. prepare to ambulate(walker, crutches)
FOCUS ON SAFETY-oob on stong side
how do you prevent shoulder adduction
support extremity on pillow and keep in neutral position
How t prevent hand shoulder syndrome
prevention:use a drawsheept and support UE at all time
INTERVENTIONS:neutral positioning, gentle ROM splinting and hand exercises
COMPLICATIONS OF IMMOBILITY
Prevent skin breakdown
inspect pressure areas q2h
turn q2, limit lying on affected limb>30m
hygiende esp after incontinence
MAINTAIN BODY FUNCTIONS
provide oral care, assess swallow and gag reflex/position in high fowlers to eat and 30m after/place food on unaffected side of mouth/check for pocketing
stop feeding is aspirate advocate for peg tube
s/s aspiration
choking, silent aspiration look for adv. breath sounds and fever. AVOID FACE MASK, KEEP SUCTION AT BEDSIDE, RAISE HOB, AUSCULTATE LUNGS
MAINTAIN BODY FUNCTIONS
strive for pre-morbid bowel routine. ways to stimulate-suppository, rectal stimuli, squatting, massage of abd.
use commode/toilet 30m after meals
use softeners, hydrate, high fiber, prune juice, privacy
MANAGE URINARY PATTERN
MAYneed foley esp in acute stage, d/c ASAP.
bladder training, use bladder scanner, medications, biofeedback, stimulate inner thigh
MENINGITIS
inflammatin of arachnoid and pia matter. may be septic/bacterial or aseptic/virial
Bacterial meningitis
forms exudate, spreads to CNS, cerebral edema, hydrocephalis
fever and headache
CLASSIC SIGN- petechial rash
N/V, light sensitive, Increased ICP
seizures
what is BRUDZINSKI's sign
+ if when you move neck the legs come up.
Viral meningitis
most recover without residula
s/s may be similar but no exudate
WHAT IS KERNIGs sign
pain when someone prevents extension of leg
+ if pt is resists extension
would not see in encephalitis
DIAGNOSTIC studies
CSF?lumbar puncture-would tell type
LABS-blood and urine cultures to ID organism
CT-see increased pressure
Skull see fx or hydrocephalis
Treatment
Broad spectrum antibioties ie vanco, supportive care-abc's, neuro give hyper or isotonic solutions caustiously
What is cushings triade
s/s of ICP
slow HR
slow Resp
Increased BP
what should you always suspet if you see slow bounding pulse, widening pulse pressure and a change in mental status
brain trauma or disease
Complicaitons of meningitis
cerebral abscess formation-capsule around pus
subdural empyema-pus in cavity
subdural effusion
acute cerebral edema
hydrocephalus-use shunting to relieve pressure
waterhouse-friderichsen syndrome-wide spread hemorrhage results in visual impairment and deafness
Residual effects
meningitis
dementia and cognitive deficits
deafness
motor deficits-hemiparesis
hydrocephalus
visual problems
sensory deficits
ENCEPHALITIS
viral or bacterial
infection of the functional part of brain (parenchymel?)
may also include meningitis may be caused from virusus or west nile
diagnostic studies encephalitis
CSF/LP
see increased lymphocytes
CT/MRI-see inflammatory process
encephalitis; clinical manifestations
mosqito bite gets really red
headache
feer
confusion
restlessness may progress to stupor the coma
involuntary movements if brain stem is involved see facial weakness or eye palsy
+libinski
asymetrical tendon reflexs