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136 Cards in this Set
- Front
- Back
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The cerebrum consists of the left and right hemisphere. Each hemisphere recieves ______ ________ from the ________ _______ of the body and controls the skeletal muscles on the ______ ________.
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sensory information
opposite side opposite side |
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This part of the brain governs sensory/ motor activity and thought and learning
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Cerebrum
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The cerebral cortex consists of frontal,parietal,temporal,and occipital lobe. It is responsible for the __________ _________ of the cerebrum.
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conscious activity
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Name 3 things the frontal lobe controls
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1. brocas area of speech
2. (prefrontal) morals,judgement,emotions 3.complex motor movements |
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What part of the cerebral cortex (lobe)is Joe using when thinking of the meaningfullness of a picture from his friend
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parietal lobe
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What part of the cerebral cortex (lobe)is Joe using when thinking of the meaningfullness of a picture from his friend
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parietal lobe
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This lobe interprets pain,touch,temp,and pressure
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parietal lobe
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This lobe controls auditory and contains wenickes area for sensory and speech
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temporal
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what lobe controls visual area
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occipital lobe
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This part of the brain assists the cerebral cortex in voluntary smooth movements
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basal ganglia
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when someone has a disorder in the basal ganglia, what happens
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it disrupts movement but does not cause paralysis( parkinsons, tremors,tics)
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These are the cell bodies in white matter
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basal ganglia
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What is included in the diencephalon
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thalamus and hypothalamus
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The thalamus relays _____ ____ to the cortex, provides a ____ ____, and is part of the reticular ______ _______.
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sensory impulses
pain gate activating system |
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The hypothalamus regulates _____ _____ for the sympathetic and parasympathetic systems
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autonomic responses
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The hypothalamus regulates stress,sleep,____, ______, fluid balance,_______.
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appetite, body temp, emotions
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The hypothalamus is responsible for the production of what?
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hormones sereted by the pituitary gland
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Name the 3 parts of the brain stem
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midbrain,pons,medulla oblongata
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The midbrain is responsible for ____ _____. Also visual reflex and ______ _____ centers
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motor coordination
auditory relay |
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What does the Pons do?
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contains respiratory centers and regulates breathing
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Where are all the afferent and efferent tracks at in the brain
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brain stem-medulla oblongata
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what 4 centers does the medulla oblongata contain
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cardiac,respiratory, vomiting,vasomotor
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heart rate,respiration, blood vessel diameter,sneezing,swallowing, vomiting,coughing are controlled by what
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medulla oblongata in the brain stem
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The cerebellum coordinates ____ _____ movement and coordinates 3 things what are they?
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smooth muscle
posture,muscle tone,equiibrium |
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what is the spinal cord protected by?
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meniges,CSfluid, adipose tisue
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The spinal cord extends from _____ ______ to the 2nd _____ ______
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first cervical
lumbar vertebra |
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The spinal cord carries info ____ and motor info _____ the brain
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to
from |
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what does the spinal cord provide neuron and synapse networks to produce?
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involuntary responses to sensory stimulation
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what are the spinal cord horns
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inner column of gray matter that contains 2 anterior and 2 posterior horns
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what do the posterior horns connect with?
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afferent (sensory) nerve fibers
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anterior horns contain
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efferent (motor) nerve fibers
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_____ _____ contains the nerve tract. Ascending tracts=_____Descending tract= ____
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white matter
sensory pathway motor pathway |
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The dura mater is part of the meninges, what is it?
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tough and fibrous membrane, that provides protection for the brain and spinal cord
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what is the arachnoid membrane
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is the delicate membrane and contains subarachnoid fluid
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what part of the meninges is the vascular membrane
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Pia mater
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The subarachnoid space is formed by the _____ ______ and the ____ _____ and contains ______
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arachnoid membrane
pia mater CSF |
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where is CSF secreted and what does it do?
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in the ventricles and circulates thru the ventricles to the subarchnoid layer where it is reabsorbed; acts as a cushion and aids in exchange of nutrients and waste
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what is normal pressure of CSF?Normal Volume?
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50-175
125-150ml |
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The blood supply of the brain contains
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1. right/left internal carotids anteriorly
2. right/left vertebral arteries posteriorly These arteries supply the brain via a anastomosis at the base of the brain called the circle of willis Cerebral autoregulation |
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how much CO and oxygen does the the brain receive
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CO-15%
oxygen-20% |
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The blood supply in the brain cannot store oxygen, engage in anerobic metabolism or store glucose, if lack of oxygen or glucose, what happens
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quickly experience signs of neuro dysfunction
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what is synaptic transmission
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when communication occurs btw neurons thru synapses, can be electrical or chemical.
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Neurotransmitters are stored and made in the ______
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axon
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The reaction btw a nuerotranmitter and receptor produces a specific _____ _____
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physiologic response
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removal of a neurotanmitter is necessary to?
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maintain the desired response
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Neurons are ____ cells and supporting cells protect/provide ______ _______ for the neurons, examples are?
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functional
metabolic suport glial/schwann are supporting cells |
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Name 3 things the neuron contains
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cell body,axons,dendrites
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Name 3 things the neuron contains
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cell body,axons,dendrites
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______ is the chemical transmission from one neuron to another
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synapse
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what is it when neurons carry impulses TO the central nervous system
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sensory neurons
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What is it when neurons are carrying impulses away from the CNS?
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motor neurons
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_____ carry info away from the cell body
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axons
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_______ conduct info toward the cell body from other _____ and _____
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dendrites
axons and dendrite |
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Axons and dendrites are Protected and insulated by _____ _____ in the PNS & ____ _____ in the CNS
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Schwann cells
Glial cells |
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______ ______ are protected by the endoneurium which is essential in regeneration of injured peripheral nerves
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Schwann cells
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_______ together with tightly woven capillaries make up the blood-brain barrier
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Astrocytes
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_______ together with tightly woven capillaries make up the blood-brain barrier
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Astrocytes
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Myelin sheath
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_____ ______is woven around the Schwann cells & Glial cells to increase the speed of transmission of impulses in axons
MS,Guillian Barre high lipid content which gives it white color |
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pairs of spinal nerves
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32
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Mixed nerve fibers are formed by the joining of the anterior motor and posterior sensory roots in the
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intervertebral foramen
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______ roots contain with afferent (sensory) nerve fibers
_______roots contain efferent (motor) nerve fibers |
Posterior (dorsal)
Anterior (ventral) |
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_____ ______ dilate pupils, increase heart rate and rhythm, contract blood vessels, and Parasympathetic (cholinergic) fibers produce the opposite effect relax smooth muscles of the bronchi
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Sympathetic (adrenergic) fibers
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what is normal ICP
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10-20
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what is monroe kelly doctrine
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The pressure-volume relationship between ICP, volume of CSF, blood, and brain tissue, and cerebral perfusion pressure (CPP) is known as the Monro-Kellie doctrine or the Monro-Kellie hypothesis.
The Monro-Kellie hypothesis states that the cranial compartment is incompressible, and the volume inside the cranium is a fixed volume. The cranium and its constituents (blood, CSF, and brain tissue) create a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another. |
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what is CPP
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difference btw mean aterial pressure and ICP, pressure perfusing the brain
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how would you assess ICP?
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LOC is the most sensitive and earliest indicator of increasing pressure; restlessness-confusion-coma;Look for headache/slowing pulse/high temp/abnormal rr
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continued assessment of ICP?
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Rise in blood pressure with widening pulse pressure
Vomiting Pupil changes Changes in motor function from weakness to hemiplegia, a positive Babinski’s reflex, decorticate or decerebrate posturing, and seizures |
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what are late signs of ICP?
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increased systolic blood pressure, widened pulse pressure, and slowed heart rate (Cushing’s triad)
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what to closely monitor in ICP?
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Monitor GCS based on patient acuity, usually q 1 hour!!
Observe for evidence of CSF leak in ears or nose |
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Hematoma
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Can occur as a result of an epidural, subdural, or intracerebral hemorrhage
Assessment findings will depend on the injury Clinical manifestations usually result from increased ICP |
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Forms slowly and results from a venous bleed
It occurs under the dura, as a result of tears in the veins crossing the subdural space |
what is a subdural hematoma
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what is a epidural hematoma?
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The most serious type of hematoma, forms rapidly and results from an arterial bleed
Forms between the dura and the skull from a tear in the meningeal artery A surgical emergency |
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A localized collection of blood within the brain tissue caused by tearing of arteries and veins in the white matter
Associated with a cerebral laceration resulting from a contusion Causes significant edema and ICP elevation |
what is a Intracerebral
hematoma |
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what is An abnormal sudden excessive discharge of electrical activity within the brain
________ is a disorder characterized by chronic seizure activity and indicates brain or central nervous system (CNS) irritation |
seizure
epilepsy |
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_____ _______ involves a rapid succession of epileptic spasms without intervals of consciousness; it is a potential complication that can occur with any type of seizure, and brain damage may result
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Status epilepticus
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-Generalized seizures
1Tonic-clonic (grand mal) 2Absence (petit mal) 3Myoclonic 4Atonic or akinetic (drop attacks) -Partial seizures 1Simple partial 2Complex partial |
Name the types of seizures
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May begin with an aura
The tonic phase involves the stiffening or rigidity of the muscles of the arms and legs and usually lasts 10 to 20 seconds followed by loss of consciousness The clonic phase consists of hyperventilation and jerking of the extremities and usually lasts about 30 seconds Full recovery from the seizure may take several hours |
what is Tonic clonic seizure?
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what is an Absence seizure?
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Brief seizure lasting seconds and the individual may or may not lose consciousness
No loss or change in muscle tone occurs Seizures may occur several times during a day and the individual returns to baseline immediately after the seizure The victim appears to be daydreaming This type of seizure is more common in children |
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_______ A seizure that presents as a brief generalized jerking or stiffening of extremities
______ or _______ A sudden momentary loss of muscle tone followed by postictal confusion The individual usually falls, which may result in injury |
Myoclonic
Atonic or Akinetic |
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what is a simple partial seizure?
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Produces sensory symptoms accompanied by motor symptoms that are localized or confined to a specific area
The client remains conscious and may report an aura |
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what is a complex partial seizure?
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Also called psychomotor or temporal lobe seizures
Characterized by periods of altered behavior that the client is not aware of The client loses consciousness for 1-3 minutes |
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Dilation of the walls of a weakened cerebral artery
Can lead to rupture |
what is a cerebral aneurysm?
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A sudden focal neurological deficit caused by cerebrovascular disease
A syndrome in which the normal blood supply to the brain is interrupted, causing neurological deficits Cerebral anoxia lasting longer than a few minutes causes cerebral infarction with irreversible change Surrounding cerebral edema and congestion causes further dysfunction |
what is a CVA?
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Diagnosis is determined by CT scan, EEG, and cerebral arteriography
The permanent disability cannot be determined until the cerebral edema subsides The order in which function may return is facial, swallowing, lower limb, speech, and arms |
more about CVA
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Ischemic
Thrombosis Embolism Transient Ischemic Attack (TIA) Hemorrhagic from rupture of a vessel |
what are causes of a CVA?
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Atherosclerosis
Hypertension Anticoagulation therapy Diabetes mellitus Stress |
name 5 risks factors for a CVA
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Obesity
Oral contraceptives Heart Disease and Atrial Fibrillation Illicit drug use Hypercoagulable states |
name 5 more risk factors for a CVA
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describe MS
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A chronic, progressive, noncontagious, degenerative disease of the CNS characterized by demyelinization of the neurons
It usually occurs between the ages of 20 and 40 and consists of periods of remissions and exacerbations The causes are unknown but thought to be a result of autoimmune response or viral infection |
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Precipitating factors include pregnancy, fatigue, stress, infection, and trauma
EEG findings are abnormal A lumbar puncture indicates increased gamma globulin, but the serum globulin level is normal CT and MRI show presence of plaque in white matter |
more on MS
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A neuromuscular disease characterized by marked weakness and abnormal fatigue of the voluntary muscles
A defect in the transmission of nerve impulses at the neuromuscular junction Causes include insufficient secretion of acetylcholine, excessive secretion of cholinesterase, or unresponsiveness of the muscle fibers to acetylcholine Confirmed by response to cholinergic medications |
Myasthenia Gravis is what?
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Progressive muscle weakness and fatigue that usually improves with rest
Difficulty chewing Dysphagia Ptosis Diplopia Weak, hoarse voice Difficulty breathing Diminished breath sounds Respiratory paralysis and failure |
Signs to look for in Myasthenia Gravis?
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Acute exacerbation of disease
Caused by a rapid, unrecognized progression of the disease, an inadequate amount of medication, or infection, fatigue, or stress |
what is a myasthenia crisis?
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Assessment
Restlessness Weakness Dyspnea Dysphagia Difficulty speaking Implementation Increase anticholinesterase medication Provide respiratory support |
what to assess in a myasthenia crisis?
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Depletion of _______, which interferes with the inhibition of excitatory impulses in Parkinsons disease
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dopamine
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It results in a dysfunction of the extrapyramidal system
It is a slow, progressive disease that results in a crippling disability The debilitation can result in falls, self-care deficits, failure of body systems, and depression Mental deterioration occurs late in the disease |
What is Parkinsons disease
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What would you look for and assess in Parkinsons disease?
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Bradykinesia, abnormal slowness of movement, and sluggishness of physical and mental responses
Aching shoulders and arms Monotonous speech Handwriting that becomes progressively smaller |
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What are these signs of?
Tremors in hands and fingers at rest (pill rolling) Tremors increasing when fatigued and decreasing with purposeful activity or sleep Rigidity with jerky interrupted movements Restlessness and pacing |
Parkinsons
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SIgns of Parkinsons
_____ facial expression Drooling Difficulty swallowing and speaking Loss of coordination and balance ______ steps, stooped position, and propulsive gait |
blank
shuffling |
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gressive degenerative disease involving the motor system
The sensory and autonomic system are not involved and mental status changes do not result from the disease |
what is ALS?
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The cause of ALS may be related to ??
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an excess of glutamate, a chemical responsible for relaying messages between the motor neurons
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As the ALS progresses,______ _____ and _______ develop until a flaccid quadriplegia develops
Eventually the respiratory muscles become affected, leading to respiratory compromise, pneumonia, and death There is no known cure and the treatment is symptomatic |
muscle weakness and atrophy
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Fatigue
Fatigue while talking Muscle weakness and atrophy Tongue atrophy Dysphagia Weakness of the hands and arms Fasciculations of the face Nasal quality of speech Slurred speech |
s/s of ALS
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An inflammation of the brain parenchyma and often the meninges
Affects the cerebrum, the brain stem, and/or the cerebellum Most often caused by a viral agent, although bacteria, fungi, or parasites may also be involved Viral encephalitis is almost always preceded by a viral infection |
What is encephalitis?
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How is encephalitis transmitted?
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Arboviruses can be transmitted to humans through the bite of an infected mosquito or tick
Echovirus, coxsackievirus, poliovirus, herpes zoster, and viruses that cause mumps and chickenpox are common enteroviruses associated with encephalitis Herpes simplex type 1 virus can cause viral encephalitis Amebic meningoencephalitis can enter the nasal mucosa of people swimming in warm fresh water, ponds, and lakes |
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WHat would you look for in someone with encephalitis?
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cold sores in the mouth, ulcers, hx of insect bites , swimming in fresh water, fever, exposure to infectious disease, and travel to where the disease is prevelent
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signs and symptoms of encephlitis
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Nausea and vomiting
Stiff neck Changes in LOC and mental status Signs of increased ICP Motor dysfunction and focal neurological deficits |
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what is meningitis
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Inflammation of the arachnoid and pia mater of the brain and spinal cord
Caused by bacterial and viral organisms, although fungal and protozoal meningitis also occur |
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what are predisposing factors of menigitis
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skull fractures, brain or spinal surgery, sinus or upper respiratory infections, the use of nasal sprays, and individuals with a compromised immune system
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what is looked at to determine the diagnosis and type of menigitis
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CSF fluid
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How is menigitis transmitted
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Direct contact, including droplet spread
Occurs in areas of high population density, crowded living areas, and prisons |
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signs/symptoms of meningits
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Mild lethargy
Memory changes Short attention span Personality and behavior changes Severe headache Generalized muscle aches and pains Nausea and vomiting Fever and chills |
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when assessing meningitis what would you see?
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Tachycardia
Deterioration in the LOC Photophobia Signs of meningeal irritation such as nuchal rigidity and a positive Kernig’s and Brudzinski’s signs Red, macular rash with meningococcal meningitis Abdominal and chest pain with viral meningitis Nystagmus |
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Purulent infection of the extradural, subdural, or intracerebral areas of the brain
Causative organism is usually bacteria, introduced either directly or indirectly |
what goes on in the brain with an abscess?
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Signs and Symptoms of a brain abscess?
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Headache
Fever Changes in LOC Changes due to increased ICP Decrease in peripheral vision Motor problems |
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A sensory disorder of cranial nerve V
Results in severe, recurrent, sharp, facial pain along the trigeminal nerve; Pain on the lips, gums, nose, or across the cheeks Situations that stimulate symptoms such as cold, washing the face, chewing, or food or fluids of extreme temperatures |
what is Trigeminal Neuralgia and how would you assess it
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Explain Bells Palsy
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A lower motor neuron lesion of cranial nerve VII that may occur as a result of trauma, hemorrhage, meningitis, or a tumor
It results in paralysis of one side of the face, usually preceded by pain Recovery usually occurs in a few weeks without residual effects |
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signs and symptoms of Bells Palsy
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Flaccid facial muscles
Inability to raise the eyebrows, frown, smile, close the eyelids, or puff out the cheeks Upward movement of the eye occurs when attempting to close the eyelid Loss of taste |
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An acute autoimmune disorder characterized by varying degrees of weakness and paralysis o
The immune system overreacts to infection and destroys the myelin sheath surrounding axons |
Guillians- Barre is what
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What disease is
It is usually preceded by a mild upper respiratory infection or gastroenteritis The recovery is a slow process and can take years The major concern is difficulty breathing |
Guillian Barres
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signs/symptoms of Guillian Barres
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Paresthesias and weakness that develop in lower extremities and progress upward to include trunk, arms, and cranial nerves
Ranges from mild paresis to total quadriplegia Can progress to respiratory failure Cardiac dysrhythmias Cerebrospinal fluid reveals an elevated protein level EEG is abnormal |
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Trauma to the spinal cord causing partial or complete disruption of the nerve tracts and neurons
The injury can range from a contusion, laceration, or compression of the cord Spinal cord edema develops and necrosis of the spinal cord can develop as a result of compromised capillary circulation and venous return |
what happens in a spinal cord injury
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spinal cord injury s/s
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Loss of motor function, sensation, reflex activity, and bowel and bladder control may result
The most common causes include motor vehicle accidents, falls, sporting and industrial accidents, and gunshot or stab wounds Complications related to the injury include respiratory failure, autonomic dysreflexia, spinal shock, further cord damage, and death |
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Cervical 5, 6, and 7
Thoracic 12 Lumbar 1 |
Most frequently involved vertebrae of spinal cord injury
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Complete transection of the cord
in a spinal cord |
The spinal cord is completely severed, with total loss of sensation, movement, and reflex activity below the level of injury
If the cord has not suffered irreparable damage, early treatment is needed to prevent partial damage from developing into total and permanent damage |
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Partial transection of the cord in spinal cord injury
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The spinal cord is partially damaged or severed
The symptoms depend on the extent and location of the damage Some function and sensation below the level of the injury is preserved |
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Anterior cord syndrome
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Damage to the anterior portion of the gray and white matter of the spinal cord, usually as a result of lost blood supply
Motor function, pain, and temperature sensation are lost below the level of injury; however, the sensations of touch, position, and vibration remain intact |
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Posterior cord injury
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Damage to the posterior portion of the gray and white matter of the spinal cord
Motor function remains intact but the client experiences a loss of vibratory sense, crude touch, and position sensation |
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Occurs from a lesion in the central portion of the spinal cord
Loss of motor function is more pronounced in the upper extremities than the lower extremities, and varying degrees and patterns of sensation remain intact |
Central cord syndrome
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Brown-Sequard syndrome
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Results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the cord
Motor function, proprioception, vibration, and deep touch sensations are lost on the same side of the body (ipsilateral) as the lesion On the opposite side of the body (contralateral) from the injury, the sensations of pain, temperature, and light touch are affected |
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Injury occurring from C1 through C8
Paralysis involving all four extremities |
Quadriplegia
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Paraplegia
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Injury occurring from T1 through L4
Paralysis involving only the lower extremities |
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how to assess a spinal cord injury
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Depends on the level of the cord injury- lowest spinal cord segment with intact motor and sensory function
Respiratory status changes Motor and sensory changes below the level of injury Spinal Shock/Autonomic Dysreflexia |
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Total sensory loss and motor paralysis below the level of injury
Loss of reflexes below the level of injury Loss of bladder and bowel control Urinary retention and bladder distention Presence of sweat, which does not occur on paralyzed areas |
how to assess a spinal cord injury
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cervical injuries
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C2 to 3 injury is usually fatal
C4 is the major innervation to the diaphragm by the phrenic nerve Involvement above C4 causes respiratory difficulty and paralysis of all four extremities Client may have movement in the shoulder if the injury is at C5 or below |
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Loss of movement of the chest, trunk, bowel, bladder, and legs depending on the level of injury
Leg paralysis (paraplegia) Autonomic dysreflexia with lesions above T6 and in cervical lesions Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, nasal stuffiness, and goose flesh |
Thoracic-level injuries include what
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Loss of movement and sensation of the lower extremities
S2 and S3 center on micturition; therefore, below this level, the bladder will contract but not empty (neurogenic bladder) Injury above S2 in males allows male clients to achieve erection, but are unable to ejaculate because of sympathetic nerve damage Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection or ejaculation |
Lumbar- and sacral-level injuries
and what to look for |
