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85 Cards in this Set
- Front
- Back
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what are neurons
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basic functional unit of the nervous system. It is capable of functioning, electrical stimuli
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what are the neurotransmitters
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PNS: acetocholine-excites
serotonin-increased with seizure activity. tend to relax SNS: Norepinephrine-speeds up everything, excitory dopamine-inhibatory |
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FRONTAL LOBE
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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 |
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TEMPORAL LOBES
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interpretive area;responsible for the intergration of somatic, auditory and visual data
primary auditory association;WERNCKES auditory receptive area |
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PARIETAL LOBE
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predominantly sensory lobes
responsible for sense of position and space of body visual spatial information |
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OCCIPITAL LOBES
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visual center
interpretation eye reflexes |
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DIENCEPHALONS AND HYPOPHYSIS
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COMPRISED OF THE THALAMUS AND PIT GLAND
temp and water regulation sleep wake cycle, hunger and agression |
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CEREBELLUM
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Coordination of movement
BALANCE position sense intefration of sensory |
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BRAIN STEM
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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 |
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protective structures
SKULL |
at about 18 mo forms a rigid container
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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 |
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protective structures
BBB |
affected by age, decreased proteins and cell membrane changes
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Things that pass the BBB
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glucose
gases CO2 water etoh penicllin does not pass readily vs. erythromycin |
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where are lumbar punctures done
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18in to reduce spinal cord injuries.
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Cerebral circulation
arterial |
anterior circulation-carotids
post circ-vertebral arteries>join basilar.circle of willis |
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Cerebral circulation
venous |
vessel wall are thinner to the brain, don't follow path of arteries, no valves
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ICP
normal |
10-20mmHg
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CPP cerebral perfusion pressure
normal |
60-130mmHg
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How do you position pts with increased ICP
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elevate HOB to promote venous drainage, use a soft collor to remain in neutral postion
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Motor and Sensory functions
Motor |
the motor cortex, a vertical band w/in each cerebral hemisphere, controls voluntary movements of the body
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What would you see if injury to this area if upper motor lesions
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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 |
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If lwr motor lesions
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Pt with HERNIATED DISK, TRAUMA OR GUILLANE BARRE
loss of voluntary control, decreased tone(polio) flaccid atrophy decreased reflexes |
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SENSORY
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sensory impulses
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Basic guidelines for assessment
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mental staus
avoid suggesting symptoms ellicit all data r/t symptoms consider culture and ethnic medications |
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What are the 5 major functions of the physical exam
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cerebral functiong
crainal nerves motor system sensory system reflexes |
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ASSESSING CEREBRAL FUNCTIONING
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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 |
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Glascow coma scale
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Total 3-15
BEST SCORES ARE THE HIGH ONES |
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Cranial Nerves
#1 OH/SOME |
olfactory-sense of smeell, have them close eyes and identify. abnormal with head trauma, smk, drug abuse, alleries
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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 |
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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 |
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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 |
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Cranial Nerves
#5 TOUCH/but |
Trigemianl-corneal/blink reflex. cotton ball across eye lid
chewing is altered facial sensations |
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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 |
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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 |
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Cranial Nerves
#8 Various/SAYS |
Auditory/acpistoc-hearing, alteration safety measures. assist with amb
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Cranial Nerves
#9 GIRLS/BAD |
GLOSSOPHARYNGEAL-tast/swallow, assess gag/cough reflexdysphagia, aspiration risk sit upright for meals
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Cranial Nerves
#10 VAGINAS/Buisness |
VAGUS-CVA look at upper palate, speech for hoarseness, vocal paralysis
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Cranial Nerves
#11 AND(some)/MARRY |
Spinal accessory-shrugging of shoulders
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cranial nerves
#12 Hinneys/MONEY |
HYPOGLOSSAL-stick tounge out, push tounge against cheek, poor articulation of words, polio or stroke
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Assessment of motor function
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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 |
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ABNORAML FINDING OF MOTOR ASSESSMENT
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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) |
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Assess Sensory system
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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 |
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ASSESS REFLEX
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biceps/triceps
brachioradialis patellar achilles 0-4 0 is absent and 4 is hyperreflexiaclonus can't stop!! |
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What is bainski respone
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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
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DIAGNOSTIC TESTS
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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 |
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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 |
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WARNING SIGNS OF STROKE
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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 |
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STROKE
non-modifiable risks |
age, race (more african americans) Gender (woman more than men
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STROKE
Midifiable risk factors |
healthy lifestyle
HTN Cardiovascular disorders abdnormal cholesterol/lipids elevated Hct DM- keeo A1C <6 Drug use Excessive ETOH consumption |
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CEREBRAL INFARCTION
patho |
disruption of CBF
ischemic cascade results in malfunction of cellmembrane with no action potential the cell dies |
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What is th epenumbra region
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Tissue that surrounds the area of necrosis, helps protect the brain
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What are the two major types of stroke and their causes?
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ISCHEMIC-vascular occlusion by throbolic, embolic or lacunar(sm vessels occluded)
may present w/TIA Hemorrhagic-intracerebral, subarachnoid. C/o headache. Symptoms are sudden |
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What is the Time course of brain attacks
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TIA/warning last sec to hours
Reversible Ischemic Deficits/Warning last2d Evolution-2d of symptoms worsening Completion |
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TIA
Define duration cause treatment |
mini brain attack
seconds to 24h decreased bloodflow. typically carotids meds to prevent stroke, antiplatlets, ASA,plavix, surgery |
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S/S ischemic stroke
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motor loss
sensory loss verbal deficits cognitive changes emotional changes |
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LEFT HEMISPHERE STROKE
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affects R side
Motor-r side hemiplegia or hemiparesis. flacid < reflexes COMMUNICTION-aphasia PERCEPTUAL changes-R field Altered intellectual ability SLOW CAUTIOUS BEHAVIOR |
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RIGHT HEMISPHERE STROKE
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L SIDE paralysis or weakness
L visual field disturbance SPATIAL-PERCEPTUAL PROBLEMS INCREASED DISTRACTIBILITY Quick and impulsice POOR judgement lack of awarness of deficits |
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DIAGNOSTIC studies
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CT/MRI
EEG Cerebral flow studies cardiac evaluation |
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NIH STROKE SCALE
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used to predict outcomes and treatment. If score is >20 or 22 then thrombolytics are contraindicated
<10 is a positive outcome |
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PHARMACOLOGICAL MANAGEMENT
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Platelet aggregation-ASA plavix
Anticoags Thrombolytic therapy |
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THROMBOLYTIC THERAPY
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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 |
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REHABILITATION
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maximize clients independence promoting optimal function as a team
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OUTCOMES AND GOAL OF REHAB
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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 |
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HOW TO ATTAIN MAX MOBILITY
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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 |
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how do you prevent shoulder adduction
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support extremity on pillow and keep in neutral position
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How t prevent hand shoulder syndrome
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prevention:use a drawsheept and support UE at all time
INTERVENTIONS:neutral positioning, gentle ROM splinting and hand exercises |
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COMPLICATIONS OF IMMOBILITY
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Prevent skin breakdown
inspect pressure areas q2h turn q2, limit lying on affected limb>30m hygiende esp after incontinence |
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MAINTAIN BODY FUNCTIONS
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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 |
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s/s aspiration
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choking, silent aspiration look for adv. breath sounds and fever. AVOID FACE MASK, KEEP SUCTION AT BEDSIDE, RAISE HOB, AUSCULTATE LUNGS
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MAINTAIN BODY FUNCTIONS
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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 |
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MANAGE URINARY PATTERN
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MAYneed foley esp in acute stage, d/c ASAP.
bladder training, use bladder scanner, medications, biofeedback, stimulate inner thigh |
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MENINGITIS
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inflammatin of arachnoid and pia matter. may be septic/bacterial or aseptic/virial
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Bacterial meningitis
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forms exudate, spreads to CNS, cerebral edema, hydrocephalis
fever and headache CLASSIC SIGN- petechial rash N/V, light sensitive, Increased ICP seizures |
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what is BRUDZINSKI's sign
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+ if when you move neck the legs come up.
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Viral meningitis
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most recover without residula
s/s may be similar but no exudate |
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WHAT IS KERNIGs sign
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pain when someone prevents extension of leg
+ if pt is resists extension would not see in encephalitis |
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DIAGNOSTIC studies
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CSF?lumbar puncture-would tell type
LABS-blood and urine cultures to ID organism CT-see increased pressure Skull see fx or hydrocephalis |
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Treatment
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Broad spectrum antibioties ie vanco, supportive care-abc's, neuro give hyper or isotonic solutions caustiously
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What is cushings triade
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s/s of ICP
slow HR slow Resp Increased BP |
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what should you always suspet if you see slow bounding pulse, widening pulse pressure and a change in mental status
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brain trauma or disease
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Complicaitons of meningitis
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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 |
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Residual effects
meningitis |
dementia and cognitive deficits
deafness motor deficits-hemiparesis hydrocephalus visual problems sensory deficits |
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ENCEPHALITIS
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viral or bacterial
infection of the functional part of brain (parenchymel?) may also include meningitis may be caused from virusus or west nile |
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diagnostic studies encephalitis
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CSF/LP
see increased lymphocytes CT/MRI-see inflammatory process |
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encephalitis; clinical manifestations
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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 |
