Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
105 Cards in this Set
- Front
- Back
|
What two things does the Central Nervous System consist of?
|
it consists of the brain and spinal cord
|
|
|
What are the two types of nerves in the Peripheral Nervous System?
|
Cranial Nerves: project from the brain and pass through the foramina (openings) in the skull (foramen magnum, foramen in the jaw...)
Spinal Nerves: project from the spinal cord and intervertebral foramina or spaces |
|
|
What are afferent pathways?
What are efferent pathways? |
ascending pathways, that carry the sensory impulses toward the CNS
descending pathways; transmit motor impulses away from the CNS to the effector organ |
|
|
What is an effector organ?
|
it it the organ that is going to feel the effect...cardiac, skeletal, smooth muscle, etc.
|
|
|
What does the somatic system consist of?
|
it consists of motor and sensory pathways regulating voluntary motor control of skeletal muscle
|
|
|
What two systems is the Autonomic Nervous System divided into?
|
Sympathetic: functions to mobilize energy in times of need, such as fight or flight. The fibers are myelinated, so impulse transmission is quick, and there is a rapid release of epinephrine and norepinephrine (adrenaline)
Parasympathetic: works through the brain stem and cranial nerves to innervate the organs in the head, thorax, and abdomen. |
|
|
What consists of the Autonomic Nervous System? What does it regulate?
|
It consists of motor and sensory components and is involved with the regulation of the body's internal environment (viscera or internal organs, such as the heart, smooth muscle, glands, etc.) through involuntary control of organ systems.
|
|
|
What are Neurons? What is its primary food?
|
It is the primary cell of the neurological system, and its primary food is glucose.
Neurons can scan the environment, integrate information, and initiate responses to maintain the body's homeostasis. |
|
|
What do Neuroglial and Schwann cells do?
|
They provide structural support and nutrition to the neurons, increase the speed of nerve impulses, and play an important role in how neurons process and store information.
|
|
|
How do myelinated neurons and unmyelinated neurons differ?
|
myelinated: myelin acts as an insulator that allows ions to flow between segments rather than along the entire length of the neuron, so transmission of nerve impulses is faster. The myelin sheath is tightly wrapped around the nerve.
Unmyelinated: myelin is loosely wrapped, and nerve impulse transmission is slower. Demyelinateing diseases include multiple sclerosis, Guillain-Barre, etc. |
|
|
What are the three types of Neurons? And what do they do?
|
Sensory Neurons: carry impulses from peripheral sensory receptors (afferent) to the CNS
Associational Neuron (Interneurons): transmit impulses from neuron to neuron, from sensory to motor neurons. Motor Neurons: transmit impulses away from the CNS to an effector organ (efferent) |
|
|
What is a synapse?
What is a presynaptic neuron? What is a postsynaptic neuron? What is a synaptic cleft? |
it is the region between adjacent neurons
it is a neuron that conducts impulses toward the synapse it is a neuron that conducts impulses away from the synapse it is the space between the neurons |
|
|
What are neurotransmitters?
|
they are chemicals that must be synthesized in the neuron, released into the synaptic cleft, bind to a receptor site on the postsynaptic membrane of another neuron, where it affects ion channels, and is removed by a specific mechanism from its site of action (because the neurotransmitter is stored on one side of the synaptic cleft, and the receptor sites are on the other side, neurotransmitters go in one direction)
|
|
|
Types of Neurotransmitters
Where they are found? effect? and clinical examples? Acetylcholine Norepinephrine Serotonin Dopamine Histamine Aminobutyric acid (GABA) Endorphins Substance P |
Acetylcholine: found in many parts of brain, spinal cord, neuromuscular junction of skeletal muscle, and many ANS synapses. Effect: excitatory or inhibitory. Clinical Ex: Alzheimer disease is associated with a decrease in acetylcholine-secreting neurons. Myastenia gravis (weakness of skeletal muscles) results from a reduction in acetylcholine receptors.
Norepinephrine: Found in many areas of the brain and spinal cord, also in some ANS synapses. Effect: excitatory or inhibitory. Clinical ex: cocaine and amphetamines, resulting in overstimulation of postsynaptic neurons Serotonin: found in many areas of the brain and spinal cord. Effect: generally inhibitory. Clinical ex.: involved with mood, anxiety, and sleep induction, Levels of serotonin are elevated in schizophrenia (delusions, hallucinations, withdrawal) Dopamine: found in some areas of the brain and ANS synapses. Effect: Generally excitatory. Clinical ex: Parkinson disease (depression of voluntary motor control) results from destruction of dopamine-secreting neurons. Drugs used to increase dopamine production induce vomiting and schizophrenia Histamine: effect: generally inhibitory. Clinical ex: no clear indication of histamine-associated pathologic conditions. Histamine apparently is involved with arousal, pituitary hormone secretion, control of cerebral circulation, and thermoregulation GABA: found in most neurons of the CNS have GABA receptors. Effect: majority of postsynaptic inhibition in the brain. Clinical ex: Drugs that increase GABA function have been used to treat epilepsy (excessive discharge of neurons) Endorphins: found widely distributed in the CNS and PNS. Effect: generally inhibitory. Clinical ex: the opiates morphine and heroin bind to endorphin and enkephalin receptors on presynaptic neurons and reduce pain by blocking the release of neurotransmitter. Substance P: Found in spinal cord, brain, and sensory neurons associated with pain, GI tract. Effect: Generally excitatory. Clinical ex: Substance P is a neurotransmitter in pain transmission pathways. Blocking the release of substance P by morphine reduces pain. |
|
|
What are two types of Neuroreceptors?
|
1. alpha-adrenergic receptors: 1-excitation and stimulation activity, 2-relaxation or inhibition, most are 1 on the effector organs
2. beta-adregenergic receptors: 1-increased heart rate and contractility and cause release of renin from the kidney (heart), 2-all remaining effects attributed to beta activity (heart and lungs) Norepinephrine stimulates all alpha 1 and beta 1 receptors, and only certain beta 2 receptors, causing vasoconstriction. Epinephrine strongly stimulates all four types of receptors inducing generalized vasodilation |
|
|
What does the Brain stem consist of?
|
it consists of the midbrain, medulla, and pons. Connecs the hemispheres of the brain, cerebellum, and spinal cord
|
|
|
What does the Forebrain consist of?
|
cerebral hemispheres, it consists of telencphalon (cerebrum, limbic system, and basal ganglia.) and diencephalon (epithalamus, thalamus, hypothalamus, and subthalamus)
|
|
|
What is Neurolgia?
|
it is the "nerve glue", it supports teh neurons of the CNS
examples: astrocytes (fill the spaces between the neurons, link everything together), oligodenggroglia (deposit the myelin), microglia (phagocytes of nervous system) |
|
|
What is the frontal lobe responsible for?
Prefrontal area? Premotor area? |
it conatains speech (Broca speech area), memory, and motor areas
responsible for goal oriented behavior (ability to concentrate, short term/recall memory, elaboration of thought involved in programming motor movements |
|
|
What does the parietal lobe consist of?
|
it consists of somatic sensory input (storage, analysis, and interpretation of stimuli)
|
|
|
What does the Occipital lobe do?
|
it is primary visucal cortex
|
|
|
What does the Temporal lobe do?
|
it is the primary auditory cortex
|
|
|
Wernicke Area
|
located in the temporal and parietal lobes constitutes a sensory speech area. Responsible for interpretation of speech.
|
|
|
Midbrain
|
consists of corpora quadrigemina (superior and inferior colliculi), tegmentum and basic pedunculi
|
|
|
Hindbrain
|
consists of the metencephalon (cerebellum [balance and posture] and pons) and myelencephalon (medulla oblongata; responsible for reflex activities swallowing, sneezing, bp, rr)
|
|
|
What are the 12 Cranial Nerves, and what are their functions?
|
I Olfactory s/smell
II Optic s/vision III Oculomotor M/ocular movement, pupillary reflex IV Trochlear M/ ocular movement V Trigeminal B/ smell, taste, chewing, pain VI Abducens M/ocular movement VII Facial B/ taste, facial movement VIII Vestibulocochlear s/equilibrium, hearing IX Glosopharyngeal b/ taste, gag reflex X Vagus m/swallowing, gag reflux XI Spinal Accessory B/shoulder muscles XII Hypoglosseal B/ tongue movement, taste |
|
|
What happens when there is an injury to the spine?
|
the areas and organs tat are innervated below that level are affected
|
|
|
What are the three systems that interact to cause pain?
|
Sensory/Discriminative system: processes information about the strength, intensity, and temporal and spatial aspects of pain. Where is the pain? what type of pain, how bad does it hurt? they result in prompt withdrawal from the painful stimulus
Motivational/Affective System: determines the individual's conditioned or learned approach/avoidance behaviors, on how to deal with the pain Cognitive/Evaluative System: takes into account spiritual and cultural influences and experiences regarding apin. how they react. may block, modulate, or enhance the perception of pain |
|
|
What is somatogenic pain?
|
such as pain of a crushed finger or the pain of a heart attack, is pain with a known cause
|
|
|
What is psychogenic pain?
|
pain for which no physical cause can be diagnosed, and the pain does not match the person's symptoms. However, it is not imaginary pain and the associated psychologic factors may cause intensity or prolong pain
|
|
|
What is Acute Pain?
|
mechanism that alerts the individual to a condition or experience that is immediately harmful to the body. Begins suddenly and is relieved after the chemical mediators that stimulate pain receptors are removed.
|
|
|
What is Somatic Acute Pain?
|
superficial (coming from the skin or close to the surface of the body) and is either sharp and well localized or dul, aching, and poorly localized and accompanied by nausea and vomiting. carried by sensory nerves
|
|
|
What is Visceral Acute Pain?
|
pain in internal organs, the abdomen, or skeleton. Poorly localized and is associated with nausea and vomiting, hypotension, restlessness, and in some cases, shock. often radiates (spreads away from teh actual site of pain) or is referred. carried by sympathetic nerve fibers
|
|
|
What is Referred Acute Pain
|
pain felt different from its origin; it radiates. pain that is present in an area removed or distant from its point of origin. Can be acute or chronic. the area is supplied by the same spinal segment as the actual site of pain
|
|
|
What is Chronic Pain?
What can it lead to? |
it is persistent-over 6 months usually defined as lasting at leaset 3-6 mths. and is related to tissue damage, inflammation, or injury of the nervous system. may be persistent/constant (low back pain) or intermittent (migranes). arthritis
it can lead to behavioral/psychological changes |
|
|
What is neuropathic chronic pain?
|
chronic pain characterized by increased sesitivity to painful stimuli and perception of innocuous stimuli as painful and spontaneous pain. results from abnormal processing of sensory information by the peripheral and central nervous system
|
|
|
Peripheral Neuropathic
|
ex: painful diabetic neuropathy.
due to trauma or disease of the peripheral nerves, such as nerve entrapment or diabetic neuropathy |
|
|
Central Neuropathic
|
caused by a lesion or dysfunction in the brain or sinal cord, such as phatom limb pain or complex regional pain syndrome (reflex sympathetic dystrophy syndrome/causalgia)
|
|
|
Chronic Pain: Terms to Know
1. Neuralgia 2. Causalgia 3. Reflex Sympathetic Dystrophies 4. Hyperesthesias 5. Myofascial Pain Syndromes 6. Hemiagnosia 7. Phantom Limb Pain 8. Trigger Points |
1. pain from a damaged peripheral nerve. severe pain occuring along the course of a nerve
2. pain that occurs 1-2 weeks after an injury to the brachial plexus, median nerve, or sciatic nerves. May be discoloration to affected area. intense burning pain accompanined by tropich skin changes, due to injury of nerve fibers 3. occurs after peripheral nerve injury and causes continuous severe burning pain, vasospasm and vasomotor changes. Extremity may be cool, cyanotic, or edematis. Muscle wasting may occur and extremity may have to be amputated 4. chronic pain condition where even light touch may elicit pain (don't even want sheets touching them) 5. injury to muscle or fascia, pain results from muscle spasm, tenderness or stiffness. Leads to muscle guarding, may have decreased use of muscle or extremity due to pain 6. loss of ability to identify source of pain on one side of the body. More associated with stroke that produces paralysis and hypersensitivity to pain on one side. Be able to feel the pain but cannot tell you specifically where the pain is 7. perception of pain in amputated limb. 8. seen w/ fibromyalgia. small hypersensitive regions in muscle or connective tissue. |
|
|
What is Pain threshold?
|
point at which you perceive stimulus (pain)
|
|
|
What is pain tolerance?
|
duration and time of intensity of pain an individual will endure before responding to pain. may vary among culture, spiritual aspects, medication, and gender.
|
|
|
What are pain receptors?
Afferent/efferent? |
on the affernt side (sensory); goes up to the brain, the brain decides what to do, goes dow to the efferent side (causes reaction). found in the skin, mucous membranes, lining of body cavities, and deep tissue
|
|
|
Temperature regulation
|
mediated primarily by hypothalamus. Peripheral thermoreceptors in skin and central thermoreceptors in the hypothalamus, spinal cord, abdominal organs, and other central locations provide teh hypothalamus with informationabout skin and core temperatures. If these temps are low the hypothalamus triggers heat production and conservation mechanisms
|
|
|
Fever
|
temporary "resetting of the hypothalamic thermostat" to a higher level in response to endogenous or exogenous pyrogens. the thermoregulatory mechanisms adjust heat production, conservation, and loss to maintain body core temp at a normal level. During fever, this level is raised so that the thermoregulatory center now adjusts head production, conservation, and loss to maintain the core temp. at the new higher temp. which function as a new set paint. fever helps the body respond to infectious processes through several mechanisms
|
|
|
Hypothermia
|
marked cooling of core temperature. Produces depression of the central nervous and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage
|
|
|
Hyperthermia
|
marked warming of core temperature
|
|
|
Trauma
|
body wound or shock produced by sudden physical injury, as from violence or accident
|
|
|
Temperature varies in response to?
|
location
activity environment circadian rhythm gender |
|
|
Sleep
What is the major part of the brain associated with this? |
is an active multiphase process.
hypothalamus is the major sleep center |
|
|
What are the two phases of sleep
|
REM and NREM
REM: 20-25% of sleep time. Occurs every 90 minutes beginning after 1-2 hrs of sleep, cerebral blood flow increases Non-rapid eye movement: NREM sleep, 75-80% of sleep time, decreased cerebral blood flow, ultimate relaxation, dec. in temp, heart rate, bp, rr, and muscle tone |
|
|
Sleep Disorders
1. Insomnia 2. Upper Airway Resistance Syndrome 3. Obstructive Sleep Apnea 4. Obesity Hypoventilation Syndrome 5. Parasomnias |
1. inability to fall or stay asleep and may be mild, moderate, or severe. May be transient, lasting a few days, and related to travel across time zones or caused by acute stress; having a cold. Long term insomnia can be idiopathic starting at early age or associated w/drug or alchol abuse, chronic pain disorders, chronic depression, the use of certain drugs, obesity, and aging
2. increased resistance to airflow with resultant snoring and brief arousals from sleep 3. soft palate, tongue, or both occlude the airway. Occlusion causes decrease in oxygen consumption and saturation. Results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 secs. or longer. Not a big opening in the back of the mouth where the uvula is.. Because of this, they can have HTN, heart failure more prone to MI's and strokes. send them for a sleep study for diagnosis. Give pressure mask (bipap or cpap) so that they can breathe and won't drop oxygen saturation 4. morbidly overweight; have short thick neck that limits airflow. recomment weightloss, do uvula plasty so won't obstruct airflow; also put on bipap or cpap 5. unusual behaviors occuring during sleep (i.e., sleepwalking, night terrors, rearranging furniture, eating food, violent behavior, and resltess leg syndrome) |
|
|
Disconjugate eye (starbismus)
|
one eye will look at you, and the other eye will look off
|
|
|
Diplopia
|
a symptom of starbismus, double vision
|
|
|
Nystagmus
|
when you ask them to gaze to left or gith, they have a twitch of more than 2 or 3 beats
|
|
|
Amblyopia
|
reduced vision in affected eye caused by cerebral blockage of the visual stimuli. poor vision
|
|
|
Scotoma
|
cirumscribed defect of central field of vision often associated with migranes, tumor, or optical neuritis. becomes blurry, flashing lights, may have floaters
|
|
|
Cataract
|
clouding/yellowing of the lens of they eye, usually occurring as a result of aging, trauma, etc...color discrimination they see more yellow due to color of the lens. most common cause of blindness in adults, but children can have it also. don't like to drive at night and visual acuity is diminished
|
|
|
Glaucoma
|
increased ocular pressure, hypertension in the arteries in the eye, causes peripheral and central visual impairment and loss, which may lead to blindness, painless, until pressure gets higher and will then have pain in the eye. pressure exerts onto optic nerve and vessels in eye and can cause problems with circulation and inflammation and irritation of that nerve
|
|
|
What is Otitis externa?
|
infection of the outer ear, commonly caused by prolonged moisture exposure (swimmer's ear)
|
|
|
What is otitis media?
|
acute otitis media, most common infection of infants and children
|
|
|
What is camphoraceous?
|
ketones, sweet smells
|
|
|
Why is hyposmia?
|
impaired sense of smell
|
|
|
What is anosmia?
|
complete loss of smell
|
|
|
What s Olfactory hallucinations?
|
smelling odors that are not really present
|
|
|
What is parosmia?
|
abnormal or perverted sense of smell
|
|
|
What is Hypogeusia?
|
decrease in taste sensations
|
|
|
what is dysgeusia?
|
a pervesion of taste in which ssubstances possess an unpleasant flaavor (ex: metallic)
|
|
|
Levels of Consciousness
Confusion Disorientation Lethargy Obtundation Stupor Coma Treatment? Nursing Implication? |
loss of ability to think rapidly and clerly; impaired judgement and decision making
beginning loss of consciousness; disorientation to time followed by disorientation to place and impaired memory; lost last is recognition of self limited spontaneous movement or speech; easy arousal with normal speech or touch; may/may not be oriented to time, place, or person mild to moderate reduction in arousal with limited response to the environment; falls asleep unless stimulated verbally or tactilely; answers questions w/ minimum response condition of deep sleep or unresponsivess from which the person may be aroused or caused to open eyes only by vigorous and repeated stimulation; response is often withdrawal or grabbing at stimulus no verval response to ext. environment or to any stimuli, noxious stimulit such as deep pain or suctioning do not yeild motor movement -Light Coma: associated with purposful movemtn on stimulation -Coma: associated w/ nonpurposful movment on stimulation -Deep coma: associated with unresponsiveness or no response to any stimulus Tx: test cranial nerves, physical assessment, blood work (see what sodium is), drug screens, CT or MRI, look at arterial vessels, EEG to see if any deficits; treat appropriately NI: very good neurological asssessment of pt. know cranial nerves very thorough exam. report any changes to physician. turn the patient, looks at their skin, look for signs of infection. talk to them. |
|
|
Coma
What it is? Causes? |
altered level of consciousness or level of arousal. there is no verbl response to external environment or stimuli. no response to noxious stimuli or deep pain (pinch). state of unarousable unresponsiveness; eyes usually closed no evidence of them opening, do not follow demands, dont talk. but they need to be talked to b/c hearing is the last to go
causes: hypoxia, hypoglycmia, drugs (overdose or sometimes put into one to recover), toxins, infection (abscess), tumors, trauma, hemotoma, aneurysm that's hemorrhaged, thrown an emboli, congenital, edema or fluid on brain, metabolic disorders (sodium), demyelinating disorders, anything that causes depression or decreased oxygen of the brain. |
|
|
What are the 5 categories of Neurological Function?
|
1. level of consciousness ( are they oriented to time, place, person, and themselves)
2. pattern of breathing (normal RR, fast, slow, are they Kussmaul, chain smoking, dying respirations?) 3. size and reactivity of pupils (pupils round, equal, react to light; eyes move correctly?) 4. eye position and reflexive responses ( do they stare or follow you?) 5. respond appropriately to reflex hammer; are movemtns purposeful/normal, do they grimace/groan?) |
|
|
When does Brain Death occur?
How do you diaganos Brain Death? Nursing Implicaion? |
occurs when the brain is irreversibly damaged so completely that it can never recover and cannot maintain the body's internal homeostasis.
Diagnos with an EEG that is flat for 6-12hrs, must occur in person who is not hypohermic; does no ingest drugs; no way person can recover mentally or physically. no spontaneous movemens, respiraions or reflexes NI: support for the family, must help hem deal wih deah; 2 physicians must examine patient and EEG's and mus deermine hat nothing can be done for paient |
|
|
What is cerebral death?
|
irreversible Coma, death of the cerebral hemispheres, exclusive of he brain sem and cerebellum. Brain damage is permanen, and he individual is forever unable to respond behaviorally in any significant way to the environmen. Brain may coninue to maintain internal homeostasis (rr, cardiovascular function, GI function, and temp)
|
|
|
What is a vegatative state?
|
loss of cerebral function and brain stem is maintaining a crude, awakening state. May open their eyes, chem, swallow, etc. Loss of bowel and bladder function, loss of speech, and do not follow commands. clinical condiion of complete unawareness of the self or surrounding environment. Sleep-wake cycles are present, and bp and breathing are mainained without support. Recovery is unlikely if state persists for 12 months.
|
|
|
What is minimally conscious state?
|
these persons may follow simple commands, manipulate objects, gesture or give yes/no responses, have inelligible speech, and have movements such as blinking or smiling
|
|
|
What is Lock-In Syndrome?
|
he individual cannot communicae through speech or body movement but is fully consious. The person retains vertical eye movement and blinking as a means of communication (only way of communication)
|
|
|
What are the different types of Breathing Patterns and their description?
|
Normal: after a period of hyperventilation tha lowers the arterial carbon dioxide pressure (PaCO2), the individual continues to breathe regualarly but with a reduced depth
Posthyperventilation apnea: Respirations stop after hyperventilation has lowered the PCO2 level below normal. Rhythmic breathing returns when the PCO2 level returns to normal Cheyne-Stokes respiration: the breathing pattern has a smooth increase in the rate and depth of breathing which peaks and is followed by a gradual smooth decrease in the rate and depth of breathing to the point of apnea, when the cycle reas itself. the hyperpneic phase lasts longer than the apneic phase. Central neurogenic hyperventilation: a sustained, deep, rapid, but regular pattern occurs, with a decreased PaCO2 and a corresponding increase in pH and PO2 Apneusis: a pronlonged inspiratory cramp (a pause a full inspiraion) occurs; a common variant of this is a brief end-inspiratory pause of 2 or 3 sec, often alernating with an end-expiratory pause. Cluster breathing: a cluster of breaths has a disordered sequence with irregular pauses between breaths. Ataxic breathing: completely irregular breathing occurs, with random shallow and deep breaths and irregular pauses. often he rate is slow Gasping breathing patern (agonal gasps): a pattern of deep "all-or-none" breaths is aaccompanied by a slow respiratory rate |
|
|
Decorticate
Decerebrate |
want a hug b/c hands are up
arms are down and wrists often turned out |
|
|
Seizures
Epilepsy other causes: |
sudden explosive disorderly discharge of cerebral neurons and is characterized by sudden tranient change in brain function. Usually involves motor, sensory, autonomic, and psychic portions of person. see changes in arousal
general term for primary conditions; 20% thought to be genetic. it is thought that plasma membrane of neural cells have defecet in membrane and leads to defect in resting membrane potential. abnormalities in potassium and calcium hypertermia, hypoxia, hypoglycemia, hyponaremia, repeated stimulation (flashing lighs), stress, sleep phases, psychological disorders that can cause "false seizures". Anything that affecs the brain |
|
|
Types of seizures?
Nursing Implications? Tx? |
partial general and unclassified, grand mal is the worst one you can have
NI: teach the patient about seizures, cue them on what will occur before they have a seizure, look at house and maybe pu foam padding around. Trained dogs can help sense seizures, need to know about meds. work related issues, protect patient; padded bedrails; assistance to bathroom; if feel like going to have seizure get them in the floor and remove all objects from around them; put them on left or right side so tongue doesn't occlude airway Tx: meds for seizures and prevention of others |
|
|
Aura
Prodroma Tonic phase Clonic phase Postical phase |
partial seizure experienced as pecliar sensation preceding onset of generalized seizure tha may take.. "a funny feeling"
early clinical manifestations, such as malaise, headache, or a sense of depression, that may occur hours-few days before onset of a seizure state of muscle contraction in which there is excessive muscle one sate of alernating contractino and relaxation of muscles time period immediaely following cessation of seizure activity |
|
|
What is agnosia?
|
failure to recognize form and shape of regular objects
|
|
|
Types of Agnosia?
|
tactile: touch, loss sense of touch
spatial: unable to find way through familiar places agraphia: loss of abiliy to write |
|
|
What is dysphasia?
|
impairment of language
|
|
|
What is aphasia?
|
loss of comprehension of language
|
|
|
States of Confusion
Acute Chronic |
Acute: delirium, something has caused it...drugs, metabolic, temp, result of traumatic event, anesthesia, nervous disorder. Person is confused, easily distracted, irritable, frustrated, trouble sleeping, loss of apetite, can also be less active, decrreased alterness, sleeps a lot. can have anxiety or depressive response. Do CT,MRI, lumbar puncture, psych eval. drug screen...treat underlying cause. Nurse: do thorough neurological exam. proect patient and others
chronic: dementia: chronic and progressive disase of the brain. there is a disturbance of calculations, learning, and judgement. deteriation of emotional control, motivation. test: mini-mental |
|
|
Alzheimer Disease
What is it? |
Increased Intracranial Pressure
progressive degeneration of cerebral corex. cause is unknown. thought deficiency in acetylcholine, substance p, norepinephrine. viral factors, trauma, and genetic factors. CT notice that there are neurofibrillatory triangles and beta amyloid plaque. degeneration of nerve cells and Alzheimer's becomes progressively worse. Clinically more forgetful, unable to concentrate, have trouble caring for themselves, have trouble communicating. CT, MRI, lumbar puncture, EEG, lab work to rule out other causes Some meds help w/ alzheimers NI: support for families; ge into suport groups; protect them (take their keys) |
|
|
What is the normal intracranial pressure (ICP)?
|
the normal is 5-15 mm Hg or 60-180 cm H20
|
|
|
What diseases/disorders can affect ICP?
|
Herniation: brain tissue shifts from greater to lesser compartment
Hemorrhagic Stroke Tumor Hematoma Hydrocephalus: various conditions characterized by excess fluid in the cranial vault, subarachnoid space, or both Cerebral Edema: increasein fluid content of brain tissue, increased extracellular or intracellular tissue volume |
|
|
Muscle Tone and Strength
1. Hypotonia 2. Hypertonia 3. Paresthesias 4. Paralysis 5. Hypokinesia 6. Paresis 7. Plegia 8. Hyperkinesia 9. Dyskinesia 10. Akinesia 11. Bradykinesia 12. rigidity 13. Cogwheel |
1. Hypotonia: flaccid, lift arm they drop it
2. Hypertonia: very spastic movements 3. paresthesias: weakness 4. Paralysis: inability to move a muscle group 5. Hypokinesia: decreased movement 6. Paresis: weakness 7. Plegia: involves more than one muscle group 8. Hyperkinesia: excessive movement 9. Dyskinesia: proximal-abnormal involuntary movement that occurs w/spasms. Tardod-involuntary movement of face, trunk , or extremiies; often involved w/drugs such as phenagren 10. akinesia: decrease in voluntary movements; disturbances in time it takes to perform movemts; Parkinson's 11. Bradykinesia: difficulty in initiating and continuing movements smoothly 12. Rigidity: muscle resistance to passive movement of rigid limb hat is uniform in both flexion and extension throughout motion 13. Cogwheel: uniform resistance may be interrupted by series of brief jerks resulting in movements much like a rachet |
|
|
Parkinson's Disease
What is it? Who does it effect? Clinical Manifestations? Evaluation? Treatment? |
it is a degeneration disorder of dopamine receptors; causes deficiency of dopamine. thought genetic or exposure to toxins.
effects men > 40. CM: rigid movemetns, tremors, gait and movements will have disturbances, loss of facial expression, may drool, higher pitched voice, difficulty w/ speech and swallowing Eval: diagnosed by history and exam Tx: meds to help wih absorption of dopamine. supportive measures for patient and family; proection for them at home (president Regan) |
|
|
Trauma
Types: Open/closed head trauma Contusions Hematomas Concussion Whiplash |
Open/Closed head trauma: either open or closed skull
Contusions: damage hat results from compression of skull and has rebound effect. "bruising of brain". Bleeding may occur, small tears in blood vessels b/c of force Hematomas: tearing of veins and rapid forming pool of blood. increase in intracranial pressure and results in intracranial vessels and shifting of ventricles to opposite side Concussion: when you have a blow to the head; may lose consicousnesss; disoriented/confused; complain of headache, dizziness, nausea; symptoms may last several weeks-1 year Whiplash: head goes forward and then back. srains/sprains tissue and ligaments in the neck. may take hours or weeks for whiplast to develop. stiffness in neck, arms, etc. put them in collar to take weight of head off the neck. meds for pain |
|
|
Degenerative Disc and Joint Diseases:
DDD DJD Spondylolysis Spondylolisthesis Spinal Stenosis Low Back Pain Sciatica Neuropathy Radiculopathy |
DDD: Degenerative disc diseasae
DJD: Degenerative joint disease Spondylolysis: degenerative process of vertebral column and associated soft tissues Spondylolisthesis: forward movement of spinal column (shift forward) down around L5-S1 area. Grade it. May have to have surgery Spinal Stenosis: spinal canal narrowed by bulging amulus or hypertrophyor thick ligament that entraps the nerve. Complain of pain and numbness. can occur in lumbar or cervical spine area. If in lumbar area, usually can't squat Low Back Pain: involves lumbar sacral area of spine. Causing pain (acute: lifting something heavy, or chronic: if you have some kind of congenital abnormality) Sciatica: irritation/inflammation of sciatic nerve, associated with low back pain. causes sharp shooting pain into buttocks and back of leg Neuropathy: loss of bowel or bladder function; numbness/tingling in extremity. Caused by inflammation or irritation; some kind of impingement of the nerve Radiculopathy: Nerve roots become damaged by compression, inflammation, or trauma. Cause weakness, muscle atrophy, decreased reflexes, drag foot. Eval: nerve conduction studies, electrical stimulus studies, electrical stimulus studies on the muscles (uncomfortable); x-ray, MRI, CT, myelogram(dye). Treat the cause. Nurse: no heavy lifting; exercises to strengthen abdominal muscles; firm bed to support spinal column. Pain meds, muscle relaxers, and steroids often given |
|
|
Types of Cerebrovascular Accidents (Strokes)
Thrombotic Hemorrhagaic Transient Ischemic Attack Lacunar Global Hypoprofusion |
Thrombotic: clot
Hemorrhagic: malformation b/w artery and vein; aneurysm has ruptured; or trauma Transient Ischemic Attack (TIA): symptoms of stroke; occlusionof artery but it opens back up no permanent damage. Symptoms reversed back to normal w/in 24 hours. Most of the time if you have a TIA, then you will have a CVA later Lacunar: occur in small arteries associated w/ smoking Global Hypoprusion (as in shock): decreased perfusion to cerebrum/brain. |
|
|
Cerebral Infarction
|
brain infarcted/dead
|
|
|
Cerebrovascular Disease
|
artherosclerotic plaque builds up in arteries in the brain
|
|
|
Cerebral hemorrhage
|
Aneurysm: weakening of wall of artery, ruptures, then bleeds
Arterio-venous malformation: abnormal channel b/w artery and vein, ruptures and bleeds Subarachnoid Hemmorrhage: hemorrhage in subarachnoid space |
|
|
Carotid Artery Disease
|
atherosclerotic plaque in carotid arteries safety net is the circle of willus
|
|
|
Cerebral Hemorrhage
Aneurysm? Arterio-venous Malformation (AVM)? Subarachnoid Hemmorrhage? |
Aneurysm: weakening of wall artery, ruptures, then bleeds
AVM: abnormal channel b/w artery and vein, ruptures and bleeds Subarachnoid Hemmorrhage: hemorrhage in subarachnoid space |
|
|
What is Meningitis caused by?
4 types CM? Eval/treatment? NI? |
is caused by bacteria, viral, fungal, or TB. Inflammation of meninges, cerebrospinal fluid, and ventricles
Bacterial: ear infection, sinus infection, pneumonia. Aspetic (Viral): mumps, herpes simplex 1&2; hand, foot, and mouth virus; viral encephalitis, flu Fungal: (histoplasmosis) bird droppings, yeast, aspergillus Tuberculosis (TB) CM: nuchal rigidity (neck is stiff), Kernig's sign (laying down, try ben their leg to abdomen then stretch), and Brudzinski sign (laying down, bend neck forward, they will flex hips and knees) Eval/treatment: lumbar puncture; reflexes; CT; MRI; lab work NI: thorough exam, notify phys. of changes, nutritional support (not able to eat), turned every 2 hrs, isolation, family support; some residual neurological deficits |
|
|
Abcess
|
local area of infection caused by trauma, surgery, infection, HIV, fever, seizures, headaches, N/V, treat cause. Supportive measures (turn, administer antibiotics)
|
|
|
Encephalitis
|
viral born from mosquito, herpes can also cause, increase in cranial pressure. Treat w/ antivirals, steroids, and supporive. Nutritional, fluid support. Support for familiy
|
|
|
HIV
|
can cause cerebral complications
|
|
|
Lyme disease
|
tiny deer tick. covered when they go into woods. treat with antibiotics
|
|
|
Amyotrophic Lateral Sclerosis
|
ALS: also known as Lou Gehrig Disease: causes muscle wasting/atrophy b/w 40-60 yrs of age. Rapidly fatal within 2-5 years. Respiratory failure; may aspirate, choke, etc. Though genetic/viral/nutrition of origin. Problems w/ speech, chewing, drooling, breathing,depression. changes in EMG and CD muscle and nerve conduction studies. Meds can help, supportive care, hospice.
|
|
|
Multiple Sclerosis
|
Primary demyelinating disorder leading to widespread neurological changes. Ages 20-50 more women than men. Yellow plaque on MRI, scar tissue forms, does not effect parasympathetic nervous system.
Problems w/ sensory impairment: numbness, tingling. Later double vision, urinary problems, problems walking, trouble speaking, muscle weakness, reflexes |
